Paediatric and perinatal epidemiology
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Paediatr Perinat Epidemiol · Mar 2011
Uncovering the complex relationship between pre-eclampsia, preterm birth and cerebral palsy.
Pre-eclampsia is a leading cause of preterm birth, which is strongly associated with cerebral palsy (CP). However, there is controversy about whether pre-eclampsia is associated with increased risk of CP. We evaluated the association between pre-eclampsia and CP in 122,476 mother-child pairs insured by the South Carolina Medicaid programme, with births between 1996 and 2002. ⋯ The greatest risk for CP was in preterm infants whose mothers did not have pre-eclampsia (OR=8.12, 95% CI 6.49, 10.17 compared with full term infants without exposure to pre-eclampsia). We conclude that pre-eclampsia with onset before 37 weeks' gestation is a significant risk factor for CP. Some of the association is probably attributable to high risk of preterm birth because of early pre-eclampsia, while a 'direct' effect of pre-eclampsia on fetal brain development also seems likely.
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Paediatr Perinat Epidemiol · Nov 2010
Multicenter StudyEffects of social and psychosocial factors on risk of preterm birth in black women.
Our objective was to examine how social and psychosocial factors may influence the risk of preterm birth. The design of the study was a hybrid retrospective and prospective cohort. African-American women residing in Baltimore, Maryland, were enrolled prenatally if they received care at one of three Johns Hopkins Medical Institution prenatal clinics (n=384) or enrolled post-partum if they delivered at Johns Hopkins Medical Institution with late, none or intermittent prenatal care (N=459). ⋯ However, we found evidence of a three-way interaction between reported lifetime experiences of racism, depressive symptoms during pregnancy and stress during pregnancy on preterm birth risk. Racism scores above the median (more racism) were associated with an increased risk of preterm birth in three subgroups with the effect moderated by depressive symptoms and stress. Social and psychosocial factors may operate in a complex manner related to risk of preterm birth.
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Paediatr Perinat Epidemiol · Nov 2010
Prenatal environmental tobacco smoke exposure and early childhood body mass index.
Maternal smoking during pregnancy is associated with increased risk of childhood overweight body mass index (BMI). Less is known about the association between prenatal secondhand tobacco smoke (SHS) exposure and childhood BMI. We followed 292 mother-child dyads from early pregnancy to 3 years of age. ⋯ Using self-reported prenatal exposure resulted in non-differential exposure misclassification of SHS exposures that attenuated the association between SHS exposure and BMI compared with serum cotinine concentrations. These findings suggest active and secondhand prenatal tobacco smoke exposure may be related to an important public health problem in childhood and later life. In addition, accurate quantification of prenatal secondhand tobacco smoke exposures is essential to obtaining valid estimates.
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Paediatr Perinat Epidemiol · Sep 2010
Modelling sequence of prior pregnancies on subsequent risk of very preterm birth.
The prevalence and intractability of preterm birth is known as is its association with reproductive history, but the relationship with sequence of pregnancies is not well studied. The data were from a population-based case-control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. ⋯ The outcomes of each prior pregnancy, stratified by pregnancy order, and starting with the pregnancy immediately before the index or control pregnancy, were categorised as one of abortion, preterm birth or term birth. We showed that each of these prior pregnancy events was an independent risk of very preterm birth. This finding does not support the hypothesis of a neutralising effect of a term birth after an abortion on the subsequent risk for very preterm birth and is further evidence for the cumulative or increasing risk associated with increasing numbers of prior abortions or preterm births.
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Paediatr Perinat Epidemiol · Jul 2010
Mortality of mothers from cardiovascular and non-cardiovascular causes following pregnancy complications in first delivery.
The combined effects of preterm delivery, small-for-gestational-age offspring, hypertensive disorders of pregnancy, placental abruption and stillbirth on early maternal death from cardiovascular causes have not previously been described in a large cohort. We investigated the effects of pregnancy complications on early maternal death in a registry-based retrospective cohort study of 782 287 women with a first singleton delivery in Denmark 1978-2007, followed for a median of 14.8 years (range 0.25-30.2) accruing 11.6 million person-years. We employed Cox proportional hazard models of early death from cardiovascular and non-cardiovascular causes following preterm delivery, small-for-gestational-age offspring and hypertensive disorders of pregnancy. ⋯ Severe pre-eclampsia was associated with death from cardiovascular causes only. There was a less than additive effect on cardiovascular mortality hazard ratios with increasing number of pregnancy complications: preterm delivery 1.90 [95% confidence intervals 1.49, 2.43]; preterm delivery and small-for-gestational-age offspring 3.30 [2.25, 4.84]; preterm delivery, small-for-gestational-age offspring and pre-eclampsia 3.85 [2.07, 7.19]. Thus, we conclude that, separately and combined, preterm delivery and small-for-gestational-age are strong markers of early maternal death from both cardiovascular and non-cardiovascular causes, while hypertensive disorders of pregnancy are markers of early death of mothers from cardiovascular causes.