Association of common maternal infections with birth outcomes: a multinational cohort study.

PURPOSE: It is unclear whether common maternal infections during pregnancy are risk factors for adverse birth outcomes. We assessed the association between self-reported infections during pregnancy with preterm birth and small-for-gestational-age (SGA) in an international cohort consortium. METHODS: Data on 120,507 pregnant women were obtained from six population-based birth cohorts in Australia, Denmark, Israel, Norway, the UK and the USA. Self-reported common infections during pregnancy included influenza-like illness, common cold, any respiratory tract infection, vaginal thrush, vaginal infections, cystitis, urinary tract infection, and the symptoms fever and diarrhoea. Birth outcomes included preterm birth, low birth weight and SGA. Associations between maternal infections and birth outcomes were first assessed using Poisson regression in each cohort and then pooled using random-effect meta-analysis. Risk ratios (RR) and 95% confidence intervals (CI) were calculated, adjusted for potential confounders. RESULTS: Vaginal infections (pooled RR, 1.10; 95% CI, 1.02-1.20) and urinary tract infections (pooled RR, 1.17; 95% CI, 1.09-1.26) during pregnancy were associated with higher risk of preterm birth. Similar associations with low birth weight were also observed for these two infections. Fever during pregnancy was associated with higher risk of SGA (pooled RR, 1.07; 95% CI, 1.02-1.12). No other significant associations were observed between maternal infections/symptoms and birth outcomes. CONCLUSION: Vaginal infections and urinary infections during pregnancy were associated with a small increased risk of preterm birth and low birth weight, whereas fever was associated with SGA. These findings require confirmation in future studies with laboratory-confirmed infection diagnosis.

Maternal prenatal paracetamol ingestion and scholastic attainments of the offspring.

Background: Fetal exposure to paracetamol (acetaminophen) has been shown to be associated with asthma and other atopic disorders, as well as behavioural problems including hyperactivity, in childhood. However, there is little information on scholastic abilities among children exposed to paracetamol in pregnancy. Objectives: To determine whether there are any differences in scholastic abilities among the offspring of women who ingested paracetamol during pregnancy compared with non-exposed children. Methods: Mothers enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) had recorded the frequency with which they had taken the medication over two time periods during pregnancy: i) the first 18 weeks and ii) 18-32 weeks. The offspring have been followed up ever since. For this study we use as outcomes: a) 14 tests of ability at reading and 2 of spelling using the study's tests and the national education system test results; b) 6 of mathematical abilities including tests of arithmetic and mathematical reasoning, and c) 1 of scientific understanding. Multiple regression was used, adjusting for 15 different exposures including reasons for taking the medication as well as demographic features. Results: Almost all unadjusted and adjusted mean differences were negative (i.e., those exposed to maternal intake of paracetamol did less well), but negative associations for exposures between 18 and 32 weeks of gestation were much more evident than for exposures earlier in pregnancy. Of the later exposures, after adjustment, 12 of the 23 scholastic tests were associated with prenatal exposure to paracetamol at p < 0.05. These negative effects were found in the girls (12 tests at p < 0.05) but not boys (0 tests at p < 0.05). Conclusion: Evidence from this longitudinal study suggests that maternal exposure to paracetamol is associated with disadvantages to the offspring in scholastic abilities such as mathematics and reading at secondary school ages. This raises the question as to whether there are longer-lasting effects on educational attainment from age 15 years onwards, including at university level. Clearly these results should be tested in other settings, but meanwhile they add to a growing accumulation of known adverse effects of exposure to paracetamol in pregnancy.

Measures of puberty in the Avon Longitudinal Study of Parents and Children (ALSPAC) offspring cohort.

Background: When studying the development of children through the preteen years into adolescence, it is often important to link features of their physical and mental health to the stage of puberty at the time. This is complex since individuals vary substantially in the ages at which they reach different pubertal milestones. Methods: The Avon Longitudinal Study of Parents and Children (ALSPAC) is an ongoing longitudinal cohort study based in southwest England that recruited over 14000 women in pregnancy, with expected dates of delivery between April 1991 and December 1992. From 1999, information on puberty was collected using a number of different methods : (a) A series of annual questionnaires were administered when the index children were aged between eight and 17 years; these were mainly concerned with the physical changes associated with puberty; (b) identification of the age at peak height growth using the SITAR methodology; and (c) retrospective information from the girls on their age at onset of menstruation (menarche). Results: The advantages and disadvantages of each method are discussed. Conclusions: The data are available for analysis by interested researchers.

Individual-level changes in religious/spiritual beliefs and behaviors over three decades in the parental generation of the ALSPAC cohort, UK.

Longitudinal data on religious/spiritual beliefs and behaviors (RSBB) are essential for understanding both how religion shapes our lives and the factors determining religiosity. Despite this importance, there are few longitudinal studies with detailed and repeated RSBB data. Using data spanning nearly 30 years from the parental generation of the Avon Longitudinal Study of Parents and Children (ALSPAC) based in the Southwest of England, we describe individual-level changes in various aspects of self-reported RSBB (religious belief, affiliation, and attendance, among others) measured on four occasions (pregnancy, plus 5, 9, and 28 years post-partum; approx. 3600 mothers and 1200 partners have data at all four time-points). Although RSBBs were generally consistent over time, a shift towards non-religiosity was observed; exceptions included Roman Catholic affiliation, which was remarkably stable over three decades, and religious attendance, which increased from pregnancy to 5 years, before declining at 28 years. Most changes in RSBB were minor, e.g., between "yes" and "not sure" regarding religious belief, rather than between "yes" and "no." We also provide a simple illustrative example of how these longitudinal data can be analyzed. In addition to describing these longitudinal patterns, this paper will help inform future research using ALSPAC's longitudinal RSBB data.

Demographic and socioeconomic predictors of religious/spiritual beliefs and behaviours in a prospective cohort study (ALSPAC) in Southwest England: Results from the offspring generation.

Background: We explored associations between possible demographic and socioeconomic causes of religious/spiritual beliefs and behaviours (RSBB) in the offspring generation of the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: We examined approximately 4,450 offspring aged 28 years with RSBB data from a prospective birth cohort study (ALSPAC) in Southwest England. Three RSBB outcome measures were assessed: religious belief (belief in God/a divine power; yes/not sure/no), religious affiliation (Christian/none/other) and religious attendance (frequency of attendance at a place of worship). We explored age- and sex-adjusted associations between 35 demographic and socioeconomic exposures and each of the three RSBB outcomes using multinomial regression. Exposure-sex interactions were also examined. Results: Some sociodemographic factors were associated with RSBB in this cohort; for instance, being female and from an ethnicity other than White were associated with increased religiosity across all domains. For many other exposures, however, associations were frequently null or inconsistent, often depending on the specific exposure and outcome combination. As an example, higher educational attainment was associated with higher rates of religious attendance, but not with religious belief or affiliation; in contrast, higher income was associated with lower levels of religiosity. No consistent interactions between sex and the exposures on RSBB were found. Effect sizes were also rather weak, with most pseudo- R 2 values below 0.5% and a maximum of 1.2%. Conclusions: The results highlight that several demographic and socioeconomic factors are associated with RSBB in this cohort. However, the number of these associations, and their magnitude, is smaller than comparable results from the parental generation of these offspring, suggesting that patterns of sociodemographic factors associated with RSBB differ between these generations. In addition to describing these associations, this paper will help inform future studies using these data, particularly regarding the choice of potential sociodemographic confounders.

Spiritual and religious beliefs and behaviour: data collected from 27/28-year-old offspring in the Avon Longitudinal Study of Parents and Children, 2019-2020.

Religious/spiritual belief and practices have sometimes been demonstrated to have positive associations with outcomes such as coping with serious illness, anxiety, depression, negative life events and general well-being, and therefore warrants consideration in many facets of health research. For example, increasing secularisation evidenced, particularly in the West, may reflect increasing rates of depression and anxiety. Very few studies have charted the ways in which religious/spiritual beliefs and practices of parents and their offspring vary longitudinally or between generations. Avon Longitudinal Study of Parents and Children (ALSPAC) is one such study that can relate belief and practices with aspects of physical and mental health and/or distinguish the different facets of the environment that may influence the development, or inter-generational loss, of belief and behaviours. This paper describes the 2019-2020 data collection in the ALSPAC on the religious/spiritual beliefs and behaviours (RSBB) of the study offspring (born 1991/1992) at ages 27-28 years. Previously collected and new data on the offspring are described here and comparisons are made with identical data completed by their parents (mothers and their partners) in early 2020. The most striking observations are that in almost all aspects of RSBB the offspring of both sexes are more secular, especially when compared with their mothers. For example, 56.2% of offspring state that they do not believe in God, or a divine power compared with 26.6% of mothers and 45.3% of mothers' partners. When asked about their type of religion, 65.4% of participants stated 'none', compared with 27.2% of mothers and 40.2% of partners. This confirms previous research reporting increasing secularisation from one generation to the next. As with the mothers and their partners, female offspring were more likely than males to believe in a divine power and to practice their beliefs.

The ALSPAC fetal and neonatal resource: detailed data abstracted from the clinical records of the new-born.

In a previous Data Note, we outlined the data obtained from clinical obstetric records concerning many details of the pregnancies resulting in the births of the children in the Avon Longitudinal Study of Parents and Children (ALSPAC). Here we describe the data that have been abstracted from medical records concerning the fetus and neonate. Full details concerning the selection biases regarding the data abstracted are outlined in the previous Data Note. The records that have been abstracted, and described in this Data Note, concern the health of the fetus (measured in relation to the results of fetal monitoring, presentation at various stages of pregnancy, and the method of delivery) as well as the status of the newborn immediately post-delivery. Details of signs, symptoms and treatments of this population of new-born babies, as recorded in the clinical records, are described for the time during which they were in hospital or under the care of a designated midwife. These data add depth to the information collected from elsewhere concerning this period of the child's life: from the questionnaires completed at the time by the mother; and clinical details from neonatal intensive or special care units which will be detailed in a further Data Note.

The mother during pregnancy and the puerperium: Detailed data abstracted from the clinical obstetric records of ALSPAC pregnancies.

Background: When the Avon Longitudinal Study of Parents and Children (ALSPAC) was planned, it was assumed that the clinical obstetric data would be easily accessible from the newly developed National Health Service computerised 'STORK' system. Pilot studies, however, showed that, although fairly accurate in regard to aspects of labour and delivery, it was, at the time (1990-2), inadequate for identifying the full antenatal and postnatal details of clinical complications and treatments of the women in the Study. Methods: A scheme was therefore developed to train research staff to find and abstract relevant details from clinical records onto proformas designed for the purpose. Extracting such data proved very time consuming (up to six hours for complicated pregnancies) and consequently expensive. Funding for the enterprise was obtained piecemeal using specific focussed grants to extract data for subsamples of the Study, including a random sample to serve as controls. Results: To date, detailed records have been completed for 8369 pregnancies, and a further 5336 (13,705 in total) have complete details on specific prenatal areas, including serial measures of maternal blood pressure, proteinuria and weight. In this Data Note we describe the information abstracted from the obstetric medical records concerning the mother during pregnancy, labour, delivery and the first two weeks of the puerperium. Information abstracted relating to the fetus (including fetal monitoring, presentation, method of delivery) and neonate (signs of asphyxia, resuscitation, treatment and well-being) have been described in a further Data Note. Conclusions: These data add depth to ALSPAC concerning ways in which the signs and symptoms, procedures and treatments of the mother prenatally, intrapartum and postnatally, may impact on the long-term health and development of both mother and child. They augment the data collected from the mothers' questionnaires (described elsewhere) and the 'STORK' digital hospital data.

Social conditions and health of pregnant Jamaican women

This study analysed data from a national sample of 10,428 mothers who had births occuring in Jamaica in September and October 1986 in order to identify which socio-economic and environmental features best predicted health problems of the mother and the baby. The four categories of problems arising during pregnancy (bleeding, vaginal infection/discharge, 'other problems', antenatal hospital admission) showed the reverse pattern to the one expected: mothers who were more highly educated and lived in better sanitary conditions tended to be those reporting more problems. Features of the mothers which could not be due to a perception bias (short stature and low haemoglobin levels) were more clearly associated with socio-economic deprivation. In addition, the clear-cut adverse outcomes of pregnancy - pre-term delivery and growth retardation - showed strong consistent associations with the conjugal union status of the mother, her usual employment status, the household expenditure on food and a newly derived social status classification based on the occupation warrants testing in other situations in Jamaica.

Environmental factors associated with pre-term delivery in Jamaica

Social and environmental factors were related to preterm delivery in a national population of 10,330 singleton births occuring in the Jamaican National Perinatal Morbidity and Mortality Survey of 1986. Among women certain of their dates, the preterm delivery rate was 14.2 por ciento . Initial two-way tabulations indicated that the significant associations with preterm delivery were the marital status of the mother, her educational level, the job of the major wage earner, whether she was herself the major wage earner, her usual employment status, the food expenditure per person in the household and the parish in which she resided. In addition, there were associations with tobacco smoking (positive) and alcohol consumption (negative). Mothers who were in work at the time of quickening had a reduced risk of of preterm delivery. There was no association with coital rate at quickening. Mothers who were young or relatively old (35+) also had an increased risk of preterm delivery. Logistic regressiion was used to determine the statistically significant independent associations. These were found to be: parish of residence, maternal age, marital status of the mother, the job of major wage earner in the household, maternal cigarette smoking and the amount spent on food in the household. There were no independent associations with maternal education level or alcohol ingestion.

Incidence of anencephaly in Jamaica

Information was collected on 2,197 stillbirths and neonatal deaths on the island of Jamaica during a 12 month period September 1986 to August 1987 as part of the population based nationwide Jamaican Perinatal Morbidity and Mortality Survey. There were 14 cases of anencephalus giving an incidence of 0.26 per 1000 total births. There was no detectable association with social class, maternal age or parity. The rate in Jamaica is considerably lower than found in any other population study.

A cluster of central nervous system defects in Jamaica

Information was collected on all stillbirths and neonatal deaths on the island of Jamaica during the 12 month period September 1986 to August 1987. There were 33 such deaths with anencephaly, spina bifida and hydrocephalus out of an estimated population of 54,400 total births. There was a statistically significant cluster in respect to time of conception in one small rural area of the island. There were no obvious differences between parents involved in the cluster and the rest of the population, but particular Jamaican fruit and vegetables have been shown to be teratogenic in animals. It is postulated that the cluster may have been associated with an unripe crop.

Maternal mortality in Jamaica: health care provision and causes of death

During the Jamaian Perinatal Mortality and Morbidity Survey, details of 62 maternal deaths occurring in the 12 month period September 1987 to August 1988 were compared with a control population of 95 por ciento of all births on the island in September and October 1987. The incidence (11.5 per 10,000 livebirths) had not fallen since a study 5 years previously. The mothers who died showed the expected trends with advanced maternal age and high parity. The major cause of maternal mortality was hypertension, (3.5 per 10,000 livebirths) followed by haemorrhage and infection. There was little evidence that these mothers had delayed their first attendance for antenatal care but they were more likely to have reduced access to basic facilities such as health centres and public transport. The risk of maternal death varied with grade of hospital facilities available, particularly for hypertension-related deaths, being lowest in areas with access to a specialist hospital and highest in areas where there were no obstetricians available.

Maternal mortality in Jamaica: socioeconomic factors

Socioeconomic factors relating to all maternal deaths identified during the 12 months of the Jamaican Perinatal Morbidity and Mortality Survey were compared with a control population of over 10,000 women. The maternal mortality rate was 11.5 per 10,000 livebirths. Initial analyses showed (a) a negative trend in risk of maternal death with increasing maternal education level, (b) that mothers who lived in households with direct pumped water and/or flush toilets enjoyed a reduced risk, (c) mothers who were themselves the major wage earner and (d) those living in households where the major wage earner was a farmer were at increased risk of maternal death. A previous analysis showed that the mothers age, her parity and variables indicating access to medical care were important. Logistic regression showed that only maternal age and toilet facilities were independently associated with maternal mortality.

Perinatal mortality in Jamaica 1986-1987

A large population-based study of all stillbirths and neonatal deaths occuring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified from an estimated population of 54,400 total births giving a perinatal death rate of 38.0 per 1000 total births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many deaths as possible. In the event, 51 por ciento of perinatal deaths received such a postmortem examination, for the most part by 3 specially trained pathologists working in the capital. Postmortem rate was affected by sex, multiplicity of the infant, month of death and area of delivery. Deaths were classified using Wigglesworth scheme. The distribution categories was similar in the months when the postmortem rate was 70 por ciento to the rest of the time period when the post-mortem rate was only 40 por ciento . The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 por ciento of deaths. This simple classification is important as it focusses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.

Area variation in perinatal mortality in Jamaica: association with type of hospital services available

Information on the area of maternal residence of 1856 singleton perinatal deaths occurring during a 12 month period (September 1986 - August 1987) were compared with those of 9933 singleton births born during a two month period (September-October 1986) and surviving the first week of life (The Jamaican Perinatal Morbidity and Mortality Survey). The overall mortality ratio of deaths to estimated survivors was 35.7 per 1000. When the area of residence was categorised according to the type of facilities available, there was a clear trend - births to mothers resident in areas with specialist hospital facilities available, had a mortality ratio of 32.0 per 1000, substantially less than those areas with some obstetric and paediatric facilities (rate 39.2 per 1000) or those with only a cottage hospital and no obstetricians (35.8 per 1000). Categorisation of the deaths using the Wigglesworth classification showed significant variation with intrapartum anoxia. This could not be explained by differences in birthweight, or demographic features of the population. It is concluded that access to a specialist hospital results in a significant reduction in mortality associated with intrapartum asphyxia, but not with other types of perinatal death.