Birth To Age Research Articles

Projected increases in the prevalence of diabetes mellitus in Aotearoa New Zealand, 2020-2044.

The prevalence of diabetes has been increasing in Aotearoa New Zealand by approximately 7% per year, and is three times higher among Māori and Pacific peoples than in Europeans. The depth of the diabetes epidemic, and the expansive breadth of services required for its management, elevate the need for high-quality evidence on the projected future burden of this complex disease. In this manuscript we have projected the prevalence of diabetes (type 1 and type 2 combined) out to 2040-2044 using age-period-cohort modelling. National-level data from central government on diabetes prevalence (Virtual Diabetes Register) were used to describe recent diabetes prevalence trends (2006-2019) by age group, calendar period and birth cohort, with these trends used to project diabetes prevalence out from 2020 to 2044. Aotearoa New Zealand will experience a significant increase in the absolute volume of prevalent diabetes, rising by nearly 90% to more than 500,000 by 2044. The age-standardised prevalence of diabetes will increase from around 3.9% of the population (268,248) to 5.0% overall (502,358). The prevalence and volume of diabetes diagnoses will increase most drastically for Pacific peoples, most notably Pacific females for whom diabetes prevalence is projected to increase to 17% of the population by 2044. The increases in the future burden of diabetes mellitus projected here will heighten pressure on health services. Immediate action is required to reduce new cases of diabetes and other obesity-related illnesses. Fiscal policies to prevent these diseases, coupled with population-level interventions to more effectively manage and control diabetes, are effective tools for reducing disease burden.

The long-term development outcomes of the offspring born to patients with systemic lupus erythematosus: a cross-sectional study.

This study aims to explore the long-term physical, neurological, social and emotional development outcomes of the offspring born to patients with systemic lupus erythematosus (SLE), and to provide insights that can assist pediatricians in enhancing the long-term prognosis of these children. We conducted a cross-sectional study on the offspring of SLE patients who had undergone pregnancy and were admitted to our obstetrics department between January 1, 2016 and September 30, 2021. The control group consisted of offspring born to mothers without connective tissue disease, and was matched 1:1 based on age (birth date ± 1 month) with the offspring of SLE patients. Physical development, including measurements of weight and height (length), was assessed. The Ages and Stages Questionnaires, Third Edition (ASQ-3) was utilized to evaluate development in five domains: communication, gross motor, fine motor, problem solving, and personal-social. The Ages and Stages Questionnaires: Social-Emotional (ASQ: SE) was used to assess social-emotional development. Weight, height (length), BMI (body mass index), and ASQ-3 domain scores at different ages and for both genders were standardized into Z-scores for comparison. In the SLE group, the offspring demonstrated higher BMI Z-scores, higher rates of obesity, and increased probabilities of abnormal social-emotional development screening. In addition, their problem solving domain Z-scores were lower as compared to the control group. All of these differences were statistically significant. It is recommended that SLE patients should pay close attention to sensible feeding practices after the birth of their offspring to prevent the occurrence of obesity. Furthermore, there should be an emphasis on strengthening monitoring and intervention efforts to enhance the problem solving abilities and social-emotional development of the offspring. By implementing these measures, the overall long-term developmental outcomes of children born to SLE patients can be improved.

Maternal Infections, Antibiotics, Steroid Use, and Diabetes Mellitus Increase Risk of Early-Onset Sepsis in Preterm Neonates: A Nationwide Population-Based Study.

The global evolution of pathogens causing early-onset sepsis (EOS), a critical condition in preterm infants, necessitates a re-evaluation of risk factors to develop updated prevention and treatment strategies. This nationwide case-control study in Taiwan analyzed data from the National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database from 2010 to 2019. The study included 176,681 mother-child pairs with preterm births. We identified 2942 clinical EOS cases from 5535 diagnosed sepsis cases, excluding unlikely cases. A control group of 14,710 preterm neonates without EOS was selected at a 1:5 ratio. Clinical EOS increased since 2017. Adjusted logistic regression identified significant EOS risk factors in preterm infants, including maternal fever, chorioamnionitis, maternal diabetes mellitus, maternal antibiotic usage, very preterm birth, birth weight (all with p < 0.001), maternal pneumonia (p = 0.002), and maternal CS (p = 0.004). Effective treatment of maternal conditions like diabetes, fever, and infections is essential to prevent EOS in preterm infants. Key measures include reducing unnecessary antibiotics or steroids, minimizing unnecessary cesarean sections, avoiding premature or prolonged rupture of membranes (PPROM), and increasing gestational age and neonatal birth weight. High-risk preterm neonates should be closely monitored for EOS and considered for antibiotics when warranted.

What makes a city breastfeeding friendly? A qualitative analysis of interviews with breastfeeding women from Europe and Asia.

The warm chain of support is the continuous enabling environment from the mother's first contact with healthcare professionals during early pregnancy, birth and immediate post-partum period, her transition from healthcare facility to home, through to work and the community at large. A breastfeeding-friendly city should be able to support a breastfeeding journey across the warm chain. To determine breastfeeding women's perspective of an ideal breastfeeding-friendly city. Between September 2021 and January 2022, twenty-two women who were breastfeeding or had ever breastfed in the last 5 years from Ireland and Malaysia were interviewed. A set of selection criteria was applied to ensure representation of a range of the characteristics known to be associated with breastfeeding success: diverse age groups, birth and breastfeeding experiences, culture and socioeconomical background. One-on-one semi-structured online interviews were conducted by the first author. Data were analysed using Braun and Clarke's Thematic Analysis framework. One overarching theme of breastfeeding at the front and centre of the city, and three major themes were developed: 1. mothers feel supported when breastfeeding is prioritised; 2. when breastfeeding is visible in the environment, it becomes normalized; 3. there is a need to have seamless breastfeeding support across the continuum of the warm chain, and at all levels of society. The findings demonstrated the importance of prioritized, and continuous support throughout the breastfeeding journey. The hopes and aspirations of a breastfeeding-friendly city expressed here would be useful for cities to consider when developing or implementing breastfeeding support programmes as well as guide development of indicators of a breastfeeding-friendly city.

The Impact of Dating Twin Pregnancy by the Larger, Smaller or Mean Twin Crown-Rump Length: A Retrospective Cohort Study.

To evaluate the impact of twin dating by ultrasound-measured crown-rump length (CRL) of the larger (CRL-L), smaller (CRL-S) or mean twin measurement (CRL-M) on the rates of preterm birth (PTB) and detection of small for gestational age (SGA) births. A retrospective cohort study. A tertiary fetal medicine centre (London, UK). All twin pregnancies between 1998 and 2023 who underwent first trimester CRL ultrasound assessment and fetal growth assessment. Data collection included CRL measurement, estimated fetal weight (EFW), pregnancy outcome and birthweight (BW) for each twin. Pregnancies were retrospectively re-dated by CRL-S, CRL-L and CRL-M. SGA < 10th centile and extreme PTB rates (< 28 weeks). In the 1129 twin pregnancies, median CRL-S was 61 mm (interquartile range [IQR]: 56.0-66.0) and CRL-L was 63 mm (IQR: 58.4-68.9) with a mean discordance of 4.0%. Prenatal SGA diagnosis occurred in 19.8% and 23.1% of smaller twins when dated by CRL-S and CRL-L, respectively. When pregnancies were dated by CRL-M versus CRL-S or CRL-L, there was no difference in prenatal SGA diagnosis (p = 0.275 and p = 0.419); SGA at birth (p = 0.132 and p = 0.325); or extreme PTB (p = > 0.999 and p = 0.765 respectively). Dating by the smaller, larger or mean twin CRL does not significantly alter rates of extreme preterm birth, SGA detection or SGA birth. Dating by the mean twin CRL reduces stigmatisation of the smaller twin and retains the utility of accurate gestational age assessment without impacting clinical outcomes.

Indirect determination of hemoglobin A2 reference intervals in Pakistani infants using data mining

BackgroundReference intervals (RIs) are crucial for distinguishing healthy from sick individuals and vary across age groups. Hemoglobinopathies are common in Pakistan, making the quantification of hemoglobin variants essential for screening. Direct RIs are established by measuring values from a healthy reference population, whereas indirect RIs, use statistical analysis of routine lab data to estimate values, making it feasible in settings where direct data is unavailable. Since Pakistan lacks locally established Hemoglobin A2 RIs for infants, this study aims to fill that gap using an indirect data mining method to improve diagnostic accuracy for hemoglobinopathies.MethodsIt was a retrospective observational study. Hemoglobin A2 measurements from all patients aged birth to 1 year between January 2015 and December 2022 were retrieved from the laboratory management system at Aga Khan University Hospital. The study population represented the entire geographical distribution of the country. Hemoglobin A2 was measured using the Bio-Rad Variant™ II analyzer. RIs were computed using an indirect KOSMIC algorithm, which assumes non-pathologic samples follow a Gaussian distribution after Box-Cox transformation.ResultsA total of 88,690 specimens were analyzed for HbA2. After excluding patients with multiple specimens, RIs were calculated for 22,713 infants, stratified into five age sub-groups. The 2.5th and 97.5th percentile results showed good agreement with RIs from Mayo Clinic Laboratories.ConclusionsThis study supports data mining as an alternative method for establishing HbA2 RIs, especially in resource-limited settings. The results are specific to the studied population, instrument, and reagent, and they elucidate the fluctuations in HbA2 synthesis with age. These intervals will enhance clinical decision-making based on HbA2 results.

Oral Glucose-Lowering Agents vs Insulin for Gestational Diabetes

Metformin and glyburide monotherapy are used as alternatives to insulin in managing gestational diabetes. Whether a sequential strategy of these oral agents results in noninferior perinatal outcomes compared with insulin alone is unknown. To test whether a treatment strategy of oral glucose-lowering agents is noninferior to insulin for prevention of large-for-gestational-age infants. Randomized, open-label noninferiority trial conducted at 25 Dutch centers from June 2016 to November 2022 with follow-up completed in May 2023. The study enrolled 820 individuals with gestational diabetes and singleton pregnancies between 16 and 34 weeks of gestation who had insufficient glycemic control after 2 weeks of dietary changes (defined as fasting glucose >95 mg/dL [>5.3 mmol/L], 1-hour postprandial glucose >140 mg/dL [>7.8 mmol/L], or 2-hour postprandial glucose >120 mg/dL [>6.7 mmol/L], measured by capillary glucose self-testing). Participants were randomly assigned to receive metformin (initiated at a dose of 500 mg once daily and increased every 3 days to 1000 mg twice daily or highest level tolerated; n = 409) or insulin (prescribed according to local practice; n = 411). Glyburide was added to metformin, and then insulin substituted for glyburide, if needed, to achieve glucose targets. The primary outcome was the between-group difference in the percentage of infants born large for gestational age (birth weight >90th percentile based on gestational age and sex). Secondary outcomes included maternal hypoglycemia, cesarean delivery, pregnancy-induced hypertension, preeclampsia, maternal weight gain, preterm delivery, birth injury, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal intensive care unit admission. Among 820 participants, the mean age was 33.2 (SD, 4.7) years). In participants randomized to oral agents, 79% (n = 320) maintained glycemic control without insulin. With oral agents, 23.9% of infants (n = 97) were large for gestational age vs 19.9% (n = 79) with insulin (absolute risk difference, 4.0%; 95% CI, -1.7% to 9.8%; P = .09 for noninferiority), with the confidence interval of the risk difference exceeding the absolute noninferiority margin of 8%. Maternal hypoglycemia was reported in 20.9% with oral glucose-lowering agents and 10.9% with insulin (absolute risk difference, 10.0%; 95% CI, 3.7%-21.2%). All other secondary outcomes did not differ between groups. Treatment of gestational diabetes with metformin and additional glyburide, if needed, did not meet criteria for noninferiority compared with insulin with respect to the proportion of infants born large for gestational age. Netherlands Trial Registry Identifier: NTR6134.

Adverse Pregnancy Outcomes in Patients with Polycystic Ovary Syndrome with Pre-Conceptional Hyperandrogenism: A Multi-Institutional Registry-Based Retrospective Cohort Study

Background/Objectives: Women with polycystic ovarian syndrome (PCOS) are at higher risk for pregnancy complications. The PCOS population is heterogeneous, with different phenotypes linked to varying risks of adverse outcomes. However, literature on pre-conceptional hyperandrogenism is limited and based on small sample sizes. Methods: This multi-institutional registry-based retrospective cohort study included pregnant patients diagnosed with PCOS with or without pre-conceptional hyperandrogenism. Utilizing the TriNetX platform, one-to-one propensity score matching was conducted to adjust for confounding factors. Exclusion criteria included multiple pregnancies and patients who received assisted reproductive technology, oral contraceptives, or spironolactone. 571 patients with PCOS and pre-conceptional hyperandrogenism and 13,465 patients with PCOS without hyperandrogenism were identified. Post-propensity matching, each cohort consisted of 564 patients. Results: Pregnant women diagnosed with PCOS and pre-conceptional hyperandrogenism showed a higher risk of large for gestational age (6.6% vs. 3.9%, OR = 1.73, 95% CI [1.007–2.972], p-value = 0.045) and preterm birth (10.3% vs. 5.9%, OR = 1.844, 95% CI [1.183–2.876], p-value = 0.006), but had no significant increase in the risk of gestational hypertension, preeclampsia/eclampsia, gestational diabetes, missed abortion, intrauterine growth restriction, placenta abruption, or cesarean section. Conclusions: Women with PCOS and pre-conceptional hyperandrogenism have an increased risk of pregnancy complications, especially large for gestational age and preterm birth. Further research is needed to clarify the underlying mechanisms, and whether treatment can improve outcomes.

Bivariate density estimation under marginal unimodality constraints

Empirical analyses of observed pairs of variables often suggest that the underlying joint distribution of these variables is highly dependent and each one of them is marginally unimodal. Exploiting marginal shape information can improve the bivariate density estimation. We develop a nonparametric density estimation method where the joint density of the bivariate outcome variables is estimated using a flexible class of mixtures of scaled Beta distributions and the mixing weights are suitably constrained to ensure marginal unimodality. Large sample consistency of the proposed density estimator is established using the method of sieves and Argmax Continuous Mapping Theorem. The proposed method enlarges the scope of previous studies in two important aspects: (i) joint density provides a simultaneous estimation of higher-order moments beyond mean and variance functions, and (ii) marginal shape constraints provide more efficient estimates. The proposed procedures are illustrated using simulated and real case study datasets on gestational age and infant birth weight.

Incidence and Risk Factors Of Retinopathy Of Prematurity In Multicenter Neonatal Intensive Care Unit Patients

Background: Retinopathy of prematurity (ROP) poses a significant risk in the management of premature infants, potentially resulting in blindness if not promptly identified and addressed. Objective: To determine the incidence of retinopathy of prematurity among newborns in multiple neonatal intensive care units (NICUs), pinpoint the associated risk factors, and evaluate the outcomes of such cases. Materials and Methods: A prospective observational study was done at the neonatal ICUs of Akbar Niazi Teaching Hospital, Islamabad, PAEC Hospital, Islamabad and Holy Family Hospital, Rawalpindi between April 2022 to December 2023.A birth occurring at gestational age ≤ 32 weeks and birth weight ≤ 1500 g. Infants with gestational age exceeding32 weeks or birth weight surpassing1500 g were considered eligible for inclusion if oxygen therapy exceeding 7 days. Total350 infants underwent retinal examination through indirect ophthalmoscope from fourth week after birth, with subsequent follow-ups. Results: Among350infants; 5.1% (n=18) were diagnosed with ROP in either one or both eyes. The classification revealed55.6% (n=10) at stage 1, 27.8% (n=5)at stage 2, and 16.7% (n=3) at stage-3. There was no reported case Winthrop at stage-4 or 5.Laser ablative therapy was administered to three cases with stage-3 ROP. In univariate analysis notable relation was observed between the incidence of ROP and factors such as gestational age (p = 0.0001), sepsis (p = 0.002), oxygen therapy (p = 0.0001), and blood transfusion rate (p = 0.002).Following logistic regression, gestational age, sepsis, oxygen therapy, and blood transfusion rate continued to be significant. Conclusion: The ROP incidence was low, with low gestational age, sepsis, oxygen therapy, and reduced blood transfusion rate identified as significant risk factors.

Analysis of risk factors for post-prematurity respiratory disease in very preterm infants

Objective: To investigate the risk factors associated with post-prematurity respiratory disease (PPRD) in very preterm infants. Methods: A prospective cohort study was conducted, enrolling 369 very preterm infants who were admitted to the neonatal intensive care unit of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, within one week of birth from January 2019 to June 2023. Data on maternal and infant clinical characteristics, neonatal morbidities, and treatments during hospitalization were collected. The very preterm infants were divided into 2 groups based on whether they developed PPRD. Continuous variables were compared using Mann-Whitney U test, while categorical variables were compared using χ² tests or continuity correction χ2 test. Multivariate Logistic regression analysis was used to identify the independent risk factors for PPRD in very preterm infants. Results: Among the 369 very preterm infants, 217 cases(58.8%) were male, with a gestational age of 30 (28, 31) weeks at birth and a birth weight of 1 320 (1 085, 1 590) g. Of these, 116 cases (31.4%) developed PPRD, while 253 cases (68.6%) did not. The very preterm infants in the PPRD group had a lower gestational age and lower birth weight (both, P<0.001). The PPRD group also had a higher proportion of males, lower Apgar scores at the 1th minute after birth and the 5th minutes after birth, a higher rate of born via cesarean delivery, and a higher incidence of bronchopulmonary dysplasia, more pulmonary surfactant treatment, longer durations of mechanical ventilation, longer total oxygen therapy, and lower Z-score for weight at discharge (all P<0.05). Multivariate Logistic regression analysis showed that gestational age (OR=0.85, 95%CI 0.73-0.99, P=0.037), born via cesarean delivery (OR=2.23, 95%CI 1.21-4.10, P=0.010), a duration of mechanical ventilation ≥7 days (OR=2.51, 95%CI 1.43-4.39, P=0.001), and a Z-score for weight at discharge (OR=0.82, 95%CI 0.67-0.99, P=0.040) were all independent risk factors for PPRD in very preterm infants. Conclusion: Very preterm infants with a small gestational age, born via cesarean section, mechanical ventilation ≥7 days, and a low Z-score for weight at discharge should be closely monitored for PPRD, and provided with standardized respiratory management after discharge.

Paternal exposure to antiseizure medications and offspring outcomes: a systematic review

BackgroundConcerns have recently been raised about risks to the fetus resulting from paternal exposure to antiseizure medications (ASMs). To address these concerns, we conducted a systematic review of the literature...

Modified Sick Neonatal Score: A Modified Score to Evaluate the Burden of Neonatal Morbidity in a Tertiary Care Hospital

Background: To assess neonatal mortality, many validated scores have been developed. The modified sick neonatal score (MSNS) is an easy, less complex suitable for both term and preterm neonates. This study was conducted to predict mortality upon admission to a NICU using the MSNS score. Methods: An observational study was conducted in the Department of Neonatology, BSMMU, Dhaka, over a period of one year. Parameters for MSNS score were collected from data sheet. Outcome expressed as survived or expired. All data were analyzed using SPSS 20. To determine the cutoff value for predicting mortality, a receiver operating curve was generated. The cutoff score’s sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results: Among the enrolled 114 neonates, mean gestational age and mean birth weight were 34.22±3.10 weeks and 1967.87±752.33g respectively. About 75.4% neonates were &lt;2500 grams and 70.2% of babies were preterm. During the study period, two third (69.3%) baby survived. The mean MSNS among survived neonate was 11.77± 2.29 and in expired neonates was 9.66±2.32 which was statistically significant (p-&lt;0.01). The area under the ROC curve was 0.740 (95% CI: 0.645- 0.835). The optimal cutoff value obtained to predict mortality was 11.50. With this cutoff score the sensitivity and specificity were 80% and 58%. Positive predictive value and negative predictive value were 46% and 87% respectively. Conclusions: MSNS tools can be used to predict early mortality with early referrals and prompt treatment to reduce neonatal mortality. Bangladesh J Child Health 2023; Vol 47 (2) : 72-77

Perinatal Outcomes in Siblings from Different Conception Methods: In Vitro Fertilization with Autologous Oocyte or Donor Egg vs. Unassisted Medical Conception.

To study the perinatal outcomes of children born from different conception methods: in vitro fertilization (IVF) with autologous oocytes or IVF with donor egg versus those conceived without medical assistance by using a sibling analysis. Retrospective cohort study conducted using electronic medical record data from 2000 through 2018, of a national healthcare organization. The cohort included mothers who had two pregnancies and their children. Cohort A compared women with two medically unassisted conceptions with those with an unassisted first conception followed by an IVF conception. Cohort B compared women with two medically unassisted conceptions with those with an unassisted conception followed by a second pregnancy from oocyte donation. None MAIN OUTCOME MEASURES: Perinatal outcomes, including small for gestational age (SGA) and preterm birth (PTB) <37weeks were investigated. Secondary outcomes included low birth weight (LBW), very low birth weight (VLBW), and large for gestational age (LGA). Cohort A comprised women who had 2 medically unassisted pregnancies and those with 1 medically unassisted pregnancy followed by IVF (n=1080 in each). Gestational age at delivery for the second conception was significantly lower in the unassisted + IVF group compared to the medically unassisted group (38.1 ± 2.1 weeks vs. 39.1 ± 1.4 weeks, p=0.001). The unassisted + IVF group had higher rates of prematurity <37 weeks (12% vs. 3.5%, p=0.001) and SGA compared to the medically unassisted group (5.4% vs. 3.4%, p=0.048). The adjusted OR (aOR) for PTB was 3.32 (95% CI, 2.11 to 5.29) and for SGA aOR 1.88 (95% CI, 1.07 to 3.32.) Cohort B included 94 women in each group. No differences were found between the medically unassisted and medically unassisted + donor egg groups regarding PTB <37 weeks (p=0.52) and SGA (p=0.32). The rate of LGA was higher in the egg donation group (24% vs. 16.5%, p=0.02). This sibling analysis suggests that IVF pregnancies with autologous eggs are more susceptible to PTB, LBW, VLBW, and SGA, while donor egg pregnancies appear relatively unaffected, except for higher rate of LGA.

Effect of melatonin treatment of pregnant Sarda ewes on lactation and lamb development.

Context Melatonin administration during pregnancy can influence fetal development and lactation. Aims This study aimed to verify whether melatonin treatment of pregnant Sarda ewes in spring improved lamb weight at birth, 7 and 21days of age, time to first colostrum intake, birth behavior and survival. Additionally, we examined melatonin's effect on milk yield and composition. Methods On 18 April, 200 ewes were assigned to two groups of 100 each, based on lambing date, body condition score, parity, age and milk yield. One group received melatonin implants on 20 April, 4 July and 17 September; the other served as control. Rams (12 per group) were introduced on 25 May and removed after 40days. Lamb weight was recorded at birth, 7 and 21days, while milk yield and composition were assessed bi-weekly from day 30 of lactation. Key results Lambs born to melatonin-treated ewes were heavier at birth (3.54 vs 2.89kg), and at 7(5.21 vs 4.40kg) and 21days of age (11.3 vs 10.1kg) and reached colostrum intake sooner than lambs from untreated ewes (55.5±5.3 vs 69.4±5.6min). Milk yield was higher in melatonin-treated ewes, with somatic cell counts decreasing in treated animals and increasing in controls over the five samplings. Milk fat was higher in treated ewes than controls during early lactation, although protein and lactose levels remained similar between groups. Conclusion Melatonin treatment throughout pregnancy improved lamb growth and milk production and quality, suggesting a potential management advantage for sheep.

Birth of the Geopolitical Age: Global Frontiers and the Making of Modern China by Shellen Xiao Wu (review)

Birth of the Geopolitical Age: Global Frontiers and the Making of Modern China by Shellen Xiao Wu (review)

Association Between Picky Eating, Weight Status, Vegetable, and Fruit Intake in Children and Adolescents: Systematic Review and Meta-Analysis.

Aim: Picky eating is a common appetitive trait reported among children and adolescents and may have detrimental effects on their weight, vegetable, and fruit intake, impacting health status. However, an updated systematic review of the literature and summary of effect estimates is required. This study aims to explore the association between picky eating with weight, vegetable and fruit intake, vegetable-only intake, and fruit-only intake. Methods: A systematic literature search of six electronic scientific databases and data extraction was performed between November 2022 and June 2023. Original articles that examined picky eating in association with weight, vegetable and/or fruit intake were included. PRISMA guidelines were followed and meta-analytical and meta-regression analyses were conducted to compute summary effect estimates and explore potential moderators. PROSPERO registration: CRD42022333043. Results: The systematic review included 59 studies of which 45 studies were included in the meta-analysis. Overall, the summarized effect estimates indicated that picky eating was inversely associated with weight [Cohen's dz: -0.27, 95% confidence interval (CI): -0.41 to -0.14, p < 0.0001]; vegetable and fruit intakes (Cohen's dz: -0.35, 95% CI: -0.45, -0.25, p < 0.0001); vegetable-only intake (Cohen's dz: -0.41, 95% CI: -0.56, -0.26, p < 0.0001), and fruit-only intake (Cohen's dz: -0.32, 95% CI: -0.45, -0.20, p < 0.0001). Picky eating was positively associated with underweight (Cohen's dz: 0.46, 95% CI: 0.20, 0.71 p = 0.0008). Conclusion: Although effect sizes were small, picky eating was inversely associated with weight, vegetable, and fruit intakes, and positively associated with underweight in children and adolescents aged birth to 17 years.

Adverse birth and obstetric outcomes in the offspring of male adolescent and young adult cancer survivors: A nationwide population-based study.

Background The growing population of male adolescent and young adult (AYA, 15-40 years old) cancer survivors has heightened interest in their reproductive health. However, studies have reported conflicting findings on the potential risks of cancer and its treatments on birth and obstetric outcomes. Methods We utilized encrypted identification numbers for both fathers and mothers to link three nationwide Taiwan datasets from 2004 to 2019, identifying 3,785 births with a paternal history of AYA cancer. For comparison, we included 37,850 matched fathers without a cancer history, matched by paternal age and infant birth year. We employed multivariable logistic regression analysis to identify independent associations between adverse birth outcomes (e.g., preterm labor, low birthweight, and congenital malformations) and obstetric outcomes (e.g., fetal growth restriction, threatened labor, and threatened abortion) and being born to male AYA cancer survivors. Results The offspring of male AYA cancer survivors did not exhibit a significantly increased risk of adverse birth (odds ratio [OR] = 1.0; 95% confidence interval [CI] = 0.9-1.1) or obstetric (OR = 1.1; 95% CI = 1.0-1.1) outcomes compared to offspring born to cancer-free matched fathers. Furthermore, the risk of preterm labor, low birthweight, congenital malformations, fetal growth restriction, and threatened labor or miscarriage was comparable between groups. Conclusions Paternal cancer history during adolescence or young adulthood does not appear to increase offspring's risk of adverse birth or obstetric outcomes. Impact This study reassures about this population's reproductive health, providing valuable insights for oncology and reproductive medicine, potentially influencing patient counseling and guidelines.

Impact of Low Maternal Weight on Pregnancy and Neonatal Outcomes.

To examine the effect of underweight maternal body mass index (BMI) on pregnancy complications and neonatal outcomes. Cohort study. Tertiary academic center. A total of 16 361 mothers who delivered a singleton between 2015-2021 with either a BMI <18.5 kg/m2 (n = 732) or normal BMI (18.5 ≥ BMI <23 or 25 kg/m2, n = 15 629) at the initial prenatal visit or within 6 months of the initial visit. Birthweight, gestational age, neonatal intensive care unit admission, preterm birth, and fetal death; obstetrical complications including preeclampsia/eclampsia, premature rupture of membranes, preterm premature rupture of membranes, and postpartum hemorrhage. Underweight women were younger and less likely to have private insurance (P < .01 for both) than normal-weight women. Approximately 23% of infants born to underweight mothers were small for gestational age and 15% were low birth weight vs 13.5% and 9% of infants of normal-weight mothers, respectively (P < .01 for both). These differences remained significant after adjusting for potential confounders. In adjusted logistic regression models, underweight women had a decreased risk of premature rupture of membranes and postpartum hemorrhage compared to normal-weight women. Underweight BMI during pregnancy is associated with an increased risk of small for gestational age and low birth weight infants and a decreased risk of premature rupture of membranes and postpartum hemorrhage. These findings suggest underweight BMI during pregnancy increases the risk of adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected.

Machine-Learning-Based Predictive Model for Bothersome Stress Urinary Incontinence Among Parous Women in Southeastern China.

Accurate identification of female populations at high risk for urinary incontinence (UI) and early intervention are potentially effective initiatives to reduce the prevalence of UI. We aimed to apply machine-learning techniques to establish, internally validate, and provide interpretable risk assessment tools. Data from a cross-sectional epidemiological survey of female urinary incontinence conducted in 2022 were used. Sociodemographic and obstetrics-related characteristics, comorbidities, and urinary incontinence questionnaire results were used to develop multiple prediction models. Seventy percent of the individuals in the study cohort were employed in model training, and the remainder were used for internal validation. Model performance was characterized by area under the receiver-operating characteristic curve (AUC) and calibration curves, as well as Brier scores. The best-performing model was finally selected to develop an online prediction tool. The results showed that bothersome stress urinary incontinence (BSUI) occurred in 9.6% (849 out of 8,830) of parous women. The XGBoost model achieved the best prediction performance (training set: AUC 0.796, 95% confidence interval [CI]: 0.778-0.815, validation set: AUC 0.720, 95% CI: 0.686-0.754). Additionally, the XGBoost model achieved the lowest (best) Brier score among the models, with sensitivity of 0.657, specificity of 0.690, accuracy of 0.688, positive predictive value of 0.231, and negative predictive value of 0.948. Based on this model, the top five risk factors for the development of BSUI among parous women were ranked as follows: body mass index, age, vaginal delivery, constipation, and maximum fetal birth weight. An online calculator was provided for clinical use. The application of machine-learning algorithms provides an acceptable, though not perfect, prediction of BSUI risk among parous women, requiring further validation and improvement in future research.