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1.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945037

RESUMO

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Assuntos
Anormalidades Congênitas/mortalidade , Mortalidade Infantil/tendências , Afro-Americanos/estatística & dados numéricos , Anormalidades Congênitas/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Recém-Nascido , Criança Pós-Termo , Recém-Nascido Prematuro , Masculino , Estados Unidos/epidemiologia
2.
PLoS One ; 14(5): e0207978, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091240

RESUMO

BACKGROUND: Being born small for gestational age (SGA) or large for gestational age (LGA) has short and long term metabolic consequences. There is a growing interest in the extent to which body composition, both in the short and the long term, differs in infants born at the extremes of these birth weights. METHODS: Body composition in 25 SGA and 25 LGA infants were assessed during the first days of life and at 3-4 months of age using air displacement plethysmography. RESULTS: SGA infants had significantly lower body fat (%) at birth compared to LGA infants. SGA infants increased their body weight and length at a significantly higher rate between birth and 3-4 months than LGA infants. Fat mass (g) in SGA infants increased 23 times between birth and 3-4 months of age compared to 2.8 times for LGA infants. At 3-4 months of age LGA infants reached a threshold in body fat (%) while SGA infants were still gaining body fat (%). CONCLUSION: Several significant differences have been identified between SGA and LGA infants, indicating that the effects of intrauterine life continues to play an important role in body composition and growth during the first 3-4 months of life.


Assuntos
Composição Corporal , Desenvolvimento Infantil , Criança Pós-Termo , Recém-Nascido Pequeno para a Idade Gestacional , Antropometria , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Pletismografia , Gravidez , Suécia , Ganho de Peso
3.
Scand J Public Health ; 47(7): 730-734, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29807485

RESUMO

Aims: to evaluate whether the information on refugee status based on the residence permit is a useful source of information for perinatal health surveillance. Methods: Using the Swedish population registers (1997-2012), we use multinomial regression models to assess the associations between migration status (refugee and non-refugee) and birth outcomes derived from birthweight and gestational age: low birthweight (LBW) (<2500 g), macrosomia (≥4000 g); preterm: (<37 w) and post-term (≥42 w). The Swedish-born population was used as a reference group. Results: Compared to the Swedish-born population, an increased OR (odds ratio) of LBW and post-term was found among migrants with and without refugee status (respectively: OR for refugees: 1.47 [95% CI: 1.33-1.63] and non-refugees:1.27 [95% CI: 1.18-1.38], for refugees: 1.41 [95% CI: 1.35-1.49] and non-refugees:1.04 [95% CI: 1.00-1.08]) with statistically significant differences between these two migrant categories. However, when looking at specific regions of origin, few regions show differences by refugee status. Compared to Swedes, lower or equal ORs of preterm and macrosomia are observed regardless of migratory status. Conclusions: Small or no differences were observed in birth outcomes among offspring of women coming from the same origin with different migratory status, compared to their Swedish counterparts. This suggests that information on migration status is not a relevant piece of information to identify immigrant women at higher risk of experiencing adverse reproductive outcomes. Our results however might be explained by the large proportion of women coming to Sweden for family reunification who are classified as non-refugee migrants.


Assuntos
Peso ao Nascer , Emigrantes e Imigrantes/estatística & dados numéricos , Idade Gestacional , Mães/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Criança Pós-Termo , Masculino , Gravidez , Nascimento Prematuro/epidemiologia , Sistema de Registros , Suécia/epidemiologia , Adulto Jovem
4.
J Matern Fetal Neonatal Med ; 32(11): 1847-1852, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29301466

RESUMO

OBJECTIVE: To investigate whether postterm pregnancy (≥42 0/7 weeks' gestation) increases the risk for adverse perinatal outcome. STUDY DESIGN: In this population based cohort study, all singleton deliveries occurring between 1991 and 2014 in a tertiary medical center were included. Pregnancy and perinatal outcomes were compared between postterm and term deliveries (37 0/7 to 41 6/7 weeks' gestation). Preterm deliveries, unknown gestational age, congenital malformations, and multiple gestations, were excluded. The association between postterm and adverse perinatal outcomes was evaluated using a general estimation equation (GEE) multivariable analyses. RESULTS: During the study period, 226,918 deliveries were included in the analysis. Of them, 95.9% (n = 217,544) were term and 4.1% (n = 9374) were postterm. Post-term pregnancies were more likely to be complicated with oligohydramnios, macrosomia, meconium stained amniotic fluid, shoulder dystocia, low Apgar scores, and hysterectomy (p < .05 in all). Perinatal mortality rates were significantly higher at postterm as well. Using the GEE model, the association between postterm and total perinatal mortality persisted (OR = 1.73, 95%CI 1.2-2.4), as well as specifically intrauterine fetal death (OR = 1.76, 95%CI 1.1-2.7) and intrapartum death (OR = 3.71, 95%CI 1.3-10.4). CONCLUSIONS: Post-term delivery involves higher rates of adverse perinatal outcomes and is independently associated with significant perinatal mortality.


Assuntos
Criança Pós-Termo , Resultado da Gravidez/epidemiologia , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Israel/epidemiologia , Masculino , Gravidez , Estudos Retrospectivos , Adulto Jovem
5.
Cochrane Database Syst Rev ; 11: CD003402, 2018 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-30480773

RESUMO

BACKGROUND: Higher intakes of foods containing omega-3 long-chain polyunsaturated fatty acids (LCPUFA), such as fish, during pregnancy have been associated with longer gestations and improved perinatal outcomes. This is an update of a review that was first published in 2006. OBJECTIVES: To assess the effects of omega-3 LCPUFA, as supplements or as dietary additions, during pregnancy on maternal, perinatal, and neonatal outcomes and longer-term outcomes for mother and child. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (16 August 2018), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing omega-3 fatty acids (as supplements or as foods, stand-alone interventions, or with a co-intervention) during pregnancy with placebo or no omega-3, and studies or study arms directly comparing omega-3 LCPUFA doses or types. Trials published in abstract form were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, assessed risk of bias in trials and assessed quality of evidence for prespecified birth/infant, maternal, child/adult and health service outcomes using the GRADE approach. MAIN RESULTS: In this update, we included 70 RCTs (involving 19,927 women at low, mixed or high risk of poor pregnancy outcomes) which compared omega-3 LCPUFA interventions (supplements and food) compared with placebo or no omega-3. Overall study-level risk of bias was mixed, with selection and performance bias mostly at low risk, but there was high risk of attrition bias in some trials. Most trials were conducted in upper-middle or high-income countries; and nearly half the trials included women at increased/high risk for factors which might increase the risk of adverse maternal and birth outcomes.Preterm birth < 37 weeks (13.4% versus 11.9%; risk ratio (RR) 0.89, 95% confidence interval (CI) 0.81 to 0.97; 26 RCTs, 10,304 participants; high-quality evidence) and early preterm birth < 34 weeks (4.6% versus 2.7%; RR 0.58, 95% CI 0.44 to 0.77; 9 RCTs, 5204 participants; high-quality evidence) were both lower in women who received omega-3 LCPUFA compared with no omega-3. Prolonged gestation > 42 weeks was probably increased from 1.6% to 2.6% in women who received omega-3 LCPUFA compared with no omega-3 (RR 1.61 95% CI 1.11 to 2.33; 5141 participants; 6 RCTs; moderate-quality evidence).For infants, there was a possibly reduced risk of perinatal death (RR 0.75, 95% CI 0.54 to 1.03; 10 RCTs, 7416 participants; moderate-quality evidence: 62/3715 versus 83/3701 infants) and possibly fewer neonatal care admissions (RR 0.92, 95% CI 0.83 to 1.03; 9 RCTs, 6920 participants; moderate-quality evidence - 483/3475 infants versus 519/3445 infants). There was a reduced risk of low birthweight (LBW) babies (15.6% versus 14%; RR 0.90, 95% CI 0.82 to 0.99; 15 trials, 8449 participants; high-quality evidence); but a possible small increase in large-for-gestational age (LGA) babies (RR 1.15, 95% CI 0.97 to 1.36; 6 RCTs, 3722 participants; moderate-quality evidence, for omega-3 LCPUFA compared with no omega-3. Little or no difference in small-for-gestational age or intrauterine growth restriction (RR 1.01, 95% CI 0.90 to 1.13; 8 RCTs, 6907 participants; moderate-quality evidence) was seen.For the maternal outcomes, there is insufficient evidence to determine the effects of omega-3 on induction post-term (average RR 0.82, 95% CI 0.22 to 2.98; 3 trials, 2900 participants; low-quality evidence), maternal serious adverse events (RR 1.04, 95% CI 0.40 to 2.72; 2 trials, 2690 participants; low-quality evidence), maternal admission to intensive care (RR 0.56, 95% CI 0.12 to 2.63; 2 trials, 2458 participants; low-quality evidence), or postnatal depression (average RR 0.99, 95% CI 0.56 to 1.77; 2 trials, 2431 participants; low-quality evidence). Mean gestational length was greater in women who received omega-3 LCPUFA (mean difference (MD) 1.67 days, 95% CI 0.95 to 2.39; 41 trials, 12,517 participants; moderate-quality evidence), and pre-eclampsia may possibly be reduced with omega-3 LCPUFA (RR 0.84, 95% CI 0.69 to 1.01; 20 trials, 8306 participants; low-quality evidence).For the child/adult outcomes, very few differences between antenatal omega-3 LCPUFA supplementation and no omega-3 were observed in cognition, IQ, vision, other neurodevelopment and growth outcomes, language and behaviour (mostly low-quality to very low-quality evidence). The effect of omega-3 LCPUFA on body mass index at 19 years (MD 0, 95% CI -0.83 to 0.83; 1 trial, 243 participants; very low-quality evidence) was uncertain. No data were reported for development of diabetes in the children of study participants. AUTHORS' CONCLUSIONS: In the overall analysis, preterm birth < 37 weeks and early preterm birth < 34 weeks were reduced in women receiving omega-3 LCPUFA compared with no omega-3. There was a possibly reduced risk of perinatal death and of neonatal care admission, a reduced risk of LBW babies; and possibly a small increased risk of LGA babies with omega-3 LCPUFA.For our GRADE quality assessments, we assessed most of the important perinatal outcomes as high-quality (e.g. preterm birth) or moderate-quality evidence (e.g. perinatal death). For the other outcome domains (maternal, child/adult and health service outcomes) GRADE ratings ranged from moderate to very low, with over half rated as low. Reasons for downgrading across the domain were mostly due to design limitations and imprecision.Omega-3 LCPUFA supplementation during pregnancy is an effective strategy for reducing the incidence of preterm birth, although it probably increases the incidence of post-term pregnancies. More studies comparing omega-3 LCPUFA and placebo (to establish causality in relation to preterm birth) are not needed at this stage. A further 23 ongoing trials are still to report on over 5000 women, so no more RCTs are needed that compare omega-3 LCPUFA against placebo or no intervention. However, further follow-up of completed trials is needed to assess longer-term outcomes for mother and child, to improve understanding of metabolic, growth and neurodevelopment pathways in particular, and to establish if, and how, outcomes vary by different types of omega-3 LCPUFA, timing and doses; or by characteristics of women.


Assuntos
Ácidos Graxos Ômega-3/administração & dosagem , Retardo do Crescimento Fetal/prevenção & controle , Recém-Nascido Pequeno para a Idade Gestacional , Pré-Eclâmpsia/prevenção & controle , Nascimento Prematuro/prevenção & controle , Suplementos Nutricionais , Feminino , Morte Fetal/prevenção & controle , Óleos de Peixe/administração & dosagem , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Criança Pós-Termo , Gravidez , Gravidez de Alto Risco , Ensaios Clínicos Controlados Aleatórios como Assunto , Alimentos Marinhos
6.
Ann Epidemiol ; 28(9): 605-611, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30006251

RESUMO

PURPOSE: Short interpregnancy interval (IPI) has been linked with adverse birth outcomes. However, the association in advanced age women needs further investigation. This study aims to examine the association between short IPI and adverse birth outcomes including preterm birth, post-term birth, low birth weight, and macrosomia, in a population of advanced age U.S. women. METHODS: The 2016 U.S. public-use natality data was analyzed. Analysis was restricted to women with second-order singleton live births who were ≥35 years at first live birth (n = 46,684). Multinomial logistic regression analysis was used to examine the association between short IPI and adverse birth outcomes. RESULTS: Short IPI in advanced age women was significantly associated with higher odds of extremely preterm birth (0-5 months IPI: adjusted odds ratio [AOR] = 2.43, 95% confidence interval [CI] = 1.07-5.52; 6-11 months IPI: AOR = 2.17, 95% CI = 1.09-4.31), very preterm birth (0-5 months IPI: AOR = 1.63, 95% CI = 1.04-2.56), and extremely low birth weight (0-5 months IPI: AOR = 2.43, 95% CI = 1.28-4.60) in the second delivery. An inverse relationship between short IPI and post-term birth was observed and no significant association between short IPI and macrosomia was found. CONCLUSIONS: Short IPI in advanced age women increases the odds of adverse birth outcomes in the second delivery.


Assuntos
Intervalo entre Nascimentos , Criança Pós-Termo , Idade Materna , Nascimento Prematuro/etiologia , Adulto , Estudos Transversais , Feminino , Macrossomia Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Nascimento Vivo , Vigilância da População , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
7.
Neonatal Netw ; 37(3): 141-148, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29789053

RESUMO

The approach to the management of meconium-stained newborns in the delivery room has been changing for over 40 years. The goal is to prevent meconium aspiration syndrome (MAS) and complications related to MAS. For decades, airway obstruction was believed to be a major component of MAS and, consequently, suction maneuvers to remove meconium from the airways were recommended to decrease the frequency and severity of MAS. Initial recommendations were based on observational studies. However, the incidence of MAS and mortality related to MAS has declined since the 1970s, mostly because of a decrease in the number of postterm deliveries. Recently updated guidelines by the American Heart Association and the Neonatal Resuscitation Program have reflected the strength of evidence supporting tracheal intubation and suctioning for nonvigorous, meconium-stained newborns. This article examines practice change since the 1970s in the delivery room management of meconium-stained newborns and evaluates evidence behind the changes.


Assuntos
Líquido Amniótico , Terapia Intensiva Neonatal/métodos , Intubação Intratraqueal/métodos , Síndrome de Aspiração de Mecônio , Mecônio , Educação em Enfermagem , Humanos , Recém-Nascido , Criança Pós-Termo/fisiologia , Síndrome de Aspiração de Mecônio/diagnóstico , Síndrome de Aspiração de Mecônio/etiologia , Síndrome de Aspiração de Mecônio/fisiopatologia , Síndrome de Aspiração de Mecônio/terapia , Administração dos Cuidados ao Paciente/métodos , Fatores de Risco
8.
Eur J Epidemiol ; 33(7): 667-678, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29214412

RESUMO

Preterm birth is linked to intellectual disability and there is evidence to suggest post-term birth may also incur risk. However, these associations have not yet been investigated in the absence of common genetic causes of intellectual disability, where risk associated with late delivery may be preventable. We therefore aimed to examine risk of intellectual disability without a common genetic cause across the entire range of gestation, using a matched-sibling design to account for unmeasured confounding by shared familial factors. We conducted a population-based retrospective study using data from the Stockholm Youth Cohort (n = 499,621) and examined associations in a nested cohort of matched outcome-discordant siblings (n = 8034). Risk of intellectual disability was greatest among those born extremely early (adjusted OR24 weeks = 14.54 [95% CI 11.46-18.44]), lessening with advancing gestational age toward term (aOR32 weeks = 3.59 [3.22-4.01]; aOR37weeks = 1.50 [1.38-1.63]); aOR38 weeks = 1.26 [1.16-1.37]; aOR39 weeks = 1.10 [1.04-1.17]) and increasing with advancing gestational age post-term (aOR42 weeks = 1.16 [1.08-1.25]; aOR43 weeks = 1.41 [1.21-1.64]; aOR44 weeks = 1.71 [1.34-2.18]; aOR45 weeks = 2.07 [1.47-2.92]). Associations persisted in a cohort of matched siblings suggesting they were robust against confounding by shared familial traits. Risk of intellectual disability was greatest among children showing evidence of fetal growth restriction, especially when birth occurred before or after term. Birth at non-optimal gestational duration may be linked causally with greater risk of intellectual disability. The mechanisms underlying these associations need to be elucidated as they are relevant to clinical practice concerning elective delivery around term and mitigation of risk in post-term children.


Assuntos
Idade Gestacional , Criança Pós-Termo , Recém-Nascido Prematuro , Deficiência Intelectual/epidemiologia , Adolescente , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Risco , Suécia/epidemiologia , Adulto Jovem
9.
J Atten Disord ; 22(9): 855-863, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-27095561

RESUMO

OBJECTIVE: The aim of the study was to hierarchically assess the predictive power of low and high birth weight, pre-term and post-term birth, and low Apgar score as the risk factors for ADHD. METHOD: The data of 132 boys diagnosed with ADHD and 146 boys from control group, aged 6 to 18 years, have been analyzed. The boys were categorized according to term of birth, birth weight, and Apgar score. CART method (Classification and Regression Trees) was used for assessment of the relationship between perinatal factors and the risk of ADHD. RESULTS: Low Apgar score (21.97% vs. 13.01%) and post-term birth (12.12% vs. 0.68%) were more frequent in the sample than in the control group. CART method additionally indicated low birth weight as associated with the risk of ADHD. Among analyzed risk factors, Apgar score had the highest predictive value. CONCLUSION: The decreased Apgar score is the most important perinatal risk factor of ADHD. Research results also indicated a high significance of post-term birth in predicting the disorder.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Adolescente , Índice de Apgar , Estudos de Casos e Controles , Criança , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Criança Pós-Termo , Masculino , Gravidez , Fatores de Risco
10.
BJOG ; 125(9): 1118-1125, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29266657

RESUMO

OBJECTIVE: The purpose of this study was to investigate whether isolated maternal hypothyroxinaemia (IMH) is associated with risks of small/large-for-gestational-age (SGA/LGA) infants. DESIGN: Population-based prospective cohort study. SETTING: Ma'anshan Maternal and Child Health (MCH) clinics, China. POPULATION: Pregnant women with singleton births (n = 3178). METHODS: Descriptive statistics were calculated for the demographic characteristics of the mothers and their newborns. Linear regression was applied to estimate the association between thyroid hormone levels and birthweight. Logistic regression was performed to calculate the association between IMH and SGA/LGA. MAIN OUTCOME MEASURES: Outcomes included SGA/LGA. RESULTS: The prevalence of IMH, defined as a free thyroxine value (FT4) lower than the 2.5th percentile with normal thyroid stimulating hormone, was 2.5% (78/3080) and 2.5% (74/2999) in the first and second trimesters, respectively. Additionally, 306 (9.6%) and 524 (16.5%) infants were defined as SGA and LGA, respectively. No evidence supported the notion that IMH is associated with an increased risk for SGA in either the first [odds ratio (OR): 1.762, 95% confidence interval (CI): 0.759-4.089] or the second (OR: 0.763, 95% CI: 0.231-2.516) trimester. However, an increased risk of LGA was observed among IMH women in the second trimester (OR: 2.088, 95% CI: 1.193-3.654). Maternal TPO-Ab positivity in the second trimester increased the risk of SGA (OR: 2.094, 95% CI: 1.333-3.290). CONCLUSION: This study provides evidence that IMH is associated with LGA. FUNDING: This work was supported by the National Natural Science Foundation of China (No. 81330068). TWEETABLE ABSTRACT: Isolated maternal hypothyroxinaemia may increase the risk of large-for-gestational-age infants.


Assuntos
Peso ao Nascer , Hipotireoidismo/complicações , Criança Pós-Termo , Recém-Nascido Pequeno para a Idade Gestacional , Complicações Hematológicas na Gravidez/sangue , Tiroxina/sangue , Tiroxina/deficiência , Adolescente , Adulto , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Hipotireoidismo/sangue , Incidência , Recém-Nascido , Modelos Logísticos , Gravidez , Complicações Hematológicas na Gravidez/etiologia , Prevalência , Estudos Prospectivos , Tireotropina/sangue , Adulto Jovem
11.
Hematology ; 23(5): 253-262, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29099685

RESUMO

OBJECTIVE: An increasing amount of evidence shows that childhood leukemia is initiated in utero. Birth characteristics initiated in utero, such as gestational age, may play a role in leukemogenesis. The purpose of our meta-analysis is to explore the association between gestational age and childhood leukemia. METHODS: Relevant studies up to 21 April 2017 were collected by searching PubMed and EMBASE databases. Subgroup analysis, sensitivity analysis and publication bias assessment were conducted. RESULTS: A total of 13 studies were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) for preterm birth and postterm birth were 1.06 (0.98, 1.13) and 1.01 (0.90, 1.13) for childhood leukemia, 1.04 (0.97, 1.11) and 1.03 (0.95, 1.12) for acute lymphocytic leukemia (ALL), 1.20 (1.00, 1.44) and 1.20 (1.00, 1.43) for acute myeloid leukemia (AML), compared with full-term birth. Study type and study region were the reasons behind the heterogeneity. In subgroup analyses, the summary ORs with 95% CI for childhood leukemia and ALL were 1.23 (1.07, 1.41) and 1.21 (1.06, 1.39) for postterm birth in cohort studies. No significant changes in sensitivity analyses and no publication bias were observed in our analysis. CONCLUSION: Our results suggest that both preterm and postterm infants have an elevated risk of developing AML. In addition, postterm birth increased the risk of childhood leukemia and ALL in cohort studies. However, more studies are warranted to validate these results and explore the biologic mechanisms underlying these relationships.


Assuntos
Idade Gestacional , Doenças do Recém-Nascido/diagnóstico , Leucemia Linfoide/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Doença Aguda , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Criança Pós-Termo , Recém-Nascido Prematuro , Leucemia Linfoide/epidemiologia , Leucemia Mieloide Aguda/epidemiologia , Razão de Chances , Gravidez , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
12.
PLoS One ; 13(12): e0210181, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30596766

RESUMO

BACKGROUND: While life-long impacts exist for infants born one or two weeks early little evidence exists for those infants born after their due date. However interventions could be used to expedite birth if the risks of continuing the pregnancy are higher than intervening. It is known that the risk of epilepsy in childhood is higher in infants exposed to perinatal compromise and therefore may be useful as a proxy for intrapartum compromise. The aim of this work is to quantify the likelihood of children developing epilepsy based on their gestational age at birth (37-39 weeks or ≥41 weeks). METHODS: The work is based on term infants born in Sweden between 1983 and 1993 (n = 1,030,168), linked to data on disability pension, child mortality and in-patient epilepsy care. The reference group was defined as infants born at 39 or 40 completed weeks of gestation; compared with infants born at early term (37/38 weeks) or late/post term (41 weeks or more). Primary outcome was defined a-priori as a diagnosis of epilepsy before 20 years of age. Secondary outcomes were childhood mortality (before five years of age), and registered for disability pension before 20 years of age. Logistic regression models were used to assess any association of the outcomes with gestational age at birth. FINDINGS: In the unadjusted results, infants born 7 or more days after their due date had higher risks of epilepsy and disability pension than the reference group, but similar risks of child death. Early term infants showed higher risks of epilepsy, disability pension and child death. After adjustment for confounders, there remained a higher risk of epilepsy for both early term (OR 1·19 (1·11-1·29)) and late/post term infants (OR 1·13 (1·06-1·22)). INTERPRETATION: Infants born at 37/38 week or 41 weeks and above, when compared to those born at 39 or 40 weeks gestation, have an increased risk of developing epilepsy. This data could be useful in helping women and care givers make decisions with regard to the timing of induction of labour.


Assuntos
Epilepsia/epidemiologia , Idade Gestacional , Criança Pós-Termo , Doenças do Prematuro/epidemiologia , Adulto , Epilepsia/fisiopatologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Doenças do Prematuro/fisiopatologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia
13.
PLoS One ; 12(11): e0188074, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29155840

RESUMO

BACKGROUND AND METHODS: Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. FINDINGS: During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. CONCLUSIONS: C-section rate in this area was much higher than national average as well as global recommendations. Very few of C-sections were undertaken for AMIs. Routine monitoring of clinical indication of C-section in public and private facilities is needed to ensure rational use of the procedure.


Assuntos
Cesárea/estatística & dados numéricos , Sofrimento Fetal/epidemiologia , Sobremedicalização/estatística & dados numéricos , Oligo-Hidrâmnio/epidemiologia , Adulto , Bangladesh/epidemiologia , Feminino , Sofrimento Fetal/diagnóstico , Sofrimento Fetal/cirurgia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Recém-Nascido , Criança Pós-Termo , Oligo-Hidrâmnio/diagnóstico , Oligo-Hidrâmnio/cirurgia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos
14.
Paediatr Perinat Epidemiol ; 31(6): 586-594, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28898924

RESUMO

BACKGROUND: Preterm birth has been linked to increased risk of autism spectrum disorders (ASD), but how this risk changes with gestational age at birth has not been well characterised, especially with regard to co-occurring intellectual disability (ID). METHODS: Register-based cohort study of singleton births in 1984-2007 in Stockholm County, Sweden (N total: 480 728; n ASD: 10 025). We assessed overall and sex-specific, gestational week-specific prevalence estimates and risk ratios of ASD with and without ID. RESULTS: Preterm and postterm births were associated with elevated risk of ASD, and the relationship between gestational age at birth and ASD with and without ID differed in males and females. Risk of ASD without ID was higher in preterm births among both sexes and decreased continuously with increasing length of gestation. Risk of ASD with ID was higher in both preterm and postterm births among both sexes, with postterm birth in females being more highly associated with ASD with ID than that in males. CONCLUSIONS: The relationship between gestational age at birth and ASD differs by the presence/absence of co-occurring ID and fetal sex. Both preterm and postterm birth are associated with increased risk of ASD. Risk of ASD is not constant within conventionally defined gestational age at birth periods. Further research on mechanism underlying these associations is needed.


Assuntos
Transtorno do Espectro Autista , Deficiência Intelectual , Adolescente , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Comorbidade , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Criança Pós-Termo/psicologia , Recém-Nascido Prematuro/psicologia , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/epidemiologia , Masculino , Gravidez , Prevalência , Medição de Risco , Fatores de Risco , Fatores Sexuais , Suécia/epidemiologia
15.
Cochrane Database Syst Rev ; 5: CD011970, 2017 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-28472859

RESUMO

BACKGROUND: Gestational diabetes (GDM) is glucose intolerance, first recognised in pregnancy and usually resolving after birth. GDM is associated with both short- and long-term adverse effects for the mother and her infant. Lifestyle interventions are the primary therapeutic strategy for many women with GDM. OBJECTIVES: To evaluate the effects of combined lifestyle interventions with or without pharmacotherapy in treating women with gestational diabetes. SEARCH METHODS: We searched the Pregnancy and Childbirth Group's Trials Register (14 May 2016), ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (14th May 2016) and reference lists of retrieved studies. SELECTION CRITERIA: We included only randomised controlled trials comparing a lifestyle intervention with usual care or another intervention for the treatment of pregnant women with GDM. Quasi-randomised trials were excluded. Cross-over trials were not eligible for inclusion. Women with pre-existing type 1 or type 2 diabetes were excluded. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by the Cochrane Collaboration. All selection of studies, data extraction was conducted independently by two review authors. MAIN RESULTS: Fifteen trials (in 45 reports) are included in this review (4501 women, 3768 infants). None of the trials were funded by a conditional grant from a pharmaceutical company. The lifestyle interventions included a wide variety of components such as education, diet, exercise and self-monitoring of blood glucose. The control group included usual antenatal care or diet alone. Using GRADE methodology, the quality of the evidence ranged from high to very low quality. The main reasons for downgrading evidence were inconsistency and risk of bias. We summarised the following data from the important outcomes of this review. Lifestyle intervention versus control groupFor the mother:There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of hypertensive disorders of pregnancy (pre-eclampsia) (average risk ratio (RR) 0.70; 95% confidence interval (CI) 0.40 to 1.22; four trials, 2796 women; I2 = 79%, Tau2 = 0.23; low-quality evidence); caesarean section (average RR 0.90; 95% CI 0.78 to 1.05; 10 trials, 3545 women; I2 = 48%, Tau2 = 0.02; low-quality evidence); development of type 2 diabetes (up to a maximum of 10 years follow-up) (RR 0.98, 95% CI 0.54 to 1.76; two trials, 486 women; I2 = 16%; low-quality evidence); perineal trauma/tearing (RR 1.04, 95% CI 0.93 to 1.18; one trial, n = 1000 women; moderate-quality evidence) or induction of labour (average RR 1.20, 95% CI 0.99 to 1.46; four trials, n = 2699 women; I2 = 37%; high-quality evidence).More women in the lifestyle intervention group had met postpartum weight goals one year after birth than in the control group (RR 1.75, 95% CI 1.05 to 2.90; 156 women; one trial, low-quality evidence). Lifestyle interventions were associated with a decrease in the risk of postnatal depression compared with the control group (RR 0.49, 95% CI 0.31 to 0.78; one trial, n = 573 women; low-quality evidence).For the infant/child/adult:Lifestyle interventions were associated with a reduction in the risk of being born large-for-gestational age (LGA) (RR 0.60, 95% CI 0.50 to 0.71; six trials, 2994 infants; I2 = 4%; moderate-quality evidence). Birthweight and the incidence of macrosomia were lower in the lifestyle intervention group.Exposure to the lifestyle intervention was associated with decreased neonatal fat mass compared with the control group (mean difference (MD) -37.30 g, 95% CI -63.97 to -10.63; one trial, 958 infants; low-quality evidence). In childhood, there was no clear evidence of a difference between groups for body mass index (BMI) ≥ 85th percentile (RR 0.91, 95% CI 0.75 to 1.11; three trials, 767 children; I2 = 4%; moderate-quality evidence).There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of perinatal death (RR 0.09, 95% CI 0.01 to 1.70; two trials, 1988 infants; low-quality evidence). Of 1988 infants, only five events were reported in total in the control group and there were no events in the lifestyle group. There was no clear evidence of a difference between lifestyle intervention and control groups for a composite of serious infant outcome/s (average RR 0.57, 95% CI 0.21 to 1.55; two trials, 1930 infants; I2 = 82%, Tau2 = 0.44; very low-quality evidence) or neonatal hypoglycaemia (average RR 0.99, 95% CI 0.65 to 1.52; six trials, 3000 infants; I2 = 48%, Tau2 = 0.12; moderate-quality evidence). Diabetes and adiposity in adulthood and neurosensory disability in later childhoodwere not prespecified or reported as outcomes for any of the trials included in this review. AUTHORS' CONCLUSIONS: Lifestyle interventions are the primary therapeutic strategy for women with GDM. Women receiving lifestyle interventions were less likely to have postnatal depression and were more likely to achieve postpartum weight goals. Exposure to lifestyle interventions was associated with a decreased risk of the baby being born LGA and decreased neonatal adiposity. Long-term maternal and childhood/adulthood outcomes were poorly reported.The value of lifestyle interventions in low-and middle-income countries or for different ethnicities remains unclear. The longer-term benefits or harms of lifestyle interventions remains unclear due to limited reporting.The contribution of individual components of lifestyle interventions could not be assessed. Ten per cent of participants also received some form of pharmacological therapy. Lifestyle interventions are useful as the primary therapeutic strategy and most commonly include healthy eating, physical activity and self-monitoring of blood glucose concentrations.Future research could focus on which specific interventions are most useful (as the sole intervention without pharmacological treatment), which health professionals should give them and the optimal format for providing the information. Evaluation of long-term outcomes for the mother and her child should be a priority when planning future trials. There has been no in-depth exploration of the costs 'saved' from reduction in risk of LGA/macrosomia and potential longer-term risks for the infants.


Assuntos
Diabetes Gestacional/terapia , Estilo de Vida , Automonitorização da Glicemia , Índice de Massa Corporal , Peso Corporal , Cesárea/estatística & dados numéricos , Depressão Pós-Parto/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Dieta para Diabéticos , Exercício , Feminino , Humanos , Recém-Nascido , Criança Pós-Termo , Trabalho de Parto Induzido/estatística & dados numéricos , Educação de Pacientes como Assunto , Períneo/lesões , Pré-Eclâmpsia/epidemiologia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Midwifery ; 50: 246-252, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28500997

RESUMO

OBJECTIVES: to investigate whether a change in the management of postmature pregnancy to earlier induction affects the length of labour and the induction process. Secondly, to assess the feasibility of the research process to inform a future larger study. DESIGN: a change in management of postmature pregnancy in an NHS hospital in October 2013, from induction at 42 weeks gestation to induction between 41-42 weeks, provided an opportunity to conduct a retrospective analysis. Pre-existing data from the maternity database and casenotes were collected and primary outcomes analysed using the Mann-Whitney test and the Hodges-Lehman confidence interval for differences in medians. SETTING: a large city based tertiary referral hospital in the North of England. PARTICIPANTS: 125 women induced before the change in policy were compared with 309 women induced after the change. MEASUREMENTS: primary outcomes were length of 1st and 2nd stage of labour, overall length of labour, length of induction to established labour and length of induction to birth. FINDINGS: the median overall length of labour for women induced at 42 weeks was 6.5hours, while for women induced at 41-42 weeks this was 5.2hours. The difference was not statistically significant (p=0.15, 95% CI for median difference -0.27 to 1.93hours) with a small effect size (Pearson's r=-0.08). The median length of induction to birth was 13.6hours for women induced at 42 weeks and 16.5hours for women induced at 41-42 weeks. This difference was also not statistically significant (p=0.14, 95% CI for median difference -7.25 to 1.20hours) with a small effect size (Pearson's r=-0.13). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study demonstrated no statistically significant differences in length of labour and induction following a change in the management of postmature pregnancy to earlier induction. A large study is needed to establish definitively the effects of earlier induction on labour outcomes.


Assuntos
Política de Saúde/tendências , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/normas , Resultado da Gravidez/epidemiologia , Adulto , Inglaterra/epidemiologia , Feminino , Idade Gestacional , Humanos , Criança Pós-Termo/metabolismo , Criança Pós-Termo/fisiologia , Trabalho de Parto Induzido/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Medicina Estatal/estatística & dados numéricos , Estatísticas não Paramétricas , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos
17.
Gynecol Obstet Invest ; 82(6): 538-546, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28501865

RESUMO

BACKGROUND/AIM: To compare the pregnancy outcome of singletons conceived after transfer of cryopreserved and thawed embryos (frozen embryo transfer [FET]) to singletons conceived after fresh embryo transfer (fresh ET) and natural conceived singletons. METHODS: Using a retrospective data analysis on a study population consisting of 1,261 singletons born after FET and 2,519 singletons born after fresh ET between 2006 and 2015. The control group consisted of singletons born after natural conception. Main outcome measures consisted of birth weight (in grams), gestational age, preterm birth (<37 weeks of gestation), being large for gestational age (LGA, above 90th weight percentile adjusted for gestational age) and Apgar scores. RESULTS: Babies born after FET had an increased risk of high birth weight (adjusted OR [AOR]) 2.92; 1.503-3.482) and being LGA (AOR fresh ET vs. FET 1.47; 1.210-1.787) compared to singletons born after fresh ET, as well as higher birth weights compared to natural conceived children. CONCLUSIONS: Singletons born after FET have a higher risk of high birth weight and being LGA compared to singletons after fresh ET and compared to natural conceived singletons. We assume that the freezing process might be the underlying cause.


Assuntos
Criopreservação , Transferência Embrionária/efeitos adversos , Fertilização In Vitro/efeitos adversos , Resultado da Gravidez , Nascimento Prematuro/etiologia , Peso ao Nascer , Estudos de Casos e Controles , Criança , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Criança Pós-Termo , Masculino , Gravidez , Estudos Retrospectivos
18.
J Pediatr ; 187: 141-146.e1, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28366357

RESUMO

OBJECTIVES: To examine the distribution of birth weight in children with nonalcoholic fatty liver disease (NAFLD) compared with the general US population, and to investigate the relationship between birth weight and severity of NAFLD. STUDY DESIGN: A multicenter, cross-sectional study of children with biopsy-proven NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network Database. Birth weight was categorized as low birth weight (LBW), normal birth weight (NBW), or high birth weight (HBW) and compared with the birth weight distribution in the general US population. The severity of liver histology was assessed by birth weight category. RESULTS: Children with NAFLD (n = 538) had overrepresentation of both LBW and HBW compared with the general US population (LBW, 9.3%; NBW, 75.8%; HBW, 14.9% vs LBW, 6.1%; NBW, 83.5%; HBW 10.5%; P < .0001). Children with HBW had significantly greater odds of having more severe steatosis (OR, 1.82, 95% CI. 1.15-2.88) and nonalcoholic steatohepatitis (OR, 2.03; 95% CI, 1.21-3.40) compared with children with NBW. In addition, children with NAFLD and LBW had significantly greater odds of having advanced fibrosis (OR, 2.23; 95% CI, 1.08-4.62). CONCLUSION: Birth weight involves maternal and in utero factors that may have long-lasting consequences. Children with both LBW and HBW may be at increased risk for developing NAFLD. Among children with NAFLD, those with LBW or HBW appear to be at increased risk for more severe disease.


Assuntos
Peso ao Nascer , Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Adolescente , Biópsia , Criança , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Recém-Nascido de Baixo Peso , Criança Pós-Termo , Masculino , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Fatores de Risco , Estados Unidos
19.
Clin Lab ; 63(2): 235-240, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28182343

RESUMO

BACKGROUND: To evaluate amniotic fluid pro- and anti-inflammatory cytokine levels in women with postterm and term pregnancies in labor and not in labor. METHODS: The study involved three groups: postterm (Group 1, n = 29), term in labor (Group 2, n = 28), and control (Group 3, n = 30). All groups were compared with respect to age, gravidity, parity, obstetric history, gestation week, cervical dilatation and effacement, maternal serum C-reactive protein and white cell count, amniotic interleukin 4, 6, and 10 levels, birthweight, and cord blood pH. RESULTS: The amniotic fluid interleukin 10 level was 24.4 ± 8.8 pg/mL in the postterm group, 13.5 ± 5.1 pg/mL in the term in labor group, and 19.8 ± 5.4 pg/mL in the control group (p < 0.001). The amniotic fluid interleukin 4 level was 86.5 ± 57.7 pg/mL in the postterm group, 38.2 ± 29.2 pg/mL in the term in labor group, and 81.9 ± 68.4 pg/mL in the control group (p = 0.002). The amniotic fluid interleukin 6 level was 329 ± 135.1 pg/mL in the postterm group, 252.8 ± 138.7 pg/mL in the term in labor group, and 227.9 ± 114.4 pg/mL in the control group (p = 0.02). There was a positive correlation between gestational age and IL-10 levels (p < 0.05). CONCLUSIONS: Amniotic fluid IL-10 and IL-4 cytokine levels were increased in postterm pregnancy and they decreased with active labor.


Assuntos
Líquido Amniótico/imunologia , Citocinas/análise , Gravidez Prolongada/imunologia , Nascimento a Termo/imunologia , Adulto , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Criança Pós-Termo , Interleucina-10/análise , Interleucina-4/análise , Interleucina-6/análise , Gravidez , Estudos Prospectivos , Adulto Jovem
20.
Obes Rev ; 18(3): 293-308, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28085991

RESUMO

Post-term birth is a preventable cause of perinatal mortality and severe morbidity. This review examined the association between maternal body mass index (BMI) and post-term birth at ≥42 and ≥41 weeks' gestation. Five databases, reference lists and citations were searched from May to November 2015. Observational studies published in English since 1990 were included. Linear and nonlinear dose-response meta-analyses were conducted by using random effects models. Sensitivity analyses assessed robustness of the results. Meta-regression and sub-group meta-analyses explored heterogeneity. Obesity classes were defined as I (30.0-34.9 kg m-2 ), II (35.0-39.9 kg m-2 ) and III (≥40 kg m-2 ; IIIa 40.0-44.9 kg m-2 , IIIb ≥ 45.0 kg m-2 ). Searches identified 16,375 results, and 39 studies met the inclusion criteria (n = 4,143,700 births). A nonlinear association between maternal BMI and births ≥42 weeks was identified; odds ratios and 95% confidence intervals for obesity classes I-IIIb were 1.42 (1.27-1.58), 1.55 (1.37-1.75), 1.65 (1.44-1.87) and 1.75 (1.50-2.04) respectively. BMI was linearly associated with births ≥41 weeks: odds ratio is 1.13 (95% confidence interval 1.05-1.21) for each 5-unit increase in BMI. The strength of the association between BMI and post-term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity. Targeted interventions to prevent the adverse outcomes associated with post-term birth should consider the difference in risk between obesity classes.


Assuntos
Índice de Massa Corporal , Criança Pós-Termo , Mães , Obesidade/epidemiologia , Peso Corporal , Bases de Dados Factuais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Ensaios Clínicos Controlados não Aleatórios como Assunto , Estudos Observacionais como Assunto , Gravidez , Complicações na Gravidez , Fatores Socioeconômicos
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