Maternal weight and infections in early childhood: a cohort study

Videholm, Samuel; Silfverdal, Sven‐Arne; Reniers, Georges

doi:10.1136/archdischild-2017-314628

Cited by 12 publications

(27 citation statements)

References 22 publications

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“…Moreover, this study only captures the most severe cases of infection that require hospitalisation; it will underestimate rates of all infections in this population as we did not have access to data for primary care settings, where the majority of childhood infections will be managed. Additionally, we were unable to adjust for the following factors: maternal antibiotic use in pregnancy and underlying maternal conditions, which may have contributed to preterm labour and potentially the long term health of the child [ 40 ]; maternal smoking, which is a risk factor for both IUGR [ 41 ] and childhood respiratory infections in childhood [ 42 ]; maternal BMI which may increase the risk of childhood infections [ 43 ]; or explore the potentially mediating effect of breastfeeding, which is known to be protective against certain infections during early childhood [ 7 , 8 ]. Finally, we only included births occurring in NHS hospitals as births occurring in private or military hospitals or at home were excluded due to poor linkage rates with hospital admission records.…”

Section: Discussionmentioning

confidence: 99%

Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study

et al. 2021

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Background Children born preterm (<37 completed weeks’ gestation) have a higher risk of infection-related morbidity than those born at term. However, few large, population-based studies have investigated the risk of infection in childhood across the full spectrum of gestational age. The objectives of this study were to explore the association between gestational age at birth and infection-related hospital admissions up to the age of 10 years, how infection-related hospital admission rates change throughout childhood, and whether being born small for gestational age (SGA) modifies this relationship. Methods and findings Using a population-based, record-linkage cohort study design, birth registrations, birth notifications and hospital admissions were linked using a deterministic algorithm. The study population included all live, singleton births occurring in NHS hospitals in England from January 2005 to December 2006 (n = 1,018,136). The primary outcome was all infection-related inpatient hospital admissions from birth to 10 years of age, death or study end (March 2015). The secondary outcome was the type of infection-related hospital admission, grouped into broad categories. Generalised estimating equations were used to estimate adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) for each gestational age category (<28, 28–29, 30–31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks) and the models were repeated by age at admission (<1, 1–2, 3–4, 5–6, and 7–10 years). An interaction term was included in the model to test whether SGA status modified the relationship between gestational age and infection-related hospital admissions. Gestational age was strongly associated with rates of infection-related hospital admissions throughout childhood. Whilst the relationship attenuated over time, at 7–10 years of age those born before 40 weeks gestation were still significantly higher in comparison to those born at 40 weeks. Children born <28 weeks had an aRR of 6.53 (5.91–7.22) during infancy, declining to 3.16 (2.50–3.99) at ages 7–10 years, in comparison to those born at 40 weeks; whilst in children born at 38 weeks, the aRRs were 1·24 (1.21–1.27) and 1·18 (1.13–1.23), during infancy and aged 7–10 years, respectively. SGA status modified the effect of gestational age (interaction P<0.0001), with the highest rate among the children born at <28 weeks and SGA. Finally, study findings indicated that the associations with gestational age varied by subgroup of infection. Whilst upper respiratory tract infections were the most common type of infection experienced by children in this cohort, lower respiratory tract infections (LRTIs) (<28 weeks, aRR = 10.61(9.55–11.79)) and invasive bacterial infections (<28 weeks, aRR = 6.02 (4.56–7.95)) were the most strongly associated with gestational age at birth. Of LRTIs experienced, bronchiolitis (<28 weeks, aRR = 11.86 (10.20–13.80)), and pneumonia (<28 weeks, aRR = 9.49 (7.95–11.32)) were the most common causes. Conclusions Gestational age at birth was strongly associated with rates of infection-related hospital admissions during childhood and even children born a few weeks early remained at higher risk at 7–10 years of age. There was variation between clinical subgroups in the strength of relationships with gestational age. Effective infection prevention strategies should include focus on reducing the number and severity of LRTIs during early childhood.

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Section: Discussionmentioning

confidence: 99%

Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study

et al. 2021

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“…Outcomes were largely grouped into 3 types of immune system–related conditions. The first included infective diseases, overall and by type-specific conditions (as outlined by Videholm et al 21 ). The second included conditions associated with an overactive immune system and inflammation, such as asthma, eczema, and allergies and anaphylaxis.…”

Section: Methodsmentioning

confidence: 99%

“…The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification was used to assign diagnoses for both the hospital and ED data. For infection, diagnoses were derived from Videholm et al, 21 while codes for autoimmune conditions were compiled from multiple published studies. 22 , 23 , 24 , 25 …”

Section: Methodsmentioning

confidence: 99%

Prenatal Opioid Exposure and Immune-Related Conditions in Children

Kelty,

Rae,

Jantzie

et al. 2024

JAMA Netw Open

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ImportancePrenatal opioid exposure (POE) may alter with fetal development of the immune system, which may influence long-term health and susceptibility to immune-related conditions.ObjectiveTo compare the risk of hospitalization and emergency department presentation for immune-related conditions in children with and without POE.Design, Setting, and ParticipantsThis retrospective, population-based cohort study used linked administrative health records of all children born in Western Australia between January 1, 2003, and December 31, 2018 (N = 401 462).ExposurePrenatal exposure to prescription opioids (overall and by trimester), neonatal abstinence syndrome diagnosis, and opioid indication (pain or opioid use disorder [OUD]).Main Outcomes and MeasuresThe main outcome was hospital admissions and emergency department presentations during which a child was diagnosed with an immune-related condition, including infections, conditions associated with an overactive immune system (eg, asthma, eczema, and allergy and anaphylaxis), and autoimmune diseases diagnosed before age 5 years or June 30, 2020. Data were analyzed between August 30, 2022, and February 27, 2023.ResultsNeonates with POE (1656 [0.4%]; mean [SD] gestational age, 37.7 [2.1] weeks; 836 females [50.5%]; 820 males [49.5%]) were more likely to be born preterm, have low birth weight for gestational age, and be coexposed to cigarette smoke compared with nonexposed neonates. Perinatal opioid exposure was associated with an increased risk of perinatal infection (adjusted odds ratio [AOR], 1.62; 95% CI, 1.38-1.90) and eczema and dermatitis (AOR, 11.91; 95% CI, 9.84-14.41) compared with nonexposure. Neonatal abstinence syndrome was also associated with both conditions (AOR, 2.91 [95% CI, 2.36-3.57] and 31.11 [95% CI, 24.64-39.28], respectively). Prenatal opioid exposure was also associated with an increased risk of childhood asthma (adjusted hazard ratio [AHR], 1.44; 95% CI, 1.16-1.79), but not allergies and anaphylaxis. It was also associated with an increased risk of childhood eczema and dermatitis, but only in children with POE from opioids used to treat OUD (AHR, 1.47; 95% CI, 1.08-1.99) rather than pain. In contrast, POE from opioids used for pain was associated with an increased risk of infection (AHR, 1.44; 95% CI, 1.32-1.58), but POE to opioids used to treat OUD was not. Autoimmune conditions were rare and were not observed to be associated with POE.Conclusions and RelevanceIn this cohort study, POE was associated with an increased risk of infection, eczema and dermatitis, and asthma, but not allergies and anaphylaxis or autoimmune conditions. These findings highlight the importance of further study of opioid-induced immune changes during pregnancy, the potential impact on long-term health in exposed children, and the mechanisms of opioid-induced immune dysregulation.

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“…For instance a study found a relatively low incidence of contacts general practitioners among Norwegian children [5]. Similarly, various Swedish studies indicated relatively low rates of different services such as hospitalisations for infection, outpatient contacts and antibiotics prescriptions compared to the level among Danish children [6–8]. On the other hand a study comparing use of antibiotic prescriptions among Swedish and Estonian children suggested that the Danish level was between that of these two countries respectively [9].…”

Section: Introductionmentioning

confidence: 99%

Too much? Mortality and health service utilisation among Danish children 1999-2016: A register-based study

Jensen

Andersen

Andersen³

et al. 2019

PLoS ONE

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ObjectivesTo describe the temporal development of mortality and health service utilisation defined as in- and outpatient hospital contacts, contacts with general practitioner and specialists, and prescribed dispensed medication among Danish children 0–5 years of age from 1999 to 2016.DesignRegister-based descriptive study.ParticipantsAll children born in Denmark in the period 1994–2016 followed until 5 years of age.Main outcome measuresAnnual incidence rates of mortality and health service utilisation outcomes, and incidence rate ratios compared to the reference calendar year 1999. The new measure of post-discharge mortality is presented.ResultsPost-discharge mortality decreased from 1999 to 2016, IRR2016 = 0.49 (95% CI: 0.36 to 0.66). Total contacts did not change much over time, IRR2016 = 1.02 (1.02 to 1.03), but increased among neonates, IRR2016 = 3.69 (3.63 to 3.75), and decreased among children with chronic disease IRR2016 = 0.94 (0.93 to 0.94). In- and out-patient hospitalisations increased, IRR2016 = 1.26 (1.24–1.27) resp. IRR2016 = 1.62 (1.60–1.63), contacts with medical specialists increased, IRR2016 = 1.43 (1.42 to 1.43), whilst contacts with general practitioner decreased, IRR2016 = 0.91 (0.91 to 0.91). Medication use decreased, IRR2016 = 0.82 (0.82 to 0.82).ConclusionsOur measure of post-discharge mortality was halved during the study period indicating improved health. Overall health service utilisation did not change much, but the type of utilisation changed, and the development over time differed between subgroups defined by age and chronic disease status. Our findings call for considerations about the benefit of increased specialisation and increased use of health services among ‘healthy’ children not suffering from chronic disease.

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Maternal weight and infections in early childhood: a cohort study

Abstract: We observed an association between overweight and obesity during pregnancy, and hospitalisations for infectious diseases during early childhood.

Cited by 12 publications

References 22 publications

Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study

Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study

Prenatal Opioid Exposure and Immune-Related Conditions in Children

Too much? Mortality and health service utilisation among Danish children 1999-2016: A register-based study

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