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1.
Environ Res ; 204(Pt D): 112393, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34798119

RESUMO

Exposures to multiple air pollutants during pregnancy have been associated with the risk of gestational diabetes mellitus (GDM). However, their combined effects are unclear. We aimed to evaluate the combined associations of five air pollutants from pre-pregnancy to the 2nd trimester with GDM. This study included 20,113 participants from the Born in Guangzhou Cohort Study (BIGCS). The inverse distance-weighted models were used to estimate individual air pollutant exposure, namely ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), particulate matter less than 10 µm in diameter (PM10), and less than 2.5 µm in diameter (PM2.5). We estimated stage-specific associations of air pollutants with GDM using generalized estimating equation, and departures from additive joint effects were assessed using the relative excess risk (RERI) and the joint relative risk (JRR). Of the 20,113 participants, 3440 women (17.1%) were diagnosed with GDM. In the adjusted model, increased concentrations of O3 and SO2 3-6 months before pregnancy were associated with GDM occurrence, as well as O3 and PM10 in the 1st trimester, the adjusted relative risk (95% confident intervals) [RRs (95%CI)] ranged from 1.05 (1.00, 1.09) to 1.21 (1.04, 1.40). The largest JRR for GDM was the combination of SO2, NO2, and PM10 in the 1st trimester (JRR = 1.32, 95% CI: 1.10, 1.59). The JRR for O3 and SO2 was less than their additive joint effects [RERI = -0.25 (-0.47, -0.04), P for interaction = 0.048]. Associations of air pollutants with GDM differed somewhat by pre-pregnancy BMI and season. This study added new evidence to the current understanding of the combined effects of multiple air pollutants on GDM. Public health strategies were needed to reduce the adverse effects of air pollution exposure on pregnant women.

2.
Front Endocrinol (Lausanne) ; 12: 771193, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34956083

RESUMO

Background: Birth weight is associated with cardiometabolic factors at birth. However, it is unclear when these associations occur in fetal life. We aimed to investigate the associations between fetal growth in different gestational periods and cord blood cardiometabolic factors. Methods: We included 1,458 newborns from the Born in Guangzhou Cohort Study, China. Z-scores of fetal size parameters [weight, abdominal circumference (AC), and femur length (FL)] at 22 weeks and growth at 22-27, 28-36, and ≥37 weeks were calculated from multilevel linear spline models. Multiple linear regression was used to examine the associations between fetal growth variables and z-scores of cord blood cardiometabolic factors. Results: Fetal weight at each period was positively associated with insulin levels, with stronger association at 28-36 weeks (ß, 0.31; 95% CI, 0.23 to 0.39) and ≥37 weeks (ß, 0.15; 95% CI, 0.10 to 0.20) compared with earlier gestational periods. Fetal weight at 28-36 (ß, -0.32; 95% CI, -0.39 to -0.24) and ≥37 weeks (ß, -0.26; 95% CI, -0.31 to -0.21) was negatively associated with triglyceride levels, whereas weight at 28-36 weeks was positively associated with HDL levels (ß, 0.12; 95% CI, 0.04 to 0.20). Similar results were observed for AC. Fetal FL at 22 and 22-27 weeks was associated with increased levels of insulin, glucose, and HDL. Conclusions: Fetal growth at different gestational periods was associated with cardiometabolic factors at birth, suggesting that an interplay between fetal growth and cardiometabolic factors might exist early in pregnancy.

5.
Child Neuropsychol ; : 1-14, 2021 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-34846268

RESUMO

To investigate the association between infancy weight gain and neurodevelopment among term-born infants. Singleton term-born infants (n = 5837) were included from the Born in Guangzhou Cohort Study. Absolute weight gain was obtained by calculating the weight difference from birth to exactly 12 months. The primary outcome was neurodevelopment at age one year, which included five developmental domains. Global developmental delay was defined as delays in ≥3 domains. Multivariable logistic regression was used to examine the associations between infancy weight gain and neurodevelopment. Compared with infants gaining 6001-7000 g (reference group), infants gaining ≤5000 g had higher odds of delay in adaptive, gross motor, fine motor, social, and global developmental delay, infants gaining 5001-6000 g had higher odds of gross motor delay and social delay. A sex-stratified analysis showed that compared with the reference group, gaining ≤5000 g was associated with higher odds of fine motor delay in male infants, while gaining >7000 g was associated with higher odds of fine motor delay in females. Inadequate infancy weight gain is associated with higher odds of poor neurodevelopment at age one year among term-born infants.

6.
Artigo em Inglês | MEDLINE | ID: mdl-34806795

RESUMO

BACKGROUND: Maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) have been linked to offspring allergic disorders. However, associations observed in previous studies were inconsistent and might be confounded by unmeasured familial factors. We aimed to examine the associations of maternal weight with offspring allergic disorders by using paternal BMI as a negative control exposure. METHODS: We included the data of 10,522 children from the Born in Guangzhou Cohort Study, 2012-2017. Data on maternal weight were obtained from questionnaires and obstetric records, and paternal weight was collected from questionnaires. Atopic dermatitis (AD) and wheezing at the age of 1 year were defined according to parent-reported physician diagnosis. Risk ratios (RRs) were estimated by log-binominal regression with mutual adjustment for maternal and paternal weight status. RESULTS: By the age of 1 year, 16.2% and 7.9% of children were diagnosed with AD and wheezing, respectively. While maternal pre-pregnancy BMI as a continuous variable was not associated with offspring AD, infants of pre-pregnancy overweight/obese women had a higher risk of AD than those born to normal weight women; no such associations were observed for paternal BMI. Both maternal pre-pregnancy BMI and paternal BMI were positively associated with the risk of offspring wheezing. Maternal GWG was not associated with AD or wheezing. CONCLUSIONS: Our findings suggest that maternal pre-pregnancy overweight/obesity might increase the risk of infant AD via intrauterine mechanisms, whereas the association with wheezing might be confounded by uncontrolled familial factors. These findings may be valuable in early-life prevention for offspring allergic diseases.

8.
China CDC Wkly ; 3(33): 693-696, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34594970

RESUMO

What is already known on this topic?: Eczema is a common allergic disease in children, which seriously affects the quality of life of children and their families. What is added by this report?: The results showed that the incidence of very-early-onset eczema was 12.4%. Primiparity was associated with a higher risk of eczema [risk ratio (95% confidence interval): 1.23 (1.06-1.42)]. What are the implications for public health practice?: Very-early-onset eczema is common. Given its adverse impact on children's health and life quality, this previously neglected public health issue needs to be prioritized. In addition, maternal parity could serve as an indicator in risk assessment and prediction for infant eczema.

9.
Front Pediatr ; 9: 662165, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34692602

RESUMO

Aim: To investigate the association between the experience of the coronavirus disease 2019 (COVID-19) pandemic and neurodevelopment of 6-month-old and 1-year-old children and explore the differences in the association by birth order. Methods: This comparison study was embedded in the Born in Guangzhou Cohort Study in China. The exposed group included 546 6-month-old and 285 1-year-old children who attended neurodevelopment assessments between March 1 and May 15, 2020, and the non-exposed group included 3,009 6-month-old and 2,214 1-year-old children during the same months from 2015 to 2019. Neurodevelopment at age 6 months and 1 year was assessed by trained clinical staff using the Ages and Stages Questionnaires, third edition (ASQ-3) and the Gesell Developmental Schedules (GDS). Results: The experience of the pandemic in 2020 was associated with a higher risk of delay in the fine motor (adjusted OR: 2.50, 95% CI: 1.25, 4.99; estimated by logistic regression) and communication (adjusted RR [aRR]: 1.13, 95% CI: 1.02, 1.25; estimated by log-binomial regression) domains at age 1 year. The association between the experience of the pandemic and communication delay at age 1 year only existed in first-born children (aRR: 1.15, 95% CI: 1.03, 1.30) but not in later-born children (aRR: 1.02, 95% CI: 0.84, 1.25). No associations were observed in any domain among 6-month-olds. Conclusion: Experiencing the COVID-19 pandemic and related public health strategies might be associated with a higher risk of delay in the development of fine motor and communication in 1-year-old children; the association observed in the communication domain only existed in first-born children.

10.
Int J Epidemiol ; 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34519790

RESUMO

BACKGROUND: Previous epidemiological studies have found positive associations between maternal infections and childhood leukaemia; however, evidence from prospective cohort studies is scarce. We aimed to examine the associations using large-scale prospective data. METHODS: Data were pooled from six population-based birth cohorts in Australia, Denmark, Israel, Norway, the UK and the USA (recruitment 1950s-2000s). Primary outcomes were any childhood leukaemia and acute lymphoblastic leukaemia (ALL); secondary outcomes were acute myeloid leukaemia (AML) and any childhood cancer. Exposures included maternal self-reported infections [influenza-like illness, common cold, any respiratory tract infection, vaginal thrush, vaginal infections and urinary tract infection (including cystitis)] and infection-associated symptoms (fever and diarrhoea) during pregnancy. Covariate-adjusted hazard ratio (HR) and 95% confidence interval (CI) were estimated using multilevel Cox models. RESULTS: Among 312 879 children with a median follow-up of 13.6 years, 167 leukaemias, including 129 ALL and 33 AML, were identified. Maternal urinary tract infection was associated with increased risk of any leukaemia [HR (95% CI) 1.68 (1.10-2.58)] and subtypes ALL [1.49 (0.87-2.56)] and AML [2.70 ([0.93-7.86)], but not with any cancer [1.13 (0.85-1.51)]. Respiratory tract infection was associated with increased risk of any leukaemia [1.57 (1.06-2.34)], ALL [1.43 (0.94-2.19)], AML [2.37 (1.10-5.12)] and any cancer [1.33 (1.09-1.63)]; influenza-like illness showed a similar pattern but with less precise estimates. There was no evidence of a link between other infections and any outcomes. CONCLUSIONS: Urinary tract and respiratory tract infections during pregnancy may be associated with childhood leukaemia, but the absolute risk is small given the rarity of the outcome.

11.
Front Psychiatry ; 12: 537411, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34220558

RESUMO

Background: Sustained withdrawal behavior is an obstacle for child development. The present study aimed to preliminarily evaluate the prevalence of social withdrawal tendency in young Chinese children using the Alarm Distress Baby Scale (ADBB) and describe the characteristics of socially withdrawn children. Method: This was a cross-sectional analysis as part of a prospective cohort study. A total of 114 children aged 3-24 months were included. The following instruments were administered: the Chinese version of ADBB, the Ages and Stages Questionnaire (ASQ-3), the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE), and the Infant Temperamental Questionnaire. The tendency of social withdrawal in children was assessed using the ADBB. Social withdrawal was defined as an ADBB score of 5 or above. Student's t-test, χ2 test, and Fisher's exact test were performed to identify the differences in maternal and child characteristics between the children with and without social withdrawal. Age-specific indicators of development in these two groups were also presented. Results: About 16.7% of the children were socially withdrawn. Compared with those without social withdrawal, children with social withdrawal were older and had higher proportions of boys (68.4 vs. 42.1%) and social-emotional development delay (63.2 vs. 0%). In age-specific analyses, social-emotional development was poorer in children with social withdrawal across all age groups from 3 to 24 months. Conclusion: Assessed by the ADBB, the prevalence of social withdrawal tendency in young Chinese children was similar to that reported in the European population; children with social withdrawal tended to have poorer social-emotional development. Further research with larger sample sizes is needed to validate the scale and confirm these findings.

12.
Endocrine ; 74(2): 290-299, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34125410

RESUMO

PURPOSE: To identify the specific glucose metrics derived from maternal continuous glucose monitoring (CGM) data, which were associated with a higher percentile of offspring birth weight. METHODS: In this cohort study, we recruited singleton pregnant women with GDM who underwent CGM for 5-14 days at a mean of 28.8 gestational weeks between Jan 2017 and Nov 2018. Commonly used single summary glucose metrics of glucose exposure (including mean 24-h, daytime, and nighttime glucose level) and variability (including J-index and mean amplitude of glycaemic excursions) were derived from CGM data. A novel comprehensive glucose metric-hours per-day spent in a severe variability glucose mode (HSSV)-was identified using the spectral clustering method, which reflects both glucose level and variability. Multiple linear regression models were used to estimate the associations of sex- and gestational age-adjusted birth weight percentile with CGM parameters. RESULTS: Ninety-seven women comprising 127,279 glucose measurements were included. Each 1-SD increase in maternal nighttime mean glucose level and HSSV was associated with 6.0 (95% CI 0.4, 11.5) and 6.3 (95% CI 0.4, 12.2) percentage points increase in birth weight percentile, respectively. No associations were found between other glucose metrics and birth weight percentile. CONCLUSION: Nighttime mean glucose level has a comparable effect size to HSSV in association with fetal growth, suggesting that endogenous hyperglycemia might drive the association between maternal hyperglycemia and birth weight. Further studies need to examine the effect of lowering nighttime glucose level and/or HSSV on preventing fetal overgrowth in GDM women.


Assuntos
Diabetes Gestacional , Benchmarking , Peso ao Nascer , Glicemia , Automonitorização da Glicemia , Estudos de Coortes , Feminino , Macrossomia Fetal , Glucose , Humanos , Gravidez , Gestantes
13.
Wei Sheng Yan Jiu ; 50(2): 237-241, 2021 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33985630

RESUMO

OBJECTIVE: To quantify and describe the distribution and trends of burden of nutritional deficiencies among children under 5 years old in China from 1990 to 2015. METHODS: Subnational data of China on children under 5 years old in 33 provinces and autonomous regions, which including 31 mainland regions, Hong Kong and Macao Special Administrative Regions, were extracted from the result of Global Burden of Disease Study 2015(GBD 2015). Based on the method of descriptive epidemiology, we analyzed the prevalence, mortality as well as disability adjusted life year(DALY) rate of nutritional deficiencies among children under 5 years old by sex, time and locations in China, as well as its temporal trend since 1990. RESULTS: In 2015, the prevalence of nutritional deficiencies among children under 5 years old was 17. 26%, and the DALY rate was 776. 26 person-years per 100000. Compared to 1990, the DALY rate of nutritional deficiencies declined by 71. 42%. The DALY rate of nutritional deficiencies decreased in the past 25 years in Eastern, Central and Western China. Meanwhile, the gap in disease burden between boys and girls declined. Among diseases caused by nutritional deficiencies, burden of protein-energy malnutrition and iron deficiency anemia among children under 5 years old were relatively higher. Compared to 1990, the DALY rate of iron deficiency anemia among children under 5 years old declined by 15. 68%, which was lower than other nutritional deficiencies among children in 2015. CONCLUSION: From 1990 to 2015, the disease burden caused by nutritional deficiencies among Chinese children under 5 years old showed downtrend. There were still differences of disease burden distributions between regions and common nutritional deficiencies.


Assuntos
Pessoas com Deficiência , Desnutrição , Criança , Pré-Escolar , China/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida
14.
Case Rep Womens Health ; 31: e00321, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33968612

RESUMO

The effects of SARS-CoV-2 infection in the first trimester on the pregnant woman and the fetus remain unclear. We describe the complete follow-up of a pregnant woman with asymptomatic SARS-CoV-2 infection in the first trimester. The woman tested positive for SARS-CoV-2 viral RNA in nasopharyngeal swabs in her seventh week of gestation and was admitted to a local hospital for treatment. Although the woman had a BMI above 28 and a total gestational weight gain of 21 kg, no pregnancy complications or severe complications related to SARS-CoV-2 were reported. An ultrasound scan identified no fetal abnormalities at 22 weeks. The pregnancy ended at term (37 weeks), and the newborn's birth weight was 3100 g. Placental insufficiency was revealed by placental histology examination but this appeared not to be related to the SARS-CoV-2 infection. In-situ hybridisation and immunohistochemical tests for SARS-CoV-2 RNA, spike protein 1, and nucleocapsid proteins were negative. However, ACE-2 was positive in samples of the placenta, umbilical cord and fetal membrane. The baby was followed up through to 10 days after birth and grew normally. Our results suggest that asymptomatic SARS-CoV-2 infection in the first trimester of pregnancy might not have significant harmful effects on the mother and the developing fetus. This finding may be of interest to the general public, midwives and general practitioners. However, large population studies are needed to confirm our findings.

15.
BMC Pregnancy Childbirth ; 21(1): 214, 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731027

RESUMO

BACKGROUND: Prevalence of neonatal microcephaly in populations without Zika-epidemics is sparse. The study aimed to report baseline prevalence of congenital microcephaly and its relationship with prenatal factors in an area at risk of Zika outbreak. METHODS: This study included singletons born after 24 gestational weeks in 2017-2018 at four hospitals in Guangzhou, China. Microcephaly was defined as a head circumference at birth >3SD below the mean for sex and gestational age. Prevalence of microcephaly was estimated by binomial exact method. Multivariable logistic regression was used to examine the associations of microcephaly with prenatal factors. The population attributable fraction (PAF) for associated risk factors was calculated. RESULTS: Of 46,610 live births included, 154 (3.3, 95% CI 2.8-3.9 per 1000 live births) microcephalies were identified. Maternal hepatitis B virus carriers (HBV, OR 1.80, 95% CI 1.05-3.10) and primipara (OR 2.68, 95% CI 1.89-3.81) had higher risk of having a microcephalic baby. Higher prevalence of microcephaly was observed in women who had premature labor (OR 1.98, 95% CI 1.17-3.34) and had a baby with fetal growth restriction (OR 16.38, 95% CI 11.81-22.71). Four identified factors (HBV, primiparity, preterm labor, and fetal growth restriction) contributed to 66.4% of the risk of microcephaly. CONCLUSIONS: The prevalence of microcephaly in Guangzhou was higher than expected. This study identified four prenatal risk factors that, together, contributed to two-thirds of the increased risk of microcephaly. This is the first reported association between maternal HBV carrier status and microcephaly.


Assuntos
Hepatite B/epidemiologia , Doenças do Recém-Nascido , Microcefalia , Complicações Infecciosas na Gravidez , Infecção por Zika virus/epidemiologia , Adulto , China/epidemiologia , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Microcefalia/diagnóstico , Microcefalia/epidemiologia , Microcefalia/virologia , Paridade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Zika virus/isolamento & purificação , Zika virus/patogenicidade
16.
Biochem Biophys Res Commun ; 552: 52-58, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33740664

RESUMO

METTL3 increasing the mature miRNA levels via N6-Methyladenosine (m6A) modification of primary miRNA (pri-miRNA) transcripts has emerged as an important post-transcriptional regulation of miRNA biogenesis. Our previous studies and others have showed that muscle specific miRNAs are essential for skeletal muscle differentiation. Whether these miRNAs are also regulated by METTL3 is still unclear. Here, we found that m6A motifs were present around most of these miRNAs, which were indeed m6A modified as confirmed by m6A-modified RNA immunoprecipitation (m6A RIP). However, we surprisingly found that these muscle specific miRNAs were repressed instead of increased by METTL3 in C2C12 in vitro differentiation and mouse skeletal muscle regeneration after injury in vivo model. To elucidate the underlined mechanism, we performed reporter assays in 293T cells and validated METTL3 increasing these miRNAs at post-transcriptional level as expected. Furthermore, in myogenic C2C12 cells, we found that METTL3 not only repressed the expression of myogenic transcription factors (TFs) which can enhance the muscle specific miRNAs, but also increased the expression of epigenetic regulators which can repress these miRNAs. Thus, METTL3 could repress the muscle specific miRNAs at transcriptional level indirectly. Taken together, our results demonstrated that skeletal muscle specific miRNAs were repressed by METTL3 and such repression is likely synthesized transcriptional and post-transcriptional regulations.


Assuntos
Metiltransferases/genética , MicroRNAs/genética , Músculo Esquelético/metabolismo , Processamento Pós-Transcricional do RNA/genética , Ativação Transcricional/genética , Animais , Diferenciação Celular/genética , Linhagem Celular , Células HEK293 , Humanos , Masculino , Metiltransferases/metabolismo , Camundongos Endogâmicos C57BL , MicroRNAs/metabolismo , Músculo Esquelético/citologia , Mioblastos/citologia , Mioblastos/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa
17.
Clin Nutr ; 40(5): 3485-3494, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33384181

RESUMO

BACKGROUND & AIMS: Maternal depression has been reported to be harmful to maternal and child health, and nutrition-mental health interactions may play a key role, but evidence from longitudinal studies throughout pregnancy remains insufficient. This study aimed to investigate the association of maternal dietary patterns with depressive symptoms throughout pregnancy. METHODS: This study was based in the Born in Guangzhou Cohort Study. Dietary patterns were defined by cluster analysis based on validated food frequency questionnaires in mid-pregnancy. A healthy diet score was also developed based on predefined criteria of existing dietary guidelines. Depressive symptoms were measured by Self-rating Depression Scale (SDS) in both early and late pregnancy, with SDS scores ≥53 defined as having depressive symptoms. Associations of dietary patterns with SDS scores were examined by linear-mixed models; associations of dietary patterns with the odds of having depressive symptoms were examined by mixed-effects logistic models. The associations of the healthy diet score with both dietary patterns and depressive symptoms were also explored. RESULTS: Six dietary patterns were identified in 17,430 pregnant women, namely 'Varied' (n = 3902, 22.4%), 'Vegetables' (n = 3269, 18.8%), 'Meats' (n = 2951, 16.9%), 'Cereals' (n = 2719, 15.6%), 'Milk' (n = 2377, 13.6%), and 'Fruits' (n = 2212, 12.7%). There were 19.3% and 15.7% of participants with depressive symptoms in early and late pregnancy, respectively. Compared with the 'Varied' pattern, all other patterns were associated with lower SDS scores during pregnancy except for 'Cereals' ('Vegetables': adjusted ß [aß] -0.78, 95% CI -1.16, -0.40; 'Meats': aß -0.48, 95% CI -0.87, -0.09; 'Milk': aß -0.52, 95% CI -0.94, -0.10; 'Fruits': aß -0.85, 95% CI -1.27, -0.42). The 'Vegetables' (adjusted OR [aOR] 0.79, 95% CI 0.67, 0.93), 'Milk' (aOR 0.76, 95% CI 0.63, 0.91), and 'Fruits' (aOR 0.77, 95% CI 0.64, 0.93) patterns were associated with lower odds of having depressive symptoms during pregnancy than the 'Varied' pattern. Results for the healthy diet score revealed the healthiness of the 'Vegetables', 'Fruits', and 'Milk' patterns and supported an inverse association between healthy dietary patterns and depressive symptoms throughout pregnancy. CONCLUSIONS: Diets rich in vegetables, fruits, nuts, and dairy products had an inverse association with depressive symptoms throughout pregnancy. Our findings add support to the existing dietary guidelines that healthy diets might also have potential benefits to maternal mental health.


Assuntos
Depressão/epidemiologia , Dieta/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Gravidez/estatística & dados numéricos , Adulto , China/epidemiologia , Estudos de Coortes , Feminino , Humanos
18.
BMJ Open ; 10(12): e041868, 2020 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-33268430

RESUMO

INTRODUCTION: Rapid, robust and continually updated evidence synthesis is required to inform management of COVID-19 in pregnant and postpartum women and to keep pace with the emerging evidence during the pandemic. METHODS AND ANALYSIS: We plan to undertake a living systematic review to assess the prevalence, clinical manifestations, risk factors, rates of maternal and perinatal complications, potential for mother-to-child transmission, accuracy of diagnostic tests and effectiveness of treatment for COVID-19 in pregnant and postpartum women (including after miscarriage or abortion). We will search Medline, Embase, WHO COVID-19 database, preprint servers, the China National Knowledge Infrastructure system and Wanfang databases from 1 December 2019. We will supplement our search with studies mapped by Cochrane Fertility and Gynaecology group, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), COVID-19 study repositories, reference lists and social media blogs. The search will be updated every week and not be restricted by language. We will include observational cohort (≥10 participants) and randomised studies reporting on prevalence of COVID-19 in pregnant and postpartum women, the rates of clinical manifestations and outcomes, risk factors in pregnant and postpartum women alone or in comparison with non-pregnant women with COVID-19 or pregnant women without COVID-19 and studies on tests and treatments for COVID-19. We will additionally include case reports and series with evidence on mother-to-child transmission of SARS-CoV-2 in utero, intrapartum or postpartum. We will appraise the quality of the included studies using appropriate tools to assess the risk of bias. At least two independent reviewers will undertake study selection, quality assessment and data extraction every 2 weeks. We will synthesise the findings using quantitative random effects meta-analysis and report OR or proportions with 95% CIs and prediction intervals. Case reports and series will be reported as qualitative narrative synthesis. Heterogeneity will be reported as I2 and τ2 statistics. ETHICS AND DISSEMINATION: Ethical approval is not required as this is a synthesis of primary data. Regular updates of the results will be published on a dedicated website (https://www.birmingham.ac.uk/research/who-collaborating-centre/pregcov/index.aspx) and disseminated through publications, social media and webinars. PROSPERO REGISTRATION NUMBER: CRD42020178076.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , COVID-19/diagnóstico , COVID-19/fisiopatologia , COVID-19/terapia , COVID-19/transmissão , Feminino , Humanos , Transmissão Vertical de Doenças Infecciosas , Metanálise como Assunto , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez , Fatores de Risco , Revisões Sistemáticas como Assunto
19.
BMC Public Health ; 20(1): 1653, 2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33148212

RESUMO

BACKGROUND: The incidence of preterm birth (PTB, < 37 weeks of gestation) has been increasing in China and many other countries in recent years. However, the causes of the increase were not well understood. The current study aims to examine the contribution of maternal age, period of delivery, and maternal birth cohorts to long-term trends in preterm birth in Guangzhou, China. METHODS: In a retrospective population-based study, data were obtained from 2,535,000 singleton live births with 20-43 gestational weeks from 2001 to 2016 and recorded in the Guangzhou Perinatal Health Care and Delivery Surveillance System, in China. The age-period-cohort models were applied to investigate the temporal changes in incidences of PTB, stratified by parity. RESULTS: The incidence of preterm birth steadily increased from 5.1% in 2001 to 5.9% in 2016, with larger rise in primiparous mothers (from 5.0 to 5.9%) compared to multiparous mothers (from 5.6 to 5.9%). A J-shaped and a V-shaped relationship were found between maternal age and PTB among primiparous and multiparous mothers, respectively. A linear cohort effect was found among primiparous mothers with the lowest risk of PTB [risk ratio (RR) = 0.81, 95% confidence interval (CI): 0.74 to 0.89] in 1961 and the highest risk (RR = 1.06, 95% CI: 1.00 to 1.13) in 1997 compared to the mothers born in 1981. An inverse U-shaped association between maternal birth cohort and PTB was found in multiparous mothers. There were weak decreasing period effects on the trend of overall PTB among multiparous mothers and on the trend of extremely (< 27 weeks) or very (28-31 weeks) PTB among both parity groups during the period of 2001-2012. CONCLUSIONS: Our findings showed the PTB incidences had been increasing in the past 16 years in Guangzhou, China and both maternal age and cohort effects contributed to these trends. Further studies are recommended on the impact of altered maternal age and parity on premature births and corresponding public education and public health policies.


Assuntos
Idade Materna , Paridade , Nascimento Prematuro/epidemiologia , Adulto , China/epidemiologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Nascido Vivo , Masculino , Mães , Gravidez , Estudos Retrospectivos
20.
BMJ ; 370: m3320, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873575

RESUMO

OBJECTIVE: To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). DESIGN: Living systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 6 October 2020, along with preprint servers, social media, and reference lists. STUDY SELECTION: Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. DATA EXTRACTION: At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. RESULTS: 192 studies were included. Overall, 10% (95% confidence interval 7% to 12%; 73 studies, 67 271 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (41%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to have symptoms (odds ratio 0.28, 95% confidence interval 0.13 to 0.62; I2=42.9%) or report symptoms of fever (0.49, 0.38 to 0.63; I2=40.8%), dyspnoea (0.76, 0.67 to 0.85; I2=4.4%) and myalgia (0.53, 0.36 to 0.78; I2=59.4%). The odds of admission to an intensive care unit (odds ratio 2.13, 1.53 to 2.95; I2=71.2%), invasive ventilation (2.59, 2.28 to 2.94; I2=0%) and need for extra corporeal membrane oxygenation (2.02, 1.22 to 3.34; I2=0%) were higher in pregnant and recently pregnant than non-pregnant reproductive aged women. Overall, 339 pregnant women (0.02%, 59 studies, 41 664 women) with confirmed covid-19 died from any cause. Increased maternal age (odds ratio 1.83, 1.27 to 2.63; I2=43.4%), high body mass index (2.37, 1.83 to 3.07; I2=0%), any pre-existing maternal comorbidity (1.81, 1.49 to 2.20; I2=0%), chronic hypertension (2.0, 1.14 to 3.48; I2=0%), pre-existing diabetes (2.12, 1.62 to 2.78; I2=0%), and pre-eclampsia (4.21, 1.27 to 14.0; I2=0%) were associated with severe covid-19 in pregnancy. In pregnant women with covid-19, increased maternal age, high body mass index, non-white ethnicity, any pre-existing maternal comorbidity including chronic hypertension and diabetes, and pre-eclampsia were associated with serious complications such as admission to an intensive care unit, invasive ventilation and maternal death. Compared to pregnant women without covid-19, those with the disease had increased odds of maternal death (odds ratio 2.85, 1.08 to 7.52; I2=0%), of needing admission to the intensive care unit (18.58, 7.53 to 45.82; I2=0%), and of preterm birth (1.47, 1.14 to 1.91; I2=18.6%). The odds of admission to the neonatal intensive care unit (4.89, 1.87 to 12.81, I2=96.2%) were higher in babies born to mothers with covid-19 versus those without covid-19. CONCLUSION: Pregnant and recently pregnant women with covid-19 attending or admitted to the hospitals for any reason are less likely to manifest symptoms such as fever, dyspnoea, and myalgia, and are more likely to be admitted to the intensive care unit or needing invasive ventilation than non-pregnant women of reproductive age. Pre-existing comorbidities, non-white ethnicity, chronic hypertension, pre-existing diabetes, high maternal age, and high body mass index are risk factors for severe covid-19 in pregnancy. Pregnant women with covid-19 versus without covid-19 are more likely to deliver preterm and could have an increased risk of maternal death and of being admitted to the intensive care unit. Their babies are more likely to be admitted to the neonatal unit. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020178076. READERS' NOTE: This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 1 of the original article published on 1 September 2020 (BMJ 2020;370:m3320), and previous updates can be found as data supplements (https://www.bmj.com/content/370/bmj.m3320/related#datasupp). When citing this paper please consider adding the update number and date of access for clarity.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/terapia , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/etiologia , Complicações Infecciosas na Gravidez/terapia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/virologia , Prognóstico , Fatores de Risco , SARS-CoV-2
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