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1.
Artigo em Inglês | MEDLINE | ID: mdl-31540218

RESUMO

Inequity in immigrants' health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey in 2012 to all the Danish maternity wards (n = 20) was conducted. Semi-structured interviews with midwives providing targeted care (n = 6) were undertaken and characteristics of care were qualitatively analyzed, having the immigrant density of the facilities, the Danish ANC policy, and theories of cultural competence as the frame of reference. Six maternity wards were providing immigrant-targeted ANC. Targeted care implied longer consultations and increased attention to the individual needs of immigrant women. At these facilities, navigation in the health care system, body awareness, and use of interpreter services were key topics. The selection of women for targeted care was based on criteria (including names) that risk stigmatizing immigrant women. The arguments for not providing targeted care included that immigrant-targeted care was considered stigmatizing. Current universal care may overlook the needs of immigrant women and contribute to inequities. A strategy could be to improve dynamic cultural competencies of midwives, interpreter services, and flexibility of the care provision of the universal ANC system.

2.
J Am Acad Dermatol ; 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31415833

RESUMO

BACKGROUND: Streptococcal tonsillitis has been implicated in psoriasis; however, few population studies have examined its role in the pediatric population. OBJECTIVE: To investigate the association between tonsillitis and pediatric psoriasis METHODS: Data from the Danish National Birth Cohort were obtained on parentally reported psoriasis by age 11 years and history of tonsillitis at ages 6 - 18 months, 10 - 11 years, and (from hospital patient registry data) 0 - 11 years. We estimated odds ratios (ORs) and 95 % Confidence Intervals (CIs) of pediatric psoriasis using logistic regression analyses. RESULTS: In total, 35 188 offspring were eligible for analyses. Tonsillitis at 6 - 18 months was not associated with pediatric psoriasis (adjusted OR 0.73, 95 % CIs 0.47-1.14), nor was recent tonsillitis at ages 10 - 11 years (adjusted OR 1.09, 95 % CI 0.81-1.47). However, recurrent tonsillitis between ages 10 - 11 was strongly associated with pediatric psoriasis (adjusted OR 2.28, 95 % CIs 1.17-4.48). Our results for streptococcal tonsillitis indicated a potential association (adjusted OR 2.12, 95 % CIs 0.86, 5.17). LIMITATIONS: It was not possible to clarify the temporal relationship between tonsillitis and pediatric psoriasis CONCLUSION: Recurrent tonsillitis is of clinical relevance to pediatric psoriasis.

3.
Neurology ; 93(12): e1148-e1158, 2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420459

RESUMO

OBJECTIVE: To test whether abruption during pregnancy is associated with long-term cerebrovascular disease by assessing the incidence and mortality from stroke among women with abruption. METHODS: We designed a population-based prospective cohort study of women who delivered in Denmark from 1978 to 2010. We used data from the National Patient Registry, Causes of Death Registry, and Danish Birth Registry to identify women with abruption, cerebrovascular events, and deaths. The outcomes included deaths resulting from stroke and nonfatal ischemic and hemorrhagic strokes. We fit Cox proportional hazards regression models for stroke outcomes, adjusting for the delivery year, parity, education, and smoking. RESULTS: The median (interquartile range) follow-up in the nonabruption and abruption groups was 15.9 (7.8-23.8) and 16.2 (9.6-23.1) years, respectively, among 828,289 women with 13,231,559 person-years of follow-up. Cerebrovascular mortality rates were 0.8 and 0.5 per 10,000 person-years among women with and without abruption, respectively (hazard ratio [HR] 1.6, 95% confidence interval [CI] 0.9-3.0). Abruption was associated with increased rates of nonfatal ischemic stroke (HR 1.4, 95% CI 1.1-1.7) and hemorrhagic stroke (HR 1.4, 95% CI 1.1-1.9). The association of abruption and stroke was increased with delivery at <34 weeks, when accompanied by ischemic placental disease, and among women with ≥2 abruptions. These associations are less likely to have been affected by unmeasured confounding. CONCLUSION: Abruption is associated with increased risk of cerebrovascular morbidity and mortality. Disruption of the hemostatic system manifesting as ischemia and hemorrhage may indicate shared etiologies between abruption and cerebrovascular complications.

4.
Fertil Steril ; 112(3): 552-561.e2, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31311623

RESUMO

OBJECTIVE: To study the associations between exposure to oral contraceptives before conception and early in pregnancy and pubertal timing in boys and girls. DESIGN: Population-based cohort study. SETTING: Not applicable. PATIENT(S): Overall, 15,800 children (70%) born during 2000-2003 into the Danish National Birth Cohort were categorized according to maternal use of combined oral contraceptive pills or progestin-only pills reported around gestational week 17: no exposure (reference), exposure 4 months before conception, and exposure in early pregnancy. Children self-assessed pubertal status using Web-based questionnaires from 11 years and biannually throughout puberty. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Adjusted mean age differences (months) for attaining individual pubertal milestones and overall pubertal timing. Proportion mediated by prepubertal body mass index. RESULT(S): In boys, intrauterine exposure to oral contraceptives showed a tendency toward slightly earlier mean age for voice break (months, -3.8; 95% confidence interval [CI] -6.5, -1.0) and first ejaculation (months, -2.9; 95% CI -5.9, 0.1) and a mean difference of -1.4 months (95% CI -3.3, 0.4) for overall pubertal timing. Girls with intrauterine exposure tended to have slightly earlier age at menarche (months, -1.9; 95% CI -4.0, 0.3) and Tanner breast stages and had a mean difference of -0.9 months (95% CI -2.7, 1.0) for overall pubertal timing. Exposure before conception was not associated with pubertal timing. Prepubertal body mass index did not play a mediating role. CONCLUSION(S): This study shows some evidence that intrauterine exposure to oral contraceptives might slightly affect pubertal timing.

5.
BMC Pregnancy Childbirth ; 19(1): 194, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164095

RESUMO

BACKGROUND: Studies have shown differences in the risk of caesarean section (CS) between ethnic minority groups. This could be a marker of unequal health care. The aim of this study was to investigate differences in the risk of CS between immigrants of various origins in Denmark, where all health care is free and easy to access, and Danish-born women. A further aim was to determine the possible influence of known risk factors for CS. METHODS: The design was a population-based register study using national Danish registers and included all live- and stillborn singleton deliveries by primiparous women in Denmark from 2004 to 2015. The total study population consisted of 298,086 births, including 25,198 births to women from the 19 largest immigrant groups in Denmark. Multinomial logistic regression analysis was used to estimate relative risk ratios (RRR) of emergency and planned CS, using vaginal delivery (VD) as reference, in immigrant women compared to Danish-born women. A number of known risk factors were included separately. RESULTS: Women from Turkey, the Philippines, Thailand, Somalia, Vietnam, Iran and Afghanistan had a statistically significant elevated risk ratio of emergency CS vs. VD compared to Danish-born women; adjusted RRR's ranging 1.15-2.19. The risk ratio of planned CS vs. VD was lower among the majority of immigrant groups, however higher among women from Poland, Thailand and Iran, when compared to Danish-born women. None of the studied explanatory variables affected the risk ratio of planned CS vs. VD, whereas maternal height contributed with varying strength to the risk ratio of emergency CS vs. VD for all immigrant groups. CONCLUSION: Substantial variations in CS risks by maternal country of birth were documented. Some of the disparities in emergency CS seem to be explained by maternal height.

6.
Fertil Steril ; 112(1): 120-129.e2, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31043232

RESUMO

OBJECTIVE: To investigate whether female coffee consumption affects the chance of achieving a clinical pregnancy and a live birth among women and couples receiving medically assisted reproduction (MAR) treatment. DESIGN: Cohort study with prospectively collected exposure data. SETTING: Public fertility clinic. PATIENT(S): A total of 1,708 women and potential partners undergoing fertility treatment, contributing with 1,511 intrauterine insemination (IUI) cycles, 2,870 in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles, and 1,355 frozen embryo transfer cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy and live birth in consecutive treatment cycles in the Danish national health registries, enabling complete follow-up, and estimation of the cumulative chance of live birth for three consecutive treatment cycles. RESULT(S): Among women receiving IVF or ICSI treatment, coffee consumption did not seem to affect the chance of achieving a clinical pregnancy and a live birth. Women treated with IUI who had a daily coffee consumption of 1-5 cups were more likely to achieve a clinical pregnancy (adjusted relative risk 1.49; 95% confidence interval, 1.05-2.11) and live birth (adjusted relative risk 1.53; 95% confidence interval, 1.06-2.21) compared with the reference group of coffee abstainers. CONCLUSION(S): Women consuming 1-5 cups versus none had a 1.5-fold higher probability of achieving a pregnancy or a live birth when receiving IUI. No associations were found, however, between women's daily coffee consumption and achieving a pregnancy or a live birth from IVF/ICSI.

7.
JAMA ; 321(17): 1702-1715, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31063572

RESUMO

Importance: Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges. Objectives: To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories. Design, Setting, and Participants: Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015. Exposures: Gestational weight gain. Main Outcomes and Measures: The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth. Results: Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79). Conclusions and Relevance: In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.


Assuntos
Índice de Massa Corporal , Ganho de Peso na Gestação , Complicações na Gravidez , Resultado da Gravidez , Adulto , Peso ao Nascer , Cesárea/estatística & dados numéricos , Diabetes Gestacional , Feminino , Humanos , Hipertensão Induzida pela Gravidez , Recém-Nascido , Obesidade , Gravidez , Nascimento Prematuro
8.
Eur Eat Disord Rev ; 27(4): 436-444, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31016786

RESUMO

OBJECTIVE: To examine how childhood weight trajectories are associated with disordered eating behaviours (DEBs) in early adolescence. METHODS: Self-reports on DEBs (fasting, purging, and binge eating) were obtained from 18,337 children in the 11-year follow-up of the Danish National Birth Cohort. For this population, birth register information on gestational age and birth weight was categorized into the following: small, appropriate, and large for gestational age. Prospective parent-reported height and weight data at child ages 1 and 7 years were dichotomized using standardized cut-offs into non-overweight and overweight. A 12-category weight trajectory variable was created, and the associations between weight trajectory and DEBs were estimated using logistic regression. RESULTS: In total, 7.0% 11- to 12-year olds reported DEBs. Compared with children born appropriate for gestational age and being non-overweight at age 1 and 7 years, children born small for gestational age and who were overweight at age 1 and 7 years had a very high risk of disordered eating (OR 7.00; CI [2.57, 19.40]). The statistical analyses revealed, however, that overweight at age 7 years was the main contributor and independently of trajectory increased the risk of disordered eating at age 11-12 years significantly (OR 3.16 CI [2.73, 3.65]). CONCLUSION: Overweight not in the first year of life, but at age 7 years was more predictive for DEBs.

9.
Gastroenterology ; 156(8): 2217-2229, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30836095

RESUMO

BACKGROUND & AIMS: The intestinal microbiota is believed to be involved in the pathogenesis of celiac disease, in addition to genetic variants and dietary gluten. The gut microbiota is strongly influenced by systemic antibiotics-especially in early life. We explored the association between exposure to a systemic antibiotic in the first year of life and risk of diagnosed celiac disease. METHODS: We performed an observational nationwide register-based cohort study. We included all children born in Denmark from 1995 through 2012 or Norway from 2004 through 2012. Children born in Denmark were followed until May 8, 2015 (age at end of follow-up was 2.3-20.3 years) and children born in Norway were followed until December 31, 2013 (age at end of follow-up was 1-10 years). We collected medical information from more than 1.7 million children, including 3346 with a diagnosis of celiac disease. Exposure to systemic antibiotics was defined as a dispensed systemic antibiotic in the first year of life. RESULTS: Exposure to systemic antibiotics in the first year of life was positively associated with diagnosed celiac disease in the Danish and Norwegian cohorts (pooled odds ratio 1.26, 95% confidence interval 1.16-1.36). We found a dose-dependent relation between an increasing number of dispensed antibiotics and the risk of celiac disease (pooled odds ratio for each additional dispensed antibiotic 1.08, 95% confidence interval 1.05-1.11). No specific type of antibiotic or age period within the first year of life was prominent. Adjustment for hospital admissions with an infectious disease in the first year of life did not change the estimates; adjustment for the number of maternally reported infections in the child in 2 large sub-cohorts decreased the association slightly (pooled odds ratio 1.18, 95% confidence interval 0.98-1.39). CONCLUSION: In a nationwide study of children in Denmark and Norway, we found exposure to systemic antibiotics in the first year of life to be associated with a later diagnosis of celiac disease. These findings indicate that childhood exposure to systemic antibiotics could be a risk factor for celiac disease.


Assuntos
Idade de Início , Antibacterianos/efeitos adversos , Doença Celíaca/induzido quimicamente , Doença Celíaca/epidemiologia , Microbioma Gastrointestinal/efeitos dos fármacos , Sistema de Registros , Fatores Etários , Antibacterianos/uso terapêutico , Doença Celíaca/fisiopatologia , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca , Feminino , Humanos , Incidência , Lactente , Masculino , Noruega , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença
10.
Eur J Pediatr ; 178(5): 695-706, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30788593

RESUMO

This study aims to describe the prevalence of spinal pain among Danish children, explore the differential nature of spinal pain, and investigate socio-demographic factors predisposing spinal pain. A descriptive study of 46,726 11-14-year-olds participating in the Danish National Birth Cohort was conducted. Self-reported spinal pain (neck, middle back, and low back pain) was registered and classified according to severity. Socioeconomic data on children and their parents were identified in Statistics Denmark registers. Associations between socio-demographic factors and aspects of spinal pain were estimated using multinomial logistic regression models. To account for sample selection, inverse probability weighting (IPW) was applied. Almost 10% boys and 14% girls reported severe spinal pain, whereas around 30% of all children reported moderate pain. Effect estimates indicated the risk to increase with increasing age. Further, children without biological full siblings, not living with both of their parents, or children living in less-educated or lower-income families were more likely to experience spinal pain. The study conclusions were essentially unaffected by IPW.Conclusion: A considerable number of children suffer from spinal pain, and it is more common among children in more disadvantaged families. Etiology of spinal pain needs to be explored further with the aim of informing efficient and targeted prevention. What is Known: • Childhood spinal pain may cause marked discomfort and impairment in children's everyday life, and is suggested as important predictor of later-in-life spinal pain. • Methodological heterogeneity in previous studies and complexity of measuring pain make inferences at a broader level inadequate. What is New: • Prevalence of severe spinal pain in 11-14-year-olds was estimated to almost 10% for boys and 14% for girls, and children in more disadvantaged families were more likely to experience spinal pain. • The results seemed unaffected by sample selection.


Assuntos
Dor nas Costas/epidemiologia , Adolescente , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Criança , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Medição da Dor , Prevalência , Fatores de Risco , Fatores Socioeconômicos
11.
Eur J Paediatr Neurol ; 23(3): 507-516, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30777617

RESUMO

BACKGROUND: Children of immigrants in Denmark have excess risk for some of the most well-established risk factors for cerebral palsy (CP). OBJECTIVES: To study differences in risk of CP between children of immigrants and children of Danish-born mothers, and explore whether socioeconomic status drives any potential association. METHODS: A register-based cohort study including 1,274,616 children born in Denmark between 1981 and 2007. Of these, 2807 had a validated CP diagnosis in the Danish CP Register. We estimated the risk of CP as odds ratios (OR) using logistic regression and assessed mediation through socioeconomic status using natural effect models. RESULTS: In children of Danish-born mothers, 2.2/1000 had CP overall and the prevalence was similar for children of immigrants. However, children of immigrants had lower risk of unilateral spastic CP than children of Danish native-born mothers; OR = 0.59 (95% CI:0.38-0.91) for Western and OR = 0.79 (95% CI:0.61-1.03) for Non-Western immigrants. By contrast, the risk of bilateral spastic CP was higher in children of Non-Western immigrants (OR = 1.27 (95% CI:1.05-1.53)), especially from Turkey and Pakistan compared with children of Danish native-born mothers. The mediation analysis revealed an indirect effect (through maternal educational level and household income) with an OR of 1.06 (95% CI:0.99-1.14) for children of Non-Western immigrants. CONCLUSIONS: While children of immigrants had lower risk of unilateral spastic CP than children of Danish-born mothers, the risk of bilateral spastic CP was increased in children of Non-Western immigrants. Socioeconomic status did not appear to be a significant contributor to the increased risk of bilateral spastic CP.


Assuntos
Paralisia Cerebral/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Classe Social , Criança , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Razão de Chances , Prevalência , Fatores de Risco
12.
Soc Sci Med ; 220: 371-378, 2018 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-30513487

RESUMO

Children exposed to socioeconomic adversity have elevated levels of psychological difficulties immediately and long-term. However, few studies have examined the consequences of long-term patterns of dynamic trajectories of family income. The Danish National Birth Cohort (DNBC) is a longitudinal, population-based birth cohort study (1996-2002). Data on household poverty from the year before birth until the child was 10 years of age (n = 12 measures) were obtained from the National Danish Registries and modeled using semiparametric group-based modeling. Child mental health symptoms were measured at 11 years using mother and child-reported Strengths and Difficulties Questionnaires (n = 40 192), and the child-reported Stress in Childhood (SiC) scale (n = 46 284). Four categories of family socioeconomic position were identified: 1) No poverty (83.5%); 2) Intermittent poverty, representing families who alternate between being above and below the poverty cut-off (8.6%); 3) Poverty during the perinatal period (4.9%); and 4) Chronic poverty (3.0%). Controlling for several early life characteristics of the family, mother and child, intermittent poverty vs. no poverty was consistently associated with child psychological difficulties (any problem: RR = 1.38, 95% CI: 1.16-1.64; conduct problems: RR = 1.38, 95% CI: 1.16-1.64; and stress: RR = 1.07, 95% CI: 1.02-1.12). An association was also found between perinatal poverty and children's symptoms of hyperactivity/inattention (RR = 1.28, 95% CI = 1.03; 1.59). We found no associations between chronic poverty and any of the outcome measures when adjusting for early life risk factors. Children growing up in households characterized by financial instability have elevated levels of psychosocial symptoms, especially externalizing behaviors, as well as stress in early adolescence.

13.
Acta Derm Venereol ; 2018 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-30460370

RESUMO

Psoriasis is associated with cardiometabolic comorbidity; however, whether this is due to common lifestyle-related risk factors is unclear. This study investigated the association between psoriasis and cardiometabolic comorbidity, taking body mass index and smoking into account. The population comprised expectant mothers in the Danish National Birth Cohort (established 1996-2002). During pregnancy, the women were asked about physician-diagnosed psoriasis. Any association with self-reported cardiometabolic comorbidity 11 years later was assessed using logistic regression. The cohort was also followed up for hospital-diagnosed comorbidity, including cardiac death, until 31 December 2014, and the risk was assessed using Cox regression. A total of 2,435 women with psoriasis (2.90%) and 81,388 women without were identified. Psoriasis was significantly associated with self-reported hypercholesterolaemia (adjusted odds ratio 1.31; 1.01-1.70) and hospital-diagnosed hypertension (adjusted hazard ratio 1.33; 1.08-1.65). Women with psoriasis have an increased risk of developing cardiometabolic comorbidity in early adult life.

14.
J Epidemiol Community Health ; 72(11): 982-989, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30126977

RESUMO

BACKGROUND: Children who experience parental cancer are at increased risk of developing emotional, social, cognitive and behavioural problems. Our aim was to investigate how experience of parental cancer in childhood or adolescence is associated with primary school achievement, educational attainment and income in early adult life. METHODS: This is a register-linkage, prospective study of children born in Denmark from 1978 through 1999 and their parents. Parental cancer experience before the ages of 15 and 18 was identified in the Danish National Patient Registry. Final grade point average (GPA) in ninth grade, educational attainment and disposable personal income at the age of 30 were identified in Statistics Denmark registers. General linear models and multinomial logistic regression were used to estimate beta estimates of GPA, and relative risk ratios (RRR) for lower educational and income levels compared with children without parental cancer, taking parental educational status into account. RESULTS: Children who had experienced parental cancer achieved a slightly lower final GPA in ninth grade and had a higher risk of low educational attainment (RRR: 1.20; 95% CI 1.14 to 1.25) and attenuated income at the age of 30 (RRR: 1.11; 95% CI 1.06 to 1.16). For all outcomes, analyses suggested substantial deterioration in achievements in subgroups of children whose parent had a severe cancer type (RRRLow education: 1.52; 95% CI 1.39 to 1.66) or if the parent died of cancer (RRRLow education: 1.61; 95% CI 1.49 to 1.75). CONCLUSION: Educational and socioeconomic attainments in early adulthood were affected negatively in individuals who had experienced parental cancer as children or adolescents. The associations appeared stronger the more severe the cancer was.

15.
Thorax ; 2018 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-30026297

RESUMO

BACKGROUND: Poor growth during infancy and childhood is a characteristic feature of cystic fibrosis (CF). However, the impact of CF on intrauterine growth is unclear. We studied the effect of CF on birth weight in Denmark and Wales, and assessed whether any associations are due to differences in gestational age at birth. METHODS: We conducted national registry linkage studies in two countries, using data for 2.2 million singletons born in Denmark (between 1980 and 2010) and Wales (between 1998 and 2015). We used hospital inpatient and outpatient data to identify 852 children with CF. Using causal mediation methods, we estimated the direct and indirect (via gestational age) effect of CF on birth weight after adjustment for sex, parity and socioeconomic background. We tested the robustness of our results by adjusting for additional factors such as maternal smoking during pregnancy in subpopulations where these data were available. RESULTS: Babies with CF were more likely to be born preterm and with low birth weight than babies with no CF (12.7% vs 5% and 9.4% vs 5.8% preterm; 11.9% vs 4.2% and 11% vs 5.4% low birth weight in Denmark and Wales, respectively). Using causal mediation methods, the total effect of CF on birth weight was estimated to be -178.8 g (95% CI -225.43 to -134.47 g) in the Danish population and -210.08 g (95% CI -281.97 to -141.5 g) in the Welsh population. About 40% of this effect of CF on birth weight was mediated through gestational age. CONCLUSIONS: CF significantly impacts on intrauterine growth and leads to lower birth weight in babies with CF, which is only partially explained by shorter gestation.

16.
Epidemiology ; 29(5): 618-626, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29923866

RESUMO

BACKGROUND: Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs. METHODS: Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up. RESULTS: We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range. CONCLUSIONS: There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at, http://links.lww.com/EDE/B379.

17.
Eur Eat Disord Rev ; 26(4): 315-328, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29700895

RESUMO

We examined the association between parental characteristics and disordered eating among 11- to 12-year-olds within the Danish National Birth Cohort. Frequency of fasting, purging, and binge eating was obtained by self-report from 37,592 children and combined into a measure of disordered eating (no, monthly, and weekly). Information on parental characteristics was obtained during pregnancy, from the 7-year follow-up, and by linkage to population registers. Data were analysed using multinomial logistic regression models with robust standard errors. In total, 3.1% reported weekly and 4.1% reported monthly disordered eating. Parental young age, low educational level, and overweight/obesity were associated with disordered eating. The relative risk ratios for, respectively, weekly and monthly disordered eating according to maternal eating disorder were 1.01 [0.75, 1.37] and 1.09 [0.84, 1.42]. Disordered eating is common among children and is associated with several parental characteristics. We found social inequality in disordered eating, but our data did not support an association with maternal eating disorder.


Assuntos
Transtorno da Compulsão Alimentar/epidemiologia , Bulimia/epidemiologia , Obesidade/epidemiologia , Pais , Adulto , Transtorno da Compulsão Alimentar/psicologia , Bulimia/psicologia , Criança , Estudos de Coortes , Dinamarca/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Gravidez , Estudos Prospectivos , Autorrelato , Adulto Jovem
18.
Scand J Work Environ Health ; 44(5): 539-546, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-29574476

RESUMO

Objectives Exposure to traffic noise and air pollution is suspected to increase susceptibility to viral infections - the main triggering factor for febrile seizures. No studies have examined these two exposures in relation to febrile seizures. We aimed to investigate whether exposure to road traffic noise and air pollution are associated with risk of febrile seizures in childhood. Methods From our study base of 51 465 singletons from a national birth cohort, we identified 2175 cases with febrile seizures using a nationwide registry. Residential address history from conception to six years of age were found in national registers, and road traffic noise (L den) and air pollution (NO 2) were modeled for all addresses. Analyses were done using Cox proportional hazard model with adjustment for potential confounders, including mutual exposure adjustment. Results An interquartile range (IQR) increase in childhood exposure to road traffic noise and air pollution was associated with an 11% [incidence rate ratio (IRR) 1.11, 95% confidence interval (CI) 1.04-1.19) and 5% (IRR 1.05, 95% CI 1.02-1.07) higher risk for febrile seizures, respectively, after adjustment for potential confounders. Weaker tendencies were seen for pregnancy exposure. In models with mutual exposure adjustment, the estimates were slightly lower, with IRR of 1.08 (95% CI 1.00-1.16) and 1.03 (95% CI 0.99-1.06) per IQR increase in childhood exposure to road traffic noise and air pollution, respectively. Conclusions This study suggests that residential exposure to road traffic noise and air pollution is associated with higher risk for febrile seizures.

19.
Eur J Obstet Gynecol Reprod Biol ; 224: 17-20, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29525518

RESUMO

OBJECTIVES: Childbearing at extremely advanced maternal age is a globally increasing trend, but only a few studies have described the outcomes of these pregnancies. The aim of this study was to describe the occurrence of childbearing at age 50 and up in the Nordic countries, as well as to examine the frequency of adverse obstetric and neonatal outcomes. STUDY DESIGN: A descriptive population-based study was designed. Data from 1991 to 2013 were collected from the Medical Birth Registries in Denmark, Finland, Norway and Sweden. We investigated the occurrence of antepartum, delivery and neonatal outcomes. RESULTS: A total of 170 deliveries, in 141 singleton and 29 multiple pregnancies, were identified in mothers aged 50 and up. The highest frequency during this period was 6 per 100,000 deliveries. The prevalence for selected adverse outcomes in singleton pregnancies were: intrauterine fetal death (IUFD) 6%, preeclampsia 4%, preterm delivery 14%, gestational diabetes 8% and cesarean delivery 50%. In multiple pregnancies, the respective prevalence were: IUFD 2%, preeclampsia 22%, preterm delivery 57%, gestational diabetes 10% and cesarean delivery 79%. Pregnancy after assisted reproductive technologies was frequent (29% of singleton and 50% of multiple pregnancies). CONCLUSIONS: This study found high frequency of obstetric and neonatal complications at extremely advanced maternal age. Despite a high prevalence of stillbirth in singleton pregnancies in the studied Nordic countries, other complications were less frequent than those previously reported in different populations. Adequate preconception consultation concerning maternal and neonatal hazards is highly recommended in this group of women.


Assuntos
Idade Materna , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Países Escandinavos e Nórdicos/epidemiologia
20.
Eur J Public Health ; 28(2): 303-309, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29020399

RESUMO

Background: Few studies have investigated international variations in the gestational age (GA) distribution of births. While preterm births (22-36 weeks GA) and early term births (37-38 weeks) are at greater risk of adverse health outcomes compared to full term births (39-40 weeks), it is not known if countries with high preterm birth rates also have high early term birth rates. We examined rate associations between preterm and early term births and mean term GA by mode of delivery onset. Methods: We used routine aggregate data on the GA distribution of singleton live births from up to 34 high-income countries/regions in 1996, 2000, 2004, 2008 and 2010 to study preterm and early term births overall and by spontaneous or indicated onset. Pearson correlation coefficients were adjusted for clustering in time trend analyses. Results: Preterm and early term births ranged from 4.1% to 8.2% (median 5.5%) and 15.6% to 30.8% (median 22.2%) of live births in 2010, respectively. Countries with higher preterm birth rates in 2004-2010 had higher early term birth rates (r > 0.50, P < 0.01) and changes over time were strongly correlated overall (adjusted-r = 0.55, P < 0.01) and by mode of onset. Conclusion: Positive associations between preterm and early term birth rates suggest that common risk factors could underpin shifts in the GA distribution. Targeting modifiable population risk factors for delivery before 39 weeks GA may provide a useful preterm birth prevention paradigm.

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