Early Birth Research Articles

A Predictive Model for Perinatal Brain Injury Using Machine Learning Based on Early Birth Data

Background/Objective: It is difficult to predict perinatal brain injury, and performing brain magnetic resonance imaging (MRI) based on suspected injury remains a clinical challenge. Therefore, we aimed to develop a reliable method for predicting perinatal brain injury using a machine learning model with early birth data. Methods: Neonates admitted to our institution from January 2017 to June 2024 with a gestational age of ≥36 weeks, a birth weight of ≥1800 g, admission within 6 h of birth, and who underwent brain MRI to confirm perinatal brain injury were included. Various machine learning models, including gradient boosting, were trained using early birth data to predict perinatal brain injury. Synthetic minority over-sampling and adaptive synthetic sampling (ADASYN) were applied to address class imbalance. Model performance was evaluated using accuracy, F1 score, and ROC curves. Feature importance scores and Shapley additive explanations (SHAP) values were also calculated. Results: Among 179 neonates, 39 had perinatal brain injury. There were significant differences between the injury and non-injury groups in mode of delivery, Apgar scores, capillary pH, lactate dehydrogenase (LDH) levels, and whether therapeutic hypothermia was performed. The gradient boosting model with the ADASYN method achieved the best performance. In terms of feature importance scores, the 1 min Apgar score was the most influential predictor. Additionally, SHAP analysis showed that LDH levels had the highest SHAP values. Conclusion: the gradient boosting model with ADASYN oversampling effectively predicts perinatal brain injury, potentially improving early detection for predicting long-term outcomes, reducing unnecessary MRI scans, and lowering healthcare costs.

A case of Clostridium difficile infection as a complication of antibiotic therapy

This clinical case demonstrates the complexity of managing a comorbid patient with antibiotic-associated diarrhea. We observed a patient who, during therapy, developed extremely early premature birth with a live premature fetus (at 25-26 weeks), antibiotic-associated (Clostridium difficile) intractable diarrhea, pseudomembranous colitis, and acute dynamic intestinal obstruction. After treatment for 14 days, the patient’s condition improved.

Childbearing Histories and Midlife Cognition: Accounting for Early Life Factors.

Childbearing histories-for example, parity and age at first birth-matter for the health outcomes of mid- and later-life women. There is growing evidence that childbearing may shape cognitive outcomes. However, previous research is not definitive due to its inability to account for selection. Selection is critical to address given that multiple factors, including socioeconomic background and cognition in adolescence, place women at risk for both specific childbearing experiences and poor cognitive functioning. We analyze the 1979 National Longitudinal Survey of Youth (NLSY79) (N=3,668), a longitudinal nationally representative dataset from the US that began collecting data during respondents' late teens and early 20s. We estimate the average treatment effects (ATEs) of childbearing histories on midlife memory and cognition using propensity-score matching techniques that incorporate an expansive set of early-life factors. In models adjusting for early life covariates, we find that any births, high parity, and early first birth are associated with worse self-reported memory, but not cognitive functioning scores. After addressing the influence of early life factors through matching techniques, the only robust differences relate to any births and early first births with self-reported memory. Selection into specific childbearing experiences partially drives the link between childbearing and cognition at mid-life, with cascading implications into later life. We suggest incorporating childbearing and early life factors into models to identify social determinants of memory and cognitive functioning.

The effect of community environment on the trajectory of depressive symptoms and cohort differences among middle-aged and older Chinese adults.

Urbanization has changed the living environment of middle-aged and older Chinese adults, but it also brings certain mental pressure to them. Few studies have explored the effect of community environment on the development trajectory and the cohort differences of depressive symptoms in Chinese individuals. Based on the longitudinal data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, using three-level hierarchical linear growth model, this study examined the effect of community environment on the trajectory of depressive symptoms and cohort differences among middle-aged and older Chinese adults in five cohorts from 1920 to 1929, 1930-1939, 1940-1949, 1950-1959, and 1960-1966. The results of this study showed that middle-aged and older adult individuals who lived in neighborhoods with better community physical and social environments had a protective effect on depressive symptoms. There was a cohort difference in the development of depressive symptoms among middle-aged and older Chinese adults. The baseline depressive symptoms in the later birth cohorts were higher than those in the earliest cohort, and the development rate were also significantly higher. The role of community environment in the development rate of depressive symptoms among middle-aged and older adult individuals varied across the cohort. A better community social environment had a more significant moderating effect on the development rate of depressive symptoms in the early birth cohort (1930-1939), and a better physical environment had a more significant moderating effect on the development rate of depressive symptoms in the 1940-1949 cohort. Under the strategic background of healthy aging in China, the construction and improvement of community environment should become an important part of coping with the realistic challenges of the aging population, such as the expanding scale of depressed population among the middle-aged and older adult individual.

Perinatal mortality among term births: Informing decisions about singleton early term births in Western Australia.

To minimise the risk of perinatal mortality, clinicians and expectant mothers must understand the risks and benefits associated with continuing the pregnancy. Report the gestation-specific risk of perinatal mortality at term. Population-based cohort study using linked health data to identify all singleton births at gestations 37-41 weeks, in Western Australia (WA) from 2009 to 2019. Lifetable analysis was used to combine the risk of each type of perinatal mortality and calculate the cumulative risk of perinatal mortality, termed the perinatal risk index (PRI). Rates of antepartum and intrapartum stillbirth and neonatal death, as well as the PRI, were examined for each gestational week at term by non-Aboriginal and Aboriginal ethnicity. For non-Aboriginal women, rates were also examined by time-period (pre- vs. post-WA Preterm Birth Prevention Initiative (the Initiative) rollout), primiparity, and obstetric risk. There were 332,084 singleton term births, including 60 perinatal deaths to Aboriginal mothers (3.2 deaths per 1000 births to Aboriginal mothers) and 399 perinatal deaths to non-Aboriginal mothers (1.3 deaths per 1000 births to non-Aboriginal mothers). For non-Aboriginal women, the PRI was at its lowest (PRI 0.80, 95% CI 0.61, 1.00) at 39 weeks gestation. For Aboriginal women, it was at its lowest at 38 weeks (PRI 2.43, 95% CI 0.48, 4.39) with similar risk at 39 weeks (PRI 2.68, 95% CI 1.22, 4.14). The PRI increased steadily after 39 weeks gestation. The risk of perinatal mortality was higher among Aboriginal women. The gestation-specific perinatal mortality rates were similar by the time-period, primiparity and obstetric risk. The gestational ages at term associated with the lowest risk of perinatal mortality reinforce that the recommendation not to deliver before 39 weeks without medical indication is applicable to both Aboriginal and non-Aboriginal women giving birth in WA. There was no increase in the perinatal mortality rate associated with the introduction of the Initiative.

Disinformation and the Ghost of Margaret Sanger

This study sought to investigate the prominence of U.S. birth control pioneer and eugenicist Margaret Sanger in social media discourse through a critical disinformation studies lens. Using computational and qualitative analysis techniques, 60 months of public Facebook posts and Google search data were analyzed to explore the scope, reach, and engagement with messages that reference Sanger and examine how injustice frames utilizing Sanger’s historical ties to eugenics are being used today to misinform and disinform on abortion and other issues. Injustice frames featuring Sanger were deployed to portray abortion as a method for Black genocide; vilify feminism as racist, anti-woman, and anti-motherhood; and depict the Black Lives Matter social justice movement and cancel culture as hypocritical. This analysis also captured a moment in time when Sanger’s legacy was being reconsidered by Planned Parenthood, the organization she founded, indicating that a long-sought-after reckoning with the racist roots of the early birth control movement in the United States may be underway—with both predictable and unpredictable rippling effects in disinformative spaces.

Clinical and statistical analysis of the course of preterm birth based on the materials of communal enterprise «Regional Perinatal Center of the Rivne Regional Council» in 2013–2023 years

One of the priority tasks of modern medical science and practice is the preservation of reproductive health and the gene pool of the nation. It is especially difficult to perform this task during the russian war in Ukraine, which has been going on for more than ten years. According to sociologists, the outcomes of a low birth rate for the country will be catastrophic precisely because of the war.One of the reasons for the decline in the quality of health in the future is the increase in the specific weight of premature births, the frequency of which, according to the World Health Organization, has increased in Ukraine already after six months of full-scale war.The objective: to conduct an analysis of the course of premature births in the conditions of war based on the materials of the communal enterprise (CE) “Regional Perinatal Center of the Rivne Regional Council” for 2013–2023.Materials and methods. A retrospective clinical and statistical analysis of 2,742 histories of pregnancy and childbirth of women who were in labor between 22/0–36/6 weeks of gestation in obstetric departments of the communal enterprise “Regional Perinatal Center of the Rivne Regional Council” in 2013–2023 was carried out.Results. According to CE “Regional Perinatal Center of the Rivne Regional Council”, a progressive decrease in the total number of births by 41.9% was observed in the Rivne Region from 2013 to 2023. At the same time, in the general population of women giving birth, the specific rate of premature births did not have a tendency to increase.In the structure of preterm births, early and late preterm births prevailed. The specific gravity of very early preterm births, which are the most unfavorable for perinatal outcomes, did not have a sustained upward trend. At the same time, the frequency of too early premature births among residents of districts and territorial communities of the Rivne region has significantly increased (2013 – 19 (79.2%) cases, 2023 – 17 (100.0%) cases; p<0.05).Every second premature birth occurred within the first day of hospitalization of a pregnant woman, while the specific rate of such too early premature births increased by 3.4 times during the analyzed period, which significantly worsens the chances of survival of newborns and is the reason for their high perinatal morbidity.The number of premature births in pregnant women with multiple pregnancies remains stable. Every third preterm birth took place on the background of early premature rupture of the fetal membranes, while a significant increase in the frequency of this complication was found in women who gave birth at 22/0–27/6 weeks of pregnancy.Traditionally, the specific rate (55.7–57.5%) of surgical delivery by caesarean section of pregnant women and mothers with premature births remains high, which contributed to a reliable reduction of the perinatal mortality rate of premature babies by 13.7% due to the reduction of antenatal losses. Indicators of early neonatal death were formed at the expense of newborns from too early and early premature births in the same ratio.Conclusions. According to thedata of CE “Regional Perinatal Center of the Rivne Regional Council”, there was a progressive decrease in the birth rate in the Rivne Region with a simultaneous stabilization of the number of premature births. The widespread use of a holistic approach during the medical care of pregnant women and the introduction of modern methods of care for premature newborns ensured a significant decrease in the rate of perinatal death of premature infants due to the reduction of antenatal losses.

Do birth outcomes mediate the association between drug use in pregnancy and neonatal metabolic bone disease? A prospective cohort study of 10,801 Chinese women.

Prenatal drug use may cause toxicity to bone health in newborns. We aimed to examine whether birth outcomes mediate the association between medication use and neonatal metabolic bone disease (MBD). A prospective cohort of 10,801 pregnant women (17-49 years) and their infants followed at a single center from 1 January 2012 to 31 December 2021 were included. Based on four single drugs, comprehensive medication use was determined and categorized into three groups using latent-class analysis: group 1 included antibiotics and furosemide or less than two drugs except for MgSO4; group 2 included MgSO4 without antibiotics or furosemide; and group 3 encompassed dexamethasone and antibiotics. Mediation analysis was conducted to assess the mediating effects of prematurity, low birth weight (LBW), and small for gestational age (SGA). There were 138 (1.3%) infants with MBD; 2,701 (25%) were born preterm, 1717 (15.9%) had LBW, and 303 (2.8%) were SGA. Pregnant women in groups 2 and 3 were 2.52 to 14.66 times more likely to deliver an infant with MBD than those in group 1. Only LBW showed a significant mediating effect on the association between comprehensive medication use and MBD, with a mediation proportion of 51.8% (45.0-64.1%, p < 0.001). Comprehensive medication use during pregnancy was associated with an increased risk of neonatal MBD, largely mediated by LBW. Early antepartum monitoring and prevention targeting adverse birth outcomes are necessary to mitigate the risk of MBD.

Long-term monitoring of a population of greater horseshoe bat emphasises the importance of a pest beetle prey on demographic trends.

The global decline in insect biomass has far-reaching implications for terrestrial and freshwater food webs, impacting species reliant on insects as a crucial component of their diet. This issue extends to species traditionally considered agricultural pests, such as the common cockchafer Melolontha melolontha. In the race to combat cockchafers through collection, insecticide use, and other control methods, the repercussions of their numerical fluctuations on predators, including species of high conservation importance like bats, have been largely overlooked. Drawing on 31-years of monitoring data for a greater horseshoe bat Rhinolophus ferrumequinum population in the Aosta Valley (Western Italian Alps), we investigated whether annual fluctuations in bat counts are influenced by cockchafer availability and weather conditions. Despite an overall positive trend in bat abundance, we observed pronounced annual fluctuations, mostly driven by cockchafer availability rather than variations in temperature and precipitation. Furthermore, we found a significant association between cockchafer availability and the median date of birth and birth rate of bats. Births occurred approximately 5 days earlier in cockchafer flight years, with earlier births also linked to warmer spring temperatures and higher numbers of warm days in April. Moreover, the ratio pups/older bats was 0.56 in cockchafer flight years, compared to 0.47 in other years. Our results underscore the importance of considering predator-prey dynamics when examining the long-term population trends of species of conservation concern. We recommend implementing restrictions on the use of chemicals and other potentially harmful practices that may diminish prey abundance or quality, including that of species considered as agricultural pests. In designing conservation strategies, a delicate balance should be struck between the current interests of farmers and the overarching goal of preserving biodiversity against potential future threats.

Community Beliefs and Practices Around High Fertility in a High-Risk Environment: A Qualitative Study on Porja Hilly Tribe Living in Andhra Pradesh, India

This study aims to document the tribal community beliefs and practices around fertility behaviours of the Porja vulnerable tribal group in Andhra Pradesh, India. With the purposive sampling method, 175 mothers of reproductive age (&gt;15–49 years) were selected based on the inclusion criteria of having experienced fertility practices and the cultural significance associated with it. The socio-demographic profiles and the fertility rates of 175 mothers have been enumerated through household survey methods and semi-structured interview schedules. The qualitative data collection involved 42 in-depth interviews and three focus group discussions (involving 6–10 women) on specific sociocultural practices around fertility behaviour patterns. Handwritten interviews and conversations were transcribed and coded into themes and categories. Views from the themes reveal that the sociocultural environment has influenced fertility behaviours. Age at marriage and conception at adolescence are the main factors affecting tribal fertility. Traditional fertility-seeking behaviour indicated sequential care from traditional birth attendants and local medicinal women (providing medicine for early conception and birth spacing). The preference for two sons’ was the theme that largely influenced fertility trends. There is a need for comprehensive healthcare intervention in the PVTG tribal areas to lessen the unhealthy reproductive practices that affect tribal survival chances, leading to higher mortality rates.

The global burden of cardiovascular disease attributable to diet low in fiber among people aged 60 years and older, 1990–2019: an age–period–cohort analysis of the global burden of disease study

ObjectivesThis study aimed to quantify the global cardiovascular disease (CVD) burden attributable to diet low in fiber among adults aged 60 years and older using data from the Global Burden of Disease (GBD) Study 2019.MethodsWe extracted data on CVD mortality, disability-adjusted life-years (DALYs), and risk-factor exposures from the GBD 2019 study for people aged 60 and older. Age-period-cohort models were used to estimate the overall annual percentage change in mortality and DALY rate (net drift, % per year), mortality and DALY rate for each age group from 1990 to 2019 (local drift, % per year), longitudinal age-specific rate corrected for period bias (age effect), and mortality and Daly rate for each age group from 1990 to 2019 (local drift, % per year). And period/cohort relative risk (period/cohort effect).ResultsFrom 1990 to 2019, global age-standardized cardiovascular disease (CVD) mortality rates attributable to low dietary fiber intake decreased by 2.37% per year, while disability-adjusted life years (DALYs) fell by 2.48% annually. Decreases were observed across all sociodemographic index regions, with fastest declines in high and high-middle SDI areas. CVD mortality and DALY rates attributable to low fiber increased exponentially with age, peaking at 85–89 years, and were higher in men than women. Regarding period effects, mortality and DALY rates declined since 2000, reaching nadirs in 2015–2019. For birth cohort patterns, risks attributable to low fiber intake peaked among early 1900s births and subsequently fell, with more pronounced reductions over time in women.ConclusionsLow dietary fiber intake is a leading contributor to the global cardiovascular disease burden, accounting for substantial mortality and disability specifically among older adults over recent decades.

Exploring Prostate Cancer Incidence Trends and Age Change in Cancer Registration Areas of Jiangsu Province, China, 2009 to 2019.

(1) Background: Over the past few decades, Jiangsu Province, China, has witnessed a remarkable surge in the incidence of prostate cancer (PCa), accompanied by notable demographic shifts; (2) Methods: PCa data for Jiangsu Province from 2009 to 2019 were obtained from the Jiangsu Cancer Registry. We calculated crude and age-specific incidence rates (ASIRs), average age at onset, and age-specific composition ratios. Standardization was performed based on the Segi's world population. Birth cohorts (1929-2019) were analyzed to assess PCa incidence by birth year. Trend analysis was conducted using the Joinpoint Regression Model, and average annual percent changes (AAPCs) with corresponding 95% confidence interval (CI) were computed. A linear regression model was used to analyze the relationship between the average age at diagnosis and calendar years; (3) Results: The ASIRs of PCa in Jiangsu Province increased significantly, with an AAPC of 11.25% (95%CI: 10.09%, 12.42%) from 2009 to 2019. This increase was observed across all age groups, particularly among those aged 0-59 years. Birth cohort analysis revealed a rising trend with earlier birth years showing higher incidence, notably in the 1959 cohort. In rural areas, the age-standardized average age at onset of PCa decreased from 75.45 years in 2009 to 73.39 years in 2019, and the peak age group shifted from 75-79 years in 2009 to 70-74 years in 2019; (4) Conclusions: The rising incidence of PCa in Jiangsu Province, along with an increased proportion of cases in younger age groups, highlights the need for targeted interventions.

Prediction model for composite adverse pregnancy outcomes: Indonesia demographic health survey analysis

Adverse Pregnancy Outcome (APO) is the leading cause of infant mortality, particularly in low and middle-income countries. Despite no significant change in neonatal mortality rates in Indonesia over the past fifteen years, identifying the risk factors for APO can help healthcare professionals provide personalized interventions and support. This study aims to determine the determinants of APO risk in Indonesia. The cross-sectional study utilized the 2017 Indonesian Health Demographic Survey (IDHS), which included 9,752 women of reproductive age. APO, including low birth weight, early birth, and stillbirth, was the outcome of the study. The demographic characteristics and other risk factors were evaluated. To identify APO-risk-associated factors, we performed multiple logistic regression analysis. The results showed that low economic status (Adj. OR= 1.407; 1.153-1.716; p= 0.001)), living in rural areas (Adj. OR= 0.804; 0.663-0.976; p= 0.027), having a history of pregnancy or childbirth complications (Adj. OR= 4.563; 3.617-5.756; p= 0.0001), premature rupture of the membrane during pregnancy or after giving birth (Adj. OR= 1.351; 1.069-1.708; p= 0.012), antenatal visits &lt;4 times (Adj. OR= 1.603; 1.123-2.288; p= 0.009), consumption of iron supplement tablets &lt;90 days (Adj. OR= 1.275; 1.063-1.529; p= 0.009), and twin pregnancy (Adj. OR= 33.715; 18.587-61.153; p= 0.0001) significantly influenced the APO prevalence. The study concluded that APO risk is significantly impacted by poor obstetric history features, multiple births, low health service utilization, and sociodemographic factors. Early detection of these risk factors is essential for reducing neonatal death caused by APO.

Education and the Timing of Family Formation: Evidence from Quantile Regression Analysis

ABSTRACTThe relationship between educational level and the age at which women start families has been extensively researched. However, studies have primarily explored how additional schooling shifts the mean or, more broadly, only one point of the age at first union and first birth distributions. This ignores variation in the association between education and the timing of family formation, and the fact that schooling might shape behaviours of vulnerable and more privileged women differently. Using quantile regressions, this article examines heterogeneity in the relationship between education and the age at first union and first birth across the distribution of these events within 50 low‐ and middle‐income countries. It investigates whether additional schooling shifts relatively early union formation and childbearing (that is, lower parts of distributions) similarly or differently than it shifts other parts of the distributions. It finds that association between an additional year at school and the age at first union and birth is weaker in the lower than the upper parts of the distributions. Education has a relatively weak effect on the reduction of early first unions and births and plays an unequalizing role in shaping family formation within countries. These findings are key to understanding persistently high levels of early marriage and pregnancy, despite the expansion of education.

Short-Term Neonatal Morbidities Associated with Early Term Births

Short-Term Neonatal Morbidities Associated with Early Term Births

Metabolomic Signatures as Potential Mediators between Ambient Fine Particulate Matter and Early Births in the Atlanta African American Maternal-Child Cohort

Metabolomic Signatures as Potential Mediators between Ambient Fine Particulate Matter and Early Births in the Atlanta African American Maternal-Child Cohort

Early life metal mixture exposure and birth outcomes - PIPA Project - Brazil

Early life metal mixture exposure and birth outcomes - PIPA Project - Brazil

Mapping the maternal metabolome and internal exposome to identify biomarkers of preterm and early term birth among African Americans

Mapping the maternal metabolome and internal exposome to identify biomarkers of preterm and early term birth among African Americans

Air pollution exposure and the maternal gut microbiome in early pregnancy: Implications for risk of early birth among African Americans

Air pollution exposure and the maternal gut microbiome in early pregnancy: Implications for risk of early birth among African Americans

Reducing child marriage in sub-Saharan Africa: Evaluating the joint potential of protective marriage and education policies

The public health burden associated with child marriage is undeniable. To combat this practice, there has been widespread passage of national minimum-age-of-marriage policies. However, evidence on their effectiveness has been mixed. Policies that guarantee access to education may also be needed to create a viable alternative to marriage. Prior studies have not considered the complementary influence of tuition-free education policies, nor tested for potential synergy between the two policies. We conducted a natural experiment to better quantify the relationship between protective marriage laws (those that establish a minimum age of 18 even with parental consent) and tuition free secondary education on the frequency of child marriage and births, considering both the individual and synergistic contribution of the two policies. We linked globally-comparable data on national policies to multiple rounds of DHS data (2003–2021) from 16 countries in sub-Saharan Africa. We used two-way fixed effects (TWFE) models to evaluate the relationship between policy change and child marriage among women aged 15–26. Neither policy alone had a statistically significant effect on either child marriage or early fertility. However, the interaction terms were significant, suggesting that implementing both a new protective marriage policy and free tuition during the observation period had a significant impact on lowering early marriage and births. This impact was more pronounced for outcomes under age 15 as compared to those under age 18. This study provides a better understanding of what policies matter to effectively reduce child marriage. While it is possible that each policy marginally contributes to a reduction in child marriage, our evidence suggests that both protective marriage policies and tuition-fee secondary school are needed to have a meaningful impact.