Population-based Birth Cohort Study Research Articles

Effect of Needle Exchange Program on Maternal Hepatitis C Virus Prevalence.

This study aimed to quantify the prevalence of maternal hepatitis C virus (HCV) before and after implementation of the needle exchange program (NEP) in Scioto County, Ohio. We conducted a population-based retrospective cohort study of all live births in Ohio (2006-2015). Frequency of maternal HCV was compared before (2006-2011) and after (2012-2015) the implementation of an NEP (2011) in Portsmouth, Ohio (Scioto County). Trends in maternal HCV prevalence in neighboring counties both physically adjacent and regional to Scioto County were also evaluated before and after NEP implementation. During the study period, there were 7,069 reported cases of maternal HCV infection at the time of delivery among 1,463,506 (0.5%) live births in Ohio. The rate of maternal HCV infection increased 137% in Scioto County between 2006 and 2011. After initiation of the NEP in Portsmouth, Ohio, in 2011, the rate of increase in the following 4 years (2012-2015) was 12%. The rate of increase in maternal HCV declined precipitously in counties physically adjacent to Scioto County, whereas regional counties continued to have substantial increases in maternal HCV. Rate of maternal HCV infection increased 137% versus 12% (rate difference: 125%) between pre- and post-NEP implementation time periods in Scioto County.

Placental transporter-mediated drug interactions and offspring congenital anomalies.

AimsP‐glycoprotein (P‐gp) and breast cancer resistance protein (BCRP) are efflux transporters expressed in the placenta, limiting their substrates from reaching the foetus. Our aim was to investigate if concomitant prenatal exposure to several substrates or inhibitors of these transporters increases the risk of congenital anomalies.MethodsThe national Drugs and Pregnancy database, years 1996–2014, was utilized in this population‐based birth cohort study. In the database, the Medical Birth Register, the Register on Induced Abortions, the Malformation register and the Register on Reimbursed Drug Purchases have been linked. The University of Washington Metabolism and Transport Drug Interaction Database was used to identify substrates and inhibitors of P‐gp and BCRP. We included singleton pregnancies ending in birth or elective termination of pregnancy due to foetal anomaly. Known teratogens were excluded. We identified women exposed 1 month before pregnancy or during the first trimester to P‐gp/BCRP polytherapy (n = 21 186); P‐gp/breast cancer resistance protein monotherapy (n = 97 906); non‐P‐gp/BCRP polytherapy (n = 78 636); and unexposed (n = 728 870). We investigated the association between the exposure groups and major congenital anomalies using logistic regression adjusting for several confounders.ResultsThe prevalence of congenital anomalies was higher in the P‐gp/BCRP polytherapy group (5.5%) compared to the P‐gp/BCRP monotherapy (4.7%, OR 1.13; 95% CI 1.05–1.21), the non‐P‐gp/BCRP polytherapy (4.9%, OR 1.14; 95% CI 1.06–1.22), and to the unexposed groups (4.2%, OR 1.23; 95% CI 1.15–1.31).ConclusionThe results suggest a role of placental transporter‐mediated drug interactions in teratogenesis.

Predictors of Early Introduction of Core and Discretionary Foods in Australian Infants-Results from HSHK Birth Cohort Study.

Early introduction of complementary foods can have a detrimental impact on children’s long-term health. This study examined the timing and determinants of early introduction of core and discretionary foods among infants in Sydney, Australia. Mothers (n = 1035) from an ongoing population-based birth cohort study were interviewed at 8, 17, 34 and 52 weeks postpartum. The outcome was ‘age at which particular core and discretionary food items were first introduced’. Multivariable logistic regression models were used to investigate family and infant-related determinants of early introduction of core (<17 weeks of age) and discretionary foods (<52 weeks of age). Of the 934 mother-infant dyads interviewed, 12% (n = 113) of infants were introduced core foods before 17 weeks of age (median: 22). Mothers working part-time (adjusted odds ratio (OR): 3.42, 95% confidence interval (CI): 1.54–7.62) and those exclusively formula-feeding their babies at four-weeks postpartum (adjusted OR 3.26, 95% CI: 1.99–5.33) were most likely to introduce core foods early. Ninety-five percent (n = 858) of infants were introduced discretionary foods before 52 weeks of age (median: 28). Low socio-economic status was significantly associated with early introduction of discretionary foods (adjusted OR: 3.72, 95% CI: 1.17–11.78). Compliance with infant feeding guidelines related to core foods was better; however, discretionary foods were introduced early in most infants.

Association between prenatal maternal infection and disordered eating behaviours in adolescence: A UK population-based prospective birth cohort study

Association between prenatal maternal infection and disordered eating behaviours in adolescence: A UK population-based prospective birth cohort study

1135: Increasing rate of no prenatal care in pregnancies complicated by Hepatitis C in the US

Despite efforts to expand access to prenatal care under the umbrella of Healthy People 2020, certain populations of women continue to be at risk for not accessing prenatal care. We aim to describe the relationship between no prenatal care (PNC) with pregnancies complicated by Hepatitis C in the US. Population-based retrospective cohort study of all US live births from 2012-2016 using vital statistic records. Quantity of PNC is recorded on the US certificate of live birth as “total number of prenatal visits” for the pregnancy. No PNC was defined as zero prenatal visits, and inadequate PNC defined as < 50% of recommended number of visits adjusted for gestational age at birth using the Kessner Index. Presence of Hepatitis C (Hep C) is also recorded on the US birth certificate. Frequency of no PNC was calculated per year among all live births (20-42 wks) and compared to births to mothers with Hep C. The rate of no PNC overall during the study period was 1.47%, increasing from 1.36% in 2012 to 1.58% in 2016, p< 0.001. Of the 19,547,691 births analyzed, 0.29% mothers had Hep C. Among births to mothers with Hep C, the rate of no PNC rose from 1.21% to 6.31%, greater than 5-fold increase, p< 0.001. The largest annual increase of no PNC with Hep C was in 2014 with a 3.5-fold increase over 1 year, an increase not similarly observed in the overall population (figure). Rates of inadequate prenatal care similarly increased in women with Hep C during the study period. The overall rate of no PNC in the US rose slightly from 2012-2016. However, the rate increased more dramatically among women with Hep C. This may be related to higher rates of maternal substance use disorders among women with Hep C, particularly intravenous drug use. Mothers’ perceptions of negative legal ramifications of having illicit drug use identified during pregnancy may lead to avoidance of prenatal care. Public health initiatives should focus on improving access to care for women with high-risk pregnancy conditions, especially as rates of substance abuse disorders and Hepatitis C are on the risk in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

405: Racial disparity in rate of rise of no prenatal care in the US

There is an increasing number of women who receive no prenatal care (PNC) during pregnancy in the US in recent years. We aim to assess whether racial differences in care explain some of this rise. Population-based retrospective cohort study of all US live births between 20-42 weeks gestation using vital statistics birth records. Live births to mothers who received no PNC were identified as documented on the US certificate of live birth. Rates of no PNC were calculated for each year of the study period (2012-2016) and compared between mothers of non-Hispanic (NH) white and NH black race. Multivariate logistic regression estimated the relative risk of race on no PNC with adjustment for coexisting risk factors. There were 19,547,691 live births analyzed. The rate of no PNC during the study period was 1.47%, and increased from 1.36% in 2012 to 1.58% in 2016, p< 0.001. The rate of no PNC doubled in white women from 0.82% to 1.61% during the study period, p< 0.001, while the rate decreased slightly in black women (2.6% to 2.12%), p< 0.001. However, NH black women had a two-fold increased risk of having no PNC compared to NH white women overall (2.27% vs 0.88%), adjRR 2.07 (95% CI 2.04-2.10), even after adjustment for confounding risks. The racial disparity in no PNC decreased over the study period adjRR 2.49, (CI 2.43-2.56) in 2012 vs adjRR 1.27 (CI 1.19-1.34) in 2016, but this was attributed mostly to an increase in no PNC in NH white rather than the decrease in no PNC in black women. We identified a racial disparity in the rate of no prenatal care in the US in recent years, with a nearly 2-fold increased risk in NH black women compared to white, even after adjustment for coexisting risks. However, the frequency of no PNC among NH black women decreased slightly over the study period, but doubled in NH white women. Public health initiative should focus on educating reproductive age women on the importance of prenatal care and improving access to care in effort to reduce the racial disparity in adverse birth outcomes in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Implementation of prevention of mother-to-child transmission (PMTCT) in South Africa: outcomes from a population-based birth cohort study in Paarl, Western Cape

ObjectivesThe coverage of prevention of mother-to-child transmission (PMTCT) services in South Africa is variable. Identifying gaps in the implementation of these services is necessary to isolate steps needed to further...

Second-generation antipsychotics and pregnancy complications

PurposeTo study if second-generation antipsychotic (S-GA) use during pregnancy is associated with an increased risk of pregnancy and neonatal complications.MethodsA population-based birth cohort study using national register data extracted from the “Drugs and Pregnancy” database in Finland, years 1996–2016. The sampling frame included 1,181,090 pregnant women and their singleton births. Women were categorized into three groups: exposed to S-GAs during pregnancy (n = 4225), exposed to first-generation antipsychotics (F-GAs) during pregnancy (n = 1576), and unexposed (no purchases of S-GAs or F-GAs during pregnancy, n = 21,125). Pregnancy outcomes in S-GA users were compared with those in the two comparison groups using multiple logistic regression models.ResultsComparing S-GA users with unexposed ones, the risk was increased for gestational diabetes (adjusted odds ratio, OR 1.43; 95% CI 1.25–1.65), cesarean section (OR 1.35; 95% CI 1.18–1.53), being born large for gestational age (LGA) (OR 1.57; 95% CI 1.14–2.16), and preterm birth (OR 1.29; 95% CI 1.03–1.62). The risk for these outcomes increased further with continuous S-GA use. Infants in the S-GA group were also more likely to suffer from neonatal complications. Comparing S-GA users with the F-GA group, the risk of cesarean section and LGA was higher (OR 1.25, 95% CI 1.03–1.51; and OR 1.89, 95% CI 1.20–2.99, respectively). Neonatal complications did not differ between the S-GA and F-GA groups.ConclusionsPrenatal exposure to S-GAs is associated with an increased risk of pregnancy complications related to impaired glucose metabolism. Neonatal problems are common and occur similarly in S-GA and F-GA users.

Eating Behavior Traits, Weight Loss Attempts, and Vertebral Dimensions Among the General Northern Finnish Population.

A population-based birth cohort study. To evaluate the associations of eating behavior traits and weight loss attempts with vertebral size among the general Northern Finnish population. Vertebral fragility fractures are a typical manifestation of osteoporosis, and small vertebral dimensions are a well-established risk factor for vertebral fracturing. Previous studies have associated cognitive eating restraint and diet-induced weight loss with deteriorated bone quality at various skeletal sites, but data on vertebral geometry are lacking. This study of 1338 middle-aged Northern Finns evaluated the associations of eating behavior traits (flexible and rigid cognitive restraint of eating, uncontrolled eating, emotional eating; assessed by the Three-Factor Eating Questionnaire-18) and weight loss attempts (assessed by a separate questionnaire item) with magnetic resonance imaging-derived vertebral cross-sectional area (CSA). Sex-stratified linear regression models were used to analyze the data, taking body mass index, leisure-time physical activity, general diet, smoking, and socioeconomic status as potential confounders. Women with rigid or rigid-and-flexible cognitive eating restraints had 3.2% to 3.4% smaller vertebral CSA than those with no cognitive restraint (P ≤ 0.05). Similarly, the women who reported multiple weight loss attempts in adulthood and midlife had 3.5% smaller vertebral size than those who did not (P = 0.03). Other consistent findings were not obtained from either sex. Rigid cognitive eating restraint and multiple weight loss attempts predict small vertebral size and thus decreased spinal health among middle-aged women, but not among men. Future longitudinal studies should confirm these findings. 3.

Parental mental vulnerability and use of healthcare services in infants

Abstract Background Parental mental illness has been associated with a number of consequences for the health and use of healthcare services of the child. However, most research has focused on maternal depression. Research examining the impact of paternal mental vulnerability (MV) as well as different degrees of MV are needed to plan interventions. Therefore, the aim of this study was to examine the association between different categories of individual and combined parental MV and the child’s use of healthcare services the first year of life. Methods A population-based birth cohort study was conducted including all Danish children born from 2000-2016 using the Danish national registers. Exposure was parental MV of three categories according to the degree of MV: Group 1 “minor MV” with mental related contacts to primary healthcare and/or prescribed psychopharmaceuticals, group 2 “moderate MV” and group 3 “severe MV” both with contacts to psychiatric hospital. Outcome was contacts to GP the first year of life expressed as incidence-rate ratios (IRR) using Poission’s regression analyses. Results The analyses included 952,709 children. 21% of the mothers and 11% of the fathers were in the MV groups. Parental MV (any parent, any MV-group) was associated with an increased risk of GP contacts daytime and out-of-hour contacts. If both parents were classified as group 1 MV, IRR were 1.21 (CI95 1.20-1.22). IRR were 1.18 (1.17-1.18) resp. IRR 1.05 (1.04-1.06) if only the mother resp. father were in MV group 1. The same pattern were seen for out-of-hour contacts; IRR 1.28 (1.26-1.31) for both parents in group 1 and IRR 1.19 (1.18-1.20) resp. IRR 1.09 (1.08-1.11) for the mother resp. father. Conclusions Maternal and paternal MV were associated with an increased risk of GP contacts daytime and out-of-hour contacts although maternal MV had the highest risk. Even minor MV had an impact on healthcare contacts and the risk increased further if both parents were classified as minor MV. Key messages Both maternal and paternal mental vulnerability has an impact on the child’s healthcare contacts. Our results indicate the need for a focus also on minor mental vulnerability in the planning of interventions.

Prevalence and determinants of mental health problems among children in Mongolia: A population-based birth cohort

BackgroundIn Mongolia, more than one-third of adolescents and children may experience mental health problems, but high-quality population-based data are lacking. In this study, the authors investigated the prevalence and the correlates of mental health conditions among school-age children. MethodsThe authors conducted a population-based birth cohort study with data collection between 2013 and 2016 in rural Bulgan, Mongolia. Mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ-Mongolia). Protective and risk factors for mental health problems in six-year-old children were assessed using logistic regression with adjustment for potential confounders. FindingsA total of 1064 mother/child pairs participated, with a follow-up rate of 96.2%. Overall, 9.5% of children had abnormal emotional and behavioral scores (SDQ ≥17), rising to 20.1% when combined with borderline scores (SDQ ≥14). In the baseline analysis, smoking in family members (adjusted odds ratio [aOR] 1.58, 95% CI 1.05–2.38) was positively linked to child mental health problems. In the follow-up analyses when children were aged 6 year, maternal depression symptoms (aOR 1.66, 95% CI 1.13–2.44), smoking of family members (aOR 1.54, 95% CI 1.06–2.21), and maternal alcohol consumption (aOR 1.55, 95% CI 1.02–2·33) were associated with greater incidence of mental health problems, while storytelling (aOR 0.65, 95% CI 0.42–0.99) and hospital visits (aOR 0.56, 95% CI 0.38–0.79) demonstrated protective associations. InterpretationMarkers of low socioeconomic status were the most influential risk factors for children's mental health problems. Effective intervention toward family members' smoking, maternal depression and alcohol consumption, and increased attention to potentially protective factors, including storytelling and access to appropriate hospital care, may better support the mental health of children in Mongolia.

Dietary Inflammatory Index of mothers during pregnancy and ADHD symptoms in the child at preschool age

TPS 771: Diet and lifestyle, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background/Aim: Inflammation is one potential pathway underlying the association of maternal diet during pregnancy with ADHD symptoms in the child. However, no previous study has quantified the proinflammatory potential of maternal diet. Thus, we evaluated the association between the dietary inflammatory index (DII) of the mothers during pregnancy and ADHD symptoms in their children at the age of 4 years in two Mediterranean regions (Spain and Greece). Methods: The study population consisted the population-based birth cohort studies- INMA (Environment and Childhood) in Spain and RHEA study in Crete (Greece). A total 2097 children and their mothers participated. The DII of maternal diet was calculated using a previously validated method based on dietary data collected during pregnancy (12th and/or 32nd week of gestation) through validated food frequency questionnaires. ADHD symptoms were assessed by ADHD-DSM-IV in INMA cohort and by ADHDT test in RHEA cohort, with questionnaires filled-out by teachers. The association between maternal DII and ADHD was analysed using multivariable-adjusted zero-inflated negative binomial regression models. Results: The DII score was higher (i.e., pro-inflamatory), on average, in the RHEA cohort (DII=2.37 vs. the INMA cohort DII=-1.34). In models adjusted for children´s age, region, gestational diabetes, parity and maternal covariates, we observed no association between maternal DII score and inattention symptoms in their children. We observed an inverse association of maternal DII with hyperactivity (IRR [CI 95%] = 0.80 [0.67-0.94]), as well as with total ADHD (IRR [CI 95%] = 0.84 [0.74-0.9]) but these associations were seen only in boys in Spanish cohort. Conclusions: Findings from this study do not suggest an association between a more proinflammatory maternal diet during pregnant and ADHD symptomatology. In fact, we found a region- and sex-specific inverse association in boys of the Spanish cohort that requires replication.

Influence of interpregnancy interval on uterine rupture

Objective This study aims to assess the independent influence of interpregnancy interval (IPI) on uterine rupture using a population-based cohort of all Ohio births, regardless of prior cesarean (PCS) or trial of labor (TOL) status. Study design Population-based retrospective cohort study of all live births in Ohio (2006–2012). Frequency of uterine rupture was quantified and stratified by number of prior cesarean deliveries and IPI. The relative and adjusted risk of IPI on uterine rupture was calculated using multivariate logistic regression. Results Of 1,034,522 live births recorded during the 7-year study period, 249 cases of uterine rupture were identified for analysis. Two-thirds of uterine rupture cases (n = 158) occurred in women with one or more PCS and one-third (n = 91) had no prior cesarean. IPI 24–59 months had the lowest frequency of uterine rupture and was used as the referent group. IPI 12–23 and IPI ≥ 60 months were not significantly associated with risk of uterine rupture, p = .847, .540 respectively. In women with PCS, IPI < 12 months was associated with greater than two-fold increased risk of uterine rupture (aRR 2.4, CI 1.5–3.8). No association between IPI < 12 months and uterine rupture was observed in women with no PCS, p = .696. Conclusion IPI < 12 months is independently associated with uterine rupture in women with prior cesarean, but does not appear to influence risk in women with an unscarred uterus.

Respiratory syncytial virus infections in children 0–24 months of age in the community

ObjectivesRespiratory syncytial virus (RSV) is a major cause of hospitalization in young children, but there are little data on RSV infections in early childhood in the community. We conducted a prospective population-based birth-cohort study to determine the rates and characteristics of RSV infections in young children. MethodsWe followed 923 children for acute respiratory infections (ARIs) from birth to age 24 months with daily diaries and study clinic visits. Nasal swab samples were obtained at the onset of ARIs and analyzed for RSV by RT-PCR and antigen tests. The rates of RSV infections and associated outcomes were estimated. ResultsRSV was detected in 289 (6%) of 4728 ARIs with a nasal sample. The mean estimated annual rate of RSV infections was 37 (95% confidence interval [CI], 35–38) per 100 children at age 0–24 months. For RSV-associated outcomes, the estimated annual rates per 100 children were 34 (95% CI, 32–37) physician visits, 16 (95% CI, 15–17) antibiotic treatments, 12 (95% CI, 11–13) acute otitis media, and 6 (95% CI, 4–7) wheezing illnesses. The prevalence of RSV was 0.6% in asymptomatic children. ConclusionsRSV infections impose a high burden of disease in healthy young children in the community.

Early birth is a key factor in educational disadvantage of twins: A data linkage study.

To assess educational outcomes of twins and quantify the degree this is mediated by gestational age and other perinatal factors. We conducted a population-based record-linkage cohort study of all live births ≥24weeks gestation in New South Wales, Australia with a corresponding standardised school test result for grade 3 in 2008-2014. The primary outcome was whether a child met the National Minimum Standard (NMS) cut-off in literacy and numeracy domains. Robust multivariable Poisson models were used to obtain adjusted relative risks (aRRs), and mediation analysis conducted to assess contributing factors on the causal pathway. Of 351791 liveborn infants, 10365 (2.9%) were twins. After adjusting for maternal covariates and compared with singletons, twins had an increased risk of not meeting the NMS for all five literacy and numeracy domains (aRR 1.27-1.45, P<.001). Gestational age alone mediated up to 73% of aRRs and small for gestational age further attenuated these effects with only minimal risk remaining after adjusting for all mediators (aRR 0.94-1.07). Almost all of the educational disadvantage experienced by twins, compared with singletons, is attributable to the risk associated with shorter gestational age, and partly by poor foetal growth. These findings support efforts to prolong gestation of twin pregnancies.

The Role of MIR9-2 in Shared Susceptibility of Psychiatric Disorders during Childhood: A Population-Based Birth Cohort Study.

Background: It has been suggested that microRNAs (miRNAs; short non-protein-coding RNA molecules that mediate post-transcriptional regulation), including mir-9 and mir-34 families, are important for brain development. Current data suggest that mir-9 and mir-34 may have shared effects across psychiatric disorders. This study aims to explore the role of genetic polymorphisms in the MIR9-2 (rs4916723) and MIR34B/C (rs4938723) genes on the susceptibility of psychiatric disorders in children from the 2004 Pelotas Birth Cohort. Methods: Psychiatric disorders were assessed in 3585 individuals using Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), criteria through the application of standard semi-structured interviews (using the Development and Well-Being Assessment, DAWBA) at the six-years-of-age follow-up. The outcome was defined as the presence of any mental disorder. We also considered two broad groups of internalizing and externalizing disorders to further investigate the role of these variants in mental health. Results: We observed an association between rs4916723 (MIR9-2) and the presence of any psychiatric disorder (odds ratios (OR) = 0.820; 95% CI = 0.7130–0.944; p = 0.006) and a suggestive effect on internalizing disorders (OR = 0.830; 95% CI = 0.698–0.987; p = 0.035). rs4938723 (MIR34B/C) was not associated with any evaluated outcome. Conclusion: The study suggests that MIR9-2 may have an important role on a broad susceptibility for psychiatric disorders and may be important mainly for internalization problems.

Perinatal depression among mothers in a South African birth cohort study: Trajectories from pregnancy to 18 months postpartum

BackgroundPerinatal depression affects 21–50% of women in South Africa and poses significant health risks to mothers and children. Trajectories of depressive symptoms change over time and have not been well characterized during the perinatal period in low and middle-income countries. MethodsData from women enrolled in a population-based birth cohort study in Paarl, South Africa with at least 3 depression measures from pregnancy through 18 months postpartum (N = 831) were analyzed. Depressive symptoms were measured continuously using the Edinburgh Postnatal Depression Scale (EPDS). Group-based trajectory models were used to estimate trajectories of depressive symptoms during the perinatal period and multinomial multivariable models to identify predictors of trajectory group membership. ResultsFive distinct trajectory patterns of depressive symptoms were identified: moderate levels of depressive symptoms during pregnancy but minimal postpartum (3.5%), minimal levels during pregnancy and increasing postpartum (3.7%), unstable levels peaking at 12 months postpartum (6.6%), mild levels with slight decrease postpartum (82.9%), and severe levels during pregnancy and postpartum (3.1%). Membership in the chronic severe symptom group was associated with stressful life events, sexual intimate partner violence and tobacco use. LimitationsModeling limitations prevented determining how changes in psychosocial predictors over time may influence depressive symptom trajectories. ConclusionsMild to severe depressive symptoms during pregnancy/postpartum were common among this South African cohort. Interventions to treat women with severe chronic depressive symptoms with co-occurring psychosocial issues are urgently needed.

Television viewing and child cognition in a longitudinal birth cohort in Singapore: the role of maternal factors

BackgroundAlthough infant media exposure has received attention for its implications on child development, upstream risk factors contributing to media exposure have rarely been explored. The study aim was to examine the relationship between maternal risk factors, infant television (TV) viewing, and later child cognition.MethodsWe used a prospective population-based birth cohort study, Growing Up in Singapore Towards healthy Outcomes (GUSTO), with 1247 pregnant mothers recruited in their first trimester. We first explored the relationship of infant TV exposure at 12 months and the composite IQ score at 4.5 years, as measured by the Kaufman Brief Intelligence Test, Second Edition (KBIT-2). Multivariable linear regressions were adjusted for maternal education, maternal mental health, child variables, birth parameters, and other relevant confounders. We then examined the associations of maternal risk factors with the amount of daily TV viewing of 12-month-old infants. Path analysis followed, to test a conceptual model designed a priori to test our hypotheses.ResultsThe average amount of TV viewing at 12 months was 2.0 h/day (SD 1.9). TV viewing in hours per day was a significant exposure variable for composite IQ (ß = − 1.55; 95% CI: − 2.81 to − 0.28) and verbal IQ (ß = − 1.77; 95% CI: − 3.22 to − 0.32) at 4.5 years. Our path analysis demonstrated that lower maternal education and worse maternal mood (standardized ß = − 0.27 and 0.14, respectively, p < 0.01 for both variables) were both risk factors for more media exposure. This path analysis also showed that maternal mood and infant TV strongly mediated the relationship between maternal education and child cognition, with an exceptional model fit (CFI > 0.99, AIC 15249.82, RMSEA < 0.001).ConclusionInfant TV exposure has a negative association with later cognition. Lower maternal education and suboptimal maternal mental health are risk factors for greater television viewing. Paediatricians have a role in considering and addressing early risks that may encourage television viewing.

Epidemiology of common otologic surgical procedures in pediatric patients: A population-based birth cohort study

ObjectiveIt is generally recognized the most common pediatric otologic surgical procedure is ventilation tube insertion (VTI). Tympanoplasty and mastoidectomy are more frequently performed on adults. In this study we examined the incidence and age distribution of these procedures by use of a population-based birth cohort design, in order to provide an overall view of the role of these procedures in the pediatric population. Materials and methodsWe used the national health insurance research database in Taiwan. We retrieved data on all patients born in the years 2000 and 2001, subsequently underwent VTI, tympanoplasty or mastoidectomy from 2000 to 2013. The incidence and age distribution of these procedures were analyzed. ResultsThe cumulative incidence of VTI, tympanoplasty, and mastoidectomy was 0.41%, 0.02% and 0.025%, respectively. VTI were more often performed on children 4 or 5 years of age. Tympanoplasties are frequently done on children older than 5, and 30.7% of them had earlier VTI. The time interval from VTI to tympanoplasty was 5.18 ± 2.27 years (mean ± SD). Mastoidectomies are more often performed on children from 2 to 9 years of age. ConclusionsVTI was the most frequent otologic surgery for the pediatric population, and was more often performed on children 4–5 years old. Also, tympanoplasty is more frequently performed on children older than 5, and a third of them had prior VTI. Overall, the time interval from VTI to tympanoplasty was 5.18 years. Furthermore, children with cleft palate and congenital metabolic disorder were more prone to otologic surgical procedures.

Predictive Model of Factors Associated With Maternal Intensive Care Unit Admission.

Severe maternal morbidity has increased in the United States over the past two decades by approximately 200%, to 144 cases per 10,000 delivery hospitalizations. There are limited data available to assist in identifying at-risk women before parturition. We sought to evaluate risk factors associated with maternal admission to an intensive care unit (ICU). We conducted a population-based cohort study of all live births delivered between 20 and 44 weeks of gestation in the United States during 2012-2016. Our primary objective was to identify prenatal factors associated with increased risk of maternal ICU admission to build a multivariable predictive model to estimate the association of these factors with ICU admission risk. We performed k-fold cross-validation for internal validation and then externally validated the model on a separate live birth cohort (2006-2011, n=856,255). There were 18,745,615 live births in the United States between 2012 and 2016. Among the mothers of these live newborns, 27,602 (0.15%) were admitted to the ICU in the peripartum period. Fourteen variables were selected for inclusion in the predictive model for maternal ICU admission. The predicted minimal and maximal risk for ICU admission ranged 0-25%. The receiver operating characteristic curve for these 14 variables achieved an area under the curve (AUC) of 0.81 (95% CI 0.79-0.81). External validation with a separate live birth cohort demonstrated a consistent measure of discrimination with an AUC of 0.83 (95% CI 0.82-0.84). Using a relatively high cut point of 5.0% or more predicted risk for ICU admission, achieved a positive predictive value (PPV) of only 4.0%. This model provides insight as to the cumulative effect of multiple risk factors on maternal ICU admission risk. The predictive model achieves an AUC of 0.81, discriminating women with significantly increased risk (30-fold) for ICU admission. Nonetheless, because of the low frequency of maternal ICU admission, the PPV of the model was low and therefore whether models such as ours may be beneficial in future efforts to reduce the prevalence and burden of maternal morbidity is uncertain.