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Canova, Cristina, e Anna Cantarutti. "Population-Based Birth Cohort Studies in Epidemiology". International Journal of Environmental Research and Public Health 17, n.º 15 (23 de julho de 2020): 5276. http://dx.doi.org/10.3390/ijerph17155276.
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Birth cohort studies are the most appropriate type of design to determine the causal relationship between potential risk factors during the prenatal or postnatal period and the health status of the newborn up to childhood and potentially adulthood. To date, there has been a growth in interest regarding observational population-based studies which are performed to provide answers to specific research questions for defined populations, for instance, assessing the exposure to environmental pollutants or drugs on the risk of developing a disease. Birth cohorts based on the recruitment and active follow-up of mothers and children allow the collection of biological material, and specific clinical and genetic information. However, they require a considerable amount of time and resources and, besides being usually of limited size, they are exposed to the risk of the loss of subjects to follow-up, with decreased statistical power and possible selection bias. For these reasons, linking the medical birth register with administrative health records for mothers and babies is increasingly being used in countries with a universal healthcare system, allowing researchers to identify large and unselected populations from birth, and to reconstruct relevant traits and care pathways of mothers and newborns. This Special Issue of the International Journal of Environmental Research and Public Health focuses on the current state of knowledge on perinatal and postnatal exposures and adverse pregnancy, maternal, fetal and neonatal outcomes through population-based birth cohort studies, with a specific focus on real-word data. The 12 accepted articles covered a wide range of themes that can be addressed specifically through birth cohort study design; however, only three were based on real word data with record-linkage to health administrative databases. In particular, two papers have addressed the topic of socioeconomic status considering several indicators both at the individual and contextual level. Two papers focused on inflammatory bowel diseases, both as an outcome of perinatal and antibiotic exposure in early life and as a condition associated with asthma, among children identified in a birth cohort based on a Regional Medical Birth Register. Three articles focused on medication use during pregnancy and its impact on maternal and fetal health. The effect of exposure to prenatal environmental risk factors on perinatal and childhood outcomes has been considered in two papers. Two papers analyzed ad hoc nationwide prospective birth cohorts set in Japan and UK. Finally, we included a systematic review with meta-analysis to evaluate the relation between growth restriction at birth and congenital heart defects. We think that this Special Issue may contribute to enriching the discussion of future challenges, opportunities, strengths and limitations for all research topics that can be investigated using a population-based birth cohort study design.
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Sullivan, Kevin J., Hiroko H. Dodge, Tiffany F. Hughes, Chung-Chou H. Chang, Xinmei Zhu, Anran Liu e Mary Ganguli. "Declining Incident Dementia Rates Across Four Population-Based Birth Cohorts". Journals of Gerontology: Series A 74, n.º 9 (12 de outubro de 2018): 1439–45. http://dx.doi.org/10.1093/gerona/gly236.
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Abstract Background Incidence rates of dementia appear to be declining in high-income countries according to several large epidemiological studies. We aimed to describe declining incident dementia rates across successive birth cohorts in a U.S. population-based sample and to explore the influences of sex and education on these trends. Methods We pooled data from two community-sampled prospective cohort studies with similar study aims and contiguous sampling regions: the Monongahela Valley Independent Elders Survey (1987–2001) and the Monongahela-Youghiogheny Healthy Aging Team (2006–Ongoing). We identified four decade-long birth cohorts spanning birth years 1902–1941. In an analysis sample of 3,010 participants (61% women, mean baseline age = 75.7 years, mean follow-up = 7.1 years), we identified 257 cases of incident dementia indicated by a Clinical Dementia Rating of 1.0 or higher. We used Poisson regression to model incident dementia rates by birth cohort, age, sex, education, and interactions of Sex × Cohort and Sex × Education. We further examined whether cohort effects varied by education, testing a Cohort × Education interaction and stratifying the models by education. Results Compared to the earliest birth cohort (1902–1911), each subsequent cohort had a significantly lower incident dementia rate (1912–1921: incidence rate ratio [IRR] = 0.655, 95% confidence interval [95% CI] = 0.477–0.899; 1922–1931: IRR = 0.387, 95% CI = 0.265–0.564; 1932–1941: IRR = 0.233, 95% CI = 0.121–0.449). We observed no significant interactions of either sex or education with birth cohort. Conclusions A decline in incident dementia rates was observed across successive birth cohorts independent of sex, education, and age.
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Dodge, Hiroko H., Jian Zhu, Tiffany F. Hughes, Beth E. Snitz, Chung-Chou H. Chang, Erin P. Jacobsen e Mary Ganguli. "Cohort effects in verbal memory function and practice effects: a population-based study". International Psychogeriatrics 29, n.º 1 (11 de outubro de 2016): 137–48. http://dx.doi.org/10.1017/s1041610216001551.
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ABSTRACTBackground:In many developed countries, cognitive functioning (as measured by neuropsychological tests) appears to be improving over time in the population at large, in parallel with the declining age-specific incidence of dementia. Here, we investigated cohort effects in the age-associated trajectories of verbal memory function in older adults. We sought to determine whether they varied by decade of birth and, if so, whether the change would be explained by increasing educational attainment.Methods:Pooling data from two prospective US population-based studies between 1987 and 2015, we identified four birth cohorts born 1902–1911, 1912–1921, 1922–1931, and 1932–1943. Among these cohorts, we compared age-associated trajectories both of performance and of practice effects on immediate and delayed recall of a 10-item Word List. We used mixed effects models, first including birth cohorts and cohort X age interaction terms, and then controlling for education and education X age interaction.Results:We observed significant cohort effects in performance (baseline and age-associated trajectories) in both immediate recall and delayed recall, with function improving between the earliest- and latest-born cohorts. For both tests, we also observed cohort effects on practice effects with the highest levels in the latest-born cohorts. Including education in the models did not attenuate these effects.Conclusions:In this longitudinal population study, across four decade-long birth cohorts, there were significant improvements in test performance and practice effects in verbal memory tests, not explained by education. Whether this reflects declining disease incidence or other secular trends awaits further investigation.
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Belgrave, Danielle C. M., Raquel Granell, Angela Simpson, John Guiver, Christopher Bishop, Iain Buchan, A. John Henderson e Adnan Custovic. "Developmental Profiles of Eczema, Wheeze, and Rhinitis: Two Population-Based Birth Cohort Studies". PLoS Medicine 11, n.º 10 (21 de outubro de 2014): e1001748. http://dx.doi.org/10.1371/journal.pmed.1001748.
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Santos, Iná S., Ana M. B. Menezes, Denise M. Mota, Elaine P. Albernaz, Aluísio J. D. Barros, Alicia Matijasevich, Fernando C. Barros e Cesar G. Victora. "Infant mortality in three population-based cohorts in Southern Brazil: trends and differentials". Cadernos de Saúde Pública 24, suppl 3 (2008): s451—s460. http://dx.doi.org/10.1590/s0102-311x2008001500011.
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We studied time trends in infant mortality and associated factors between three cohort studies carried out in Pelotas, Rio Grande do Sul State, Brazil, in 1982, 1993, and 2004. All hospital births and deaths were determined by means of regular visits to hospitals, registrar's offices, and cemeteries. This data was used to calculate neonatal, post-neonatal, and infant mortality rates per thousand live births. Rates were also calculated according to cause of death, sex, birth weight, gestational age, and family income. The infant mortality rate fell from 36.4 per 1,000 live births in 1982 to 21.1 in 1993 and 19.4 in 2004. Major causes of infant mortality in 2004 were perinatal causes and respiratory infections. Mortality among low birth weight children from poor families fell 16% between 1993 and 2004; however, this rate increased by more than 100% among high-income families due to the increase in the number of preterm deliveries in this group. The stabilization of infant mortality in the last decade is likely to be due to excess medical interventions relating to pregnancies and delivery care.
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Strouse, Jennifer, Brittney M. Donovan, Munazza Fatima, Ruth Fernandez-Ruiz, Rebecca J. Baer, Nichole Nidey, Chelsey Forbess et al. "Impact of autoimmune rheumatic diseases on birth outcomes: a population-based study". RMD Open 5, n.º 1 (abril de 2019): e000878. http://dx.doi.org/10.1136/rmdopen-2018-000878.
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ObjectivesAutoimmune rheumatic diseases (ARDs) affect women of childbearing age and have been associated with adverse birth outcomes. The impact of diseases like ankylosing spondylitis and psoriatic arthritis (PsA) on birth outcomes remains less studied to date. Our objective was to evaluate the impact of ARDs on preterm birth (PTB), congenital anomalies, low birth weight (LBW) and small for gestational age (SGA), in a large cohort of women.MethodsWe conducted a propensity score-matched analysis to predict ARD from a retrospective birth cohort of all live, singleton births in California occurring between 2007 and 2012. Data were derived from birth certificate records linked to hospital discharge International Classification of Diseases, ninth revision codes.ResultsWe matched 10 244 women with a recorded ARD diagnosis (rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid syndrome, PsA); ankylosing spondylitis and juvenile idiopathic arthritis (JIA) to those without an ARD diagnosis. The adjusted OR (aOR) of PTB was increased for women with any ARD (aOR 1.93, 95% CI 1.78 to 2.10) and remained significant for those with RA, SLE, PsA and JIA. The odds of LBW and SGA were also significantly increased among women with an ARD diagnosis. ARDs were not associated with increased odds of congenital anomalies.ConclusionConsistent with prior literature, we found that women with ARDs are more likely to have PTB or deliver an SGA infant. Some reassurance is provided that an increase in congenital anomalies was not found even in this large cohort.
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Cockburn, Myles G., Ann S. Hamilton, John Zadnick, Wendy Cozen e Thomas M. Mack. "Development and Representativeness of a Large Population-Based Cohort of Native Californian Twins". Twin Research 4, n.º 4 (1 de agosto de 2001): 242–50. http://dx.doi.org/10.1375/twin.4.4.242.
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AbstractWe have established a large cohort of twins to facilitate studies of the role of genetics and environment in the development of disease. The cohort has been derived from all multiple births occurring in California between 1908–82 (256,616 in total). We report here on our efforts to contact these twins and their completion of a detailed 16 page risk factor questionnaire. Addresses of the individuals were obtained by linking the birth records with the California Department of Motor Vehicles (DMV) roster of licensees. To date this has been completed for twins born between 1908 and 1972 (200,589 individuals). The linkage has revealed 112,468 matches and, because of less complete DMV records in some years, was less successful in older females than in younger females and all males. Over 41,000 twins have participated by completing the questionnaire. Based on estimates of numbers of individuals receiving a questionnaire, we estimate our crude response rate to be between 42.2% and 49.6%, highest among females in their 40s (62.8%). We describe the representativeness of the twins in the original birth cohort, those identified by the linkage, and those completing the questionnaire. Compared to the 1990 resident population of California-born resident singletons, the respondents were of similar age, sex, race and residential distribution (for although we were able to locate fewer older females, they had a higher response rate), but were less likely to have been educated for more than 12 years. We provide a brief synopsis of studies nested within this cohort. We also elucidate our plans for expanding the cohort in the near future.
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Maitre, Léa, Jeroen de Bont, Maribel Casas, Oliver Robinson, Gunn Marit Aasvang, Lydiane Agier, Sandra Andrušaitytė et al. "Human Early Life Exposome (HELIX) study: a European population-based exposome cohort". BMJ Open 8, n.º 9 (setembro de 2018): e021311. http://dx.doi.org/10.1136/bmjopen-2017-021311.
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PurposeEssential to exposome research is the collection of data on many environmental exposures from different domains in the same subjects. The aim of the Human Early Life Exposome (HELIX) study was to measure and describe multiple environmental exposures during early life (pregnancy and childhood) in a prospective cohort and associate these exposures with molecular omics signatures and child health outcomes. Here, we describe recruitment, measurements available and baseline data of the HELIX study populations.ParticipantsThe HELIX study represents a collaborative project across six established and ongoing longitudinal population-based birth cohort studies in six European countries (France, Greece, Lithuania, Norway, Spain and the UK). HELIX used a multilevel study design with the entire study population totalling 31 472 mother-child pairs, recruited during pregnancy, in the six existing cohorts (first level); a subcohort of 1301 mother-child pairs where biomarkers, omics signatures and child health outcomes were measured at age 6–11 years (second level) and repeat-sampling panel studies with around 150 children and 150 pregnant women aimed at collecting personal exposure data (third level).Findings to dateCohort data include urban environment, hazardous substances and lifestyle-related exposures for women during pregnancy and their offspring from birth until 6–11 years. Common, standardised protocols were used to collect biological samples, measure exposure biomarkers and omics signatures and assess child health across the six cohorts. Baseline data of the cohort show substantial variation in health outcomes and determinants between the six countries, for example, in family affluence levels, tobacco smoking, physical activity, dietary habits and prevalence of childhood obesity, asthma, allergies and attention deficit hyperactivity disorder.Future plansHELIX study results will inform on the early life exposome and its association with molecular omics signatures and child health outcomes. Cohort data are accessible for future research involving researchers external to the project.
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Matijasevich, Alicia, Juraci A. Cesar, Iná S. Santos, Aluísio J. D. Barros, Maria Alice S. O. Dode, Fernando C. Barros e Cesar G. Victora. "Hospitalizations during infancy in three population-based studies in Southern Brazil: trends and differentials". Cadernos de Saúde Pública 24, suppl 3 (2008): s437—s443. http://dx.doi.org/10.1590/s0102-311x2008001500009.
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Three cohort studies of children born in the urban area of Pelotas, Southern Brazil, were carried out in 1982, 1993, and 2004. The aim of these studies was to measure the occurrence of hospitalization in the first year of life and to examine the association between hospitalization and the cause of admission and sex, birth weight, and family income. Cause of admission was categorized as "diarrhea" and "all other causes". The frequency of children hospitalized at least once during their first year of life was 19.6% in 1982, 18.1% in 1993, and 19.2% in 2004. There was a marked reduction in hospitalizations due to diarrhea, but the frequency of hospitalization for all causes remained constant. In all three cohorts, infants from poorer families and those born weighing under 2,000g showed the highest frequencies of hospitalization due to diarrhea and all other causes, and the latter also showed a marked increase in hospitalizations due to all causes. These findings could be explained by an epidemic of preterm births in the study population.
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Silveira, Mariangela F., Cesar G. Victora, Bernardo L. Horta, Bruna G. C. da Silva, Alicia Matijasevich, Fernando C. Barros, Aluisio J. D. Barros et al. "Low birthweight and preterm birth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015". International Journal of Epidemiology 48, Supplement_1 (22 de junho de 2018): i46—i53. http://dx.doi.org/10.1093/ije/dyy106.
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Abstract Background Despite positive changes in most maternal risk factors in Brazil, previous studies did not show reductions in preterm birth and low birthweight. We analysed trends and inequalities in these outcomes over a 33-year period in a Brazilian city. Methods Four population-based birth cohort studies were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, with samples ranging from 4231 to 5914 liveborn children. Low birthweight (LBW) was defined as <2500 g, and preterm birth as less than 37 weeks of gestation. Information was collected on family income, maternal skin colour and other risk factors for low birthweight. Multivariable linear regression was used to estimate the contribution of risk factors to time trends in birthweight. Results Preterm births increased from 5.8% (1982) to 13.8% (2015), and LBW prevalence increased from 9.0% to 10.1%, being higher for boys and for children born to mothers with low income and brown or black skin colour. Mean birthweight remained stable, around 3200 g, but increased from 3058 to 3146 g in the poorest quintile and decreased from 3307 to 3227 g in the richest quintile. After adjustment for risk factors for LBW, mean birthweight was estimated to have declined by 160 g over 1982–2015 (reductions of 103 g in the poorest and 213 g in the richest quintiles). Conclusions Data from four birth cohorts show that preterm births increased markedly. Mean birthweights remained stable over a 33-year period. Increased prevalence of preterm and early term births, associated with high levels of obstetric interventions, has offset the expected improvements due to reduction in risk factors for low birthweight.
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Matijasevich, Alicia, Cesar G. Victora, Mariangela F. Silveira, Fernando C. Wehrmeister, Bernardo L. Horta, Fernando C. Barros, Ana M. B. Menezes et al. "Maternal reproductive history: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015". International Journal of Epidemiology 48, Supplement_1 (18 de março de 2019): i16—i25. http://dx.doi.org/10.1093/ije/dyy169.
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Abstract Background Brazil experienced important progress in maternal and child health in recent decades. We aimed at describing secular trends as well as socioeconomic and ethnic inequalities in reproductive history indicators (birth spacing, previous adverse perinatal outcome, parity and multiple births) over a 33-year span. Methods Four population-based birth cohort studies included all hospital births in 1982, 1993, 2004 and 2015 in Pelotas, Southern Brazil. Information on reproductive history was collected through interviews. Indicators were stratified by family income quintiles and skin colour. Absolute and relative measures of inequality were calculated. Results From 1982 to 2015, the proportion of primiparae increased from 39.2% to 49.6%, and median birth interval increased by 23.2 months. Poor women were more likely to report short intervals and higher parity, although reductions were observed in all income and ethnic groups. History of previous low birthweight was inversely related to income and increased by 7.7% points (pp) over time—more rapidly in the richest (12.1 pp) than in the poorest quintile (0.4 pp). Multiple births increased from 1.7% to 2.7%, with the highest increase observed among the richest quintile and for white women (220% and 70% increase, respectively). Absolute and relative income and ethnic-related inequalities for short birth intervals increased, whereas inequalities for previous low birthweight decreased over time. Conclusions In this 33-year period there were increases in birth intervals, multiple births and reports of previous low-birthweight infants. These trends may be explained by increased family planning coverage, assisted reproduction and a rise in preterm births, respectively. Our results show that socioeconomic and ethnic inequalities in health are dynamic and vary over time, within the same location.
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Wanigaratne, Susitha, Pamela Uppal, Manvir Bhangoo, Alia Januwalla, Deepa Singal e Marcelo L. Urquia. "Sex ratios at birth among second-generation mothers of South Asian ethnicity in Ontario, Canada: a retrospective population-based cohort study". Journal of Epidemiology and Community Health 72, n.º 11 (21 de junho de 2018): 1044–51. http://dx.doi.org/10.1136/jech-2018-210622.
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BackgroundSon-biased sex ratios at birth (M:F), an extreme manifestation of son preference, are predominately found in East and South Asia. Studies have examined sex ratios among first-generation migrants from these regions, but few have examined second-generation descendants. Our objective was to determine whether son-biased sex ratios persist among second-generation mothers with South Asian ethnicity in Ontario, Canada.MethodologyA surname algorithm identified a population-based cohort of mothers with South Asian ethnicity who gave birth in Ontario between 1993 and 2014 (n=59 659). Linking to official immigration data identified births to first-generation mothers (ie, immigrants). Births not to immigrants were designated as being to second-generation mothers (ie, born in Canada) (n=10 273). Sex ratios and 95% CI were stratified by the sex of previous live births and by whether it was preceded by ≥1 abortion for both first-generation and second-generation mothers.ResultsAmong mothers with two previous daughters and at least one prior abortion since the second birth, both second-generation mothers and first-generation mothers had elevated sex ratios at the third birth (2.80 (95% CI 1.36 to 5.76) and 2.46 (95% CI 1.93 to 3.12), respectively). However, among mothers with no prior abortion, second-generation mothers had a normal sex ratio, while first-generation mothers gave birth to 142 boys for every 100 girls (95% CI 125 to 162 boys for every 100 girls).ConclusionSon preference persists among second-generation mothers of South Asian ethnicity. Culturally sensitive and community-driven gender equity interventions are needed.
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Barros, Fernando C., e Cesar G. Victora. "Maternal-child health in Pelotas, Rio Grande do Sul State, Brazil: major conclusions from comparisons of the 1982, 1993, and 2004 birth cohorts". Cadernos de Saúde Pública 24, suppl 3 (2008): s461—s467. http://dx.doi.org/10.1590/s0102-311x2008001500012.
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Important changes were observed in maternal characteristics, health care indicators, and child health during the 22 years covered by the three population-based birth cohort studies conducted in the city of Pelotas, Southern Brazil. Maternal education levels improved, cigarette smoking during pregnancy was reduced, and birth intervals became longer. Also, there were more single mothers, and maternal obesity increased. Coverage of antenatal and delivery care by professionals improved, but inductions and caesarean sections increased markedly, the latter accounting for 45% of deliveries in 2004. With regard to child health, the reductions in neonatal and infant mortality rates were modest, and the significant increase in preterm births - 14.7% of all births in 2004 - appears to have colluded with this stagnation. Other infant health indicators, such as immunization coverage and breastfeeding duration, showed improvements over the period. Regarding infant nutrition, malnourishment at age 12 months decreased, but the prevalence of overweight was higher in 2004. The existence of three population-based birth cohorts using comparable methodology allowed for the study of important secular trends in maternal and child health.
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Webb, R. T., A. R. Pickles, S. A. King-Hele, L. Appleby, P. B. Mortensen e K. M. Abel. "Parental mental illness and fatal birth defects in a national birth cohort". Psychological Medicine 38, n.º 10 (13 de dezembro de 2007): 1495–503. http://dx.doi.org/10.1017/s0033291707002280.
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BackgroundFew large studies describe links between maternal mental illness and risk of major birth defect in offspring. Evidence is sparser still for how effects vary between maternal diagnoses and no previous study has assessed risk with paternal illnesses.MethodA population-based birth cohort was created by linking Danish national registers. We identified all singleton live births during 1973–1998 (n=1.45 m), all parental psychiatric admissions from 1969 onwards, and all fatal birth defects until 1 January 1999. Linkage and case ascertainment were almost complete. Relative risks were estimated using Poisson regression.ResultsRisk of fatal birth defect was elevated in relation to history of any maternal admission and also with affective disorders specifically, although the strongest effect found was with maternal schizophrenia. The rate was more than doubled in this group compared to the general population [relative risk (RR) 2.34, 95% confidence interval (CI) 1.45–3.77], which also represented a significant excess risk compared with all other admitted maternal disorders (p=0.018). Risk of death from causes other than birth defect was no higher with schizophrenia than with other maternal conditions. There was no elevation in risk of fatal birth defect if the father was admitted with schizophrenia or any other psychiatric diagnosis.ConclusionsThere are many possible explanations for a higher risk of fatal birth defect with maternal schizophrenia and affective disorder. These include genetic effects directly linked with maternal illness, lifestyle factors (diet, smoking, alcohol and drugs), poor antenatal care, psychotropic medication toxicity, and gene–environment interactions. Further research is needed to elucidate the causal mechanisms.
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Meisner, Julianne, Manali V. Vora, Mackenzie S. Fuller, Amanda I. Phipps e Peter M. Rabinowitz. "Maternal veterinary occupation and adverse birth outcomes in Washington State, 1992–2014: a population-based retrospective cohort study". Occupational and Environmental Medicine 75, n.º 5 (24 de fevereiro de 2018): 359–68. http://dx.doi.org/10.1136/oemed-2017-104817.
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ObjectiveWomen in veterinary occupations are routinely exposed to potential reproductive hazards, yet research into their birth outcomes is limited. We conducted a population-based retrospective cohort study of the association between maternal veterinary occupation and adverse birth outcomes.MethodsUsing Washington State birth certificate, fetal death certificate and hospital discharge data from 1992 to 2014, we compared birth outcomes of mothers in veterinary professions (n=2662) with those in mothers in dental professions (n=10 653) and other employed mothers (n=8082). Relative risks (RRs) and 95% CIs were estimated using log binomial regression. Outcomes studied were premature birth (<37 weeks), small for gestational age (SGA), malformations and fetal death (death at ≥20 weeks gestation). Subgroup analyses evaluated risk of these outcomes among veterinarians and veterinary support staff separately.ResultsWhile no statistically significant associations were found, we noted a trend for SGA births in all veterinary mothers compared with dental mothers (RR=1.16, 95% CI 0.99 to 1.36) and in veterinarians compared with other employed mothers (RR=1.37, 95% CI 0.96 to 1.96). Positive but non-significant association was found for malformations among children of veterinary support staff.ConclusionsThese results support the need for further study of the association between veterinary occupation and adverse birth outcomes.
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Iwanaga, Masako, e Midori Soda. "Time Trend and Age-Period-Cohort Effects on the Incidence of Patients with Adult T-Cell Leukemia in a Population-Based Study in Japan, 1991-2010". Blood 124, n.º 21 (6 de dezembro de 2014): 2616. http://dx.doi.org/10.1182/blood.v124.21.2616.2616.
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Abstract Background: Adult T-cell leukemia-lymphoma (ATL) is an aggressive T-cell malignancy, which is exclusively associated with human T-cell leukemia virus type I (HTLV-1) infection. Japan is a well-known endemic area of ATL, with approximately 400 new cases and 1,000 deaths annually. A recent Japanese study reported that the trend in the age-standardized incidence rate of ATL has remained relatively stable. However, age-standardized rate may mask important epidemiological characteristics related with age and birth-cohort. To date, several epidemiological studies reported the interesting birth-cohort patterns on the incidence of lymphoid malignancies. However, little has been known about the effects of age and birth-cohort on the time trend in the incidence of ATL. Methods: A dataset of patients with ATL (ICD-O-3 code 9827) was obtained from the Nagasaki Prefecture Cancer Registry that contains all cancer data from a population of approximately 1.5 million since 1985. To calculate the average annual percent change (AAPC) for crude incidence rate and age-standardized (world) incidence rate (ASRw) (per 100,000), the Joinpoint Regression Program with Hudson’s method was used. The effects of age, calendar-period, and birth-cohort on the time trends of the ATL incidence were evaluated by performing the age-period-cohort (APC) analysis using the R-package Epi. For the APC analysis, ten 5-year age groups and five 5-year calendar periods were set, resulting to create 14 birth cohorts. Parameter estimates of the APC models were obtained by fitting five models (age, age-drift, age-period, age-cohort, and age-period-cohort). In the full model of the age-period-cohort model, period and birth cohort effects were evaluated as relative risk (RR). This work was supported in part by the Health Labour Sciences Research Grant (H26-sinkoujitsuyouka-ippan-013). Results: A total of 1,971 patients (1,085 men and 886 women) who were diagnosed during 1991-2010 were analyzed. The crude incidence rate showed a slightly increasing tendency from 8.2 (year 1991) to 9.7 (year 2010) for men (AAPC, +0.6, 95%CIs, -1.6 to 1.8) and 5.7 (year 1991) to 8.4 (year 2010) for women (AAPC, +1.3, 95%CIs, -0.2 to 2.8), without statistically significant. Meanwhile, the ASRw showed a significantly decreasing tendency from 5.2 (year 1991) to 3.7 (year 2010) for men (AAPC, -2.1, 95%CIs, -3.2 to -1.1) and from 3.5 (year 1991) to 2.5 (year 2010) for women (AAPC, -1.8, 95%CIs, -3.3 to -0.3). The age-specific incidence rate was highest in patients aged 70 years or older, particularly the rate in patients aged 80 years or older drastically increased after year 2003. In the APC analyses, both the age-cohort model and age-period model were statistically significant for men (P<0.0001 for both) and women (P=0.002 for both), indicating that both a cohort effect and a period effect were the major effects on the incidence of ATL. The RR among various cohorts showed a drastic difference of the cohort effect on the ATL incidence from a higher risk in cohorts before 1931 but a lower risk in cohorts after 1931 in men, and from a higher risk in cohorts before 1940 but a lower risk in cohorts after 1940 in women. The RR among various periods was almost stable in 1, but becomes high after the period 2000 in both sexes. Discussion and Conclusion: The earlier birth-cohort and the recent calendar period were significantly associated with the incidence of ATL beyond the age effect. The birth cohort effect reflects the exposure to environmental factors, thus the effect can be explained by the higher HTLV-1 infection in early generation. Sex difference in the cohort effect may be reflected the way of life, biological, and behavioral factors. Continued ATL incidence and careful analysis of period effects are of importance to elucidate this unique epidemiology of ATL. Disclosures No relevant conflicts of interest to declare.
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McGee, Glen, Neil J. Perkins, Sunni L. Mumford, Marianthi-Anna Kioumourtzoglou, Marc G. Weisskopf, Jonathan S. Schildcrout, Brent A. Coull, Enrique F. Schisterman e Sebastien Haneuse. "Methodological Issues in Population-Based Studies of Multigenerational Associations". American Journal of Epidemiology 189, n.º 12 (1 de julho de 2020): 1600–1609. http://dx.doi.org/10.1093/aje/kwaa125.
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Abstract Laboratory-based animal research has revealed a number of exposures with multigenerational effects—ones that affect the children and grandchildren of those directly exposed. An important task for epidemiology is to investigate these relationships in human populations. Without the relative control achieved in laboratory settings, however, population-based studies of multigenerational associations have had to use a broader range of study designs. Current strategies to obtain multigenerational data include exploiting birth registries and existing cohort studies, ascertaining exposures within them, and measuring outcomes across multiple generations. In this paper, we describe the methodological challenges inherent to multigenerational studies in human populations. After outlining standard taxonomy to facilitate discussion of study designs and target exposure associations, we highlight the methodological issues, focusing on the interplay between study design, analysis strategy, and the fact that outcomes may be related to family size. In a simulation study, we show that different multigenerational designs lead to estimates of different exposure associations with distinct scientific interpretations. Nevertheless, target associations can be recovered by incorporating (possibly) auxiliary information, and we provide insights into choosing an appropriate target association. Finally, we identify areas requiring further methodological development.
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Macdonald, Erin M., John J. Koval, Renato Natale, Timothy Regnault e M. Karen Campbell. "Population-Based Placental Weight Ratio Distributions". International Journal of Pediatrics 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/291846.
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The placental weight ratio (PWR) is a health indicator that reflects the balance between fetal and placental growth. The PWR is defined as the placental weight divided by the birth weight, and it changes across gestation. Its ranges are not well established. We aimed to establish PWR distributions by gestational age and to investigate whether the PWR distributions vary by fetal growth adequacy, small, average, and large for gestational age (SGA, AGA, and LGA). The data came from a hospital based retrospective cohort, using all births at two London, Ontario hospitals in the past 10 years. All women who delivered a live singleton infant between 22 and 42 weeks of gestation were included(n=41441). Nonparametric quantile regression was used to fit the curves. The results demonstrate decreasing PWR and dispersion, with increasing gestational age. A higher proportion of SGA infants have extreme PWRs than AGA and LGA, especially at lower gestational ages. On average, SGA infants had higher PWRs than AGA and LGA infants. The overall curves offer population standards for use in research studies. The curves stratified by fetal growth adequacy are the first of their kind, and they demonstrate that PWR differs for SGA and LGA infants.Corrigendum to “Population-Based Placental Weight Ratio Distributions”
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Tsai, Meng-Shan, Mei-Huei Chen, Ching-Chun Lin, Sharon Ng, Chia-Jung Hsieh, Chen-yu Liu, Wu-Shiun Hsieh e Pau-Chung Chen. "Children's environmental health based on birth cohort studies of Asia". Science of The Total Environment 609 (dezembro de 2017): 396–409. http://dx.doi.org/10.1016/j.scitotenv.2017.07.081.
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Houben, E., L. Broeders, E. A. P. Steegers e R. M. C. Herings. "Cohort profile: the PHARMO Perinatal Research Network (PPRN) in the Netherlands: a population-based mother–child linked cohort". BMJ Open 10, n.º 9 (setembro de 2020): e037837. http://dx.doi.org/10.1136/bmjopen-2020-037837.
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PurposeObservational population-based research is a very suitable non-invasive method for studies in the vulnerable populations of pregnant women and children. Therefore, the PHARMO Perinatal Research Network (PPRN) was set up as a resource for life course perinatal and paediatric research by linking population-based data from existing registrations.ParticipantsFrom 1999 to 2017, the PPRN captures approximately 542 900 pregnancies of 387 100 mothers (‘Pregnancy Cohort’). Additionally, mother–child linkage is currently available for a quarter of these pregnancies (‘Child Cohort’). The PPRN contains preconceptional information on maternal healthcare, as well as detailed pregnancy and neonatal data, extending into long-term follow-up and outcomes after birth for both mother and child up to nearly 20 years. It includes linked data from different primary and secondary healthcare settings.Findings to dateThrough record linkage of the Netherlands Perinatal Registry and the PHARMO Database Network, we have established a large population-based research network including data on demographics, medication use, medical conditions and details concerning labour, birth and neonatal outcomes. Here, we provide an overview of record types available from the PPRN, available database follow-up and pregnancy characteristics of the PPRN cohorts. The PPRN has been used for a number of different pharmacoepidemiological studies, for example, to confirm that preterm-born infants were more likely than full-term infants to be hospitalised or use medication. Similar long-term comparisons showed that children born following spontaneous preterm labour were at increased risk of neurodevelopmental and respiratory conditions. Most recently, the PPRN provided important evidence on the trends in use of potentially harmful medication during pregnancy.Future plansThe PPRN provides a unique and rich data set facilitating large-scale observational pharmacoepidemiological perinatal research. The patient-level linkage of many different healthcare data sources allows for long-term follow-up of mother and child, with ongoing annual updates.
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Barros, Aluísio J. D., Cesar G. Victora, Iná S. Santos, Alicia Matijasevich, Cora L. Araújo e Fernando C. Barros. "Infant malnutrition and obesity in three population-based birth cohort studies in Southern Brazil: trends and differences". Cadernos de Saúde Pública 24, suppl 3 (2008): s417—s426. http://dx.doi.org/10.1590/s0102-311x2008001500007.
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The aim of this study was to compare the evolution of nutritional deficits and overweight in one-year-old children from three birth cohorts started in 1982, 1993 and 2004 in Pelotas, Southern Brazil. Samples from the 1982 and 1993 cohorts and all children from 2004 were weighed and measured, and their mothers interviewed. Anthropometric deficits and overweight were assessed using both NCHS and WHO growth standards. A comparison of the existence of nutritional deficits showed that, after a decline between 1982 and 1993, its prevalence stabilized between 1993 and 2004. Across the whole period, a decrease in all deficits was observed. Obesity, on the other hand, increased. A deficit in the ratio of body length to age was found to be strongly associated with family income. The group with income below one minimum wage was the only to present a significant reduction of stunting during the study period. The most significant improvements in the reduction of nutritional deficits occurred in the first half of the study period, while social differentials remained. Fighting malnutrition is still necessary among the 40% of the population considered poor, and must be accompanied by efforts to combat overweight which is being observed in all social strata.
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Victora, Cesar Gomes, Cora Luiza Pavin Araújo, Ana Maria Batista Menezes, Pedro Curi Hallal, Maria de Fátima Vieira, Marilda Borges Neutzling, Helen Gonçalves et al. "Methodological aspects of the 1993 Pelotas (Brazil) birth cohort study". Revista de Saúde Pública 40, n.º 1 (fevereiro de 2006): 39–46. http://dx.doi.org/10.1590/s0034-89102006000100008.
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This paper describes the main methodological aspects of a cohort study, with emphasis on its recent phases, which may be relevant to investigators planning to carry out similar studies. In 1993, a population based study was launched in Pelotas, Southern Brazil. All 5,249 newborns delivered in the city's hospitals were enrolled, and sub-samples were visited at the ages of one, three and six months and of one and four years. In 2004-5 it was possible to trace 87.5% of the cohort at the age of 10-12 years. Sub-studies are addressing issues related to oral health, psychological development and mental health, body composition, and ethnography. Birth cohort studies are essential for investigating the early determinants of adult disease and nutritional status, yet few such studies are available from low and middle-income countries where these determinants may differ from those documented in more developed settings.
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Madsen, Kathrine Bang, Lena Hohwü, Jin Liang Zhu, Jørn Olsen e Carsten Obel. "Social selection in cohort studies and later representation of childhood psychiatric diagnoses: The Danish National Birth Cohort". Scandinavian Journal of Public Health 48, n.º 2 (15 de agosto de 2017): 207–13. http://dx.doi.org/10.1177/1403494817726619.
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Aim: This study aimed to estimate the relative representation of childhood psychiatric diagnoses and use of psychotropic medication in the Danish National Birth Cohort (DNBC) compared to the general population. Methods: The general population was identified as all childbirths in Denmark during 1998–2002 ( N=344,160). Linking the DNBC ( N=91,442) and the general population to the Danish national health registries, all children were followed until they received an ICD-10 psychiatric diagnosis, had a prescription of psychotropic medication or to the end of follow-up in 2013. The prevalence ratios (PRs) with corresponding 95% confidence intervals (CI) were estimated for each psychiatric diagnosis and by sex. Age at first diagnosis presented as means were compared using the one-sample t-test. Results: In the DNBC, the selected childhood psychiatric diagnoses were underrepresented by 3% (PR=0.97, 95% CI 0.94–0.99), ranging from a 20% underrepresentation for schizophrenia (PR=0.80, 95% CI 0.59–1.09) to a 6% over-representation for anxiety disorder or obsessive-compulsive disorder (PR=1.06, 95% CI 0.97–1.17). The majority of the specific diagnoses were modestly underrepresented in the DNBC compared to the general population, while use of psychotropic medication had similar representation. Girls were generally more underrepresented than boys. Depression was on average diagnosed 0.4 years earlier in the DNBC than in the general population ( p=0.023). Conclusions: These findings suggest that the social selection may influence the prevalence of diagnosed childhood psychiatric disorders in the DNBC.
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Agrawal, M., S. Shrestha, G. Corn, N. M. Nielsen, M. Frisch, J. F. Colombel e T. Jess. "OP07 The epidemiology of inflammatory bowel diseases among immigrants to Denmark: A population-based cohort study". Journal of Crohn's and Colitis 14, Supplement_1 (janeiro de 2020): S006—S007. http://dx.doi.org/10.1093/ecco-jcc/jjz203.006.
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Abstract Background The incidence of inflammatory bowel diseases (IBDs) among immigrants and in countries with historically low IBD risk is rising, implicating environmental risk factors in IBD pathogenesis. The purpose of our study was to determine the incidence rates of Crohn’s disease (CD) and ulcerative colitis (UC), among immigrants to Denmark, a high IBD incidence country, according to the country of birth and age at immigration, in comparison with the corresponding incidence rates in the Danish host population. Methods Using the Danish Civil Registration System, we identified all residents in Denmark with a known country of birth between January 1977 and December 2018. First-generation immigrants were persons who, along with parents, were born outside Denmark; second-generation immigrants were Danish-born persons whose parents were born outside Denmark. We recorded immigrants’ (or parents’) country of birth, age at immigration and duration of stay in Denmark. Study participants were followed for CD and UC diagnosis in the Danish National Patient Registry. Incidence rate ratios (IRRs) according to immigration status were estimated using log-linear Poisson regression analysis, and stratified by IBD prevalence in the country of birth (low, intermediate and high), and among first-generation immigrants, by age at immigration and duration of stay in Denmark. Results In this cohort of 9,038,025 subjects, among 1,295,518 first-generation and 208,826 second-generation immigrants eligible for inclusion, 4,805 first-generation and 898 second-generation immigrants were diagnosed with CD or UC. The risk of IBD among first-generation immigrants reflected risk in the country of birth (low, intermediate or high, Table 1), and increased with >20 years stay in Denmark (Table 2). Among second-generation immigrants, the risk of CD and UC was comparable to that in Danish natives (Table 1). Younger age at immigration did not impact IBD risk. Conclusion In this population-based study, the risk of IBD among first-generation immigrants reflected that in their country of birth, and increased with >20 years stay in Denmark. Among second-generation immigrants, the risk was comparable to native Danes. These findings underscore the role of environmental risk factors in the aetiology of IBD. Further studies to determine risk factors for IBD among immigrants to Denmark are ongoing.
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Zouiouich, Semi, Erikka Loftfield, Inge Huybrechts, Vivian Viallon, Panayiotis Louca, Emily Vogtmann, Philippa M. Wells et al. "Markers of metabolic health and gut microbiome diversity: findings from two population-based cohort studies". Diabetologia 64, n.º 8 (10 de junho de 2021): 1749–59. http://dx.doi.org/10.1007/s00125-021-05464-w.
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Abstract Aims/hypothesis The gut microbiome is hypothesised to be related to insulin resistance and other metabolic variables. However, data from population-based studies are limited. We investigated associations between serologic measures of metabolic health and the gut microbiome in the Northern Finland Birth Cohort 1966 (NFBC1966) and the TwinsUK cohort. Methods Among 506 individuals from the NFBC1966 with available faecal microbiome (16S rRNA gene sequence) data, we estimated associations between gut microbiome diversity metrics and serologic levels of HOMA for insulin resistance (HOMA-IR), HbA1c and C-reactive protein (CRP) using multivariable linear regression models adjusted for sex, smoking status and BMI. Associations between gut microbiome diversity measures and HOMA-IR and CRP were replicated in 1140 adult participants from TwinsUK, with available faecal microbiome (16S rRNA gene sequence) data. For both cohorts, we used general linear models with a quasi-Poisson distribution and Microbiome Regression-based Kernel Association Test (MiRKAT) to estimate associations of metabolic variables with alpha- and beta diversity metrics, respectively, and generalised additive models for location scale and shape (GAMLSS) fitted with the zero-inflated beta distribution to identify taxa associated with the metabolic markers. Results In NFBC1966, alpha diversity was lower in individuals with higher HOMA-IR with a mean of 74.4 (95% CI 70.7, 78.3) amplicon sequence variants (ASVs) for the first quartile of HOMA-IR and 66.6 (95% CI 62.9, 70.4) for the fourth quartile of HOMA-IR. Alpha diversity was also lower with higher HbA1c (number of ASVs and Shannon’s diversity, p < 0.001 and p = 0.003, respectively) and higher CRP (number of ASVs, p = 0.025), even after adjustment for BMI and other potential confounders. In TwinsUK, alpha diversity measures were also lower among participants with higher measures of HOMA-IR and CRP. When considering beta diversity measures, we found that microbial community profiles were associated with HOMA-IR in NFBC1966 and TwinsUK, using multivariate MiRKAT models, with binomial deviance dissimilarity p values of <0.001. In GAMLSS models, the relative abundances of individual genera Prevotella and Blautia were associated with HOMA-IR in both cohorts. Conclusions/interpretation Overall, higher levels of HOMA-IR, CRP and HbA1c were associated with lower microbiome diversity in both the NFBC1966 and TwinsUK cohorts, even after adjustment for BMI and other variables. These results from two distinct population-based cohorts provide evidence for an association between metabolic variables and gut microbial diversity. Further experimental and mechanistic insights are now needed to provide understanding of the potential causal mechanisms that may link the gut microbiota with metabolic health. Graphical abstract
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Firestone, Ridvan, Soo Cheng, Neil Pearce, Jeroen Douwes, Franco Merletti, Costanza Pizzi, Emanuele Pivetta, Franca Rusconi e Lorenzo Richiardi. "Internet-Based Birth-Cohort Studies: Is This the Future for Epidemiology?" JMIR Research Protocols 4, n.º 2 (12 de junho de 2015): e71. http://dx.doi.org/10.2196/resprot.3873.
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Wu, Wilfred, Erin A. S. Clark, Tracy A. Manuck, M. Sean Esplin, Michael W. Varner e Lynn B. Jorde. "A Genome-Wide Association Study of spontaneous preterm birth in a European population". F1000Research 2 (25 de novembro de 2013): 255. http://dx.doi.org/10.12688/f1000research.2-255.v1.
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Background: Preterm birth is defined as a birth prior to 37 completed weeks’ gestation. It affects more than 10% of all births worldwide, and is the leading cause of neonatal mortality in non-anomalous newborns. Even if the preterm newborn survives, there is an increased risk of lifelong morbidity. Despite the magnitude of this public health problem, the etiology of spontaneous preterm birth is not well understood. Previous studies suggest that genetics is an important contributing factor. We therefore employed a genome-wide association approach to explore possible fetal genetic variants that may be associated with spontaneous preterm birth.Methods: We obtained preterm birth phenotype and genotype data from the National Center for Biotechnology Information Genotypes and Phenotypes Database (study accession phs000103.v1.p1). This dataset contains participants collected by the Danish National Birth Cohort and includes 1000 preterm births and 1000 term births as controls. Whole genomes were genotyped on the Illumina Human660W-Quad_v1_A platform, which contains more than 500,000 markers. After data quality control, we performed genome-wide association studies for the 22 autosomal chromosomes.Results: No single nucleotide polymorphism reached genome-wide significance after Bonferroni correction for multiple testing.Conclusion: We found no evidence of genetic association with spontaneous preterm birth in this European population. Approaches that facilitate detection of both common and rare genetic variants, such as evaluation of high-risk pedigrees and genome sequencing, may be more successful in identifying genes associated with spontaneous preterm birth.
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Zonfrillo, Mark R., James G. Linakis, Eunice S. Yang e Michael J. Mello. "A Systematic Review of Longitudinal Cohort Studies Examining Unintentional Injury in Young Children". Global Pediatric Health 5 (1 de janeiro de 2018): 2333794X1877421. http://dx.doi.org/10.1177/2333794x18774219.
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Objective. Injury is the leading cause of death and long-term disability in children. Longitudinal cohorts are designed to follow subjects longitudinally in order to determine if early-life exposures are related to certain health outcomes. Methods. We conducted a systematic review to identify studies of children from birth through 5 years who were followed longitudinally with unintentional injury as an outcome of interest. Results. Of the 1892 unique references based on the search criteria, 12 (published between 2000 and 2013) were included. The studies varied on the population of focus, injury definition, and incidence rates. Existing studies that longitudinally follow children aged 0 to 5 years are limited in number, scope, and generalizability. Conclusions. Further study using population-based longitudinal cohorts is necessary to more comprehensively estimate incidence of injury in young children.
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Kristoffersen, Espen Saxhaug, Sigrid Børte, Knut Hagen, John-Anker Zwart e Bendik Slagsvold Winsvold. "Caesarean section and the association with migraine: a retrospective register-linked HUNT population cohort study". BMJ Open 10, n.º 11 (novembro de 2020): e040685. http://dx.doi.org/10.1136/bmjopen-2020-040685.
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ObjectivesTo evaluate the association between caesarean section and migraine in a population-based register-linked cohort study.SettingData from the population-based Nord-Trøndelag Health Studies (HUNT2 and HUNT3) were linked to information from the Norwegian Medical Birth Registry.Participants65 343 participants responded to the headache questions in any of the two HUNT studies. Only those answering the headache questions in HUNT2 or 3 and had information about mode of delivery in the Norwegian Medical Birth Registry (born after 1967) were included. Our final sample consisted of 6592 women and 4602 men, aged 19–41 years.OutcomesORs for migraine given caesarean section. Analyses were performed in multivariate logistic regression models.ResultsAfter adjusting for sex, age and fetal growth restriction, delivery by caesarean section was not associated with migraine later in life (OR 0.86, 95% CI 0.64 to 1.15). Delivery by caesarean section was associated with a reduced OR of non-migrainous headache (OR 0.77, 95% CI 0.60 to 0.99).ConclusionNo association was found between caesarean section and migraine in this population-based register-linked study.
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Salavati, Nastaran, Petra C. Vinke, Fraser Lewis, Marian K. Bakker, Jan Jaap H. M. Erwich e Eline M. M.van der Beek. "Offspring Birth Weight Is Associated with Specific Preconception Maternal Food Group Intake: Data from a Linked Population-Based Birth Cohort". Nutrients 12, n.º 10 (16 de outubro de 2020): 3172. http://dx.doi.org/10.3390/nu12103172.
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The preconception period has been recognized as one of the earliest sensitive windows for human development. Maternal dietary intake during this period may influence the oocyte quality, as well as placenta and early embryonic development during the first trimester of pregnancy. Previous studies have found associations between macronutrient intake during preconception and pregnancy outcomes. However, as food products consist of multiple macro- and micronutrients, it is difficult to relate this to dietary intake behavior. Therefore, the aim of this study was to investigate the association between intake of specific food groups during the preconception period with birth weight, using data from the Perined-Lifelines linked birth cohort. The Perined-Lifelines birth cohort consists of women who delivered a live-born infant at term after being enrolled in a large population-based cohort study (The Lifelines Cohort). Information on birth outcome was obtained by linkage to the Dutch perinatal registry (Perined). In total, we included 1698 women with data available on birth weight of the offspring and reliable detailed information on dietary intake using a semi-quantitative food frequency questionnaire obtained before pregnancy. Based on the 2015 Dutch Dietary Guidelines and recent literature 22 food groups were formulated. Birth weight was converted into gestational age-adjusted z-scores. Multivariable linear regression was performed, adjusted for intake of other food groups and covariates (maternal BMI, maternal age, smoking, alcohol, education level, urbanization level, parity, sex of newborn, ethnicity). Linear regression analysis, adjusted for covariates and intake of energy (in kcal) (adjusted z score [95% CI], P) showed that intake of food groups “artificially sweetened products” and “vegetables” was associated with increased birth weight (resp. (β = 0.001 [95% CI 0.000 to 0.001, p = 0.002]), (β = 0.002 [95% CI 0.000 to 0.003, p = 0.03])). Intake of food group “eggs” was associated with decreased birth weight (β = −0.093 [95% CI −0.174 to −0.013, p = 0.02]). Intake in food groups was expressed in 10 g per 1000 kcal to be able to draw conclusions on clinical relevance given the bigger portion size of the food groups. In particular, preconception intake of “artificially sweetened products” was shown to be associated with increased birth weight. Artificial sweeteners were introduced into our diets with the intention to reduce caloric intake and normalize blood glucose levels, without compromising on the preference for sweet food products. Our findings highlight the need to better understand how artificial sweeteners may affect the metabolism of the mother and her offspring already from preconception onwards.
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Rosén, Måns, e Bengt Haglund. "Follow-up of an age-period-cohort analysis on alcohol-related mortality trends in Sweden 1970–2015 with predictions to 2025". Scandinavian Journal of Public Health 47, n.º 4 (15 de janeiro de 2018): 446–51. http://dx.doi.org/10.1177/1403494817752521.
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Background and aims: Several studies have indicated that birth cohorts are important in explaining trends in alcohol-related mortality. An earlier study from Sweden with data up to 2002 showed that birth cohorts that grew up under periods of more liberal alcohol policies had higher alcohol-related mortality than those cohorts growing up under more restrictive time periods. In spite of increasing alcohol consumption, predictions in 2002 also indicated lower alcohol-related mortality in the future. The aim of this study is to follow-up whether the effects of birth cohorts and the predictions made for Sweden still holds using data up to 2015. Method: The study comprised an age-period-cohort analysis and predictions based on population predictions from Statistics Sweden. The analysis was based on all alcohol-related deaths in the Swedish population between 1969 and 2015 for the cohorts born in the decades 1920 through 1990. Data were restricted to people 15–84 years of age. In total, the analysis covered 68,341 deaths and more than 284 million person-years. Results: Male and female cohorts born in the 1940s to 1950s exhibited the highest alcohol-related mortality, while those born in the 1970s continued to have the lowest alcohol-related mortality rates. The predicted mortality rates for males are still anticipated to decrease somewhat through 2025. Conclusions: The updated age-period-cohort analysis further supports the importance of focusing on restrictive alcohol policies targeting adolescents.
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Bladh, Marie, Ann Josefsson, John Carstensen, Orvar Finnström e Gunilla Sydsjö. "Intergenerational Cohort Study of Preterm and Small-for-Gestational-Age Birth in Twins and Singletons". Twin Research and Human Genetics 18, n.º 5 (2 de setembro de 2015): 581–90. http://dx.doi.org/10.1017/thg.2015.60.
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To date, several studies have investigated the intergenerational effect of preterm and small-for-gestational-age (SGA) births. However, most studies excluded both twin mothers and twin offspring from the analyses. Thus, the objective of this study was to investigate the intergenerational effect of preterm birth and SGA births among twins and singletons. A prospective population-based register study of mother–firstborn offspring pairs recorded in the Swedish Medical Birth Register was performed. The study included 4,073 twins and 264,794 singletons born from 1973–1983 and their firstborns born from 1986–2009. Preterm birth was defined as birth at <37 weeks of gestation, and SGA as birth weight <2 standard deviations of the Swedish standard. Logistic regressions were performed to estimate the intergenerational effect of each birth characteristic. Adjustments were made for maternal grandmothers’ and mothers’ socio-demographic factors, in addition to maternal birth characteristics. Among mothers born as singletons, being born preterm was associated with an increased risk of delivering a preterm child (adjusted odds ratio (OR) 1.39, 95% Confidence Interval (CI) = 1.29–1.50), while being born SGA increased the likelihood of having an SGA child (adjusted OR 3.04, 95% CI = 2.80–3.30) as well as a preterm child (adjusted OR 1.30, 95% CI = 1.20–1.40). In twin mothers, the corresponding ORs tended to be lower, and the only statistically significant association was between an SGA mother and an SGA child (adjusted OR 2.15, 95% CI = 1.40–3.31). A statistically significant interaction between twinning and mother's size for gestational age was identified in a multivariate linear regression analysis, indicating that singleton mothers born SGA were associated with a lower birth weight compared with mothers not born SGA. Preterm birth and SGA appear to be transferred from one generation to the next, although not always reaching statistical significance. These effects seem to be less evident in mothers born as twins compared with those born as singletons.
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Stenberg, Sten-Åke, Denny Vågerö, Reidar Österman, Emma Arvidsson, Cecilia Von Otter e Carl-Gunnar Janson. "Stockholm Birth Cohort Study 1953—2003: A new tool for life-course studies". Scandinavian Journal of Public Health 35, n.º 1 (janeiro de 2007): 104–10. http://dx.doi.org/10.1080/14034940600777385.
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Aims: To create a new tool for life-course studies of health outcomes as well as social outcomes. Methods: Two anonymous data sets, one a local birth cohort and the other a nationwide registry, covering information from early and middle life, respectively, were matched using a ``key for probability matching'' based on a large number of variables, common to both data sets. The first data set provides social and health information from birth, childhood, and adolescence on boys and girls, born in Stockholm in 1953. The second data set provides information on income, work, and education as well as any inpatient visits and any mortality from mid-life for the entire Swedish population. Results: For 96% of the original cohort it was possible to add data from mid-life. Thus, a new database has been created, referred to as the Stockholm Birth Cohort Study, which provides rich and unique life-course data from birth to age 50 for 14,294 individuals: 7,305 men and 6,989 women. Comparison of matched and unmatched cases in the original cohort suggests that those individuals that could not be matched had slightly more favourable social and intellectual circumstances and had often moved away from Sweden in the 1980s. Conclusion: The new database provides excellent opportunities for life-course studies on health and social outcomes. It allows for studies that have not previously been possible in Sweden or elsewhere. Further, it provides an opportunity for collaborative work with similar databases in Copenhagen and Aberdeen.
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Yoshimasu, K., W. J. Barbaresi, R. C. Colligan, J. M. Killian, R. G. Voigt, A. L. Weaver e S. K. Katusic. "P01-306-Adhd, gender, and psychiatric comorbidity in a populaiton-based birth cohort". European Psychiatry 26, S2 (março de 2011): 308. http://dx.doi.org/10.1016/s0924-9338(11)72017-x.
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IntroductionADHD is frequently associated with comorbid psychiatric disorders. However, epidemiologic studies in the general population are rare.ObjectiveTo evaluate associations between ADHD and comorbid psychiatric disorders using research-identified incident ADHD cases and population-based controls.MethodSubjects included a birth cohort of all children born 1976-1982 remaining in Rochester, MN after age five (n = 5718). Among them we identified 379 ADHD incident cases and 758 age-sex matched non-ADHD controls, passively followed to age 19. Through a systematic, multistaged process, utilizing detailed, routinely collected data, all psychiatric diagnoses confirmed by medical professionals were identified (n = 314 ADHD cases, n = 712 controls with research authorization). For each psychiatric disorder, cumulative incidence rates for subjects with and without ADHD were calculated; corresponding hazard ratios (HR) adjusted for sex, mothers age/education, were estimated using a Cox model. Associations between ADHD status and Internalizing-Externalizing dimensions were estimated using odds ratios (OR).ResultsADHD was associated with significantly increased risk for adjustment disorders (HR = 3.82), conduct disorder/oppositional defiant disorder (HR = 9.45), mood disorders (HR = 3.57), anxiety disorders (HR = 2.95), tic disorders (HR = 6.41), eating disorders (HR = 5.52), personality disorders (HR = 5.49), and substance-related disorders (HR = 4.04). When psychiatric comorbidities were classified on the Internalizing-Externalizing dimension, ADHD was strongly associated with coexisting internalizing/externalizing (OR = 10.6, vs none), and externalizing-only (OR = 10.0), disorders. No significant gender x ADHD interactions were observed.ConclusionThis population-based study confirms that children with ADHD are at significant risk for co-morbid psychiatric disorders. Besides treating the ADHD, clinicians should assess and monitor potential psychiatric comorbidities in children with ADHD.
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Gong, Tong, Bronwyn Brew, Arvid Sjölander e Catarina Almqvist. "Towards non-conventional methods of designing register-based epidemiological studies: An application to pediatric research". Scandinavian Journal of Public Health 45, n.º 17_suppl (julho de 2017): 30–35. http://dx.doi.org/10.1177/1403494817702339.
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Aims: Various epidemiological designs have been applied to investigate the causes and consequences of fetal growth restriction in register-based observational studies. This review seeks to provide an overview of several conventional designs, including cohort, case-control and more recently applied non-conventional designs such as family-based designs. We also discuss some practical points regarding the application and interpretation of family-based designs. Methods: Definitions of each design, the study population, the exposure and the outcome measures are briefly summarised. Examples of study designs are taken from the field of low birth-weight research for illustrative purposes. Also examined are relative advantages and disadvantages of each design in terms of assumptions, potential selection and information bias, confounding and generalisability. Kinship data linkage, statistical models and result interpretation are discussed specific to family-based designs. Results: When all information is retrieved from registers, there is no evident preference of the case-control design over the cohort design to estimate odds ratios. All conventional designs included in the review are prone to bias, particularly due to residual confounding. Family-based designs are able to reduce such bias and strengthen causal inference. In the field of low birth-weight research, family-based designs have been able to confirm a negative association not confounded by genetic or shared environmental factors between low birth weight and the risk of asthma. Conclusions: We conclude that there is a broader need for family-based design in observational research as evidenced by the meaningful contributions to the understanding of the potential causal association between low birth weight and subsequent outcomes.
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Eide, M. G., D. Moster, L. M. Irgens, T. Reichborn-Kjennerud, C. Stoltenberg, R. Skjærven, E. Susser e K. Abel. "Degree of fetal growth restriction associated with schizophrenia risk in a national cohort". Psychological Medicine 43, n.º 10 (9 de janeiro de 2013): 2057–66. http://dx.doi.org/10.1017/s003329171200267x.
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BackgroundAccumulating evidence suggests that fetal growth restriction may increase risk of later schizophrenia but this issue has not been addressed directly in previous studies. We examined whether the degree of fetal growth restriction was linearly related to risk of schizophrenia, and also whether maternal pre-eclampsia, associated with both placental dysfunction and poor fetal growth, was related to risk of schizophrenia.MethodA population-based cohort of single live births in the Medical Birth Registry of Norway (MBRN) between 1967 and 1982 was followed to adulthood (n = 873 612). The outcome was schizophrenia (n=2207) registered in the National Insurance Scheme (NIS). The degree of growth restriction was assessed by computing sex-specific z scores (standard deviation units) of ‘birth weight for gestational age’ and ‘birth length for gestational age’. Analyses were adjusted for potential confounders. Maternal pre-eclampsia was recorded in the Medical Birth Registry by midwives or obstetricians using strictly defined criteria.ResultsThe odds ratio (OR) for schizophrenia increased linearly with decreasing birth weight for gestational age z scores (p value for trend = 0.005). Compared with the reference group (z scores 0.01–1.00), the adjusted OR [95% confidence interval (CI)] for the lowest z-score category (< − 3.00) was 2.0 (95% CI 1.2–3.5). A similar pattern was observed for birth length for gestational age z scores. Forty-nine individuals with schizophrenia were identified among 15 622 births with pre-eclampsia. The adjusted OR for schizophrenia following maternal pre-eclampsia was 1.3 (95% CI 1.0–1.8).ConclusionsAssociations of schizophrenia risk with degree of fetal growth restriction and pre-eclampsia suggest future research into schizophrenia etiology focusing on mechanisms that influence fetal growth, including placental function.
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Shang, Li, Liyan Huang, Liren Yang, Longtao Leng, Cuifang Qi, Guilan Xie, Ruiqi Wang, Leqian Guo, Wenfang Yang e Mei Chun Chung. "Impact of air pollution exposure during various periods of pregnancy on term birth weight: a large-sample, retrospective population-based cohort study". Environmental Science and Pollution Research 28, n.º 3 (11 de setembro de 2020): 3296–306. http://dx.doi.org/10.1007/s11356-020-10705-3.
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AbstractPrevious studies have suggested that maternal exposure to air pollution might affect term birth weight. However, the conclusions are controversial. Birth data of all term newborns born in Xi’an city of Shaanxi, China, from 2015 to 2018 and whose mother lived in Xi’an during pregnancy were selected form the Birth Registry Database. And the daily air quality data of Xi’an city was collected from Chinese Air Quality Online Monitoring and Analysis Platform. Generalized additive models (GAM) and 2-level binary logistic regression models were used to estimate the effects of air pollution exposure on term birth weight, the risk term low birth weight (TLBW), and macrosomia. Finally, 321521 term newborns were selected, including 4369(1.36%) TLBW infants and 24,960 (7.76%) macrosomia. The average pollution levels of PM2.5, PM10, and NO2 in Xi’an city from 2015 to 2018 were higher than national limits. During the whole pregnancy, maternal exposure to PM2.5, PM10, SO2, and CO all significantly reduced the term birth weight and increased the risk of TLBW. However, NO2 and O3 exposure have significantly increased the term birth weight, and O3 even increased the risk of macrosomia significantly. Those effects were also observed in the first and second trimesters of pregnancy. But during the third trimester, high level of air quality index (AQI) and maternal exposure to PM2.5, PM10, SO2, NO2, and CO increased the term birth weight and the risk of macrosomia, while O3 exposure was contrary to this effect. The findings suggested that prenatal exposure to air pollution might cause adverse impacts on term birth weight, and the effects varied with trimesters and pollutants, which provides further pieces of evidence for the adverse effects of air pollution exposure in heavy polluted-area on term birth weight.
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Chen, Y. H., S. Y. Tsai e H. C. Lin. "Increased mortality risk among offspring of mothers with postnatal depression: a nationwide population-based study in Taiwan". Psychological Medicine 41, n.º 11 (28 de abril de 2011): 2287–96. http://dx.doi.org/10.1017/s0033291711000584.
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BackgroundThere is compelling evidence that children of mothers with postnatal depression (PD) experience poor developmental outcomes. However, no studies have specifically ascertained the risk of mortality for offspring during preschool years, the most catastrophic outcome in the vulnerable period. This nationwide population-based study aimed to investigate whether maternal depression in the first year after giving birth was associated with increased mortality risk among their preschool children aged up to 5 years.MethodThree nationwide population-based datasets [the National Health Insurance Research Database (NHIRD), birth certificate registry and death certificate registry] were linked in this study. A total of 10 236 offspring of mothers with PD were recruited, together with a comparison cohort of 81 888 births matched with the affected women in terms of maternal age and year of delivery. Each child was traced for 5 years from delivery between 2001 and 2003 until the end of 2008 to determine mortality during preschool years.ResultsDuring preschool years, 98 (0.96%) deaths were identified among the offspring of mothers with PD and 470 (0.57%) children in the comparison cohort died. For children up to 5 years old, exposure to maternal PD was independently associated with a 1.47-fold [95% confidence interval (CI) 1.16–1.87] increased mortality risk, after adjusting for family income, urbanization level and the characteristics of mother, father and infant. The risk of death by unnatural causes was even higher (about 2.23 times the risk, 95% CI 1.34–3.70) among exposed offspring.ConclusionsPD places preschool children at significantly increased risk of mortality, especially from unnatural causes of death.
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Bertoldi, Andréa Dâmaso, Fernando C. Barros, Pedro R. C. Hallal, Gregore I. Mielke, Paula D. Oliveira, Maria Fatima S. Maia, Bernardo L. Horta et al. "Trends and inequalities in maternal and child health in a Brazilian city: methodology and sociodemographic description of four population-based birth cohort studies, 1982–2015". International Journal of Epidemiology 48, Supplement_1 (18 de março de 2019): i4—i15. http://dx.doi.org/10.1093/ije/dyy170.
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Abstract Background Few low-middle-income countries have data from comparable birth cohort studies spanning over time. We report on the methods used by the Pelotas cohorts (1982, 1993, 2004 and 2015) and describe time trends in sociodemographic characteristics of the participant families. Methods During the four study years, all maternity hospitals in the city were visited daily, and all urban women giving birth were enrolled. Data on socioeconomic and demographic characteristics were collected using standardized questionnaires, including data on maternal and paternal skin colour, age and schooling, maternal marital status, family income and household characteristics. The analyses included comparisons of time trends and of socioeconomic and ethnic group inequalities. Results Despite a near 50% increase in the city’s population between 1982 and 2015, the total number of births declined from 6011 to 4387. The proportion of mothers aged ≥35 years increased from 9.9% to 14.8%, and average maternal schooling from 6.5 [standard deviation (SD) 4.2] to 10.1 (SD 4.0) years. Treated water was available in 95.3% of households in 1982 and 99.3% in 2015. Three-quarters of the families had a refrigerator in 1982, compared with 98.3% in 2015. Absolute income-related inequalities in maternal schooling, household crowding, household appliances and access to treated water were markedly reduced between 1982 and 2015. Maternal skin colour was associated with inequalities in age at childbearing and schooling, as well as with household characteristics. Conclusions During the 33-year period, there were positive changes in social and environmental determinants of health, including income, education, fertility and characteristics of the home environment. Socioeconomic inequality was also reduced.
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Kreyberg, Ina, Katarina Hilde, Karen Eline S. Bains, Kai-Håkon Carlsen, Berit Granum, Guttorm Haugen, Gunilla Hedlin et al. "Snus in pregnancy and infant birth size: a mother–child birth cohort study". ERJ Open Research 5, n.º 4 (outubro de 2019): 00255–2019. http://dx.doi.org/10.1183/23120541.00255-2019.
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RationaleWhile recent studies show that maternal use of snus during pregnancy is increasing, the potential effects on infant birth size is less investigated, with conflicting results.ObjectivesWe aimed to determine if maternal use of snus during pregnancy influences the infant anthropometric and proportional size measures at birth.MethodsIn 2313 mother–child pairs from the population-based, mother–child birth cohort PreventADALL (Preventing Atopic Dermatitis and ALLergies) in Norway and Sweden, we assessed nicotine exposure by electronic questionnaire(s) at 18 and 34 weeks of pregnancy, and anthropometric measurements at birth. Associations between snus exposure and birth size outcomes were analysed by general linear regression.ResultsBirthweight was not significantly different in infants exposed to snus in general, and up to 18 weeks of pregnancy in particular, when adjusting for relevant confounders including maternal age, gestational age at birth, pre-pregnancy body mass index, parity, fetal sex and maternal gestational weight gain up to 18 weeks. We found no significant effect of snus use on the other anthropometric or proportional size measures in multivariable linear regression models. Most women stopped snus use in early pregnancy.ConclusionExposure to snus use in early pregnancy, with most women stopping when knowing about their pregnancy, was not associated with birth size. We were unable to conclude on effects of continued snus use during pregnancy because of lack of exposure in our cohort.
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Spadea, Teresa, Barbara Pacelli, Andrea Ranzi, Claudia Galassi, Raffaella Rusciani, Moreno Demaria, Nicola Caranci et al. "An Italian Network of Population-Based Birth Cohorts to Evaluate Social and Environmental Risk Factors on Pregnancy Outcomes: The LEAP Study". International Journal of Environmental Research and Public Health 17, n.º 10 (21 de maio de 2020): 3614. http://dx.doi.org/10.3390/ijerph17103614.
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In Italy, few multicentre population-based studies on pregnancy outcomes are available. Therefore, we established a network of population-based birth cohorts in the cities of Turin, Reggio Emilia, Modena, Bologna, and Rome (northern and central Italy), to study the role of socioeconomic factors and air pollution exposure on term low birthweight, preterm births and the prevalence of small for gestational age. In this article, we will report the full methodology of the study and the first descriptive results. We linked 2007–2013 delivery certificates with municipal registry data and hospital records, and selected singleton livebirths from women who lived in the cities for the entire pregnancy, resulting in 211,853 births (63% from Rome, 21% from Turin and the remaining 16% from the three cities in Emilia-Romagna Region). We have observed that the association between socioeconomic characteristics and air pollution exposure varies by city and pollutant, suggesting a possible effect modification of both the city and the socioeconomic position on the impact of air pollution on pregnancy outcomes. This is the largest Italian population-based birth cohort, not distorted by selection mechanisms, which has also the advantage of being sustainable over time and easily transferable to other areas. Results from the ongoing multivariable analyses will provide more insight on the relative impact of different strands of risk factors and on their interaction, as well as on the modifying effect of the contextual characteristics. Useful recommendations for strategies to prevent adverse pregnancy outcomes may eventually derive from this study.
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Matijasevich, Alicia, Iná S. Santos, Aluísio J. D. Barros, Ana M. B. Menezes, Elaine P. Albernaz, Fernando C. Barros, Iândora K. Timm e Cesar G. Victora. "Perinatal mortality in three population-based cohorts from Southern Brazil: trends and differences". Cadernos de Saúde Pública 24, suppl 3 (2008): s399—s408. http://dx.doi.org/10.1590/s0102-311x2008001500005.
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Trends in perinatal mortality were studied in the city of Pelotas, Southern Brazil, using three population-based cohort studies carried out in 1982, 1993 and 2004. The objective of the present study was to analyze trends and differences in perinatal mortality during the 1982-2004 period. All hospital deliveries and perinatal deaths were monitored through daily visits to maternity wards. Cause of death was determined using information from hospital records and by interviewing physicians. Perinatal mortality fell by 43% in the two decades, with a greater reduction between 1982 and 1993. Intrapartum fetal deaths decreased by 72% and deaths from asphyxia fell from 4.5 per thousand in 1982 to 1.4 per thousand in 2004. In conclusion, reductions in perinatal mortality were also seen across all birth weight categories between 1982 and 1993, but the same was not true for the 1993 to 2004 period, when mortality increased in several categories above 2,000g.
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Chen, YH, HL Lin e HC Lin. "Does multiple sclerosis increase risk of adverse pregnancy outcomes? A population-based study". Multiple Sclerosis Journal 15, n.º 5 (24 de março de 2009): 606–12. http://dx.doi.org/10.1177/1352458508101937.
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Objective To determine whether maternal multiple sclerosis (MS) is associated with increased risk of adverse pregnancy outcomes in an East Asian country by using a nationwide population-based dataset. Method This study linked two nationwide population-based datasets, the birth certificate registry and the Taiwan National Health Insurance Research Dataset. We identified a total of 174 women who gave birth from 2001 to 2003, who were diagnosed with MS within the 2 years preceding the index deliveries, together with 1,392 matched women without chronic disease as a comparison cohort. Multivariate logistic regression analyses were performed for estimation. Results We found that compared with healthy mothers, MS was independently associated with a 2.25-fold risk of preterm birth (95% CI = 1.37–3.70) and a 1.89-fold (95% CI = 1.30–2.76) higher risk of babies small for gestational age, after adjusting for family income and maternal, paternal, and infant characteristics. Mothers with MS were also more likely to have cesarean deliveries. Conclusion Our study documents increased the risk of adverse pregnancy outcomes for mothers with MS, highlighting a need for more intensive monitoring and obstetric care during pregnancy. Future studies should explore the distinct manifestations and mechanisms of MS in diverse ethnic groups, so more complete information can be provided to affected women concerning pregnancy.
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Yang, Yang Claire, Christine E. Walsh, Moira P. Johnson, Daniel W. Belsky, Max Reason, Patrick Curran, Allison E. Aiello, Marianne Chanti-Ketterl e Kathleen Mullan Harris. "Life-course trajectories of body mass index from adolescence to old age: Racial and educational disparities". Proceedings of the National Academy of Sciences 118, n.º 17 (19 de abril de 2021): e2020167118. http://dx.doi.org/10.1073/pnas.2020167118.
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No research exists on how body mass index (BMI) changes with age over the full life span and social disparities therein. This study aims to fill the gap using an innovative life-course research design and analytic methods to model BMI trajectories from early adolescence to old age across 20th-century birth cohorts and test sociodemographic variation in such trajectories. We conducted the pooled integrative data analysis (IDA) to combine data from four national population-based NIH longitudinal cohort studies that collectively cover multiple stages of the life course (Add Health, MIDUS, ACL, and HRS) and estimate mixed-effects models of age trajectories of BMI for men and women. We examined associations of BMI trajectories with birth cohort, race/ethnicity, parental education, and adult educational attainment. We found higher mean levels of and larger increases in BMI with age across more recent birth cohorts as compared with earlier-born cohorts. Black and Hispanic excesses in BMI compared with Whites were present early in life and persisted at all ages, and, in the case of Black–White disparities, were of larger magnitude for more recent cohorts. Higher parental and adulthood educational attainment were associated with lower levels of BMI at all ages. Women with college-educated parents also experienced less cohort increase in mean BMI. Both race and education disparities in BMI trajectories were larger for women compared with men.
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Adams, Mark, Thomas M. Berger, Cristina Borradori-Tolsa, Myriam Bickle-Graz, Sebastian Grunt, Roland Gerull, Dirk Bassler e Giancarlo Natalucci. "Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study". BMJ Open 9, n.º 3 (março de 2019): e024560. http://dx.doi.org/10.1136/bmjopen-2018-024560.
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ObjectivesTo investigate if centre-specific levels of perinatal interventional activity were associated with neonatal and neurodevelopmental outcome at 2 years of age in two separately analysed cohorts of infants: cohort A born at 22–25 and cohort B born at 26–27 gestational weeks, respectively.DesignGeographically defined, retrospective cohort study.SettingAll nine level III perinatal centres (neonatal intensive care units and affiliated obstetrical services) in Switzerland.PatientsAll live-born infants in Switzerland in 2006–2013 below 28 gestational weeks, excluding infants with major congenital malformation.Outcome measuresOutcomes at 2 years corrected for prematurity were mortality, survival with any major neonatal morbidity and with severe-to-moderate neurodevelopmental impairment (NDI).ResultsCohort A associated birth in a centre with high perinatal activity with low mortality adjusted OR (aOR 0.22; 95% CI 0.16 to 0.32), while no association was observed with survival with major morbidity (aOR 0.74; 95% CI 0.46 to 1.19) and with NDI (aOR 0.97; 95% CI 0.46 to 2.02). Median age at death (8 vs 4 days) and length of stay (100 vs 73 days) were higher in high than in low activity centres. The results for cohort B mirrored those for cohort A.ConclusionsCentres with high perinatal activity in Switzerland have a significantly lower risk for mortality while having comparable outcomes among survivors. This confirms the results of other studies but in a geographically defined area applying a more restrictive approach to initiation of perinatal intensive care than previous studies. The study adds that infants up to 28 weeks benefited from a higher perinatal activity and why further research is required to better estimate the added burden on children who ultimately do not survive.
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Yeboah-Korang, Amoah, Mohammad I. Beig, Mohammad Q. Khan, Jay L. Goldstein, Don M. Macapinlac, Darryck Maurer, Amnon Sonnenberg e Claus J. Fimmel. "Hepatitis C screening in commercially insured U.S. birth-cohort patients: Factors associated with testing and effect of an EMR-based screening alert". Journal of Translational Internal Medicine 6, n.º 2 (26 de junho de 2018): 82–89. http://dx.doi.org/10.2478/jtim-2018-0012.
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Abstract Background and Objectives Hepatitis C virus (HCV) testing rates among U.S. birth-cohort patients have been studied extensively, limited data exists to differentiate birth-cohort screening from risk- or liver disease-based testing. This study aims to identify factors associated with HCV antibody (HCV-Ab) testing in a group of insured birth cohort patients, to determine true birth cohort testing rates, and to determine whether an electronic medical record (EMR)-driven Best Practice Alert (BPA) would improve birth cohort testing rates. Methods All birth-cohort outpatients between 2010 and 2015 were identified. HCV-Ab test results, clinical, and demographic variables were extracted from the EMR, and factors associated with testing were analyzed by logistic regression. True birth-cohort HCV screening rates were determined by detailed chart review for all outpatient visits during one calendar month. An automated Best Practice Alert was used to identify unscreened patients at the point of care, and to prompt HCV testing. Screening rates before and after system-wide implementation of the BPA were compared. Results The historic HCV-Ab testing rate was 11.2% (11,976/106,753). Younger age, female gender, and African American, Asian, or Hispanic ethnicity, and medical comorbidities such as chronic hemodialysis, HIV infection, and rheumatologic and psychiatric comorbidities were associated with higher testing rates. However, during the one-month sampling period, true age cohort-based testing was performed in only 69/10,089 patients (0.68%). Following the system-wide implementation of the HCV BPA, testing rates increased from 0.68% to 10.76% (P<0.0001). Conclusions We documented low HCV-Ab testing rates in our baby boomers population. HCV testing was typically performed in the presence of known risk factors or established liver disease. The implementation of an EMR-based HCV BPA resulted in a marked increase in testing rates. Our study highlights current HCV screening gaps, and the utility of the EMR to improve screening rates and population health.
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Peralta, Gabriela P., Alicia Abellan, Parisa Montazeri, Mikel Basterrechea, Ana Esplugues, Sandra González-Palacios, Célina Roda et al. "Early childhood growth is associated with lung function at 7 years: a prospective population-based study". European Respiratory Journal 56, n.º 6 (27 de agosto de 2020): 2000157. http://dx.doi.org/10.1183/13993003.00157-2020.
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Previous studies have related early postnatal growth with later lung function but their interpretation is limited by the methods used to assess a child's growth. We aimed to assess the association of early childhood growth, measured by body mass index (BMI) trajectories up to 4 years, with lung function at 7 years.We included 1257 children from the Spanish Infancia y Medio Ambiente population-based birth cohort. Early childhood growth was classified into five categories based on BMI trajectories up to 4 years previously identified using latent class growth analysis. These trajectories differed in birth size (“lower”, “average”, “higher”) and in BMI gain velocity (“slower”, “accelerated”). We related these trajectories to lung function (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC and forced expiratory flow at 25%–75% of FVC (FEF25–75%)) at 7 years, using multivariable mixed regression.Compared to children with average birth size and slower BMI gain (reference), children with higher birth size and accelerated BMI gain had a higher FVC % pred (3.3%, 95% CI 1.0%–5.6%) and a lower FEV1/FVC % pred (−1.5%, 95% CI −2.9%–−0.1%) at 7 years. Similar associations were observed for children with lower birth size and accelerated BMI gain. Children with lower birth size and slower BMI gain had lower FVC % pred at 7 years. No association was found for FEF25–75%.Independently of birth size, children with accelerated BMI gain in early childhood had higher lung function at 7 years but showed airflow limitation. Children with lower birth size and slower BMI gain in early childhood had lower lung function at 7 years.
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Paltiel, Ora, Rebecca Yanetz, Ronit Calderon, Orly Manor, Susan Harlap e Yehiel Friedlander. "Very High Birth Weight of Offspring Is Associated with an Increased Risk of Leukemia in Their Mothers; Results of a Population-Based Cohort Study." Blood 110, n.º 11 (16 de novembro de 2007): 4677. http://dx.doi.org/10.1182/blood.v110.11.4677.4677.
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Abstract High birth weight (HBW) is related to maternal diabetes, height, BMI and weight gain during pregnancy. Many previous studies have shown an association between HBW and childhood leukemia. Postulated mechanisms have included exposure to growth factors involved in somatic growth and leukemogenesis (e.g. IGF-1), common genetic mechanisms or higher cell number in larger individuals providing increased opportunity for genetic errors. It is not known to what extent the association is due to heritable factors, intra-uterine factors or both. To our knowledge, the association between offspring’s birth weight and leukemia risk in the parents has not been addressed. Methods: We utilized data from the Jerusalem Perinatal Study, a population-based research cohort including all births in West Jerusalem between 1964 and 1976. The database contains information on birth characteristics of the newborns, obstetric complications and birth outcomes as well as demographic data on the parents. After excluding the parents of twins and offspring with congenital malformations, we linked 39,336 mothers and 38,031 fathers of live-born infants through their unique identification numbers to the Israel Cancer Registry. We examined the association between leukemia and the average birth weight of all offspring of the same mother or father, as a categorical and continuous variable, as well as the effect of having at least one offspring weighing ≥4500 gm. Fewer than 2% of parents had offspring weighing 4500 gm or more. Results: Leukemias developed in 57 mothers and 132 fathers. Controlling for maternal age, having at least 1 child weighing ≥4500 gm at birth was associated with a 3-fold increase in the risk of leukemia (hazard ratio -HR 3.4, 95% confidence interval (CI) 1.06–10.91, p=0.04), compared to having no children at the extremes of birth weight. This result was unchanged after multivariate adjustment. Furthermore having an average birth weight among all offspring of ≥4500 gm increased the risk of leukemia in mothers more than 8 fold (HR 8.3, 95% CI: 2.5–27.7, p=0.0006), after controlling for maternal age and diabetes, compared to an average birth weight of 2500–3999 gm. This result was strengthened after further multivariate adjustment for family size and socioeconomic status (HR 8.99, 95%CI: 2.8–29.27, p=0.001). In a subgroup for which these data were available (∼13,000 mothers), results were unchanged after adjusting for maternal height. Birth weight assessed as a continuous variable was not related to mother’s leukemia. Specific subgroups of leukemia in the mother which were associated with HBW were CLL (HR 11.04, p=0.002) and CML (7.84, p=0.05) but these analyses were severely limited by small numbers. There was no association between HBW and father’s risk of leukemia. Conclusions: HBW is associated with leukemia not only in infants and children, but appears to confer an increased risk among their mothers. Whether this is due to a common exposure (eg pelvic irradiation), shared genes, or epigenetic phenomena bears exploring, after confirmation of these results in other cohorts.
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Barros, Aluísio J. D., Iná S. Santos, Alicia Matijasevich, Cora L. Araújo, Denise P. Gigante, Ana M. B. Menezes, Bernardo L. Horta, Elaine Tomasi, Cesar G. Victora e Fernando C. Barros. "Methods used in the 1982, 1993, and 2004 birth cohort studies from Pelotas, Rio Grande do Sul State, Brazil, and a description of the socioeconomic conditions of participants' families". Cadernos de Saúde Pública 24, suppl 3 (2008): s371—s380. http://dx.doi.org/10.1590/s0102-311x2008001500002.
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Three birth cohorts are currently being followed in Pelotas, Southern Brazil, in order to assess changes in birth conditions, growth, development, morbidity, and infant mortality, as well as the influence of pre- and perinatal factors on the subsequent morbidity of participants in their adult lives. We provide a description of the methodology used for the cohort studies that began in 1982, 1993, and 2004 in Pelotas, and a description of the economic conditions of the families involved. For the three cohorts, similar strategies were used to recruit babies born to mothers living in the municipality's urban area. These included daily visits to maternity hospitals where births were identified, mothers interviewed, and newborns examined. Over this time frame, there has been a significant reduction in the number of births due to declining fertility rates amongst the target population. Salaries (measured as a multiple of the minimum wage) were stable across cohorts, but quality of life indicators - such as the availability of piped water, flushing toilets and refrigerators - showed clear improvements. Mothers' levels of education improved markedly. Important changes in the demographic profile of risk factors and health outcomes are being recorded by the Pelotas cohorts.
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King, Carina, Naor Bar-Zeev, Tambosi Phiri, James Beard, Hazzie Mvula, Amelia Crampin, Ellen Heinsbroek et al. "Population impact and effectiveness of sequential 13-valent pneumococcal conjugate and monovalent rotavirus vaccine introduction on infant mortality: prospective birth cohort studies from Malawi". BMJ Global Health 5, n.º 9 (setembro de 2020): e002669. http://dx.doi.org/10.1136/bmjgh-2020-002669.
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BackgroundPneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RV) are key tools for reducing common causes of infant mortality. However, measurement of population-level mortality impact is lacking from sub-Saharan Africa. We evaluated mortality impact and vaccine effectiveness (VE) of PCV13 introduced in November 2011, with subsequent RV1 roll-out in October 2012, in Malawi.MethodsWe conducted two independent community-based birth cohort studies. Study 1, in northern Malawi (40000population), evaluated population impact using change-point analysis and negative-binomial regression of non-traumatic 14–51-week infant mortality preintroduction (1 January 2004 to 31 September 2011) and postintroduction (1 October 2011 to 1 July 2019), and against three-dose coverage. Study 2, in central Malawi (465 000 population), was recruited from 24 November 2011 to 1 June 2015. In the absence of preintroduction data, individual three-dose versus zero-dose VE was estimated using individual-level Cox survival models. In both cohorts, infants were followed with household visits to ascertain vaccination, socioeconomic and survival status. Verbal autopsies were conducted for deaths.ResultsStudy 1 included 20 291 live births and 216 infant deaths. Mortality decreased by 28.6% (95% CI: 15.3 to 39.8) post-PCV13 introduction. A change point was identified in November 2012. Study 2 registered 50 731 live births, with 454 deaths. Infant mortality decreased from 17 to 10/1000 live births during the study period. Adjusted VE was 44.6% overall (95% CI: 23.0 to 59.1) and 48.3% (95% CI: −5.9 to 74.1) against combined acute respiratory infection, meningitis and sepsis-associated mortality.ConclusionThese data provide population-level evidence of infant mortality reduction following sequential PCV13 and RV1 introduction into an established immunisation programme in Malawi. These data support increasing coverage of vaccine programmes in high-burden settings.