Associations between child and adolescent marriage and reproductive outcomes in Brazil, Ecuador, the United States and Canada.

BACKGROUND: Although marriage is associated with favourable reproductive outcomes among adult women, it is not known whether the marriage advantage applies to girls (< 18 years). The contribution of girl child marriage (< 18 years) to perinatal health is understudied in the Americas. METHODS: National singleton birth registrations were used to estimate the prevalence of girl child marriage among mothers in Brazil (2011-2018, N = 23,117,661), Ecuador (2014-2018, N = 1,519,168), the USA (2014-2018, N = 18,618,283) and Canada (2008-2018, N = 3,907,610). The joint associations between marital status and maternal age groups (< 18, 18-19 and 20-24 years) with preterm birth (< 37 weeks), small-for-gestational age (SGA < 10 percentile) and repeat birth were assessed with logistic regression. RESULTS: The proportion of births to < 18-year-old mothers was 9.9% in Ecuador, 8.9% in Brazil, 1.5% in the United States and 0.9% in Canada, and marriage prevalence among < 18-year-old mothers was 3.0%, 4.8%, 3.7% and 1.7%, respectively. In fully-adjusted models, marriage was associated with lower odds of preterm birth and SGA among 20-24-year-old mothers in the four countries. Compared to unmarried 20-24-year-old women, married and unmarried < 18-year-old girls had higher odds of preterm birth in the four countries, and slightly higher odds of SGA in Brazil and Ecuador but not in the USA and Canada. In comparisons within age groups, the odds of repeat birth among < 18-year-old married mothers exceeded that of their unmarried counterparts in Ecuador [AOR: 1.99, 95%CI: 1.82, 2.18], the USA [AOR: 2.96, 95%CI: 2.79, 3.14], and Canada [AOR: 2.17, 95%CI: 1.67, 2.82], although minimally in Brazil [AOR: 1.09, 95%CI: 1.07, 1.11]. CONCLUSIONS: The prevalence of births to < 18-year-old mothers varies considerably in the Americas. Girl child marriage was differentially associated with perinatal health indicators across countries, suggesting context-specific mechanisms.

Child marriage and perinatal health in Ecuador, 2015-2020. / Casamiento infantil y salud perinatal en Ecuador, 2015-2020.

This study sought to estimate the prevalence and distribution of newborns to mothers under age 18 in Ecuador and the association between perinatal indicators and maternal marital status. Newborn records obtained from Ecuador's Instituto Nacional de Estadísticas y Censos (INEC) between 2015 and 2020 were used to assess the joint association between maternal age groups (10-15, 16-17, 18-19, and 20-24 years) and marital status (married, common-law, and single) with low birthweight, preterm birth, and inadequate prenatal care. The prevalence of newborns to mothers under age 18 was 9.3% overall, but declined over the study period, drastically among married mothers. The association between marital status and perinatal indicators depended on maternal age. The more favorable outcomes observed among married mothers aged 20-24 years (compared to their single counterparts) weaken or disappear among mothers under age 18. Mothers in stable unions exhibited outcomes in between those of married and single mothers.

Este estudio buscó estimar la prevalencia y distribución de nacidos vivos de madres menores de 18 años en Ecuador y la asociación entre indicadores perinatales y estado marital materno. A partir de los registros de nacidos vivos obtenidos del Instituto Nacional de Estadísticas y Censos de Ecuador para el período 2015-2020, se estimó la asociación conjunta entre grupos de edad (10-15, 16-17, 18-19 y 20-24 años) y la situación conyugal materna (casada, unión estable y soltera), con bajo peso al nacer, parto pretérmino e inadecuada atención prenatal. La prevalencia de partos de madres menores de 18 años fue del 9,3% y declinó en el periodo de estudio, drásticamente entre las mujeres casadas. La asociación entre estado marital y las variables explicativas dependió de la edad materna. Los resultados más favorables de salud observados entre las madres casadas de 20-24 años, en comparación con las madres solteras, se debilitan o desaparecen entre las menores de edad. Las madres en uniones de hecho experimentaron resultados intermedios entre las mujeres casadas y las solteras.

Does time since immigration modify neighborhood deprivation gradients in preterm birth? A multilevel analysis.

Immigrants' health is jointly influenced by their pre- and post-migration exposures, but how these two influences operate with increasing duration of residence has not been well-researched. We aimed to examine how the influence of maternal country of birth and neighborhood deprivation effects, if any, change over time since migration and how neighborhood effects among immigrants compare with those observed in the Canadian-born population. Birth data from Ontario hospital records (2002-2007) were linked with an official Canadian immigration database (1985-2000). The outcome measure was preterm birth. Neighborhoods were ranked according to a neighborhood deprivation index developed for Canadian urban areas and collapsed into tertiles of approximately equal size. Time since immigration was measured from the date of arrival to Canada to the date of delivery, ranging from 1 to 22 years. We used cross-classified random effect models to simultaneously account for the membership of births (N = 83,233) to urban neighborhoods (N = 1,801) and maternal countries of birth (N = 168). There were no differences in preterm birth between neighborhood deprivation tertiles among immigrants with less than 15 years of residence. Among immigrants with 15 years of stay or more, the adjusted absolute risk difference (ARD%, 95% confidence interval) between high-deprived (tertile 3) and low-deprived (tertile 1) neighborhoods was 1.86 (0.68, 2.98), while the ARD% observed among the Canadian-born (N = 314,237) was 1.34 (1.11, 1.57). Time since migration modifies the neighborhood deprivation gradient in preterm birth among immigrants living in Ontario cities. Immigrants reached the level of inequalities in preterm birth observed at the neighborhood level among the Canadian-born after 14 years of stay, but neighborhoods did not influence preterm birth among more recent immigrants, for whom the maternal country of birth was more predictive of preterm birth.

[Reference birthweights for the Argentine population by multiplicity of birth, sex, and gestational age]. / Referencias poblacionales argentinas de peso al nacer según multiplicidad del parto, sexo y edad gestacional.

OBJECTIVE: To develop new and improved reference birthweights for the Argentine population as a whole with a breakdown by gestational age (GA), sex and multiplicity of birth. METHODS: The population studied included all live births resulting from single (n = 3,478,286) and double (n = 57,654) births in Argentina during the period 2003- 2007. The probable errors in classifying GA on the basis of last menstruation were corrected using normal mixture models. The percentiles were obtained by quantile regression, which also made it possible to smooth out the curves. RESULTS: Birthweight curves for single births were obtained between weeks 22 and 43 of gestation, and curves for double births between weeks 24 and 41, with a breakdown by the sex of the neonate. Compared with those of previous studies, these reference birthweights do not overestimate the proportion of live births large for their GA. An increase in birthweight was also observed during the period of study. CONCLUSIONS: The proposed curves have the advantages of being based on large numbers, of being representative of the most recent Argentine births, of distinguishing the number of births and the sex of the neonates, and of minimizing GA classification errors. They are therefore a useful tool for measuring inequalities and thus identifying population groups at higher risk of adverse perinatal events.

Impact of COVID-19 on immunization of Brazilian infants.

OBJECTIVE: To examine recent vaccination trends among Brazilian children during their first year of life, and the impact of the coronavirus disease 2019 (COVID-19) pandemic on these trends. METHODS: Monthly vaccination and birth data from the DATASUS (Department of Informatics of the Unified Health System) database of the Ministry of Health of Brazil were obtained from January 2017 to December 2020. Interrupted time series analysis was used to compare vaccination trends before and after March 2020, when isolation measures were first implemented in Brazil. RESULTS: There was no strong evidence of a significant change in trends during the study period, or before and during the pandemic at national level. However, the mean number of vaccinations per child was 10.6, which is lower than the 13 doses expected under the immunization schedule. CONCLUSIONS: Although the pandemic did not appreciably impact on vaccinations, incomplete immunization among children aged <1 year in Brazil is cause for concern. A potential impact of the COVID-19 pandemic on specific antigens or regional and sociodemographic disparities in vaccinations cannot be ruled out without further research.

Casamiento infantil y salud perinatal en Ecuador, 2015-2020 / Child marriage and perinatal health in Ecuador, 2015-2020

RESUMEN Este estudio buscó estimar la prevalencia y distribución de nacidos vivos de madres menores de 18 años en Ecuador y la asociación entre indicadores perinatales y estado marital materno. A partir de los registros de nacidos vivos obtenidos del Instituto Nacional de Estadísticas y Censos de Ecuador para el período 2015-2020, se estimó la asociación conjunta entre grupos de edad (10-15, 16-17, 18-19 y 20-24 años) y la situación conyugal materna (casada, unión estable y soltera), con bajo peso al nacer, parto pretérmino e inadecuada atención prenatal. La prevalencia de partos de madres menores de 18 años fue del 9,3% y declinó en el periodo de estudio, drásticamente entre las mujeres casadas. La asociación entre estado marital y las variables explicativas dependió de la edad materna. Los resultados más favorables de salud observados entre las madres casadas de 20-24 años, en comparación con las madres solteras, se debilitan o desaparecen entre las menores de edad. Las madres en uniones de hecho experimentaron resultados intermedios entre las mujeres casadas y las solteras.

ABSTRACT This study sought to estimate the prevalence and distribution of newborns to mothers under age 18 in Ecuador and the association between perinatal indicators and maternal marital status. Newborn records obtained from Ecuador's Instituto Nacional de Estadísticas y Censos (INEC) between 2015 and 2020 were used to assess the joint association between maternal age groups (10-15, 16-17, 18-19, and 20-24 years) and marital status (married, common-law, and single) with low birthweight, preterm birth, and inadequate prenatal care. The prevalence of newborns to mothers under age 18 was 9.3% overall, but declined over the study period, drastically among married mothers. The association between marital status and perinatal indicators depended on maternal age. The more favorable outcomes observed among married mothers aged 20-24 years (compared to their single counterparts) weaken or disappear among mothers under age 18. Mothers in stable unions exhibited outcomes in between those of married and single mothers.

Trends in mental health service utilisation in immigrant youth in Ontario, Canada, 1996-2012: a population-based longitudinal cohort study.

OBJECTIVE: To describe trends in mental health service use of youth by immigration status and characteristics. DESIGN: Population-based longitudinal cohort study from 1996 to 2012 using linked health and administrative datasets. SETTING: Ontario, Canada. PARTICIPANTS: Youth 10-24 years, living in Ontario, Canada. EXPOSURE: The main exposure was immigration status (recent immigrants vs long-term residents). Secondary exposures were region of origin and refugee status. MAIN OUTCOME MEASURE: Mental health hospitalisations, emergency department (ED) visits and outpatient visits within consecutive 3-year time periods. Poisson regression models estimated rate ratios (RR). RESULTS: Over 2.5 million person years per period were included. Rates of recent immigrant mental health service utilisation were at least 40% lower than long-term residents (p<0.0001).Mental health hospitalisation and ED visit rates increased in long-term residents (hospitalisations, RR 1.09 (95% CI 1.08 to 1.09); ED visits, RR 1.15 (1.14 to 1.15)) and recent immigrants (hospitalisations RR 1.05 (1.03 to 1.07); ED visits, RR 1.08 (1.05 to 1.11)). Mental health outpatient visit rates increased in long-term residents (RR 1.03 (1.03 to 1.03)) but declined in recent immigrant (RR 0.94 (0.93 to 0.95)). Comparable divergent trends in acute care and outpatient service use were observed among refugees and across most regions of origin. Recent immigrant acute care use was driven by longer-term refugees (hospitalisations RR 1.12 (1.03 to 1.21); ED visits RR 1.11 (1.02 to 1.20)). CONCLUSIONS: Mental health service utilisation was lower among recent immigrants than long-term residents. While acute care use is increasing at a faster rate among long-term residents than recent immigrants, the decrease in outpatient mental health visits in immigrants highlights a potential emerging disparity in access to preventative care.

Multiple maternities and neighborhood income.

This study aimed to examine differences in multiple maternities by neighborhood-income levels in Toronto, Canada. Hospital records were used to perform secondary analysis of 144,731 maternities resulting in single or multiple infants live-born to mothers residing in the City of Toronto 1996 to 2001. The independent variable was neighborhood income, defined as mean household neighborhoodincome quintiles. Multiple logistic regression analysis was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Differences by income levels were found in twin maternities but not in higher order maternities. Twin maternities were more likely to occur in the richest neighborhood-income quintile compared to the rest of the population (AOR: 1.25, 95% CI: 1.10-1.41), after adjustment for potential confounders. The positive association between high neighborhood income and twin maternities found in this study suggests that the richest neighborhoods select families whose characteristics pose them at increased risk of having twins. Further studies are needed to clarify the underlying mechanisms leading to socioeconomic differences in multiple births.

Contrasting socioeconomic gradients in small for gestational age and preterm birth in Argentina, 2003-2007.

OBJECTIVES: To examine the socioeconomic gradients in birth outcomes among singleton infants in Argentina, 2003-2007. METHODS: We analyzed data of 3,230,031 singleton infants born in 2003-2007, obtained from vital statistics. Associations between birth outcomes [small for gestational age (SGA), low birth weight (LBW), and preterm birth (PTB)] and socioeconomic indicators (maternal education and area-based material deprivation quintiles) were assessed with logistic regression. RESULTS: The risk of SGA increased with higher socioeconomic disadvantage, but that of PTB decreased. Compared to mothers who attained a tertiary or university degree, mothers who did not complete primary school were more likely to have a SGA infant [adjusted OR (95 % CI): 1.65 (1.62, 1.68)], but less likely to deliver preterm [0.92 (0.90, 0.94)]. As a result of the conflicting trends in SGA and PTB, LBW exhibited inconsistent socioeconomic gradients. CONCLUSIONS: The excess risk of adverse birth outcomes associated with socioeconomic disadvantage was consistently reflected by SGA, but not by LBW and PTB. These findings challenge the usefulness of LBW as an indicator population health. Further research is needed to explain the reverse socioeconomic gradients in PTB.

International migration and adverse birth outcomes: role of ethnicity, region of origin and destination.

BACKGROUND: The literature on international migration and birth outcomes shows mixed results. This study examined whether low birth weight (LBW) and preterm birth differed between non-migrants and migrant subgroups, defined by race/ethnicity and world region of origin and destination. METHODS: A systematic review and meta-regression analyses were conducted using three-level logistic models to account for the heterogeneity between studies and between subgroups within studies. RESULTS: Twenty-four studies, involving more than 30 million singleton births, met the inclusion criteria. Compared with US-born black women, black migrant women were at lower odds of delivering LBW and preterm birth babies. Hispanic migrants also exhibited lower odds for these outcomes, but Asian and white migrants did not. Sub-Saharan African and Latin-American and Caribbean women were at higher odds of delivering LBW babies in Europe but not in the USA and south-central Asians were at higher odds in both continents, compared with the native-born populations. CONCLUSIONS: The association between migration and adverse birth outcomes varies by migrant subgroup and it is sensitive to the definition of the migrant and reference groups.

Referencias poblacionales argentinas de peso al nacer según multiplicidad del parto, sexo y edad gestacional / Reference birthweights for the Argentine population by multiplicity of birth, sex, and gestational age

OBJETIVO: Desarrollar referencias nuevas y mejoradas de peso al nacer según la edad gestacional (EG), el sexo y la multiplicidad del parto, para la población argentina en su conjunto. MÉTODOS: La población de estudio incluyó a todos los nacidos vivos de partos simples (n = 3 478 286) y dobles (n = 57 654) en Argentina durante el período 2003-2007. Los probables errores en la clasificación de la EG basada en la fecha de la última menstruación fueron corregidos con el uso de modelos de distribuciones normales mixtas. Los percentiles se obtuvieron mediante la regresión de cuantiles, que además posibilitó el suavizamiento de las curvas. RESULTADOS: Se obtuvieron curvas de peso al nacer para partos simples entre las semanas 22 y 43 de gestación y para partos dobles entre las semanas 24 y 41, según el sexo del neonato. Comparadas con estudios previos, estas referencias no sobreestiman la proporción de nacidos vivos grandes para su EG. Se observó también un aumento del peso al nacer a lo largo del período de estudio. CONCLUSIONES: Las curvas propuestas tienen las ventajas de basarse en grandes números, de ser representativas de los nacimientos argentinos más recientes, de distinguir el tipo de parto y el sexo de los neonatos, y de minimizar los errores de clasificación de la EG. Constituyen por lo tanto una herramienta útil para medir desigualdades y así identificar grupos poblacionales con mayor riesgo de eventos perinatales adversos.

OBJECTIVE: To develop new and improved reference birthweights for the Argentine population as a whole with a breakdown by gestational age (GA), sex and multiplicity of birth. METHODS: The population studied included all live births resulting from single (n = 3,478,286) and double (n = 57,654) births in Argentina during the period 2003- 2007. The probable errors in classifying GA on the basis of last menstruation were corrected using normal mixture models. The percentiles were obtained by quantile regression, which also made it possible to smooth out the curves. RESULTS: Birthweight curves for single births were obtained between weeks 22 and 43 of gestation, and curves for double births between weeks 24 and 41, with a breakdown by the sex of the neonate. Compared with those of previous studies, these reference birthweights do not overestimate the proportion of live births large for their GA. An increase in birthweight was also observed during the period of study. CONCLUSIONS: The proposed curves have the advantages of being based on large numbers, of being representative of the most recent Argentine births, of distinguishing the number of births and the sex of the neonates, and of minimizing GA classification errors. They are therefore a useful tool for measuring inequalities and thus identifying population groups at higher risk of adverse perinatal events.

Capacidades locales de gestión como y accesibilidad a los servicios de primer nivel para la obtención de cuidados prenatales / Local capacities of management as predictive factor of the use and accessibility to the services of first level for the obtaining of prenatal cares

Objetivo: determinar si las condiciones locales de gestión de los centros de salud de primer de atención están asociadas con la utilización de servicios prenatales. Metodología: se a cabo un estudio transversal en el año 2003, basado en una encuesta a madres recientes de la Provincia de Buenos Aires. Como factores determinantes de la utilización fueron consideradas variables socio-demográficas, familiares, de necesidad de salud y características locales servicios. Resultados: completas capacidades de gestión local del centro de salud y menores ingresos estuvieron asociados con una mayor utilización de servicios prenatales. Conclusiones: en una población de bajos recursos las capacidades locales de gestión se constituyen como predictor de la utilización de servicios prenatales.

Objective: To determine whether the local management competencies of the health centers are associated with the utilization of local prenatal care services. Methodology: A cross-sectionalstudy was carried out based on a survey of recent mothers in the province of Buenos Aires, includinginformation on factors determining utilization of prenatal services, such as demographic, socioeconomic, health, and local characteristics of the health care services. Results: Completelocal management competencies of the health centers and lower income were associated with prenatal care use. Conclusion: In a deprived population the local management competencies ofthe health centers arise as a predictor of prenatal care utilization.