Population Birth Research Articles

Customized versus population birth weight charts for identification of newborns at risk of long-term adverse cardio-metabolic and respiratory outcomes: a population-based prospective cohort study

BackgroundCustomized birth weight charts take into account physiological maternal characteristics that are known to influence fetal growth to differentiate between physiological and pathological abnormal size at birth. It is unknown whether customized birth weight charts better identify newborns at risk of long-term adverse outcomes than population birth weight charts. We aimed to examine whether birth weight classification according to customized charts is superior to population charts at identification of newborns at risk of adverse cardio-metabolic and respiratory health outcomes.MethodsIn a population-based prospective cohort study among 6052 pregnant women and their children, we measured infant catch-up growth, overweight, high blood pressure, hyperlipidemia, liver steatosis, clustering of cardio-metabolic risk factors, and asthma at age 10. Small size and large size for gestational age at birth was defined as birth weight in the lowest or highest decile, respectively, of population or customized charts. Association with birth weight classification was assessed using logistic regression models.ResultsOf the total of 605 newborns classified as small size for gestational age by population charts, 150 (24.8%) were reclassified as appropriate size for gestational age by customized charts, whereas of the total of 605 newborns classified as large size for gestational age by population charts, 129 (21.3%) cases were reclassified as appropriate size for gestational age by customized charts. Compared to newborns born appropriate size for gestational age, newborns born small size for gestational age according to customized charts had increased risks of infant catch-up growth (odds ratio (OR) 5.15 (95% confidence interval (CI) 4.22 to 6.29)), high blood pressure (OR 2.05 (95% CI 1.55 to 2.72)), and clustering of cardio-metabolic risk factors at 10 years (OR 1.66 (95% CI 1.18 to 2.34)). No associations were observed for overweight, hyperlipidemia, liver steatosis, or asthma. Newborns born large-size for gestational age according to customized charts had higher risk of catch-down-growth only (OR 3.84 (95% CI 3.22 to 4.59)). The direction and strength of the observed associations were largely similar when we used classification according to population charts.ConclusionsSmall-size-for-gestational-age newborns seem to be at risk of long-term adverse cardio-metabolic health outcomes, irrespective of the use of customized or population birth weight charts.

MODERN DEMOGRAPHIC TRENDS IN UKRAINE AS A GROUND FOR REALIZATION OF PREVENTION STRATEGIES

The data of the world statistics show that the process of demographic ageing becomes significant in modern conditions, and the number of elderly people annually increases by 3%. Owing to the global tendencies for ageing, the health care and social security systems are facing important challenges to ensure healthy lives and promote the well-being for this segment of population, provide affordable and quality medical care according to needs. Establishing modern peculiarities and trends of medical and demographic situation in Ukraine in the context of ageing population in order to substantiate medical and preventive measures. According to the data of the State Service of Statistics of Ukraine of the Ministry of Public Health for 1990-2017 the tendencies of medical and demographic characteristics of the population of Ukraine have been identified. The national medical and demographic indicators have been compared with the indicators of the countries of WHO European Region according to the data of the European Database “Health for everybody”. Using the least squares method, a forecast of the Ukrainian population and its age structure for the period up to 2030 has been made. A tendency for Ukrainian population decline by 18,1% over the course of 1990-2017, which is caused by, along with other reasons, decrease in population birth rate by 25,4% and increase in mortality by 19,8%, has been identified. A steady tendency for a decline in the proportion of children’s population up to the age 14 years inclusive for the twenty-seven-year period from 21,5% till 15,5%, and for an increase in the proportion of population aged more than 60 years from 18,3 till 22,9% has been detected. The share of people over 65 in the age structure of population has increased from 12,0% till 16,5%. The analysis of regional indicators confirms that there are unfavorable demographic tendencies in the southeastern, northeastern and central provinces, and more favorable tendencies in the provinces of the West Region of the country. The proportion of children’s population up to the age 14 years inclusive was in Ukraine close to the indicator in the countries of European Union and less than the average in WHO European Region (17,8%), the proportion of people over 65 - close to European regional indicator (15,5%) and less than the indicator in the countries of European Union (19,0%). A forecast of the population and its age structure up to 2030 has been made, according to which less than 40 million will live in Ukraine, and the proportion of persons over 65 years will reach 19,1%. The tendencies for Ukrainian population decline and changes in its age structure towards ageing make it necessary to take measures to prevent negative medical and demographic trends and provide conditions for healthy ageing, to increase the affordability and quality of medical care, including for persons of senior age groups, and improve the work of health care facilities on prophylaxis of diseases.

Trajectories of alcohol use problems based on early adolescent alcohol use: Findings from a 35 year population cohort

BackgroundEarly exposure to alcohol in adolescence is associated with a range of long term harms. Better understanding of trajectories of alcohol use from adolescence to early adulthood would help target prevention strategies to high risk groups. MethodsChristchurch (New Zealand) general population birth cohort (n = 1265). A latent trajectory model of drinking behaviour at age 14–16 was used to predict drinking outcomes at age 18–35, net of covariate factors known to be associated with substance use outcomes in this cohort. ResultsThree classes of adolescent alcohol use were identified. These were: occasional drinkers, emergent binge drinkers and increasing heavy drinkers. ConclusionsThis analysis identifies three groups of adolescent alcohol users with differing patterns of use. Emergent binge drinkers likely require public policy responses to alcohol use whereas increasing heavy drinkers are potentially able to be identified individually on the basis of patterns of alcohol use and social variables. This group may benefit from psychosocial interventions and are unlikely to respond to a broad public health approach.

Association between maternal pre-pregnancy obesity and preterm birth according to maternal age and race or ethnicity: a population-based study

The relation between maternal pre-pregnancy obesity and preterm birth is controversial and inconclusive. We aimed to clarify the association between pre-pregnancy obesity and preterm birth by maternal age and race or ethnicity in a large, multiracial, multiethnic, and diverse population in the USA. We did a population-based cohort study using nationwide birth certificate data from the US National Vital Statistics System for 2016 and 2017. We included all mothers who had a live singleton birth and who did not have pre-existing hypertension or diabetes. Pre-pregnancy obesity was defined as a pre-pregnancy BMI of at least 30 kg/m2. Preterm birth was defined as gestational age of less than 37 weeks. We used logistic regression models adjusted for maternal age, race or ethnicity, parity, education levels, smoking during pregnancy, previous history of preterm birth, marital status, infant sex, and timing of initiation of prenatal care to estimate the odds ratio (OR) of preterm birth. We included 7 141 630 singleton livebirths in our analysis, 527 637 (7·4%) of which were preterm births. 127 611 (7·5%) Hispanic mothers, 244 578 (6·6%) non-Hispanic white mothers, and 102 509 (10·4%) non-Hispanic black mothers had preterm births. In the overall population, maternal pre-pregnancy obesity was significantly associated with an increased risk of preterm birth compared with maternal pre-pregnancy healthy weight (ie, BMI of 18·5-24·9 kg/m2; adjusted OR 1·18 [95% CI 1·18-1·19]). In non-Hispanic white women, maternal obesity was inversely associated with preterm birth among those younger than 20 years (adjusted OR 0·92 [95% CI 0·88-0·97]), but positively associated with preterm birth among those aged 20 years or older (1·04 [1·01-1·06], 1·20 [1·18-1·23], 1·34 [1·31-1·37], 1·40 [1·36-1·43], and 1·39 [1·31-1·46] among those aged 20-24 years, 25-29 years, 30-34 years, 35-39 years, and ≥40 years, respectively). In Hispanic women, maternal obesity was not associated with preterm birth among those younger than 20 years (0·98 [0·93-1·04]), but positively associated with preterm birth among those aged 20 years or older (1·06 [1·03-1·09], 1·21 [1·17-1·24], 1·32 [1·28-1·36], 1·38 [1·33-1·43], and 1·30 [1·22-1·40] among those aged 20-24 years, 25-29 years, 30-34 years, 35-39 years, and ≥40 years, respectively). In non-Hispanic black women, maternal obesity was inversely associated with preterm birth among those younger than 30 years (0·76 [0·71-0·81] in those <20 years, 0·83 [0·80-0·86] in those aged 20-24 years, and 0·98 [0·95-1·01] among those aged 25-29 years), but positively associated with preterm birth among those aged 30 years or older (1·15 [1·11-1·19], 1·26 [1·20-1·32], and 1·29 [1·18-1·42] among those aged 30-34 years, 35-39 years, and ≥40 years, respectively). Maternal pre-pregnancy obesity is significantly associated with the risk of preterm birth in the general population, but the risk differs according to maternal age and race or ethnicity. Future investigation is warranted to understand the underlying mechanisms. US National Institutes of Health.

The Perinatal Condition Around Birth and Cardiovascular Risk Factors in the Japanese General Population: The Suita Study.

Aim: To investigate the relationship between perinatal condition around birth and cardiovascular risk in later life.Methods: Retrospective data were examined from 1241 city dwellers (521 men, 720 women; age 41–69 years) who had undergone medical examination at a single institution including blood tests and physical measurements from 2007 to 2008. The questionnaire was conducted to determine how perinatal factors affect their lives later. We also selected and studied a total of 28 individuals (12 men and 16 women) specifically about the conformity rate of the breastfeeding method between participants' memories and what was written in the maternal and child health handbooks.Results: The conformity rate of the breastfeeding method between a self-questionnaire and his/her maternal and child health handbook was well correlated (r = 0.73; p < 0.025). Among the data in women who were born at home, HbA1C levels (5.36 ± 0.03 vs. 5.25 ± 0.05 mg/dL, p = 0.03) and low-density lipoprotein cholesterol (136.0 ± 1.4 vs. 129.3 ± 2.5 mg/dL, p = 0.04) were higher than women who were born at the hospital. Women raised by formula showed higher low-density lipoprotein cholesterol levels than women fed breast milk or a mixture of breast milk and formula (150.2 ± 4.8 vs. 138.7 ± 3.7, 142.5 ± 2.6 mg/dL, p = 0.04). Fasting blood glucose levels at an adult time in men and women born through breech presentation were higher than those by the cephalic presentation (123.2 ± 7.8 vs. 106.8 ± 1.2 mg/dL, p = 0.03).Conclusion: The study proposed that some perinatal conditions around birth such as delivery place, presenting part, and lactation affected especially Japanese women's cardiovascular risks between ages 41 and 69 years.

Using population data to understand the epidemiology and risk factors for diabetic ketoacidosis in Australian children with type 1 diabetes

Children with type 1 diabetes (T1D) are at risk of diabetic ketoacidosis (DKA) at T1D diagnosis and/or subsequently. The objective is to determine the incidence and prevalence of T1D by the presence of DKA and identify the characteristics of subsequent DKA episodes. The study population included all children aged <15 years with T1D during a hospital/day-stay admission in New South Wales, Australia, from 1 January 2001 to 31 December 2013. T1D and DKA were identified using International Classification of Diseases Australian Modification codes. Data sources included routinely collected longitudinally linked population hospitalization and birth records. Chi-squared analyses, logistic, and multinomial regression were used to determine the association between child characteristics and admissions with and without DKA. The point prevalence of T1D among 0-14-year olds on 31 December 2013 was 144.2 per 100 000. For children aged 0-12 years, the incidence of T1D was 16.3 per 100 000 child-years. One-third had DKA at T1D diagnosis and were more likely to be readmitted with DKA than those without DKA at T1D diagnosis. Children with more than one readmission for DKA were more likely to be female, reside in an inner regional area or an area of socioeconomic disadvantage, and be Australian-born. Among all hospitalizations of children with T1D, those with DKA were more likely to be aged 10-14 years, require intensive care, have longer length of stay, and admitted outside school days. Routinely collected administrative health data are a reliable source to monitor incidence and health service use of childhood T1D. Children at risk of repeated DKA, particularly females, adolescents, and those from inner regional or socioeconomically disadvantaged areas, should be targeted during education and follow-up.

Large-scale functional LIPA variant characterization to improve birth prevalence estimates of lysosomal acid lipase deficiency.

Lysosomal acid lipase (LAL) deficiency is an autosomal recessive disorder caused by LIPA gene mutations that disrupt LAL activity. We performed in vitro functional testing of 149 LIPA variants to increase the understanding of the variant effects on LAL deficiency and to improve disease prevalence estimates. Chosen variants had been reported in literature or population databases. Functional testing was done by plasmid transient transfection and LAL activity assessment. We assembled a set of 165 published LAL deficient patient genotypes to evaluate this assay's effectiveness to recapitulate genotype/phenotype relationships. Rapidly progressive LAL deficient patients showed negligible enzymatic activity (<1%), whereas patients with childhood/adult LAL deficiency typically have 1–7% average activity. We benchmarked six in silico variant effect prediction algorithms with these functional data. PolyPhen‐2 was shown to have a superior area under the receiver operating curve performance. We used functional data along with Genome Aggregation Database (gnomAD) allele frequencies to estimate LAL deficiency birth prevalence, yielding a range of 3.45–5.97 cases per million births in European‐ancestry populations. The low estimate only considers functionally assayed variants in gnomAD. The high estimate computes allele frequencies for variants absent in gnomAD, and uses in silico scores for unassayed variants. Prevalence estimates are lower than previously published, underscoring LAL deficiency's rarity.

Статистические подходы к анализу и моделированию сезонности в демографических данных

Согласно майскому указу Президента (2018 г.), в число национальных целей и стратегических задач развития РФ на период до 2024 г. входят «обеспечение устойчивого естественного роста численности населения РФ и повышение ожидаемой продолжительности жизни до 78 лет». Возросшая необходимость мониторинга текущей демографической ситуации, изучение структуры демографических показателей, пристальное внимание научного сообщества к реализации национальных целей обусловили выбор темы настоящего исследования.&#x0D; В работе исследовались проблемы моделирования сезонности демографических показателей РФ (числа рождений, числа умерших, младенческой смертности, числа заключенных браков) по ежемесячным данным Росстата за период 2007-2018 гг. Зарубежные исследования показали, что, наряду с традиционными демографическими методами, ARIMA-модели дают хорошие результаты при прогнозировании демографических показателей (численности населения, уровня рождаемости и смертности, продолжительности жизни населения). Использование статистического подхода на основе SARIMA-моделей в данной работе позволило получить адекватные модели с хорошими статистическими и прогностическими свойствами. Стационарность процессов с учетом сезонности анализировали на основе HEGY-теста. Исследуемые в работе показатели имели ряд особенностей, которые были учтены при моделировании. Ряды числа рождений и числа умерших имели второй и первый порядки интегрируемости соответственно и содержали детерминированную сезонность, ряд числа заключенных браков имел первый порядок обычной и сезонной интегрируемости, ряд младенческой смертности не содержал сезонность, что было подтверждено на основе анализа автокорреляционной функции и периодограммы. Для анализируемых показателей в работе были построены точечные и интервальные оценки прогноза на 2019 г. Для сравнения качества прогнозирования SARIMA-моделей в работе были оценены также сезонные модели Хольта-Уинтерса.

1701-P: Genome-Wide Association Study Identifies Novel Potential Associations with Birth Weight in a Southwestern American Indian Population

Epidemiologic studies in many populations have shown that birth weight is associated with risk of type 2 diabetes (T2D) in adulthood. In a Southwestern American Indian population, lower and higher birth weight groups are at higher risk for T2D than those with normal birth weight. We performed a genome-wide association study (GWAS) of birth weight in 3700 Southwestern American Indians (2037 female; 1663 male). 496,190 SNPs (allele frequency&amp;gt;1%) were directly genotyped using an Axiom array designed to capture common variation in this community (Affymetrix; Santa Clara, CA). Birth weight was ascertained from Arizona state and medical records. T2D was determined according to American Diabetes Association criteria at a research exam or during clinical care. Birth weight data were normalized separately by sex and analyzed for genetic associations using a mixed model (SOLAR-Eclipse; Catonsville, MD) accounting for genetic relationships (based on genetic markers among all pairs of individuals) and adjusted for birth year and the 1st 5 genetic principal components. We identified 41 variants suggestively associated (p&amp;lt;0.0001) with birth weight. The strongest associations are with rs4799141 in PARD6G (β=-0.14 SD per T allele; p=7.5E-6), rs17333221 in MEOX2 (β=-0.15 SD per C allele; p=1.0E-5), rs11704996 in TRIOBP (β=0.15 SD per A allele; p=1.0E-5) and a missense variant in ABCC8, R1420H (β=0.41 SD per H allele; p=1.5E-5). 5 of the 41 variants are also nominally associated with T2D (p&amp;lt;0.05) in 7659 individuals from this population; the most notable was the R1420H variant in ABCC8, which we previously reported as associated with T2D (OR=2.2, p=3.0E-5) and for which activating mutations cause hyperinsulinemic hypoglycemia of infancy. In sum, we identified novel suggestive genetic associations with birth weight, which require confirmation in additional studies, and show that R1420H in ABCC8 is a strong genetic determinant of birth weight in this population. Disclosure L.E. Wedekind: None. W. Hsueh: None. S. Kobes: None. M.T. Olaiya: None. W.C. Knowler: None. L.J. Baier: None. R.L. Hanson: None.

Cohort profile: Finnish Health and Early Life Microbiota (HELMi) longitudinal birth cohort.

PurposeHELMi (Health and Early Life Microbiota) is a longitudinal, prospective general population birth cohort, set up to identify environmental, lifestyle and genetic factors that modify the intestinal microbiota development in the first years of life and their relation to child health and well-being.ParticipantsThe HELMi cohort consists of 1055 healthy term infants born in 2016–2018 mainly at the capital region of Finland and their parents. The intestinal microbiota development of the infants is characterised based on nine, strategically selected, faecal samples and connected to extensive online questionnaire-collected metadata at weekly to monthly intervals focusing on the diet, other exposures and family’s lifestyle as well as the health and growth of the child. Motor and cognitive developmental screening takes place at 18 months. Infant’s DNA sample, mother’s breast milk sample and both parent’s spot faecal samples have been collected.Findings to dateThe mean age of the mothers was 32.8 (SD 4.1) and fathers/coparents 34.8 (5.3) years at the time of enrolment. Seventeen percentage (n=180) of the infants were born by caesarean section. Just under half (49%) were firstborns; 50.7% were males. At 3 months of age, 86% of the babies were exclusively breastfed and 2% exclusively formula-fed.Future plansThe current follow-up from pregnancy to first 24 months will be completed in March 2020, totalling to over 10 000 biological samples and over 50 000 questionnaire entries. The results are expected to identify environmental and host factors that affect early gut microbiota development and health, and hence give indications of how to prevent or reverse microbiota perturbations in infancy. This prospective cohort will be followed up further to identify how the early microbiota relates to later health outcomes, especially weight gain, infections and allergic and other chronic diseases.Trial registration number NCT03996304; Pre-results.

Stillbirth and associated perinatal outcomes in obstetric cholestasis: a systematic review and meta-analysis of observational studies.

BackgroundObstetric cholestasis is a condition occurring in pregnancy with suspected adverse perinatal outcomes. Stillbirth is a significant adverse event associated with obstetric cholestasis and considered for intervention in pregnancy.ObjectivesThere are multiple studies with epidemiological data with regards to the outcomes of obstetric cholestasis. Our hypothesis is to the test the association of stillbirth and related outcomes in obstetric cholestasis.Search Strategy & Selection criteriaTwo independent reviewers did independent searches and selection with a standardized design as outlined in the PRISMA statement.AnalysisThe retrieved relevant literature was subjected to a rigorous quality assessment and followed by standardized interpretable results.ResultsThe pooled estimate in this study showed that there was no significant difference in the stillbirth rates in the obstetric (OC) population when compared to the non-obstetric cholestasis (reference) population. However, there was an increased risk of preterm birth in the OC population compared to the reference population; however, the cesarean section and induction of labor results were directly related.DiscussionThis study provides an epidemiological data related to the perinatal outcomes associated with obstetric cholestasis, specifically stillbirth. This result is likely to produce a benchmark for current evidence-based practice and to assist future research in understanding the implication of associated stillbirth risk and related outcomes with OC.

The Cost-Effectiveness of Professional Doula Care for a Woman's First Two Births: A Decision Analysis Model.

Multiple studies have demonstrated the benefits of intrapartum doula care, including lower risk for cesarean birth and shortened labor time for nulliparous women. However, analyses investigating the cost-effectiveness of doula care are limited. This study evaluated the potential cost-effectiveness of professional doula support during a woman's first birth in a theoretical population of US women, with all women having a second birth without doula care. A cost-effectiveness model was designed to compare outcomes in women with a professional doula versus no doula labor support. A theoretical cohort of 1.6 million women, the approximate number of annual low-risk, nulliparous, term, singleton births in the United States, was used. Outcomes included mode of birth, maternal death, uterine rupture, cesarean hysterectomy, costs, and quality-adjusted life years (QALYs). Probability estimates used in the model were derived from the literature, and a cost-effectiveness threshold was set at $100,000 per QALY. Sensitivity analyses were used to investigate the robustness of the results. In this theoretical model, professional doula care during the first birth resulted in fewer cesarean births and improved QALYs. Additionally, doula support resulted in 202,538 fewer cesarean births, 46 fewer maternal deaths secondary to fewer cesarean births, 99 fewer uterine ruptures, and 26 fewer hysterectomies, with an additional cost of $185 million and 7617 increased QALYs for the first and subsequent births. Sensitivity analyses demonstrated a professional doula was potentially cost-saving up to $884 and cost-effective up to $1360 per doula. Professional doula care during a woman's first birth may lead to improved outcomes and increased QALYs during her first and second births. Given the limitations of this analysis, the cost-effectiveness estimate is likely conservative, further supporting broader integration of professional doulas into the US maternity care system and highlighting the need for higher doula care reimbursement.

Early and late births in high-latitude populations of free-ranging Bison (&lt;i&gt;Bison bison&lt;/i&gt;)

The timing of parturition in high-latitude populations of Bison (Bison bison) is not well documented, but previous observations have indicated that births do not start until mid-May and largely end in late June or early July, similar to those of other northern ungulates. In three high-latitude Bison populations in northwestern Canada, the onset of parturition occurred as early as late March and early April—5–6 weeks earlier than previously observed—and two isolated cases of late births occurred in mid-November and mid-December. Our observations suggest that the onset of parturition in high-latitude Bison can be earlier than previously known, and late births, while apparently rare, may occur. Determining whether our observations signal a substantial, lasting shift in the timing and, possibly, synchrony of parturition in high-latitude populations of Bison will require further monitoring for early-born calves.

Pregnant Inuit Women's Exposure to Metals and Association with Fetal Growth Outcomes: ACCEPT 2010⁻2015.

Environmental contaminants such as heavy metals are transported to the Arctic regions via atmospheric and ocean currents and enter the Arctic food web. Exposure is an important risk factor for health and can lead to increased risk of a variety of diseases. This study investigated the association between pregnant women’s levels of heavy and essential metals and the birth outcomes of the newborn child. This cross-sectional study is part of the ACCEPT birth cohort (Adaption to Climate Change, Environmental Pollution, and dietary Transition) and included 509 pregnant Inuit women ≥18 years of age. Data were collected in five Greenlandic regions during 2010–2015. Population characteristics and birth outcomes were obtained from medical records and midwives, respectively, and blood samples were analyzed for 13 metals. Statistical analysis included one-way ANOVA, Spearman’s rho, and multiple linear and logistic regression analyses. The proportion of current smokers was 35.8%. The levels of cadmium, chromium, and nickel were higher compared to reported normal ranges. Significant regional differences were observed for several metals, smoking, and parity. Cadmium and copper were significantly inversely related to birth outcomes. Heavy metals in maternal blood can adversely influence fetal development and growth in a dose–response relationship. Diet and lifestyle factors are important sources of toxic heavy metals and deviant levels of essential metals. The high frequency of smokers in early pregnancy is of concern, and prenatal exposure to heavy metals and other environmental contaminants in the Greenlandic Inuit needs further research.

Long-term trends in wild-capture and population dynamics point to an uncertain future for captive elephants.

Maintaining sustainable populations in captivity without supplementation through wild-capture is a major challenge in conservation that zoos and aquaria are working towards. However, the capture of wild animals continues for many purposes where conservation is not the primary focus. Wild-capture hinders long-term conservation goals by reducing remaining wild populations, but the direct and long-term indirect consequences of wild-capture for captive population viability are rarely addressed using longitudinal data. We explored the implications of changes in wild-capture on population dynamics in captivity over 54 years using a multi-generational studbook of working Asian elephants ( Elephas maximus) from Myanmar, the largest remaining captive elephant population. Here we show that population growth and birth rates declined between 1960 and 2014 with declines in wild-capture. Importantly, wild-caught females had reduced birth rates and a higher mortality risk. However, despite the disadvantages of wild-capture, the population may not be sustainable without it, with immediate declines owing to an unstable age-structure that may last for 50 years. Our results highlight the need to assess the long-term demographic consequences of wild-capture to ensure the sustainability of captive and wild populations as species are increasingly managed and conserved in altered or novel environments.

STILLBIRTHS IN EUROPE – SIGNIFICANT PUBLIC HEALTH PROBLEM

BACKGROUND Together with the achievements and efforts for further reduction of infant mortality and under-five-mortality the stillbirths remain a significant global public health problem. In 2015 the estimated number of stillbirths is 2.6 million, e.g. 7178 deaths per day (WHO). Most of these deaths occur in developing countries, but the problem is important for Europe as well in the context of ageing population and low birth rate. The aim of this report is to analyse the trends in stillbirth rates in European region since 1990s to 2015. METHODS Primary data on stillbirths were extracted from European database “Health for all”. The countries were grouped by Gross National Income (GNI) per capita according to World Bank criteria relevant to 2018-2019. The means of stillbirths in different countries groups were compared and Pearson’s correlation coefficients with GNI and other variables were calculated. Data processing was performed by SPSS v.24. RESULTS Decreasing trend in stillbirths has been observed in parallel with the increase of GNI, significantly more expressed in high-income countries. The mean stillbirth rate in the seven countries with lower-middle income was 2.5 times higher as compared to the mean for 34 high-income countries. The discrepancy in the mean GNI for both groups is over 16 times. For 12 higher-middle income countries the mean stillbirth rate is 1.5 times higher compared to high-income countries, and GNI – 6 times lower. A moderate correlation of stillbirths with GNI has been found and it increases from r=-0,305 in 1970s to r=-0,420 for 2013-2015. Some increase in correlation of stillbirths with proportion of live births to mothers aged under 20 years has also been observed - from r=+0.215 to r=+0.532. CONCLUSION Socio-economic development and decrease in early pregnancy are among the leading factors to further reduction of stillbirths in European region. Keywords: Stillbirth, European region, public health, gross national income Normal 0 false false false EN-US X-NONE X-NONE

Stressful life events, inflammation and emotional and behavioural problems in children: A population-based study

ObjectiveTo test the hypothesis that higher plasma levels of inflammatory markers due to exposure to adverse life events may lead to internalising and externalising symptoms in children. MethodUsing data from the Avon Longitudinal Study of Parents and Children, a general population birth cohort, we explored if inflammatory markers [serum C-reactive protein (CRP) and interleukin-6 (IL-6)] at age 9 years explain the longitudinal association between adverse life events (at ages 1–9 and 9–11 years) and internalising and externalising symptoms (at ages 9 and 11 years). Data (n = 4583) were analysed using cross-lagged panel modelling to take into account reciprocal associations and reverse causality, and path analyses to test for mediation. Gender, ethnicity, body mass index, maternal education, paternal social class and maternal depression were used as potential confounders. ResultsCRP was not associated with adverse life events. There was evidence for partial mediation by IL-6 such that exposure to adverse life events was associated with increased levels of IL-6 later, in turn associated with later internalising symptoms. These associations were robust to adjustment for confounders. IL-6 did not explain part of the opposite association, that of earlier internalising symptoms and later life events, nor did it explain either direction of the association between life events and externalising symptoms. ConclusionOur findings suggest a pathway that may connect early psychosocial adversity and childhood internalising symptoms via higher plasma levels of inflammatory markers, such as IL-6.

The Epidemiology of Brachial Plexus Birth Palsy in the United States: Declining Incidence and Evolving Risk Factors.

The epidemiology of brachial plexus birth palsy (BPBP) in the United States may be changing over time due to population-level changes in obstetric care. The Kids' Inpatient Database from 1997 to 2012 was analyzed. Annual estimates of BPBP incidence and disease determinant distribution were calculated for the general population and the study population with BPBP. Long-term trends were analyzed. A multivariate logistic regression model was used to quantify the risk associated with each determinant. The database yielded a combined total of 5,564,628 sample births extrapolated to 23,385,597 population births. The population incidence of BPBP dropped 47.1% over the 16-year study period, from 1.7 to 0.9 cases per 1000 live births (P<0.001). Female, black, and Hispanic subgroups had moderately increased risks of BPBP. Among children with BPBP, 55.0% had no identifiable risk factor. Shoulder dystocia was the strongest risk factor for BPBP in the regression model [odds ratio (OR), 113.2; P<0.001], although the risk of sustaining a BPBP in the setting of shoulder dystocia decreased from 10.7% in 1997 to 8.3% in 2012 (P=0.006). Birth hypoxia was independently associated with BPBP (OR, 3.1; P<0.001). Cesarean delivery (OR, 0.16; P<0.001) and multiple gestation birth (OR, 0.45; P<0.001) were associated with lower incidence of BPBP. Notably, the rate of cesarean delivery increased by 62.8% during the study period, from 20.9% in 1997 to 34.0% in 2012 (P<0.001). Over a 16-year period, the incidence of BPBP fell dramatically, paralleled by a significant increase in the rate of cesarean delivery. Systemic changes in obstetric practice may have contributed to these trends. As more than half of BPBP cases have no identifiable risk factor, prospective investigation of established risk factors and characterization of new disease determinants are needed to more reliably identify infants at greatest risk. Racial and geographic inequalities in disease burden should be investigated to identify interventional targets. Level III-case series.

The Association of Clavicle Fracture With Brachial Plexus Birth Palsy

Shoulder dystocia is the strongest known risk factor for brachial plexus birth palsy (BPBP). Fractures of the clavicle are known to occur in the setting of shoulder dystocia. It remains unknown whether a clavicle fracture that occurs during a birth delivery with shoulder dystocia increases the risk of BPBP or, alternatively, is protective. The purpose of this study was to use a large, national database to determine whether a clavicle fracture in the setting of shoulder dystocia is associated with an increased or decreased risk of BPBP. The 1997 to 2012 Kids' Inpatient Database (KID) was analyzed for this study. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify newborns diagnosed with shoulder dystocia and BPBP as well as a concurrent fracture of the clavicle. Newborns with shoulder dystocia were stratified into 2 groups: dystocia without a clavicle fracture and dystocia with a clavicle fracture. Multivariable logistic regression was used to quantify the risk for BPBP among shoulder dystocia subgroups. The dataset included 5,564,628 sample births extrapolated to 23,385,597 population births over the 16-year study period. A BPBP occurred at a rate of 1.2 per 1,000 births. Shoulder dystocia complicated 18.8% of births with a BPBP. A total of 7.84% of newborns with a BPBP also sustained a clavicle fracture. Births with shoulder dystocia and a clavicle fracture incurred BPBP at a rate similar to that for newborns with shoulder dystocia and no fracture (9.82% vs 11.77%). Shoulder dystocia without a concurrent clavicle fracture was an independent risk factor for BPBP (odds ratio, 112.1; 95% confidence interval, 103.5-121.4). Those with shoulder dystocia and clavicle fracture had a risk for BPBP comparable with those with shoulder dystocia but no fracture (odds ratio, 126.7 vs 112.1). This population-level investigation suggests that, among newborns with shoulder dystocia, clavicle fracture is not associated with a significant change in the risk ofBPBP. Prognostic II.

Migration and Nuptiality in Course of Revitalization the Economic Development of Yakutia

Over the period of semicentenial development the economic processes in Yakutia have been accompanied by large-scale migratory population movement. An active exploration of new territories resulted in migration to become a basic population change component substantially defining population age structure, birth and death rate in the region. The article considers the interrelation of migratory inflow and nuptiality changes in local territories of intensive economic development. The correlation analysis of time-series data is provided. The hypothesis is tested of existing one-year time log between a migrant arrival and wedding. It was discovered that the periods of intensified regional economic development accompanied by large-scale inflow of migrants, featured very high strength of relationship between the stream of arrivals and marriage registrations. In particular, Pearson’s pair correlation coefficient between the arrivals and marriages made up 0.885 in West Yakutia in 1960th, and 0.962 - in South Yakutia in 1970th. The revealed relationship was largely determined by a favorable proportion between the number of persons in marriable age among migrants and their commitment towards long stay in Yakutia, including their intentions to establish a family. The analysis of dynamic numbers has shown that the deep social and economic, political changes of the 1990th in the region were accompanied by radical change of migration vector and the increase in migratory seasonal component. These factors resulted in a considerably falling migratory rate, reduced or even discontinued interrelation between arrival rates and officially registered marriages.