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Tanner D, Lavista Ferres JM, Mitchell EA. Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014-15. Sci Rep 2024; 14:6002. [PMID: 38472269 PMCID: PMC10933328 DOI: 10.1038/s41598-024-56572-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
In the United States the rate of stillbirth after 28 weeks' gestation (late stillbirth) is 2.7/1000 births. Fetuses that are small for gestational age (SGA) or large for gestational age (LGA) are at increased risk of stillbirth. SGA and LGA are often categorized as growth or birthweight ≤ 10th and ≥ 90th centile, respectively; however, these cut-offs are arbitrary. We sought to characterize the relationship between birthweight and stillbirth risk in greater detail. Data on singleton births between 28- and 44-weeks' gestation from 2014 to 2015 were extracted from the US Centers for Disease Control and Prevention live birth and fetal death files. Growth was assessed using customized birthweight centiles (Gestation Related Optimal Weight; GROW). The analyses included logistic regression using SGA/LGA categories and a generalized additive model (GAM) using birthweight centile as a continuous exposure. Although the SGA and LGA categories identified infants at risk of stillbirth, categorical models provided poor fits to the data within the high-risk bins, and in particular markedly underestimated the risk for the extreme centiles. For example, for fetuses in the lowest GROW centile, the observed rate was 39.8/1000 births compared with a predicted rate of 11.7/1000 from the category-based analysis. In contrast, the model-predicted risk from the GAM tracked closely with the observed risk, with the GAM providing an accurate characterization of stillbirth risk across the entire birthweight continuum. This study provides stillbirth risk estimates for each GROW centile, which clinicians can use in conjunction with other clinical details to guide obstetric management.
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Affiliation(s)
- Darren Tanner
- AI for Health, AI for Good Research Lab, Microsoft Corporation, Redmond, WA, USA.
| | | | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Bard AM, Clark LV, Cosgun E, Aldinger KA, Timms A, Quina LA, Lavista Ferres JM, Jardine D, Haas EA, Becker TM, Pagan CM, Santani A, Martinez D, Barua S, McNutt Z, Nesbitt A, Mitchell EA, Ramirez JM. Known pathogenic gene variants and new candidates detected in Sudden Unexpected Infant Death using Whole Genome Sequencing. medRxiv 2023:2023.09.11.23295207. [PMID: 37745463 PMCID: PMC10516094 DOI: 10.1101/2023.09.11.23295207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Purpose To gain insights into potential genetic factors contributing to the infant's vulnerability to Sudden Unexpected Infant Death (SUID). Methods Whole Genome Sequencing (WGS) was performed on 145 infants that succumbed to SUID, and 576 healthy adults. Variants were filtered by gnomAD allele frequencies and predictions of functional consequences. Results Variants of interest were identified in 86 genes, 63.4% of our cohort. Seventy-one of these have been previously associated with SIDS/SUID/SUDP. Forty-three can be characterized as cardiac genes and are related to cardiomyopathies, arrhythmias, and other conditions. Variants in 22 genes were associated with neurologic functions. Variants were also found in 13 genes reported to be pathogenic for various systemic disorders. Variants in eight genes are implicated in the response to hypoxia and the regulation of reactive oxygen species (ROS) and have not been previously described in SIDS/SUID/SUDP. Seventy-two infants met the triple risk hypothesis criteria (Figure 1). Conclusion Our study confirms and further expands the list of genetic variants associated with SUID. The abundance of genes associated with heart disease and the discovery of variants associated with the redox metabolism have important mechanistic implications for the pathophysiology of SUID.
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Thompson JMD, Heazell AEP, Cronin RS, Wilson J, Li M, Gordon A, Askie LM, O'Brien LM, Raynes‐Greenow C, Stacey T, Mitchell EA, McCowan LME, Bradford BF. Does fetal size affect maternal perception of fetal movements? Evidence from an individual participant data meta-analysis. Acta Obstet Gynecol Scand 2023; 102:1586-1592. [PMID: 37553853 PMCID: PMC10577624 DOI: 10.1111/aogs.14652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Maternal perception of fetal movements during pregnancy are reassuring; however, the perception of a reduction in movements are concerning to women and known to be associated with increased odds of late stillbirth. Prior to full term, little evidence exists to provide guidelines on how to proceed unless there is an immediate risk to the fetus. Increased strength of movement is the most commonly reported perception of women through to full term, but perception of movement is also hypothesized to be influenced by fetal size. The study aimed to assess the pattern of maternal perception of strength and frequency of fetal movement by gestation and customized birthweight quartile in ongoing pregnancies. A further aim was to assess the association of stillbirth to perception of fetal movements stratified by customized birthweight quartile. MATERIAL AND METHODS This analysis was an individual participant data meta-analyses of five case-control studies investigating factors associated with stillbirth. The dataset included 851 cases of women with late stillbirth (>28 weeks' gestation) and 2257 women with ongoing pregnancies who then had a liveborn infant. RESULTS The frequency of prioritized fetal movement from 28 weeks' gestation showed a similar pattern for each quartile of birthweight with increased strength being the predominant perception of fetal movement through to full term. The odds of stillbirth associated with reduced fetal movements was increased in all quartiles of customized birthweight centiles but was notably greater in babies in the lowest two quartiles (Q1: adjusted OR: 9.34, 95% CI: 5.43, 16.06 and Q2: adjusted OR: 6.11, 95% CI: 3.11, 11.99). The decreased odds associated with increased strength of movement was present for all customized birthweight quartiles (adjusted OR range: 0.25-0.56). CONCLUSIONS Increased strength of fetal movements in late pregnancy is a positive finding irrespective of fetal size. However, reduced fetal movements are associated with stillbirth, and more so when the fetus is small.
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Affiliation(s)
- John M. D. Thompson
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
- Department of Pediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | | | - Robin S. Cronin
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
| | - Jessica Wilson
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
| | - Minglan Li
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
| | - Adrienne Gordon
- Discipline of Obstetrics, Gynecology and NeonatologyUniversity of SydneySydneyNew South WalesAustralia
| | | | - Louise M. O'Brien
- Department of Neurology Sleep Disorders CenterUniversity of MichiganAnn ArborMichiganUSA
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichiganUSA
| | | | - Tomasina Stacey
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative CareKing's College LondonLondonUK
| | - Edwin A. Mitchell
- Department of Pediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | - Lesley M. E. McCowan
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
| | - Billie F. Bradford
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
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Tanner D, Murthy S, Lavista Ferres JM, Ramirez JM, Mitchell EA. Risk factors for late (28+ weeks' gestation) stillbirth in the United States, 2014-2015. PLoS One 2023; 18:e0289405. [PMID: 37647261 PMCID: PMC10468071 DOI: 10.1371/journal.pone.0289405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 07/05/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND In the United States (US) late stillbirth (at 28 weeks or more of gestation) occurs in 3/1000 births. AIM We examined risk factors for late stillbirth with the specific goal of identifying modifiable factors that contribute substantially to stillbirth burden. SETTING All singleton births in the US for 2014-2015. METHODS We used a retrospective population-based design to assess the effects of multiple factors on the risk of late stillbirth in the US. Data were drawn from the US Centers for Disease Control and Prevention live birth and fetal death data files. RESULTS There were 6,732,157 live and 18,334 stillbirths available for analysis (late stillbirth rate = 2.72/1000 births). The importance of sociodemographic determinants was shown by higher risks for Black and Native Hawaiian and Other Pacific Islander mothers compared with White mothers, mothers with low educational attainment, and older mothers. Among modifiable risk factors, delayed/absent prenatal care, diabetes, hypertension, and maternal smoking were associated with increased risk, though they accounted for only 3-6% of stillbirths each. Two factors accounted for the largest proportion of late stillbirths: high maternal body mass index (BMI; 15%) and infants who were small for gestational age (38%). Participation in the supplemental nutrition for women, infants and children program was associated with a 28% reduction in overall stillbirth burden. CONCLUSIONS This study provides population-based evidence for stillbirth risk in the US. A high proportion of late stillbirths was associated with high maternal BMI and small for gestational age, whereas participation in supplemental nutrition programs was associated with a large reduction in stillbirth burden. Addressing obesity and fetal growth restriction, as well as broadening participation in nutritional supplementation programs could reduce late stillbirths.
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Affiliation(s)
- Darren Tanner
- AI for Good Research Lab, Microsoft Corporation, Redmond, WA, United States of America
| | - Sushama Murthy
- AI for Good Research Lab, Microsoft Corporation, Redmond, WA, United States of America
| | | | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, United States of America
- Departments of Neurological Surgery and Pediatrics, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Edwin A. Mitchell
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Thompson RA, Thompson JMD, Wilson J, Cronin RS, Mitchell EA, Raynes-Greenow CH, Li M, Stacey T, Heazell AEP, O'Brien LM, McCowan LME, Anderson NH. Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta-analysis. BJOG 2023. [PMID: 36852504 DOI: 10.1111/1471-0528.17444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Identify independent and novel risk factors for late-preterm (28-36 weeks) and term (≥37 weeks) stillbirth and explore development of a risk-prediction model. DESIGN Secondary analysis of an Individual Participant Data (IPD) meta-analysis investigating modifiable stillbirth risk factors. SETTING An IPD database from five case-control studies in New Zealand, Australia, the UK and an international online study. POPULATION Women with late-stillbirth (cases, n = 851), and ongoing singleton pregnancies from 28 weeks' gestation (controls, n = 2257). METHODS Established and novel risk factors for late-preterm and term stillbirth underwent univariable and multivariable logistic regression modelling with multiple sensitivity analyses. Variables included maternal age, body mass index (BMI), parity, mental health, cigarette smoking, second-hand smoking, antenatal-care utilisation, and detailed fetal movement and sleep variables. MAIN OUTCOME MEASURES Independent risk factors with adjusted odds ratios (aOR) for late-preterm and term stillbirth. RESULTS After model building, 575 late-stillbirth cases and 1541 controls from three contributing case-control studies were included. Risk factor estimates from separate multivariable models of late-preterm and term stillbirth were compared. As these were similar, the final model combined all late-stillbirths. The single multivariable model confirmed established demographic risk factors, but additionally showed that fetal movement changes had both increased (decreased frequency) and reduced (hiccoughs, increasing strength, frequency or vigorous fetal movements) aOR of stillbirth. Poor antenatal-care utilisation increased risk while more-than-adequate care was protective. The area-under-the-curve was 0.84 (95% CI 0.82-0.86). CONCLUSIONS Similarities in risk factors for late-preterm and term stillbirth suggest the same approach for risk-assessment can be applied. Detailed fetal movement assessment and inclusion of antenatal-care utilisation could be valuable in late-stillbirth risk assessment.
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Affiliation(s)
- R A Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - J M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - J Wilson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - R S Cronin
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Women's Health Division, Counties Manukau Health, Auckland, New Zealand
| | - E A Mitchell
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - C H Raynes-Greenow
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - M Li
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Women's Health Division, Counties Manukau Health, Auckland, New Zealand
| | - T Stacey
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - A E P Heazell
- University of Manchester, Manchester, UK
- University of Michigan, Ann Arbor, Michigan, USA
| | - L M O'Brien
- University of Michigan, Ann Arbor, Michigan, USA
| | - L M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - N H Anderson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
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Affiliation(s)
- David Tappin
- Child Health, University of Glasgow, Glasgow, UK
| | | | - James Carpenter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Fern Hauck
- Family Medicine and Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
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Mitchell EA, Taylor BJ, Milne BJ. Regional variation in sudden unexpected death in infancy in New Zealand. J Paediatr Child Health 2023; 59:319-327. [PMID: 36511387 PMCID: PMC10108071 DOI: 10.1111/jpc.16293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/10/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
AIM To estimate the relative risk of sudden unexpected death in infancy (SUDI) by district health board (DHB) in New Zealand after adjustment for socio-economic deprivation, ethnicity and other demographic factors. METHODS We conducted a population-based cohort study using data from the Integrated Data Infrastructure, a large research database containing linked data from a range of government agencies. The study population was all live births and their mothers in New Zealand from 2012 to 2018. The exposure of interest was DHB. The outcome was SUDI. RESULTS There were 418 068 live births in New Zealand from 2012 to 2018, and of these 415 401 (99.4%) had valid DHB data. There was considerable variation in the proportion of infants in each DHB living in the most deprived decile varying from 4.5% in Nelson, West Coast and Canterbury to 29.7% in Counties Manukau. There were 267 SUDI cases, giving an overall rate of 0.64/1000 live births during the study period (2012-2018). The SUDI rate varied from 1.11/1000 in Northland to 0.30/1000 in Waitemata and Auckland. Counties Manukau had the largest number of deaths (n = 54; rate = 1.08/1000). Five DHB regions had increased risk of SUDI compared to the reference group but, after adjustment, no DHB was significantly increased. CONCLUSIONS This study found that there is marked variation in SUDI risk by DHB, but this is explained by socio-economic and demographic variation within DHBs. This study emphasises the importance of the contribution of social determinants of health to SUDI.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Barry J Taylor
- Women's and Children's Health, The University of Otago, Dunedin, New Zealand
| | - Barry J Milne
- Centre of Methods and Policy Application in the Social Sciences, The University of Auckland, Auckland, New Zealand
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Mitchell EA, Rajay A, Freeman L, McIntosh C. Falls of newborn infants in a New Zealand hospital: A case series. J Paediatr Child Health 2023; 59:253-257. [PMID: 36367052 PMCID: PMC10099460 DOI: 10.1111/jpc.16275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/15/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
AIM The fall of a newborn baby to the hospital floor is a devastating experience for the family and staff caring for the mother and baby. The aim of this study was to report our experience in an ethnically diverse and socioeconomically disadvantaged community. METHODS The study was a retrospective case series of all baby falls in the Counties Manukau Health (New Zealand) post-natal care wards, birthing suites and birthing units from 2015 to 2018. Information from the incident reporting system was used to identify the circumstances surrounding the fall. In addition, medical records of the mother and the baby were examined for the admission during which the fall occurred. RESULTS There were 32 cases (rate 12.1/10 000 live births). Mothers of babies who fell were more likely to present late for antenatal care, to smoke and be obese. They were more likely to have delivered by caesarean. Falls were more likely to occur at night and around weekends. In most instances (84%) the mother fell asleep with baby on the bed while breastfeeding. There were no major injuries. CONCLUSIONS The rate of baby falls is considerably greater than previous reports. Recommendations are made to reduce this occurrence. These can be incorporated into safe sleep education.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Aakash Rajay
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lesa Freeman
- Patient Safety and Quality Assurance Lead, Counties Manukau Health (CMDHB), Auckland, New Zealand
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Weatherly M, Trivedi A, Chembrolu R, Gupta S, Ramirez JM, Lavista Ferres JM, Anderson TM, Mitchell EA. Maternal infections in pregnancy and the risk of sudden unexpected infant death in the offspring in the U.S., 2011-2015. PLoS One 2023; 18:e0284614. [PMID: 37083949 PMCID: PMC10121007 DOI: 10.1371/journal.pone.0284614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Infection is thought to play a part in some infant deaths. Maternal infection in pregnancy has focused on chlamydia with some reports suggesting an association with sudden unexpected infant death (SUID). OBJECTIVES We hypothesized that maternal infections in pregnancy are associated with subsequent SUID in their offspring. SETTING All births in the United States, 2011-2015. DATA SOURCE Centers for Disease Control and Prevention (CDC) Birth Cohort Linked Birth-Infant Death Data Files. STUDY DESIGN Cohort study, although the data were analysed as a case control study. Cases were infants that died from SUID. Controls were randomly sampled infants that survived their first year of life; approximately 10 controls per SUID case. EXPOSURES Chlamydia, gonorrhea and hepatitis C. RESULTS There were 19,849,690 live births in the U.S. for the period 2011-2015. There were 37,143 infant deaths of which 17,398 were classified as SUID cases (a rate of 0.86/1000 live births). The proportion of the control mothers with chlamydia was 1.7%, gonorrhea 0.2% and hepatitis C was 0.3%. Chlamydia was present in 3.8% of mothers whose infants subsequently died of SUID compared with 1.7% of controls (unadjusted OR = 2.35, 95% CI = 2.15, 2.56; adjusted OR = 1.08, 95% CI = 0.98, 1.19). Gonorrhea was present in 0.7% of mothers of SUID cases compared with 0.2% of mothers of controls (OR = 3.09, (2.50, 3.79); aOR = 1.20(0.95, 1.49)) and hepatitis C was present in 1.3% of mothers of SUID cases compared with 0.3% of mothers of controls (OR = 4.69 (3.97, 5.52): aOR = 1.80 (1.50, 2.15)). CONCLUSIONS The marked attenuation of SUID risk after adjustment for a wide variety of socioeconomic and demographic factors suggests the small increase in the risk of SUID of the offspring of mothers with infection with hepatitis C in pregnancy is due to residual confounding.
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Affiliation(s)
- Maggie Weatherly
- Master of Science in Data Science, University of Washington, Seattle, Washington, United States of America
| | - Anusua Trivedi
- AI for Good Lab, Microsoft, Redmond, Washington, United States of America
| | - Ratna Chembrolu
- Master of Science in Data Science, University of Washington, Seattle, Washington, United States of America
| | - Sanjana Gupta
- Master of Science in Data Science, University of Washington, Seattle, Washington, United States of America
| | - Jan-Marino Ramirez
- Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, Washington, United States of America
| | | | - Tatiana M Anderson
- AI for Good Lab, Microsoft, Redmond, Washington, United States of America
| | - Edwin A Mitchell
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Slykerman RF, Li E, Mitchell EA. Probiotics for Reduction of Examination Stress in Students (PRESS) study: A randomized, double-blind, placebo-controlled trial of the probiotic Lacticaseibacillus rhamnosus HN001. PLoS One 2022; 17:e0267778. [PMID: 35675229 PMCID: PMC9176810 DOI: 10.1371/journal.pone.0267778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Studies suggest that bioactive compounds such as probiotics may positively influence psychological health. This study aimed to determine whether supplementation with the probiotic Lacticaseibacillus rhamnosus HN001 reduced stress and improve psychological wellbeing in university students sitting examinations. Methods In this randomized, double-blind, placebo-controlled study, 483 undergraduate students received either the probiotic L. rhamnosus HN001, or placebo, daily during a university semester. Students completed measures of stress, anxiety, and psychological wellbeing at baseline and post-intervention before examinations. Mann Whitney U tests compared the change in psychological outcomes between groups. Results Of the 483 students, 391 (81.0%) completed the post-intervention questions. There was no significant difference between the probiotic and placebo supplemented groups in psychological health outcomes. The COVID19 pandemic restrictions may have influenced the typical trajectory of stress leading up to examinations. Conclusion We found no evidence of significant benefit of probiotics on the psychological health of university students. These findings highlight the challenges of conducting probiotic trials in human populations where the potential for contextual factors such as COVID19 response, and participant adherence to the intervention may influence results.
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Affiliation(s)
- Rebecca F. Slykerman
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Eileen Li
- A Better Start – National Science Challenge University of Auckland, New Zealand
| | - Edwin A. Mitchell
- Department of Pediatrics, Child & Youth Health, University of Auckland, New Zealand
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Mitchell EA, Zhang D, Thompson JMD, Liu C, Leversha A, Milne BJ. Maternal mental health and substance use disorders in sudden unexpected death in infancy using routinely collected health data in New Zealand, 2000-2016. Arch Dis Child 2022; 107:archdischild-2021-323006. [PMID: 35676082 DOI: 10.1136/archdischild-2021-323006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mortality from sudden unexpected death in infancy (SUDI) has declined dramatically since the 'Back to Sleep' campaign. Deaths now are more prevalent in those with socioeconomic disadvantage. The investigation of SUDI frequently identifies parents that have mental health or drug, alcohol and addiction problems. AIMS To estimate the prevalence of maternal mental health and substance use disorders and assess the magnitude of their risk for SUDI. METHODS We conducted a population-based cohort study using data from the Integrated Data Infrastructure (IDI), a large research database containing linked data from a range of government agencies. The study population was all live births and their mothers in New Zealand from 2000 to 2016. The exposures of interest were maternal mental health problems and maternal substance use disorders in the year prior to the birth. The outcome was deaths from SUDI. RESULTS The total population was 1086 504 live births and of these 1078 811 (99.3%) were able to be linked to other data sets within the IDI. The prevalence of maternal mental health problems in the total population was 5.2% and substance use disorder was 0.7%. There were 42 deaths from SUDI (0.75/1000) that were exposed to maternal mental illness and 864 deaths (0.84/1000) that were not exposed (adjusted relative risk (aRR)=1.23, 95% CI 0.90 to 1.68). There were 21 deaths from SUDI (2.67/1000) that were exposed to maternal substance use disorders and 885 (0.83/1000) that were not exposed (aRR=1.82, 95% CI 1.17 to 2.83). CONCLUSIONS Maternal substance use disorders, but not maternal mental health problems, in the year prior to the child's birth was associated with an increased risk of SUDI. However, the numbers that are affected are small and the effect size moderate. This group of women should receive additional SUDI prevention services and Safe Sleep advice.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Doney Zhang
- Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Chris Liu
- Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
| | - Alison Leversha
- Community Paediatrics, Auckland District Health Board, Auckland, New Zealand
| | - Barry J Milne
- Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Thompson JMD, Wilson J, Bradford BF, Li M, Cronin RS, Gordon A, Raynes-Greenow CH, Stacey T, Cullling VM, Askie LM, O'Brien LM, Mitchell EA, McCowan LME, Heazell AEP. A better understanding of the association between maternal perception of foetal movements and late stillbirth-findings from an individual participant data meta-analysis. BMC Med 2021; 19:267. [PMID: 34775977 PMCID: PMC8591897 DOI: 10.1186/s12916-021-02140-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late stillbirth continues to affect 3-4/1000 pregnancies in high-resource settings, with even higher rates in low-resource settings. Reduced foetal movements are frequently reported by women prior to foetal death, but there remains a poor understanding of the reasons and how to deal with this symptom clinically, particularly during the preterm phase of gestation. We aimed to determine which women are at the greatest odds of stillbirth in relation to the maternal report of foetal movements in late pregnancy (≥ 28 weeks' gestation). METHODS This is an individual participant data meta-analysis of all identified case-control studies of late stillbirth. Studies included in the IPD were two from New Zealand, one from Australia, one from the UK and an internet-based study based out of the USA. There were a total of 851 late stillbirths, and 2257 controls with ongoing pregnancies. RESULTS Increasing strength of foetal movements was the most commonly reported (> 60%) pattern by women in late pregnancy, which were associated with a decreased odds of late stillbirth (adjusted odds ratio (aOR) = 0.20, 95% CI 0.15 to 0.27). Compared to no change in strength or frequency women reporting decreased frequency of movements in the last 2 weeks had increased odds of late stillbirth (aOR = 2.33, 95% CI 1.73 to 3.14). Interaction analysis showed increased strength of movements had a greater protective effect and decreased frequency of movements greater odds of late stillbirth at preterm gestations (28-36 weeks' gestation). Foetal hiccups (aOR = 0.45, 95% CI 0.36 to 0.58) and regular episodes of vigorous movement (aOR = 0.67, 95% CI 0.52 to 0.87) were associated with decreased odds of late stillbirth. A single episode of unusually vigorous movement was associated with increased odds (aOR = 2.86, 95% CI 2.01 to 4.07), which was higher in women at term. CONCLUSIONS Reduced foetal movements are associated with late stillbirth, with the association strongest at preterm gestations. Foetal hiccups and multiple episodes of vigorous movements are reassuring at all gestations after 28 weeks' gestation, whereas a single episode of vigorous movement is associated with stillbirth at term.
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Affiliation(s)
- John M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand. .,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Jessica Wilson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand.,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Billie F Bradford
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand.,School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington, New Zealand
| | - Minglan Li
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand
| | - Robin S Cronin
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand
| | - Adrienne Gordon
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | | | - Tomasina Stacey
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, UK
| | - Vicki M Cullling
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand
| | - Lisa M Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Louise M O'Brien
- Departments of Neurology Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA.,Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1042, New Zealand
| | - Alexander E P Heazell
- Division of Developmental Biology & Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, England, UK
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14
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MacFarlane M, Thompson JMD, Mitchell EA, Lawton B, McLardy EM, Jonas SD, Tepania-Palmer G, Roa T, Warren G, Jowsey T. Pēpē-infant sleep practices and sudden unexpected death in infancy in Aotearoa New Zealand. Int J Gynaecol Obstet 2021; 155:305-317. [PMID: 34473352 DOI: 10.1002/ijgo.13910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore pēpē [infant] sleep practices and the key motivators among selected Māori and non-Māori māmā [mothers] in Auckland, New Zealand, in relation to the risk of sudden unexpected death in infancy (SUDI). METHODS Qualitative research underpinned by a kaupapa Māori cultural framework was undertaken. In-depth face-to-face interviews occurred in the homes of māmā with young pēpē born in Counties Manukau, Auckland. Interview transcripts were analyzed using general purpose thematic analysis. RESULTS Thirty māmā participated, including 17 Māori. Two-thirds of māmā reported previous or current bed sharing. The fundamental human need for adequate sleep motivated half the māmā in the present study, and especially Māori māmā, to bed share. The second most common reason given was closeness and convenience. This was followed by breastfeeding, which was cited as a reason by Māori māmā only. These findings were interpreted in terms of intrinsic fear, culture, and māmā deployment of knowledge. CONCLUSION Service providers are encouraged to respond to the lived experiences and cultural realities, values, and beliefs of māmā when designing and delivering effective SUDI prevention interventions. Innovative approaches for providing structured and opportunistic, culturally appropriate education and support around safe sleep are likely to be well-received by māmā and their whānau [family/ies].
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Affiliation(s)
- Melanie MacFarlane
- Department of Paediatrics: Child and Youth Health, Te Whare Wānanga o Tāmaki Makaurau-University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Paediatrics: Child and Youth Health, Te Whare Wānanga o Tāmaki Makaurau-University of Auckland, Auckland, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Te Whare Wānanga o Tāmaki Makaurau-University of Auckland, Auckland, New Zealand
| | - Beverley Lawton
- Te Tātai Hauora O Hine-Centre for Women's Health Research, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | | | | | | | - Tom Roa
- Te Pua Wānanga ki te Ao-Faculty of Māori and Indigenous Studies, Te Whare Wānanga o Waikato-University of Waikato, Hamilton, New Zealand
| | | | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, Te Whare Wānanga o Tāmaki Makaurau, Auckland, New Zealand
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15
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Cronin RS, Thompson JMD, Taylor RS, Wilson J, Falloon KF, Skelton S, Brown E, Culling VM, Mitchell EA, McCowan LME. Modification of maternal late pregnancy sleep position: a survey evaluation of a New Zealand public health campaign. BMJ Open 2021; 11:e047681. [PMID: 33980531 PMCID: PMC8118030 DOI: 10.1136/bmjopen-2020-047681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A 'Sleep-On-Side When Baby's Inside' public health campaign was initiated in New Zealand in 2018. This was in response to evidence that maternal supine going-to-sleep position was an independent risk factor for stillbirth from 28 weeks' gestation. We evaluated the success of the campaign on awareness and modification of late pregnancy going-to-sleep position through nationwide surveys. METHODS AND ANALYSIS Two web-based cross-sectional surveys were conducted over 12 weeks in 2019-2020 in a sample of (1) pregnant women ≥28 weeks, primary outcome of going-to-sleep position; and (2) health professionals providing pregnancy care, primary outcome of knowledge of going-to-sleep position and late stillbirth risk. Univariable logistic regression was performed to identify factors associated with supine going-to-sleep position. DISCUSSION The survey of pregnant women comprised 1633 eligible participants. Going-to-sleep position last night was supine (30, 1.8%), non-supine (1597, 97.2%) and no recall (16, 1.0%). Supine position had decreased from 3.9% in our previous New Zealand-wide study (2012-2015). Most women (1412, 86.5%) had received sleep-on-side advice with no major resultant worry (1276, 90.4%). Two-thirds (918, 65.0%) had changed their going-to-sleep position based on advice, with most (611 of 918, 66.5%) reporting little difficulty. Supine position was associated with Māori (OR 5.05, 95% CI 2.10 to 12.1) and Asian-non-Indian (OR 4.20, 95% CI 1.27 to 13.90) ethnicity; single (OR 10.98, 95% CI 4.25 to 28.42) and cohabitating relationship status (OR 2.69, 95% CI 1.09 to 6.61); hospital-based maternity provider (OR 2.55, 95% CI 1.07 to 6.10); education overseas (OR 3.92, 95% CI 1.09 to 14.09) and primary-secondary level (OR 2.80, 95% CI 1.32 to 6.08); and not receiving sleep-on-side advice (OR 6.70, 95% CI 3.23 to 13.92). The majority of health professionals (709 eligible participants) reported awareness of supine going-to-sleep position and late stillbirth risk (543, 76.6%). CONCLUSION Most pregnant women had received and implemented sleep-on-side advice without major difficulty or concern. Some groups of women may need a tailored approach to acquisition of going-to-sleep position information.
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Affiliation(s)
- Robin S Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Division of Women's Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - John M D Thompson
- Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Rennae S Taylor
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Jessica Wilson
- Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Karen F Falloon
- General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Sophie Skelton
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Elsie Brown
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Vicki M Culling
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Vicki Culling Associates, Wellington, New Zealand
| | - Edwin A Mitchell
- Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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16
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Anderson TM, Allen K, Ramirez J, Mitchell EA. Circadian variation in sudden unexpected infant death in the United States. Acta Paediatr 2021; 110:1498-1504. [PMID: 33251652 PMCID: PMC8246563 DOI: 10.1111/apa.15695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
Aim To determine which factors are associated with sudden unexpected infant death (SUID) by time of day. Methods Data were analysed from the National Fatality Review Case Reporting System (2006‐2015). Out of 20 005 SUID deaths in 37 states, 12 191 (60.9%) deaths had a recorded nearest hour of discovery of the infant. We compared distribution patterns between time of death and 118 variables to determine which were significantly correlated with SUID time of death using advanced statistical modelling techniques. Results The 12‐hour time periods that were most different were 10:00 to 21:00 (daytime) and 22:00 to 09:00 (nighttime). The main features that were associated with nighttime SUID were bed sharing, younger infants, non‐white infants, placed supine to sleep and found supine, and caregiver was the parent. Daytime SUID was associated with older infants, day care, white infants, sleeping in an adult bed and prone sleep position. Factors not associated with time of death were sex of the infant, smoking and breastfeeding. Conclusion Sudden unexpected infant death deaths that occur at night are associated with a separate set of risk factors compared to deaths that occur during the day. However, to minimise risk, it is important to practice safe sleep guidelines during both nighttime and daytime sleep.
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Affiliation(s)
| | | | - Jan‐Marino Ramirez
- Seattle Children’s Research Institute Seattle WA USA
- Departments of Neurological Surgery and Pediatrics University of Washington School of Medicine Seattle WA USA
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health University of Auckland Auckland New Zealand
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17
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Anderson TM, Ferres JML, Ramirez JM, Mitchell EA. Sudden Unexpected Postnatal Collapse Resulting in Newborn Death in the United States. MCN Am J Matern Child Nurs 2021; 46:130-136. [PMID: 33587345 PMCID: PMC8349372 DOI: 10.1097/nmc.0000000000000711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The sudden collapse of an apparently healthy newborn, or sudden unexpected postnatal collapse (SUPC) is fatal in about half of cases. Epidemiological characteristics of sudden unexpected infant death (SUID) in the first week of life differ from those in the postperinatal age group (7-365 days). AIM To describe the characteristics of SUPC resulting in neonatal death. METHODS We analyzed the Centers for Disease Control and Prevention Birth Cohort Linked Birth/Infant Death Data Set (2003-2013: 41,125,233 births and 37,624 SUIDs). SUPC was defined as infants born ≥35 weeks gestational age, with a 5-minute Apgar score of ≥7, who died suddenly and unexpectedly in the first week of life. RESULTS Of the 37,624 deaths categorized as SUID during the study period, 616 met the SUPC criteria (1.5/100,000 live births). Eleven percent occurred on the first day of life and nearly three quarters occurred during postnatal days 3-6. SUPC deaths differed statistically from SUID deaths occurring 7-364 days of age, in particular for sex, marital status, and live birth order. IMPLICATIONS These data support the need for adequate nurse staffing during the immediate recovery period and for the entire postpartum stay as well as nurse rounding for new mothers in the hospital setting.
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18
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Thompson JMD, Slykerman RF, Wall CR, Murphy R, Mitchell EA, Waldie KE. Factor structure of the SDQ and longitudinal associations from pre-school to pre-teen in New Zealand. PLoS One 2021; 16:e0247932. [PMID: 33705464 PMCID: PMC7951836 DOI: 10.1371/journal.pone.0247932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/16/2021] [Indexed: 11/20/2022] Open
Abstract
Objective The objective of this study was to assess the validity of the Strengths and Difficulties Questionnaire in a cohort of New Zealand children followed from birth to the age of eleven. The study also aimed to assess the stability of the child data in relation to behavioural outcomes during this period. Methods Children in the Auckland Birthweight Collaborative Study were assessed at approximately 3½, 7 and 11 years of age. At all time-points parents completed the parent version of the Strengths and Difficulties Questionnaire, and the children themselves completed the self-report version at 11 years of age. The validity and internal consistency were assessed using exploratory factor analysis, Cronbach’s alpha, and McDonald’s Omega. Cross tabulations and Chi-square statistics were used to determine whether Total Difficulty scores, as per accepted cut-offs, remained stable over time (between normal and abnormal/borderline categories). Results The factor structure remained relatively consistent across all three time-points, though several questions did not load as per the originally published factor analysis at the earliest age. The internal consistency of the Strengths and Difficulties Questionnaire was good at all time-points and for parent- and child-completed versions. There was low agreement in the total scores between time points. Conclusions The factor analysis shows that the Strengths and Difficulties Questionnaire has a similar factor structure, particularly in older ages, to that previously published and shows good internal consistency. At the pre-school follow up, a larger than expected proportion of children were identified with high scores, particularly in the conduct sub-scale. Children’s behaviour changes over time, with only poor to moderate agreement between those identified as abnormal or borderline over the longitudinal follow up.
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Affiliation(s)
- John M. D. Thompson
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Rebecca F. Slykerman
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Clare R. Wall
- Discipline of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karen E. Waldie
- School of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand
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19
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Garstang J, Cohen M, Mitchell EA, Sidebotham P. Classification of sleep-related sudden unexpected death in infancy: A national survey. Acta Paediatr 2021; 110:869-874. [PMID: 32654334 DOI: 10.1111/apa.15472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
AIM To identify how British Child Death Overview Panels (CDOPs) and paediatric pathologists classify cause of death for sleep-related Sudden Unexpected Death in Infancy (SUDI). To determine compliance with national requirements for SUDI investigation. METHODS Electronic survey of CDOPs and pathologists using three vignettes of SUDI cases illustrating: accidental asphyxia, typical Sudden Infant Death Syndrome (SIDS) and SIDS with co-sleeping. RESULTS Thirty-eight (41%) of 92 CDOPs returned questionnaires, and 32 were complete. Thirteen (14%) of 90 pathologists returned complete questionnaires. Thirty-one (97%) CDOPs and 7 (53%) pathologists agreed with the cause of death in the accidental asphyxia case; 24 (75%) CDOPs and 9 (69%) pathologists in the typical SIDS case; and 11 (34%) CDOPs and 1 (8%) pathologist in the co-sleeping SIDS case. Pathologists used the terms SUDI or unascertained as the cause of death for the accidental asphyxia case (46%) and the co-sleeping SIDS case (77%). These terms were used by CDOPs for the typical SIDS case (25%) and the co-sleeping SIDS case (41%). Seventeen (46%) CDOPs reported compliance with guidelines for investigation in more than 75% of cases. CONCLUSION There is wide variation in classification of deaths, with only limited agreement between CDOPs and pathologists. The terms SIDS and accidental asphyxia are underused, even in typical cases.
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Affiliation(s)
- Joanna Garstang
- Allens Croft Children's Centre Birmingham Community Healthcare NHS Trust University of Birmingham Birmingham UK
| | - Marta Cohen
- Sheffield Children's Hospital NHS Trust Sheffield UK
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health The University of Auckland Auckland New Zealand
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20
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Allen K, Anderson TM, Chajewska U, Ramirez J, Mitchell EA. Factors associated with age of death in sudden unexpected infant death. Acta Paediatr 2021; 110:174-183. [PMID: 32304589 PMCID: PMC7574313 DOI: 10.1111/apa.15308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 12/28/2022]
Abstract
Aim This study aimed to systematically analyse the pregnancy, birth and demographic‐related factors associated with age of death in sudden unexpected infant death (SUID). Methods Data were analysed from the Centers for Disease Control and Prevention's Cohort Linked Birth/Infant Death data set (2011‐2013; 11 737 930 live births). SUID was defined as deaths from sudden infant death syndrome, ill‐defined causes, or accidental suffocation and strangulation in bed. There were 9668 SUID cases (7‐364 days; gestation >28 weeks; 0.82/1000 live births). The odds of death at different ages were compared to determine which variables significantly affect the SUID age of death. Results Forty‐three features indicated a significant change in age of death with two main patterns: (a) younger chronologic age at death was associated with maternal smoking and factors associated with lower socio‐economic status, and (b) older age was associated with low birthweight, prematurity and admission to the neonatal intensive care unit. However, when age was corrected for gestation, these factors were associated with younger age. Conclusion Factors that varied with age of death are well‐documented risk factors for SUID. The majority of these risk factors were associated with younger age at death after allowing for gestational age at birth.
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Affiliation(s)
| | | | | | - Jan‐Marino Ramirez
- Seattle Children’s Research Institute Seattle WA USA
- Departments of Neurological Surgery and Pediatrics University of Washington School of Medicine Seattle WA USA
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health University of Auckland Auckland New Zealand
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21
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Heazell A, Budd J, Smith LK, Li M, Cronin R, Bradford B, McCowan L, Mitchell EA, Stacey T, Roberts D, Thompson J. Associations between social and behavioural factors and the risk of late stillbirth - findings from the Midland and North of England Stillbirth case-control study. BJOG 2020; 128:704-713. [PMID: 32992405 DOI: 10.1111/1471-0528.16543] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate behavioural and social characteristics of women who experienced a late stillbirth compared with women with ongoing live pregnancies at similar gestation. DESIGN Case-control study. SETTING 41 maternity units in the UK. POPULATION Women who had a stillbirth ≥28 weeks' gestation (n = 287) and women with an ongoing pregnancy at the time of interview (n = 714). METHODS Data were collected using an interviewer-administered questionnaire which included questions regarding women's behaviours (e.g. alcohol intake and household smoke exposure) and social characteristics (e.g. ethnicity, employment, housing). Stress was measured by the 10-item Perceived Stress Scale. MAIN OUTCOME MEASURE Late stillbirth. RESULTS Multivariable analysis adjusting for co-existing social and behavioural factors showed women living in the most deprived quintile had an increased risk of stillbirth compared with the least deprived quintile (adjusted odds ratio [aOR] 3.16; 95% CI 1.47-6.77). There was an increased risk of late stillbirth associated with unemployment (aOR 2.32; 95% CI 1.00-5.38) and women who declined to answer the question about domestic abuse (aOR 4.12; 95% CI 2.49-6.81). A greater number of antenatal visits than recommended was associated with a reduction in stillbirth (aOR 0.26; 95% CI 0.16-0.42). CONCLUSIONS This study demonstrates associations between late stillbirth and socio-economic deprivation, perceived stress and domestic abuse, highlighting the need for strategies to prevent stillbirth to extend beyond maternity care. Enhanced antenatal care may be able to mitigate some of the increased risk of stillbirth. TWEETABLE ABSTRACT Deprivation, unemployment, social stress & declining to answer about domestic abuse increase risk of #stillbirth after 28 weeks' gestation.
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Affiliation(s)
- Aep Heazell
- Faculty of Biology, Medicine and Health, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Budd
- St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - L K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - M Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - R Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - B Bradford
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lme McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - T Stacey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.,Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - D Roberts
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Jmd Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
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Heazell AEP, Timms K, Scott RE, Rockliffe L, Budd J, Li M, Cronin R, McCowan LME, Mitchell EA, Stacey T, Roberts D, Thompson JMD. Associations between consumption of coffee and caffeinated soft drinks and late stillbirth-Findings from the Midland and North of England stillbirth case-control study. Eur J Obstet Gynecol Reprod Biol 2020; 256:471-477. [PMID: 33218821 DOI: 10.1016/j.ejogrb.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The consumption of caffeinated drinks and soft drinks is widespread in society, including by pregnant women. Data regarding the association of caffeine intake and stillbirth are varied. We aimed to investigate the degree of consumption of caffeinated drinks or soft drinks in the last four weeks of pregnancy in women who experienced a late stillbirth compared to women with ongoing live pregnancies at similar gestation. Influences on maternal caffeine intake and soft drink consumption during pregnancy were also investigated. STUDY DESIGN A case-control study undertaken in 41 maternity units in the United Kingdom. Cases were women who had a singleton non-anomalous stillbirth ≥28 weeks' gestation (n = 290) and controls were women with an ongoing pregnancy at the time of interview (n = 729). Data were collected using an interviewer-administered questionnaire which included questions regarding consumption of a variety of caffeinated drinks and soft drinks in the last four weeks of pregnancy as well as other behaviours (e.g. cigarette smoking). RESULTS Multivariable analysis adjusting for co-existing demographic and behavioural factors found the consumption of instant coffee, energy drinks and cola were associated with increased risk of stillbirth. There was an independent association between caffeine intake and late stillbirth (adjusted Odds Ratio 1.27, 95 % Confidence Interval (95 %CI) 1.14, 1.43 for each 100 mg increment/day). 15 % of cases and 8% of controls consumed more than the World Health Organisation (WHO) recommendation (>300 mg of caffeine/day; aOR 2.30, 95 % CI 1.40, 4.24). The population attributable risk for stillbirth associated with >300 mg of caffeine/day was 7.4 %. The majority of respondents reduced caffeine consumption in pregnancy. Midwives and internet resources were the most frequently used sources of information which influenced maternal behaviour with regard to soft drinks and caffeine, and this did not differ between cases and controls. CONCLUSIONS Women should be informed that consumption of caffeine during pregnancy is associated with increased risk of stillbirth, particularly at levels greater than recommended by the WHO (>300 mg/day). Recommendations from midwives and internet-based resources are likely to be the most effective means to influence maternal behaviour.
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Affiliation(s)
- Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom; St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Kate Timms
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom; Lydia Becker Institute of Inflammation and Immunology, Faculty of Biology, Medicine & Health, University of Manchester, United Kingdom
| | - Rebecca E Scott
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Lauren Rockliffe
- Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Jayne Budd
- St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Robin Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Tomasina Stacey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom; Calderdale and Huddersfield NHS Foundation Trust, Lindley, Huddersfield, United Kingdom
| | - Devender Roberts
- Liverpool Women's Hospital NHS Foundation Trust, Crown Street, Liverpool, United Kingdom
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
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23
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Slykerman RF, Thompson JMD, Coomarasamy C, Wall CR, Waldie KE, Murphy R, Mitchell EA. Early adolescent physical activity, sleep and symptoms of depression at 16 years of age. Acta Paediatr 2020; 109:1394-1399. [PMID: 31855286 DOI: 10.1111/apa.15140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/23/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Abstract
AIM To examine early adolescent physical activity and risk of later depressive symptoms at age 16 years in a prospective cohort study. METHODS Participants were children and parents enrolled at birth of the child. Approximately half the children enrolled in the Auckland Birthweight Collaborative Study were small for gestational age at birth (SGA ≤10th percentile for sex and gestation) and half were appropriate for gestational age (AGA >10th percentile). Maternal demographic data were collected at birth, and children were followed through to age 16 years. Depression at 16 was assessed using the Center for Epidemiological Studies Depression Scale for Children. Accelerometer measures of physical activity and sleep were measured at 11 years of age. RESULTS Moderate to severe depression was present in 15.6% of the 467 16-year-olds. Objectively measured physical activity and sleep at 11 years were not significantly associated with depressive symptoms at 16 years of age. CONCLUSION Prospectively collected objective measures of physical activity levels and sleep were not predictive of depressive symptoms later in adolescence in a healthy community cohort. While interventions to promote increased physical activity and sleep in adolescents who are depressed may be effective, physical activity and sleep in the general population of adolescents does not protect against future depression.
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Affiliation(s)
- Rebecca F. Slykerman
- Department of Psychological Medicine University of Auckland Auckland New Zealand
| | - John MD. Thompson
- Department of Paediatrics: Child and Youth Health University of Auckland Auckland New Zealand
| | - Christin Coomarasamy
- Department of Paediatrics: Child and Youth Health University of Auckland Auckland New Zealand
| | - Clare R. Wall
- Department of Nutrition University of Auckland Auckland New Zealand
| | - Karen E. Waldie
- School of Psychology University of Auckland Auckland New Zealand
| | - Rinki Murphy
- Department of Medicine University of Auckland Auckland New Zealand
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health University of Auckland Auckland New Zealand
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24
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Mitchell EA, Yan X, Ren SY, Anderson TM, Ramirez JM, Lavista Ferres JM, Johnston R. Geographic Variation in Sudden Unexpected Infant Death in the United States. J Pediatr 2020; 220:49-55.e2. [PMID: 32061407 PMCID: PMC7995635 DOI: 10.1016/j.jpeds.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/04/2019] [Accepted: 01/06/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess the geographic variation of sudden unexpected infant death (SUID) and test if variation in geographic factors, such as state, latitude, and longitude, play a role in SUID risk across the US. STUDY DESIGN We analyzed the Centers for Disease Control and Prevention's Cohort Linked Birth/Infant Death dataset (2005-2010; 22 882 SUID cases, 25 305 837 live births, rate 0.90/1000). SUID was defined as infant deaths (ages 7-364 days) that included sudden infant death syndrome, ill-defined and unknown cause of mortality, and accidental suffocation and strangulation in bed. SUID geographic variation was analyzed using 2 statistical models, logistic regression and generalized additive model (GAM). RESULTS Both models produced similar results. Without adjustment, there was marked geographic variation in SUID rates, but the variation decreased after adjusting for covariates including known risk factors for SUID. After adjustment, nine states demonstrated significantly higher or lower SUID mortality than the national average. Geographic contribution to SUID risk in terms of latitude and longitude were also attenuated after adjustment for covariates. CONCLUSION Understanding why some states have lower SUID rates may enhance SUID prevention strategies.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Xiaohan Yan
- AI For Good Research Lab, Microsoft, Redmond, WA
| | | | - Tatiana M Anderson
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA; Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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25
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Cronin RS, Wilson J, Gordon A, Li M, Culling VM, Raynes-Greenow CH, Heazell AEP, Stacey T, Askie LM, Mitchell EA, Thompson JMD, McCowan LME, O’Brien LM. Associations between symptoms of sleep-disordered breathing and maternal sleep patterns with late stillbirth: Findings from an individual participant data meta-analysis. PLoS One 2020; 15:e0230861. [PMID: 32214393 PMCID: PMC7098581 DOI: 10.1371/journal.pone.0230861] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/10/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep-disordered breathing (SDB) affects up to one third of women during late pregnancy and is associated with adverse pregnancy outcomes, including hypertension, diabetes, impaired fetal growth, and preterm birth. However, it is unclear if SDB is associated with late stillbirth (≥28 weeks' gestation). The aim of this study was to investigate the relationship between self-reported symptoms of SDB and late stillbirth. METHODS Data were obtained from five case-control studies (cases 851, controls 2257) from New Zealand (2 studies), Australia, the United Kingdom, and an international study. This was a secondary analysis of an individual participant data meta-analysis that investigated maternal going-to-sleep position and late stillbirth, with a one-stage approach stratified by study and site. Inclusion criteria: singleton, non-anomalous pregnancy, ≥28 weeks' gestation. Sleep data ('any' snoring, habitual snoring ≥3 nights per week, the Berlin Questionnaire [BQ], sleep quality, sleep duration, restless sleep, daytime sleepiness, and daytime naps) were collected by self-report for the month before stillbirth. Multivariable analysis adjusted for known major risk factors for stillbirth, including maternal age, body mass index (BMI kg/m2), ethnicity, parity, education, marital status, pre-existing hypertension and diabetes, smoking, recreational drug use, baby birthweight centile, fetal movement, supine going-to-sleep position, getting up to use the toilet, measures of SDB and maternal sleep patterns significant in univariable analysis (habitual snoring, the BQ, sleep duration, restless sleep, and daytime naps). Registration number: PROSPERO, CRD42017047703. RESULTS In the last month, a positive BQ (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.02-2.04), sleep duration >9 hours (aOR 1.82, 95% CI 1.14-2.90), daily daytime naps (aOR 1.52, 95% CI 1.02-2.28) and restless sleep greater than average (aOR 0.62, 95% CI 0.44-0.88) were independently related to the odds of late stillbirth. 'Any' snoring, habitual snoring, sleep quality, daytime sleepiness, and a positive BQ excluding the BMI criterion, were not associated. CONCLUSION A positive BQ, long sleep duration >9 hours, and daily daytime naps last month were associated with increased odds of late stillbirth, while sleep that is more restless than average was associated with reduced odds. Pregnant women may be reassured that the commonly reported restless sleep of late pregnancy may be physiological and associated with a reduced risk of late stillbirth.
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Affiliation(s)
- Robin S. Cronin
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- * E-mail: ,
| | - Jessica Wilson
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adrienne Gordon
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Minglan Li
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vicki M. Culling
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Alexander E. P. Heazell
- Division of Developmental Biology & Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, England, United Kingdom
| | - Tomasina Stacey
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, United Kingdom
| | - Lisa M. Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Edwin A. Mitchell
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John M. D. Thompson
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lesley M. E. McCowan
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Louise M. O’Brien
- Departments of Neurology Sleep Disorders Center, and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
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26
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Flynn AC, Thompson JMD, Dalrymple KV, Wall C, Begum S, Johny JP, Cutfield WS, North R, McCowan LME, Godfrey KM, Mitchell EA, Poston L. Childhood dietary patterns and body composition at age 6 years: the Children of SCOPE study. Br J Nutr 2020; 124:1-21. [PMID: 32098635 PMCID: PMC7116586 DOI: 10.1017/s0007114520000628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Dietary patterns describe the quantity, variety, or combination of different foods and beverages in a diet and the frequency of habitual consumption. Better understanding of childhood dietary patterns and antenatal influences could inform intervention strategies to prevent childhood obesity. We derived empirical dietary patterns in 1142 children (average age 6.0 (0.2) years) in Auckland, New Zealand whose mothers had participated in the Screening for Pregnancy Endpoints (SCOPE) cohort study and explored associations with measures of body composition. Participants (Children of SCOPE) had their diet assessed by food frequency questionnaire (FFQ) and empirical dietary patterns were extracted using factor analysis. Three distinct dietary patterns were identified; 'Healthy', 'Traditional' and 'Junk'. Associations between dietary patterns and measures of childhood body composition (waist, hip, arm circumferences, body mass index (BMI), bioelectrical impedance analysis (BIA) derived body fat percentage, and sum of skinfold thicknesses (SST)) were assessed by linear regression, with adjustment for maternal influences. Children who had higher 'Junk' dietary pattern scores had 0.24cm greater arm (0.08 SD (95%CI 0.04, 0.13)) and 0.44cm hip (0.05 SD (95% CI 0.01, 0.10)) circumferences, 1.13cm greater SST (0.07 SD (95%CI 0.03, 0.12)) and were more likely to be obese (OR=1.74 (95%CI 1.07, 2.82)); those with higher 'Healthy' pattern scores were less likely to be obese (OR=0.62 (95%CI 0.39, 1.00)). In a large mother-child cohort, a dietary pattern characterised by high sugar and fat foods was associated with greater adiposity and obesity risk in children aged 6 years, while a 'Healthy' dietary pattern offered some protection against obesity. Targeting unhealthy dietary patterns could inform public health strategies to reduce the prevalence of childhood obesity.
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Affiliation(s)
- Angela C Flynn
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, UK
| | - John M D Thompson
- Department of Paediatrics, Child & Youth Health, Faculty of Medical and health Sciences, University of Auckland, New Zealand
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - Kathryn V Dalrymple
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, UK
| | - Clare Wall
- Department of Nutrition, School of Medical Sciences, University of Auckland, New Zealand
| | - Shahina Begum
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, UK
| | - Jaijus Pallippadan Johny
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | | | - Robyn North
- Department of General Medicine, Auckland City Hospital, Auckland New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Edwin A Mitchell
- Department of Paediatrics, Child & Youth Health, Faculty of Medical and health Sciences, University of Auckland, New Zealand
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, UK
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Lavista Ferres JM, Anderson TM, Johnston R, Ramirez JM, Mitchell EA. Distinct Populations of Sudden Unexpected Infant Death Based on Age. Pediatrics 2020; 145:e20191637. [PMID: 31818863 PMCID: PMC6939839 DOI: 10.1542/peds.2019-1637] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES In most recent studies, authors combine all cases of sudden infant death syndrome, other deaths from ill-defined or unknown causes, and accidental suffocation and strangulation in bed as a single population to analyze sudden unexpected infant death (SUID). Our aim with this study is to determine if there are statistically different subcategories of SUID that are based on the age of death of an infant. METHODS In this retrospective, cross-sectional analysis, we analyzed the Centers for Disease Control and Prevention Birth Cohort Linked Birth/Infant Death Data Set (2003-2013: 41 125 233 births and 37 624 SUIDs). Logistic regression models were developed to identify subpopulations of SUID cases by age of death, and we subsequently analyzed the effects of a set of covariates on each group. RESULTS Two groups were identified: sudden unexpected early neonatal deaths (SUENDs; days 0-6) and postperinatal SUIDs (days 7-364). These groups significantly differed in the distributions of assigned International Classification of Diseases, 10th Revision code, live birth order, marital status, age of mother, birth weight, and gestational length compared to postperinatal SUIDs (days 7-364). Maternal smoking during pregnancy was not a significant risk factor for deaths that occurred in the first 48 hours. CONCLUSIONS SUEND should be considered as a discrete entity from postperinatal SUID in future studies. These data could help improve the epidemiological understanding of SUEND and SUID and provide clues to a mechanistic understanding underlying the causes of death.
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Affiliation(s)
| | - Tatiana M Anderson
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington;
| | | | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
- Departments of Neurological Surgery and Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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28
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Anderson NH, Gordon A, Li M, Cronin RS, Thompson JMD, Raynes-Greenow CH, Heazell AEP, Stacey T, Culling VM, Wilson J, Askie LM, Mitchell EA, McCowan LME. Association of Supine Going-to-Sleep Position in Late Pregnancy With Reduced Birth Weight: A Secondary Analysis of an Individual Participant Data Meta-analysis. JAMA Netw Open 2019; 2:e1912614. [PMID: 31577362 PMCID: PMC6777255 DOI: 10.1001/jamanetworkopen.2019.12614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Supine maternal position in the third trimester is associated with reduced uterine blood flow and increased risk of late stillbirth. As reduced uterine blood flow is also associated with fetal growth restriction, this study explored the association between the position in which pregnant women went to sleep and infant birth weight. OBJECTIVE To examine the association between supine position when going to sleep in women after 28 weeks of pregnancy and lower birth weight and birth weight centiles. DESIGN, SETTING, AND PARTICIPANTS Prespecified subgroup analysis using data from controls in an individual participant data meta-analysis of 4 case-control studies investigating sleep and stillbirth in New Zealand, Australia, and the United Kingdom. Participants were women with ongoing pregnancies at 28 weeks' gestation or more at interview. MAIN OUTCOMES AND MEASURES The primary outcome was adjusted mean difference (aMD) in birth weight. Secondary outcomes were birth weight centiles (INTERGROWTH-21st and customized) and adjusted odds ratios (aORs) for birth weight less than 50th and less than 10th centile (small for gestational age) for supine vs nonsupine going-to-sleep position in the last 1 to 4 weeks, adjusted for variables known to be associated with birth size. RESULTS Of 1760 women (mean [SD] age, 30.25 [5.46] years), 57 (3.2%) reported they usually went to sleep supine during the previous 1 to 4 weeks. Adjusted mean (SE) birth weight was 3410 (112) g among women who reported supine position and 3554 (98) g among women who reported nonsupine position (aMD, 144 g; 95% CI, -253 to -36 g; P = .009), representing an approximate 10-percentile reduction in adjusted mean INTERGROWTH-21st (48.5 vs 58.6; aMD, -10.1; 95% CI, -17.1 to -3.1) and customized (40.7 vs 49.7; aMD, -9.0; 95% CI, -16.6 to -1.4) centiles. There was a nonsignificant increase in birth weight at less than the 50th INTERGROWTH-21st centile (aOR, 1.90; 95% CI, 0.83-4.34) and a 2-fold increase in birth weight at less than the 50th customized centile (aOR, 2.12; 95% CI, 1.20-3.76). Going to sleep supine was associated with a 3-fold increase in small for gestational age birth weight by INTERGROWTH-21st standards (aOR, 3.23; 95% CI, 1.37-7.59) and a nonsignificant increase in small for gestational age birth weight customized standards (aOR, 1.63; 95% CI, 0.77-3.44). CONCLUSIONS AND RELEVANCE This study found that going to sleep in a supine position in late pregnancy was independently associated with reduced birth weight and birth weight centile. This novel association is biologically plausible and likely modifiable. Public health campaigns that encourage women in the third trimester of pregnancy to settle to sleep on their side have potential to optimize birth weight.
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Affiliation(s)
- Ngaire H. Anderson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adrienne Gordon
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Minglan Li
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robin S. Cronin
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John M. D. Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Alexander E. P. Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Division of Developmental Biology & Medicine, University of Manchester, Manchester, England, United Kingdom
| | - Tomasina Stacey
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, West Yorkshire, England, United Kingdom
| | | | - Jessica Wilson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa M. Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Edwin A. Mitchell
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lesley M. E. McCowan
- Department Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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29
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Bradford BF, Cronin RS, McCowan LME, McKinlay CJD, Mitchell EA, Thompson JMD. Association between maternally perceived quality and pattern of fetal movements and late stillbirth. Sci Rep 2019; 9:9815. [PMID: 31285538 PMCID: PMC6614481 DOI: 10.1038/s41598-019-46323-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/25/2019] [Indexed: 11/24/2022] Open
Abstract
We investigated fetal movement quality and pattern and association with late stillbirth in this multicentre case-control study. Cases (n = 164) had experienced a non-anomalous singleton late stillbirth. Controls (n = 569) were at a similar gestation with non-anomalous singleton ongoing pregnancy. Data on perceived fetal movements were collected via interviewer-administered questionnaire. We compared categorical fetal movement variables between cases and controls using multivariable logistic regression, adjusting for possible confounders. In multivariable analysis, maternal perception of the following fetal movement variables was associated with decreased risk of late stillbirth; multiple instances of ‘more vigorous than usual’ fetal movement (aOR 0.52, 95% CI 0.32–0.82), daily perception of fetal hiccups (aOR 0.28, 95%CI 0.15–0.52), and perception of increased length of fetal movement clusters or ‘busy times’ (aOR 0.23, 95%CI 0.11–0.47). Conversely, the following maternally perceived fetal movement variables were associated with increased risk of late stillbirth; decreased frequency of fetal movements (aOR 2.29, 95%CI 1.31–4.0), and perception of ‘quiet or light’ fetal movement in the evening (aOR 3.82, 95%CI 1.57–9.31). In conclusion, women with stillbirth were more likely than controls to have experienced alterations in fetal movement, including decreased strength, frequency and in particular a fetus that was ‘quiet’ in the evening.
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Affiliation(s)
- Billie F Bradford
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Robin S Cronin
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Christopher J D McKinlay
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand.,Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Dalrymple KV, Thompson JMD, Begum S, Godfrey KM, Poston L, Seed PT, McCowan LME, Wall C, Shelling A, North R, Cutfield WS, Mitchell EA. Relationships of maternal body mass index and plasma biomarkers with childhood body mass index and adiposity at 6 years: The Children of SCOPE study. Pediatr Obes 2019; 14:e12537. [PMID: 31232532 PMCID: PMC6731120 DOI: 10.1111/ijpo.12537] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Maternal obesity has been implicated in the origins of childhood obesity through a suboptimal environment in-utero. OBJECTIVE We examined relationships of maternal early pregnancy body mass index (BMI), overweight/obesity, and plasma biomarkers of obesity, inflammation, insulin resistance, and placental function with measures of childhood BMI and adiposity. METHODS BMI z-score, sum of skinfold thicknesses (SST), body fat percentage (BFP, by bioelectrical impedance), and waist, arm, and hip circumferences were measured in 1173 6-year-old children of nulliparous pregnant women in the Screening for Pregnancy Endpoints (SCOPE) study, New Zealand. Relationships of maternal early pregnancy (15 weeks' gestation) BMI and biomarkers with these childhood anthropometric measures were assessed by linear regression, with appropriate adjustment. RESULTS 28.1% of mothers were classified as overweight and 10.1% with obesity; compared with normal weight mothers, the BFP of their children were 5.3% higher (0.16 SD [95% CI, 0.04-0.29] p = .01) and 7.8% higher (0.27 [0.08-0.47] p = .006) with comparable values for BMI z-score and arm, waist, and hip circumferences. Early pregnancy maternal BMI and plasma placental growth factor (PlGF) were associated with higher child's SST, BMI z-score, hip circumference, and BFP. None of the metabolic or inflammatory maternal biomarkers were associated with childhood obesity. CONCLUSION In this contemporary large prospective cohort study with extensive maternal/childhood phenotyping and a high prevalence of maternal overweight/obesity, we found independent relationships of maternal early pregnancy BMI with childhood BMI and adiposity; similar associations were observed with PlGF, which may imply a role for placenta function in the developmental programming of childhood obesity risk.
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Affiliation(s)
- Kathryn V Dalrymple
- Department of Women and Children’s Health, School of Life
Course Sciences, King’s College London, UK
| | - John M D Thompson
- Department of Paediatrics, Child & Youth Health, Faculty of
Medical and Health Science, University of Auckland, New Zealand,Department of Obstetrics and Gynaecology, Faculty of Medical and
Health Science, University of Auckland, New Zealand
| | - Shahina Begum
- Department of Women and Children’s Health, School of Life
Course Sciences, King’s College London, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical
Research Centre, University of Southampton and University Hospital Southampton NHS
Foundation Trust, UK
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life
Course Sciences, King’s College London, UK
| | - Paul T Seed
- Department of Women and Children’s Health, School of Life
Course Sciences, King’s College London, UK
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and
Health Science, University of Auckland, New Zealand
| | - Clare Wall
- Department of Nutrition, School of Medical Sciences, University of
Auckland, New Zealand
| | - Andrew Shelling
- Department of Obstetrics and Gynaecology, Faculty of Medical and
Health Science, University of Auckland, New Zealand
| | - Robyn North
- Department of General Medicine, Auckland City Hospital, Auckland New
Zealand
| | | | - Edwin A Mitchell
- Department of Paediatrics, Child & Youth Health, Faculty of
Medical and Health Science, University of Auckland, New Zealand
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Bradford BF, Cronin RS, McKinlay CJD, Thompson JMD, Mitchell EA, Stone PR, McCowan LME. A diurnal fetal movement pattern: Findings from a cross-sectional study of maternally perceived fetal movements in the third trimester of pregnancy. PLoS One 2019; 14:e0217583. [PMID: 31188847 PMCID: PMC6561638 DOI: 10.1371/journal.pone.0217583] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/14/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Encouraging awareness of fetal movements is a common strategy used to prevent stillbirths. Information provided to pregnant women about fetal movements is inconsistent perhaps due to limited knowledge about normal fetal movement patterns in healthy pregnancies. We aimed to describe maternally perceived fetal movement strength, frequency, and pattern in late pregnancy in women with subsequent normal outcomes. METHODS Participants were ≥28 weeks' gestation, with a non-anomalous, singleton pregnancy who had been randomly selected from hospital booking lists and had consented to participate. Fetal movement data was gathered during pregnancy via a questionnaire administered face-to-face by research midwives. Participants remained eligible for the study if they subsequently gave birth to a live, appropriate-for-gestational-age baby at ≥37 weeks. RESULTS Participants were 274 women, with normal pregnancy outcomes. The majority (59.3%, n = 162) of women reported during antenatal interview that the strength of fetal movements had increased in the preceding two weeks. Strong fetal movements were felt by most women in the evening (72.8%, n = 195) and at night-time including bedtime (74.5%, n = 199). The perception of fetal hiccups was also reported by most women (78.8%). Women were more likely to perceive moderate or strong fetal movements when sitting quietly compared with other activities such as having a cold drink or eating. CONCLUSIONS Our data support informing women in the third trimester that as pregnancy advances it is normal to perceive increasingly strong movement, episodes of movements that are more vigorous than usual, fetal hiccups, and a diurnal pattern involving strong fetal movement in the evening. This information may help pregnant women to better characterise normal fetal movement and appropriately seek review when concerned about fetal movements. Care providers should be responsive to concerns about decreased fetal movements in the evening, as this is unusual.
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Affiliation(s)
- Billie F. Bradford
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robin S. Cronin
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Christopher J. D. McKinlay
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
| | - John M. D. Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter R. Stone
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lesley M. E. McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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O’Brien LM, Warland J, Stacey T, Heazell AEP, Mitchell EA. Maternal sleep practices and stillbirth: Findings from an international case-control study. Birth 2019; 46:344-354. [PMID: 30656734 PMCID: PMC7379524 DOI: 10.1111/birt.12416] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Late stillbirth, which occurs ≥28 weeks' gestation, affects 1.3-8.8 per 1000 births in high-income countries. Of concern, most occur in women without established risk factors. Identification of potentially modifiable risk factors that relate to maternal behaviors remains a priority in stillbirth prevention research. This study aimed to investigate, in an international cohort, whether maternal sleep practices are related to late stillbirth. METHODS An Internet-based case-control study of women who had a stillbirth ≥28 weeks' gestation within 30 days before completing the survey (n = 153) and women with an ongoing third-trimester pregnancy or who had delivered a live born child within 30 days (n = 480). Bivariate and multivariate logistic regressions were used to determine unadjusted and adjusted odds ratios (OR and aOR, respectively) with 95% confidence intervals (95% CIs) for stillbirth. RESULTS Sleeping >9 hours per night in the previous month was associated with stillbirth (aOR 1.75 [95% CI 1.10-2.79]), as was waking on the right side (2.27 [1.31-3.92]). Nonrestless sleep in the last month was also found to be associated with stillbirth (1.73 [1.03-2.99]), with good sleep quality in the last month approaching significance (1.64 [0.98-2.75]). On the last night of pregnancy, not waking more than one time was associated with stillbirth (2.03 [1.24-3.34]). No relationship was found with going to sleep position during pregnancy, although very few women reported settling in the supine position (2.4%). CONCLUSIONS Long periods of undisturbed sleep are associated with late stillbirth. Physiological studies of how the neuroendocrine and autonomic system pathways are regulated during sleep in the context of late pregnancy are warranted.
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Affiliation(s)
- Louise M. O’Brien
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics and GynecologyMichigan MedicineAnn ArborMichigan
| | - Jane Warland
- Mothers, Babies and Families Research Group, School of Nursing and MidwiferyUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | | | - Alexander E. P. Heazell
- St. Mary’s Hospital, Manchester Academic Health Science CentreManchester University NHS Foundation TrustManchesterUK,Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Edwin A. Mitchell
- Department of Paediatrics, Child and Youth HealthUniversity of AucklandAucklandNew Zealand
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Cronin RS, Li M, Thompson JM, Gordon A, Raynes-Greenow CH, Heazell AE, Stacey T, Culling VM, Bowring V, Anderson NH, O'Brien LM, Mitchell EA, Askie LM, McCowan LM. An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth. EClinicalMedicine 2019; 10:49-57. [PMID: 31193832 PMCID: PMC6543252 DOI: 10.1016/j.eclinm.2019.03.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Maternal supine going-to-sleep position has been associated with increased risk of late stillbirth (≥ 28 weeks), but it is unknown if the risk differs between right and left side, and if some pregnancies are more vulnerable. METHODS Systematic searches were undertaken for an individual-level participant data (IPD) meta-analysis of case-control studies, prospective cohort studies and randomised trials undertaken up until 26 Jan, 2018, that reported data on maternal going-to-sleep position and stillbirth. Participant inclusion criteria included gestation ≥ 28 weeks', non-anomalous, singleton pregnancies. The primary outcome was stillbirth. A one-stage approach stratified by study and site was used for the meta-analysis. The interaction between supine going-to-sleep position and fetal vulnerability was assessed by bi-variable regression. The multivariable model was adjusted for a priori confounders. Registration number: PROSPERO, CRD42017047703. FINDINGS Six case-control studies were identified, with data obtained from five (cases, n = 851; controls, n = 2257). No data was provided by a sixth study (cases, n = 100; controls, n = 200). Supine going-to-sleep position was associated with increased odds of late stillbirth (adjusted odds ratio [aOR] 2.63, 95% CI 1.72-4.04, p < 0.0001) compared with left side. Right side had similar odds to left (aOR 1.04, 95% CI 0.83-1.31, p = 0.75). There were no significant interactions between supine going-to-sleep position and assessed indicators of fetal vulnerability, including small-for-gestational-age infants (p = 0.32), maternal obesity (p = 0.08), and smoking (p = 0.86). The population attributable risk for supine going-to-sleep position was 5.8% (3.2-9.2). INTERPRETATION This IPD meta-analysis confirms that supine going-to-sleep position is independently associated with late stillbirth. Going-to-sleep on left or right side appears equally safe. No significant interactions with our assessed indicators of fetal vulnerability were identified, therefore, supine going-to-sleep position can be considered a contributing factor for late stillbirth in all pregnancies. This finding could reduce late stillbirth by 5.8% if every pregnant woman ≥ 28 weeks' gestation settled to sleep on her side.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lesley M.E. McCowan
- University of Auckland, New Zealand
- Corresponding author at: Department of Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
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Anderson TM, Lavista Ferres JM, Ren SY, Moon RY, Goldstein RD, Ramirez JM, Mitchell EA. Maternal Smoking Before and During Pregnancy and the Risk of Sudden Unexpected Infant Death. Pediatrics 2019; 143:peds.2018-3325. [PMID: 30858347 PMCID: PMC6564075 DOI: 10.1542/peds.2018-3325] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Maternal smoking during pregnancy is an established risk factor for sudden unexpected infant death (SUID). Here, we aim to investigate the effects of maternal prepregnancy smoking, reduction during pregnancy, and smoking during pregnancy on SUID rates. METHODS We analyzed the Centers for Disease Control and Prevention Birth Cohort Linked Birth/Infant Death Data Set (2007-2011: 20 685 463 births and 19 127 SUIDs). SUID was defined as deaths at <1 year of age with International Classification of Diseases, 10th Revision codes R95 (sudden infant death syndrome), R99 (ill-defined or unknown cause), or W75 (accidental suffocation or strangulation in bed). RESULTS SUID risk more than doubled (adjusted odds ratio [aOR] = 2.44; 95% confidence interval [CI] 2.31-2.57) with any maternal smoking during pregnancy and increased twofold between no smoking and smoking 1 cigarette daily throughout pregnancy. For 1 to 20 cigarettes per day, the probability of SUID increased linearly, with each additional cigarette smoked per day increasing the odds by 0.07 from 1 to 20 cigarettes; beyond 20 cigarettes, the relationship plateaued. Mothers who quit or reduced their smoking decreased their odds compared with those who continued smoking (reduced: aOR = 0.88, 95% CI 0.79-0.98; quit: aOR = 0.77, 95% CI 0.67-0.87). If we assume causality, 22% of SUIDs in the United States can be directly attributed to maternal smoking during pregnancy. CONCLUSIONS These data support the need for smoking cessation before pregnancy. If no women smoked in pregnancy, SUID rates in the United States could be reduced substantially.
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Affiliation(s)
- Tatiana M. Anderson
- Center for Integrative Brain Research, Seattle
Children’s Research Institute, Seattle, Washington
| | | | | | - Rachel Y. Moon
- Department of Pediatrics, School of Medicine,
University of Virginia, Charlottesville, Virginia
| | - Richard D. Goldstein
- Boston Children’s Hospital and Harvard Medical
School, Harvard University, Boston, Massachusetts
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle
Children’s Research Institute, Seattle, Washington;,Department of Neurological Surgery and Pediatrics,
School of Medicine, University of Washington, Seattle, Washington; and
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health,
The University of Auckland, Auckland, New Zealand
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35
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Silverwood RJ, Rutter CE, Mitchell EA, Asher MI, Garcia‐Marcos L, Strachan DP, Pearce N. Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation? Clin Exp Allergy 2019; 49:430-441. [PMID: 30508327 PMCID: PMC6487816 DOI: 10.1111/cea.13325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/19/2018] [Accepted: 11/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence of symptoms of asthma in children. We undertook comprehensive analyses addressing risk factors for asthma symptoms in combination, at both the individual and the school level, to explore the potential role of reverse causation due to selective avoidance or confounding by indication. OBJECTIVE To explore the role of reverse causation in risk factors of asthma symptoms. METHODS We compared two sets of multilevel logistic regression analyses, using (a) individual level exposure data and (b) school level average exposure (ie prevalence), in two different age groups. In individual level analyses, reverse causation is a possible concern if individual level exposure statuses were changed as a result of asthma symptoms or diagnosis. School level analyses may suffer from ecologic confounding, but reverse causation is less of a concern because individual changes in exposure status as a result of asthma symptoms would only have a small effect on overall school exposure levels. RESULTS There were 131 924 children aged 6-7 years (2428 schools, 25 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (odds ratio = 2.06; 95% confidence interval 1.97-2.16), early life antibiotic use (1.65; 1.58-1.73) and open fire cooking (1.44; 1.26-1.65). In school level analyses, these risk factors again showed increased risks. There were 238 586 adolescents aged 13-14 years (2072 schools, 42 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (1.80; 1.75-1.86), cooking on an open fire (1.32; 1.22-1.43) and maternal tobacco use (1.23; 1.18-1.27). In school level analyses, these risk factors again showed increased risks. CONCLUSIONS & CLINICAL RELEVANCE These analyses strengthen the potentially causal interpretation of previously reported individual level findings, by providing evidence against reverse causation.
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Affiliation(s)
- Richard J. Silverwood
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Charlotte E. Rutter
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth HealthFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - M. Innes Asher
- Department of Paediatrics: Child and Youth HealthFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Luis Garcia‐Marcos
- Pediatric Allergy and Pulmonology Units‘Virgen de la Arrixaca’ University Children's HospitalUniversity of Murcia and IMIB Bioresearch InstituteMurciaSpain
| | - David P. Strachan
- Population Health Research InstituteSt George's University of LondonLondonUK
| | - Neil Pearce
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
- Centre for Global NCDsLondon School of Hygiene and Tropical MedicineLondonUK
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Stacey T, Tennant P, McCowan L, Mitchell EA, Budd J, Li M, Thompson J, Martin B, Roberts D, Heazell A. Gestational diabetes and the risk of late stillbirth: a case-control study from England, UK. BJOG 2019; 126:973-982. [PMID: 30891907 DOI: 10.1111/1471-0528.15659] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the separate effects of being 'at risk' of gestational diabetes mellitus (GDM) and screening for GDM, and of raised fasting plasma glucose (FPG) and clinical diagnosis of GDM, on the risk of late stillbirth. DESIGN Prospective case-control study. SETTING Forty-one maternity units in the UK. POPULATION Women who had a stillbirth ≥28 weeks of gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733). METHODS Causal mediation analysis explored the joint effects of (i) 'at risk' of GDM and screening for GDM and (ii) raised FPG (≥5.6 mmol/l) and clinical diagnosis of GDM on the risks of late stillbirth. Adjusted odds ratios (aOR) were estimated by logistic regression adjusted for confounders identified by directed acyclic graphs. MAIN OUTCOME MEASURES Screening for GDM and FPG levels RESULTS: Women 'at risk' of GDM, but not screened, experienced 44% greater risk of late stillbirth than those not 'at risk' (aOR 1.44, 95% CI 1.01-2.06). Women 'at risk' of GDM who were screened experienced no such increase (aOR 0.98, 95% CI 0.70-1.36). Women with raised FPG not diagnosed with GDM experienced four-fold greater risk of late stillbirth than women with normal FPG (aOR 4.22, 95% CI 1.04-17.02). Women with raised FPG who were diagnosed with GDM experienced no such increase (aOR 1.10, 95% CI 0.31-3.91). CONCLUSIONS Optimal screening and diagnosis of GDM mitigate the higher risks of late stillbirth in women 'at risk' of GDM and/or with raised FPG. Failure to diagnose GDM leaves women with raised FPG exposed to avoidable risk of late stillbirth. TWEETABLE ABSTRACT Risk of #stillbirth in gestational diabetes is mitigated by effective screening and diagnosis.
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Affiliation(s)
- T Stacey
- School of Healthcare, University of Leeds, Leeds, UK
| | - Pwg Tennant
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,School of Medicine, University of Leeds, Leeds, UK.,The Alan Turing Institute, London, UK
| | - Lme McCowan
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - J Budd
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Li
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Jmd Thompson
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - B Martin
- Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - D Roberts
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Aep Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Kelly P, Thompson JMD, Rungan S, Ameratunga S, Jelleyman T, Percival T, Elder H, Mitchell EA. Do data from child protective services and the police enhance modelling of perinatal risk for paediatric abusive head trauma? A retrospective case-control study. BMJ Open 2019; 9:e024199. [PMID: 30826760 PMCID: PMC6429859 DOI: 10.1136/bmjopen-2018-024199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES First, to investigate whether there is a relationship between a family being known to child protective services or police at the time of birth and the risk of abusive head trauma (AHT, formerly known as shaken baby syndrome). Second, to investigate whether data from child protective services or police improve a predictive risk model derived from health records. DESIGN Retrospective case control study of child protective service and police records. SETTING Nine maternity hospitals. PARTICIPANTS 142 consecutive cases of AHT admitted to a tertiary children's hospital from 1991 to 2010 and born in one of the nine participating maternity hospitals. 550 controls matched by the date and hospital of birth. OUTCOME MEASURE Abusive head trauma. RESULTS There is a relationship between families known to child protective services or police and the risk of AHT. Notification to child protective services: univariable OR 7.24 (95% CI 4.70 to 11.14). Involvement with youth justice: univariable OR 8.94 (95% CI 4.71 to 16.95). Police call-out for partner violence: univariable OR 3.85 (95% CI 2.51 to 5.91). Other violence offence: univariable OR 2.73 (95% CI 1.69 to 4.40). Drug offence: univariable OR 2.82 (95% CI 1.63 to 4.89). However, in multi-variable analysis with data from perinatal health records, notification to child protective services was the only one of these variables to remain in the final model (OR 4.84; 95% CI 2.61 to 8.97) and had little effect on overall predictive power. The area under the receiver operating characteristic curve was 89.5% (95% CI 86.6 to 92.5) using variables from health data alone and 90.9% (95% CI 88.0 to 93.7) when notification was added. CONCLUSIONS Family involvement with child protective services or police is associated with increased risk of AHT. However, accessing such data at the time of birth would add little predictive power to a risk model derived from routine health information.
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Affiliation(s)
- Patrick Kelly
- Te Puaruruhau, Starship Children’s Health, Auckland, New Zealand
- Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - John M D Thompson
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Santuri Rungan
- Community Child Health, Sydney Children’s Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Timothy Jelleyman
- Department of Paediatrics, Waitemata District Health Board, Takapuna, New Zealand
| | - Teuila Percival
- Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Kidz First Children’s Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Hinemoa Elder
- School of Graduate Studies, Te Whare Wānanga o Awanuiārangi, Auckland, New Zealand
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Walker RE, Walker CG, Camargo CA, Bartley J, Flint D, Thompson JMD, Mitchell EA. Nasal microbial composition and chronic otitis media with effusion: A case-control study. PLoS One 2019; 14:e0212473. [PMID: 30794625 PMCID: PMC6386383 DOI: 10.1371/journal.pone.0212473] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/04/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives Chronic otitis media with effusion (COME) in children can cause prolonged hearing loss, which is associated with an increased risk of learning delays and behavioural problems. Dispersal of bacterial pathogens from the nasal passages to the middle ear is implicated in COME. We sought to determine whether there is an association between nasal microbial composition and COME in children. Methods A case-control study of children aged 3 and 4 years was conducted. Cases undergoing placement of tympanostomy tubes for COME were compared to healthy controls. Nasal swabs were collected and a questionnaire was administered. The V1-3 region of the 16S rRNA gene was amplified, and sequenced on the Illumina MiSeq. Results 73 children with COME had a lower Shannon diversity index than 105 healthy controls (1.62 [.80] versus 1.88 [.84], respectively; P = .046). The nasal microbiota of cases and controls differed in composition using Bray-Curtis dissimilarity (p = 0.002). Children with COME had a higher abundance of otopathogens and lower abundance of commensals including alpha haemolytic Streptococci and Lactococcus. Cluster analysis revealed 4 distinct nasal microbial profiles. Profiles that were Corynebacterium-dominated (aOR 4.18 [95%CI, 1.68–10.39], Streptococcus-dominated (aOR 3.12 [95%CI, 1.08–9.06], or Moraxella-dominated (aOR 4.70 [95%CI, 1.73–12.80] were associated with COME, compared to a more mixed microbial profile when controlling for age, ethnicity, and recent antibiotics use. Conclusions Children with COME have a less diverse nasal microbial composition with a higher abundance of pathogens, compared to healthy children who have a more mixed bacterial profile with a higher abundance of commensals. Further research is required to determine how nasal microbiota may relate to the pathogenesis or maintenance of COME, and whether modification of the nasal microbiota can prevent or treat children at risk of COME.
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Affiliation(s)
- Rebecca E. Walker
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Caroline G. Walker
- Centre for Longitudinal Research–He Ara ki Mua, Department of Population Health, The University of Auckland, Auckland, New Zealand
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jim Bartley
- Division of Otolaryngology-Head and Neck Surgery, Counties-Manukau District Health Board, Manukau SuperClinic, Manukau City, Auckland, New Zealand
| | - David Flint
- Division of Otolaryngology-Head and Neck Surgery, Counties-Manukau District Health Board, Manukau SuperClinic, Manukau City, Auckland, New Zealand
| | - John M. D. Thompson
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Slykerman RF, Joglekar MV, Hardikar AA, Satoor SN, Thompson JMD, Jenkins A, Mitchell EA, Murphy R. Maternal stress during pregnancy and small for gestational age birthweight are not associated with telomere length at 11 years of age. Gene 2019; 694:97-101. [PMID: 30738962 DOI: 10.1016/j.gene.2019.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/19/2018] [Accepted: 01/22/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Previous studies indicate that low birth weight and exposure to maternal stress during pregnancy may result in shortened telomeres in infants. Shorter telomere length has in turn been linked with accelerated ageing and with age-related diseases. This study aimed to investigate the association between pregnancy and birth factors and relative telomere length in offspring at 11 years of age. METHODS Participants were aged 11 years enrolled in the Auckland Birthweight Collaborative Study at birth (n = 380). Half of the children were born small for gestational age (SGA = birthweight ≤ 10th percentile) and half were appropriate for gestational age (AGA = birthweight > 10th percentile). Maternal stress during pregnancy was assessed using the Perceived Stress Scale. Relative leukocyte telomere length (RTL) in leukocytes was measured at 11 years of age using quantitative real-time PCR. RESULTS RTL was normally distributed (mean = 3.78, SD = 1.05). There were no significant associations between RTL at age 11 years and birthweight, sex, maternal smoking, maternal stress during pregnancy or maternal pre-pregnancy body mass index. CONCLUSION At age 11 years, RTL did not differ between children by birthweight or pregnancy-related stressors. Further telomere-related studies in newborns, children and adolescents are merited to increase knowledge of potential telomere modulating factors.
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Affiliation(s)
- Rebecca F Slykerman
- Department of Psychological Medicine, University of Auckland, Auckland 1142, New Zealand.
| | - Mugdha V Joglekar
- NHMRC CTC, University of Sydney, Sydney, New South Wales 2006, Australia
| | | | - Sarang N Satoor
- NHMRC CTC, University of Sydney, Sydney, New South Wales 2006, Australia
| | - John M D Thompson
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1142, New Zealand
| | - Alicia Jenkins
- NHMRC CTC, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1142, New Zealand
| | - Rinki Murphy
- Department of Medicine, University of Auckland, Auckland 1142, New Zealand
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Wickens K, Barthow C, Mitchell EA, Kang J, van Zyl N, Purdie G, Stanley T, Fitzharris P, Murphy R, Crane J. Effects of Lactobacillus rhamnosus HN001 in early life on the cumulative prevalence of allergic disease to 11 years. Pediatr Allergy Immunol 2018; 29:808-814. [PMID: 30430649 DOI: 10.1111/pai.12982] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/02/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND In a two-centre randomized placebo-controlled trial of Lactobacillus rhamnosus HN001 (HN001) (6 × 109 colony-forming units [cfu]) or Bifidobacterium lactis HN019 (HN019) (9 × 109 cfu) taken daily from 35-week gestation to 6 months' post-partum in mothers while breastfeeding and from birth to age 2 years in infants, we showed that HN001 significantly protected against eczema development at 2, 4 and 6 years and atopic sensitization at 6 years. There was no effect of HN019. We report here the findings for 11 year outcomes. METHODS At age 11 years, eczema was defined as previously using the UK Working Party's Diagnostic Criteria. Asthma, wheeze, hay fever and rhinitis were defined based on the International Study of Asthma and Allergies in Childhood (ISAAC) questions. Atopic sensitization was defined as one or more positive responses (mean wheal diameter ≥3 mm) to a panel of food and aeroallergens. Analysis was intention-to-treat using hazard ratios to assess probiotic effects on the 11-year lifetime prevalence and relative risks for point or 12-month prevalence at 11 years. RESULTS Early childhood HN001 supplementation was associated with significant reductions in the 12-month prevalence of eczema at age 11 years (relative risk [RR] = 0.46, 95% CI 0.25-0.86, P = 0.015) and hay fever (RR = 0.73, 95% CI 0.53-1.00, P = 0.047). For the lifetime prevalence, HN001 was associated with a significant reduction in atopic sensitization (hazard ratio [HR] = 0.71, 95% CI 0.51-1.00, P = 0.048), eczema (HR = 0.58, 95% CI 0.41-0.82, P = 0.002) and wheeze (HR = 0.76, 95% CI 0.57-0.99, P = 0.046). HN019 had no significant effect on these outcomes. CONCLUSION This is the first early probiotic intervention to show positive outcomes for at least the first decade of life across the spectrum of allergic disease.
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Affiliation(s)
- Kristin Wickens
- Wellington Asthma Research Group, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Christine Barthow
- Wellington Asthma Research Group, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Janice Kang
- Wellington Asthma Research Group, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Noleen van Zyl
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Gordon Purdie
- Dean's Department, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Thorsten Stanley
- Department of Paediatrics, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | | | - Rinki Murphy
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Julian Crane
- Wellington Asthma Research Group, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
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Slykerman RF, Kang J, Van Zyl N, Barthow C, Wickens K, Stanley T, Coomarasamy C, Purdie G, Murphy R, Crane J, Mitchell EA. Effect of early probiotic supplementation on childhood cognition, behaviour and mood a randomised, placebo-controlled trial. Acta Paediatr 2018; 107:2172-2178. [PMID: 30246890 DOI: 10.1111/apa.14590] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/01/2018] [Accepted: 09/20/2018] [Indexed: 12/12/2022]
Abstract
AIM To determine whether probiotic supplementation in early life improves neurocognitive outcomes assessed at 11 years of age. METHODS A total of 474 children who were born March 2004-Aug 2005 participated in a two-centre randomised placebo-controlled trial of infants at risk of developing allergic disease. Pregnant women were randomised to take Lactobacillus rhamnosus strain HN001, Bifidobacterium animalis subsp. lactis strain HN019 or placebo daily from 35 weeks gestation until six months if breastfeeding, and their infants the same treatment from birth to two years. Intelligence, executive function, attention, depression and anxiety were assessed when the children were 11 years of age. RESULTS A total of 342 (72.2%) children were assessed (HN001 n = 109, HN019 n = 118 and placebo n = 115). Overall, there were no significant differences in the neurocognitive outcomes between the treatment groups. CONCLUSION HN001 and HN019 given in early life were not associated with neurocognitive outcomes at 11 years of age in this study. However, we cannot exclude that other probiotics may have a beneficial effect. Further clinical trials are indicated.
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Affiliation(s)
- R F Slykerman
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - J Kang
- Department of Medicine; University of Otago; Wellington New Zealand
| | - N Van Zyl
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - C Barthow
- Department of Medicine; University of Otago; Wellington New Zealand
| | - K Wickens
- Department of Medicine; University of Otago; Wellington New Zealand
| | - T Stanley
- Department of Paediatrics; University of Otago; Wellington New Zealand
| | - C Coomarasamy
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - G Purdie
- Dean's Office; University of Otago; Wellington New Zealand
| | - R Murphy
- Department of Medicine; University of Auckland; Auckland New Zealand
| | - J Crane
- Department of Medicine; University of Otago; Wellington New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
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MacFarlane M, Thompson JMD, Zuccollo J, McDonald G, Elder D, Stewart AW, Lawton B, Percival T, Baker N, Schlaud M, Fleming P, Taylor B, Mitchell EA. Smoking in pregnancy is a key factor for sudden infant death among Māori. Acta Paediatr 2018; 107:1924-1931. [PMID: 29869345 DOI: 10.1111/apa.14431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 11/27/2022]
Abstract
AIM To examine the sudden unexpected death in infancy (SUDI) disparity between Māori and non-Māori in New Zealand. METHODS A nationwide prospective case-control study ran from March 2012 to February 2015. Exposure to established SUDI risk factors was analysed to investigate the disparity experienced by Māori. Infant ethnicity was based on mother's ethnicity. Māori ethnicity was prioritised. Non-Māori includes Pacific, Asian, NZ European and Other. RESULTS There were 137 cases and 649 controls. The Māori SUDI rate was 1.41/1000 live births compared to 0.53/1000 for non-Māori. Parents/caregivers of 132 cases (96%) and 258 controls (40%) were interviewed. Smoking in pregnancy was associated with an equally increased SUDI risk for Māori (adjusted OR = 8.11, 95% CI = 2.64, 24.93) and non-Māori (aOR = 5.09, 95% CI = 1.79, 14.47), as was bed-sharing (aOR = 3.66, 95% CI = 1.49, 9.00 vs aOR = 11.20, 95% CI = 3.46, 36.29). Bed-sharing prevalence was similar; however, more Māori controls smoked during pregnancy (46.7%) than non-Māori (22.8%). The main contributor relating to increased SUDI risk for Māori/non-Māori infants is the combination of smoking in pregnancy and bed sharing. CONCLUSION The association between known SUDI risk factors, including bed sharing and/or smoking in pregnancy and SUDI risk, is the same regardless of ethnicity. Māori infants are exposed more frequently to both behaviours because of the higher Māori smoking rate.
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Affiliation(s)
- M MacFarlane
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - J M D Thompson
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - J Zuccollo
- University of Otago; Wellington New Zealand
| | - G McDonald
- University of Otago; Dunedin New Zealand
| | - D Elder
- University of Otago; Wellington New Zealand
| | - A W Stewart
- University of Auckland; Auckland New Zealand
| | - B Lawton
- Centre for Women's Health Research; Victoria University of Wellington; Wellington New Zealand
| | - T Percival
- University of Auckland; Auckland New Zealand
| | - N Baker
- Nelson Hospital; Nelson New Zealand
| | - M Schlaud
- Robert Koch University; Berlin Germany
| | | | - B Taylor
- University of Otago; Dunedin New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
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Heazell AEP, Budd J, Li M, Cronin R, Bradford B, McCowan LME, Mitchell EA, Stacey T, Martin B, Roberts D, Thompson JMD. Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study. BMJ Open 2018; 8:e020031. [PMID: 29982198 PMCID: PMC6042603 DOI: 10.1136/bmjopen-2017-020031] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth. DESIGN Case-control study. SETTING 41 maternity units in the UK. PARTICIPANTS Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age. METHODS Data were collected using an interviewer-administered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2 weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2 weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders. PRIMARY OUTCOME MEASURE Association of maternally perceived fetal movements in relation to late stillbirth. RESULTS In multivariable analyses, women who reported increased strength of movements in the last 2 weeks had decreased risk of late stillbirth compared with those whose movements were unchanged (adjusted OR (aOR) 0.18, 95% CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were at increased risk (aOR 4.51, 95% CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95% CI 0.17 to 0.56). CONCLUSIONS Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth. TRIAL REGISTRATION NUMBER NCT02025530.
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Affiliation(s)
- Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jayne Budd
- Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Robin Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Billie Bradford
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | | | - Edwin A Mitchell
- Department of Paediatrics, Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | | | - Bill Martin
- Department of Obstetrics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - Devender Roberts
- Department of Obstetrics, Liverpool Women's NHS Foundation Trust, Liverpool, Liverpool, UK
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - John M D Thompson
- Department of Paediatrics, Child Health and Youth Health, University of Auckland, Auckland, New Zealand
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Mitchell EA, Stewart AW, Braithwaite I, Murphy R, Hancox RJ, Wall C, Beasley R. Factors associated with body mass index in children and adolescents: An international cross-sectional study. PLoS One 2018; 13:e0196221. [PMID: 29718950 PMCID: PMC5931641 DOI: 10.1371/journal.pone.0196221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/09/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The increasing prevalence of overweight and obesity in childhood has implications for their future health. There are many potential contributors to overweight and obesity in childhood. The aim was to investigate the association between postulated risk factors and body mass index (BMI) in children and adolescents. METHODS Secondary analysis of data from a multi-centre, multi-country, cross-sectional study (ISAAC Phase Three). Parents/guardians of children aged 6-7 years completed a questionnaire about their child's current height and weight, and the postulated risk factors. Adolescents aged 13-14 years reported their own height and weight and answered questions about the postulated risk factors. A general linear mixed model was used to determine the association between BMI and the postulated risk factors. Imputation was used if there were missing responses for 3 or fewer explanatory variables. RESULTS 65,721 children (27 centres, 15 countries) and 189,282 adolescents (70 centres, 35 countries) were included in the final analyses. Many statistically significant associations were identified, although for most variables the effect sizes were small. In children birth weight (for each kg increase in birth weight the BMI increased by +0.43 kg/m2, p<0.001), television viewing (5+ hours/day +0.33 kg/m2 vs. <1 hour/day, p<0.001), fast food (≥3 times/week +0.16 kg/m2 vs. never, p<0.001) vigorous physical activity (3+ hours/week 0.071 kg/m2 vs. never, p = 0.023) and maternal smoking in the first year of life (+0.13 kg/m2, p<0.001) were associated with a higher BMI in the adjusted model. Nut consumption (≥3 times/week -0.11 kg/m2 vs. never, p = 0.002) was associated with a lower BMI. Early life exposures (antibiotics, paracetamol and breast feeding) were also associated with BMI. For adolescents statistically significant associations with BMI and were seen with maternal smoking (+0.25 kg/m2, p<0.001), television viewing (5+ hours/day +0.23 kg/m2 vs. <1 hour/day, p<0.001), fast food (≥3 times/week -0.19 kg/m2 vs. never, p<0.001), vigorous physical activity (3+ hours/week 0.047 kg/m2 vs. never, p<0.001) and nuts (≥3 times/week -0.22 kg/m2 vs. never, p<0.001). CONCLUSIONS Although several early life exposures were associated with small differences in BMI, most effect sizes were small. Larger effect sizes were seen with current maternal smoking, television viewing (both with higher BMI) and frequent nut consumption (lower BMI) in both children and adolescents, suggesting that current behaviours are more important than early exposures. Although many variables may influence BMI in childhood, the putative factors studied are not of sufficient magnitude to support major public health interventions.
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Affiliation(s)
- Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Alistair W. Stewart
- School of Population Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Rinki Murphy
- Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Robert J. Hancox
- Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Clare Wall
- Discipline of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
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Guan J, Singh-Mallah G, Liu K, Thorstensen E, Shorten P, Mitchell EA, Taylor R, Harris P, Brimble M, Thompson JMD, Murphy R. The role for cyclic Glycine-Proline, a biological regulator of insulin-like growth factor-1 in pregnancy-related obesity and weight changes. J BIOL REG HOMEOS AG 2018; 32:465-478. [PMID: 29921371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cyclic Glycine-Proline (cGP) regulates the homeostasis of insulin-like growth factor (IGF)-1 function and cGP/IGF-1 ratio determines IGF-1 bioactivity in vitro and in vivo. Plasma IGF-1 represents largely inactive IGF-1 and weakly associated with human obesity and hypertension. We evaluated the regulatory role for cGP in pregnancy-related obesity and hypertension, and in obesity status between pregnancy and postpartum. Women were recruited in their first pregnancy. A cross-sectional study compared plasma concentration of cGP, IGF-1 and IGF binding protein (IGFBP)-3 in women with obesity and/or hypertension to normal controls 6-year postpartum using UPLC-MS and ELISA. A longitudinal study compared the changes of these peptides from 15-week gestation to 6-year post-partum in the women who remained normal weight, remained obese or changed to obese or to normal respectively. Study 1 is a cross-sectional study. The obese group had lower IGF-1(p = 0.001), higher cGP/IGF-1 ratio (p = 0.0055) and the hypertensive group had lower IGFBP-3 (p = 0.046) and cGP (p = 0.043) than the controls. Study 2 is a longitudinal study. Women with weight loss had increased cGP/IGF-1 ratio (p = 0.0026) and decreased IGFBP-3 (p = 0.0001) compared with women whose weight remained normal. Women with weight gain had lower IGFBP-3 (p less than 0.0001) only. Women who remained obese had increased cGP/IGF-1 ratio (p = 0.006) only. Increase in cGP/IGF-1 ratio is associated with obesity, but not hypertension. Changes of IGFBP-3 and/or cGP/IGF-1 ratio are associated with weight changes. The data suggest the role for cGP in obesity through autocrine regulation of IGF-1.
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Affiliation(s)
- J Guan
- Department Pharmacology and Clinical Pharmacology, School of Medical Sciences, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, New Zealand
| | - G Singh-Mallah
- Centre for Brain Research, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, New Zealand
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - K Liu
- Department Pharmacology and Clinical Pharmacology, School of Medical Sciences, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - E Thorstensen
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - P Shorten
- AgResearch Ltd, Ruakura Research Centre, Hamilton, New Zealand
- Riddet Institute, University of Massey, Palmerston North, New Zealand
| | - E A Mitchell
- Department of Paediatrics, Child and Youth Health, School of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - R Taylor
- Department of O&G, School of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - P Harris
- Department of Medicinal Chemistry, School of Chemistry, University of Auckland, Auckland, New Zealand
| | - M Brimble
- Brain Research New Zealand, New Zealand
- Department of Medicinal Chemistry, School of Chemistry, University of Auckland, Auckland, New Zealand
| | - J M D Thompson
- Department of Paediatrics, Child and Youth Health, School of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - R Murphy
- Department of Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
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Wickens K, Barthow C, Mitchell EA, Stanley TV, Purdie G, Rowden J, Kang J, Hood F, van den Elsen L, Forbes-Blom E, Franklin I, Barnes P, Fitzharris P, Maude RM, Stone P, Abels P, Murphy R, Crane J. Maternal supplementation alone with Lactobacillus rhamnosus HN001 during pregnancy and breastfeeding does not reduce infant eczema. Pediatr Allergy Immunol 2018; 29:296-302. [PMID: 29415330 DOI: 10.1111/pai.12874] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND In a randomized placebo-controlled trial, we previously found that the probiotic Lactobacillus rhamnosus HN001 (HN001) taken by mothers from 35 weeks of gestation until 6 months post-partum if breastfeeding and their child from birth to age 2 years halved the risk of eczema during the first 2 years of life. We aimed to test whether maternal supplementation alone is sufficient to reduce eczema and compare this to our previous study when both the mother and their child were supplemented. METHODS In this 2-centre, parallel double-blind, randomized placebo-controlled trial, the same probiotic as in our previous study (HN001, 6 × 109 colony-forming units) was taken daily by mothers from 14-16 weeks of gestation till 6 months post-partum if breastfeeding, but was not given directly to the child. Women were recruited from the same study population as the first study, where they or their partner had a history of treated asthma, eczema or hay fever. RESULTS Women were randomized to HN001 (N = 212) or placebo (N = 211). Maternal-only HN001 supplementation did not significantly reduce the prevalence of eczema, SCORAD ≥ 10, wheeze or atopic sensitization in the infant by 12 months. This contrasts with the mother and child intervention study, where HN001 was associated with reductions in eczema (hazard ratio (HR): 0.39, 95% CI 0.19-0.79, P = .009) and SCORAD (HR = 0.61, 95% 0.37-1.02). However, differences in the HN001 effect between studies were not significant. HN001 could not be detected in breastmilk from supplemented mothers, and breastmilk TGF-β/IgA profiles were unchanged. CONCLUSION Maternal probiotic supplementation without infant supplementation may not be effective for preventing infant eczema.
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Affiliation(s)
| | | | | | | | | | - Judy Rowden
- University of Auckland, Auckland, New Zealand
| | - Janice Kang
- University of Otago, Wellington, New Zealand
| | - Fiona Hood
- University of Otago, Wellington, New Zealand
| | | | | | | | | | | | - Robyn M Maude
- Victoria University of Wellington, Wellington, New Zealand
| | - Peter Stone
- University of Auckland, Auckland, New Zealand
| | - Peter Abels
- University of Otago, Wellington, New Zealand
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47
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Krishnan M, Thompson JMD, Mitchell EA, Murphy R, McCowan LME, Shelling AN, On Behalf Of The Children Of Scope Study Group G. Analysis of association of gene variants with obesity traits in New Zealand European children at 6 years of age. Mol Biosyst 2018. [PMID: 28636007 DOI: 10.1039/c7mb00104e] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Childhood obesity is a public health problem, which is associated with a long-term increased risk of cardiovascular disease and premature mortality. Several gene variants have previously been identified that have provided novel insights into biological factors that contribute to the development of obesity. As obesity tracks through childhood into adulthood, identification of the genetic factors for obesity in early life is important. The objective of this study was to identify putative associations between genetic variants and obesity traits in children at 6 years of age. We recruited 1208 children of mothers from the New Zealand centre of the international Screening for Pregnancy Endpoints (SCOPE) study. Eighty common genetic variants associated with obesity traits were evaluated by the Sequenom assay. Body mass index standardised scores (BMI z-scores) and percentage body fat (PBF; measured by bio-impedance assay (BIA)) were used as anthropometric measures of obesity. A positive correlation was found between BMI z-scores and PBF (p < 0.001, r = 0.756). Two subsets of gene variants were associated with BMI z-scores (HOXB5-rs9299, SH2B1-rs7498665, NPC1-rs1805081 and MSRA-rs545854) and PBF (TMEM18-rs6548238, NPY-rs17149106, ETV-rs7647305, NPY-rs16139, TIMELESS-rs4630333, FTO-rs9939609, UCP2-rs659366, MAP2K5-rs2241423 and FAIM2-rs7138803) in the genotype models. However, there was an absence of overlapping association between any of the gene variants with BMI z-scores and PBF. A further five variants were associated with BMI z-scores (TMEM18-rs6548238, FTO-rs9939609 and MC4R-rs17782313) and PBF (SH2B1-rs7498665 and FTO-rs1421085) once separated by genetic models (additive, recessive and dominant) of inheritance. This study has identified significant associations between numerous gene variants selected on the basis of prior association with obesity and obesity traits in New Zealand European children.
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Affiliation(s)
- Mohanraj Krishnan
- Department of Obstetrics and Gynaecology, University of Auckland, New Zealand.
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, New Zealand. and Department of Paediatrics: Child & Youth Health, University of Auckland, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child & Youth Health, University of Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, University of Auckland, New Zealand and Maurice Wilkins Centre for Biodiscovery, University of Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, New Zealand.
| | - Andrew N Shelling
- Department of Obstetrics and Gynaecology, University of Auckland, New Zealand.
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48
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Warland J, Heazell AEP, Stacey T, Coomarasamy C, Budd J, Mitchell EA, O'Brien LM. "They told me all mothers have worries", stillborn mother's experiences of having a 'gut instinct' that something is wrong in pregnancy: Findings from an international case-control study. Midwifery 2018; 62:171-176. [PMID: 29684796 DOI: 10.1016/j.midw.2018.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/07/2018] [Accepted: 04/03/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe and explore 'gut instinct' that something was wrong in women who identified that they experienced gut instinct during pregnancy. METHOD A case-control study utilising an international web-based questionnaire. Stillborn cases (n = 146) and liveborn controls (n = 234) answered the gut instinct question within 30 days of the pregnancy ending. Of those, 84 cases and 27 controls also provided qualitative comment data. Descriptive statistics were used for the question, with a fixed option and summative content analysis was used to analyse the comment data. FINDINGS In all, 110 (75%) of the stillborn cases answered "yes" to the gut instinct question vs only 28 (12%) of the controls who had a livebirth meaning the risk of stillbirth was 22.5 fold higher in those who experience "gut instinct" than in those who do not experience this feeling. Four themes were identified from the comment data namely: When the gut instinct occurred; How the gut instinct made the woman feel; Dreams and other related phenomena; Reassured by someone or something. CONCLUSIONS Women who had a stillborn baby reported a "gut instinct" that something was wrong more frequently than mothers of a live born baby. Our findings may be influenced by recall negativity bias, and a prospective study is needed to confirm or refute our findings. The possibility that "maternal intuition" exists during pregnancy and responds to changes in fetal or placental health merits further exploration. IMPLICATIONS FOR PRACTICE Maternity care providers should be alert to the woman when she expresses intuitive feelings, as well as asking her to report her concerns and act appropriately to assess and manage fetal wellbeing.
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Affiliation(s)
- Jane Warland
- Mother's Babies and Families Research Group, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia.
| | - Alexander E P Heazell
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK; Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Health, University of Manchester, Manchester, UK.
| | | | - Christin Coomarasamy
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
| | - Jayne Budd
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK; Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Health, University of Manchester, Manchester, UK.
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
| | - Louise M O'Brien
- Sleep Disorders Center and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.
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49
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Li M, Thompson JMD, Cronin RS, Gordon A, Raynes-Greenow C, Heazell AEP, Stacey T, Culling V, Bowring V, Mitchell EA, McCowan LME, Askie L. The Collaborative IPD of Sleep and Stillbirth (Cribss): is maternal going-to-sleep position a risk factor for late stillbirth and does maternal sleep position interact with fetal vulnerability? An individual participant data meta-analysis study protocol. BMJ Open 2018; 8:e020323. [PMID: 29643161 PMCID: PMC5898330 DOI: 10.1136/bmjopen-2017-020323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Accumulating evidence has shown an association between maternal supine going-to-sleep position and stillbirth in late pregnancy. Advising women not to go-to-sleep on their back can potentially reduce late stillbirth rate by 9%. However, the association between maternal right-sided going-to-sleep position and stillbirth is inconsistent across studies. Furthermore, individual studies are underpowered to investigate interactions between maternal going-to-sleep position and fetal vulnerability, which is potentially important for producing clear and tailored public health messages on safe going-to-sleep position. We will use individual participant data (IPD) from existing studies to assess whether right-side and supine going-to-sleep positions are independent risk factors for late stillbirth and to test the interaction between going-to-sleep position and fetal vulnerability. METHODS AND ANALYSIS An IPD meta-analysis approach will be used using the Cochrane Collaboration-endorsed methodology. We will identify case-control and prospective cohort studies and randomised trials which collected maternal going-to-sleep position data and pregnancy outcome data that included stillbirth. The primary outcome is stillbirth. A one stage procedure meta-analysis, stratified by study with adjustment of a priori confounders will be carried out. ETHICS AND DISSEMINATION The IPD meta-analysis has obtained central ethics approval from the New Zealand Health and Disability Ethics Committee, ref: NTX/06/05/054/AM06. Individual studies should also have ethical approval from relevant local ethics committees. Interpretation of the results will be discussed with consumer representatives. Results of the study will be published in peer-reviewed journals and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42017047703.
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Affiliation(s)
- Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Robin S Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Adrienne Gordon
- Department of Newborn Care, Royal Prince Alfred Hospital Women and Babies, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander E P Heazell
- Division of Developmental Biomedicine, Faculty of Medical and Human Sciences, Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
- St. Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Edwin A Mitchell
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
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50
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Crane J, Barthow C, Mitchell EA, Stanley TV, Purdie G, Rowden J, Kang J, Hood F, Barnes P, Fitzharris P, Maude R, Stone P, Murphy R, Wickens K. Is yoghurt an acceptable alternative to raw milk for reducing eczema and allergy in infancy? Clin Exp Allergy 2018; 48:604-606. [PMID: 29442385 DOI: 10.1111/cea.13121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Crane
- University of Otago, Wellington, New Zealand
| | - C Barthow
- University of Otago, Wellington, New Zealand
| | | | - T V Stanley
- University of Otago, Wellington, New Zealand
| | - G Purdie
- University of Otago, Wellington, New Zealand
| | - J Rowden
- University of Auckland, Auckland, New Zealand
| | - J Kang
- University of Otago, Wellington, New Zealand
| | - F Hood
- University of Otago, Wellington, New Zealand
| | - P Barnes
- University of Otago, Wellington, New Zealand
| | | | - R Maude
- Victoria University, Wellington, New Zealand
| | - P Stone
- University of Auckland, Auckland, New Zealand
| | - R Murphy
- University of Auckland, Auckland, New Zealand
| | - K Wickens
- University of Otago, Wellington, New Zealand
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