Neonatal Mortality Risk Related to Birth Weight and Gestational Age in British Columbia

Kierans, William J.; Verhulst, Lorne; Mohamed, Jemal; Foster, Leslie T.

doi:10.1016/s1701-2163(16)32507-5

Cited by 3 publications

(4 citation statements)

References 19 publications

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“… a For categories with missing data, the denominators are provided. b Calculated as weight in kilograms divided by height in meters squared. The data were imputed because of a high degree of missingness (109 735 of 388 254 deliveries [28.26%]). c Consists of preexisting hypertension, hypertensive kidney disease, high blood pressure (distinct from preexisting hypertension), and proteinuria. d Refers to women who did not enter labor spontaneously, but were induced using artificial rupture of membranes, prostaglandins, or administration of oxytocin. e Refers to women who entered labor spontaneously, but then required artificial rupture of membranes or administration of oxytocin. f Data only collected after 2005. g Based on population-based charts of Kierans et al h Below the 10th percentile of birth weight for their gestational age and sex. i Above the 90th percentile of birth weight for their gestational age and sex.…”

Section: Resultssupporting

confidence: 92%

“…For neonatal characteristics, we examined gestational age, whether there was a congenital anomaly, sex, and whether the infant was small or large for gestational age. Infants were considered small for gestational age if they were below the 10th percentile and large for gestational age if they were above the 90th percentile of birth weight for their gestational age and sex based on the population-based charts of Kierans et al, which were created in British Columbia.…”

Section: Methodsmentioning

confidence: 99%

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Association of Epidural Analgesia During Labor and Delivery With Autism Spectrum Disorder in Offspring

Hanley

Bickford

et al. 2021

JAMA

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IMPORTANCEEvidence from studies investigating the association of epidural analgesia use during labor and delivery with risk of autism spectrum disorder (ASD) in offspring is conflicting.OBJECTIVE To assess the association of maternal use of epidural analgesia during labor and delivery with ASD in offspring using a large population-based data set with clinical data on ASD case status. DESIGN, SETTING, AND PARTICIPANTSThis population-based retrospective cohort study included term singleton children born in British Columbia, Canada, between April 1, 2000, and December 31, 2014. Stillbirths and cesarean deliveries were excluded. Clinical ASD diagnostic data were obtained from the British Columbia Autism Assessment Network and the British Columbia Ministry of Education. All children were followed up until clinical diagnosis of ASD, death, or the study end date of December 31, 2016.EXPOSURES Use of epidural analgesia during labor and delivery. MAIN OUTCOMES AND MEASURESA clinical diagnosis of ASD made by pediatricians, psychiatrists, and psychologists with specialty training to assess ASD. Cox proportional hazards models were used to estimate the hazard ratio of epidural analgesia use and ASD. Models were adjusted for maternal sociodemographics; maternal conditions during pregnancy; labor, delivery, and antenatal care characteristics; infant sex; gestational age; and status of small or large for gestational age. A conditional logistic regression model matching women with 2 births or more and discordance in ASD status of the offspring also was performed. RESULTSOf the 388 254 children included in the cohort (49.8% female; mean gestational age, 39.2 [SD, 1.2] weeks; mean follow-up, 9.05 [SD, 4.3] years), 5192 were diagnosed with ASD (1.34%) and 111 480 (28.7%) were exposed to epidural analgesia. A diagnosis of ASD was made for 1710 children (1.53%) among the 111 480 deliveries exposed to epidural analgesia (94 157 women) vs a diagnosis of ASD in 3482 children (1.26%) among the 276 774 deliveries not exposed to epidural analgesia (192 510 women) (absolute risk difference, 0.28% [95% CI, 0.19%-0.36%]). The unadjusted hazard ratio was 1.32 (95% CI, 1.24-1.40) and the fully adjusted hazard ratio was 1.09 (95% CI, 1.00-1.15). There was no statistically significant association of epidural analgesia use during labor and delivery with ASD in the within-woman matched conditional logistic regression (839/1659 [50.6%] in the exposed group vs 1905/4587 [41.5%] in the unexposed group; fully adjusted hazard ratio, 1.07 [95% CI, 0.87-1.30]). CONCLUSIONS AND RELEVANCEIn this population-based study, maternal epidural analgesia use during labor and delivery was associated with a small increase in the risk of autism spectrum disorder in offspring that met the threshold for statistical significance. However, given the likelihood of residual confounding that may account for the results, these findings do not provide strong supporting evidence for this association.

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Section: Resultssupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Association of Epidural Analgesia During Labor and Delivery With Autism Spectrum Disorder in Offspring

Hanley

Bickford

et al. 2021

JAMA

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“…The major strength of this study is a very precise phenotyping with standardized definitions of labor, including number of contractions and cervical change parameters, strict and extensive eligibility criteria, with inclusion of only preterm births at or before 34 weeks. The large gestational age difference in definitions of preterm and term births prevented misclassification of some term pregnancies as preterm due to uncertain gestational age estimates observed even in well-dated pregnancies, ( Kierans et al, 2007 ).…”

Section: Discussionmentioning

confidence: 99%

Onset of human preterm and term birth is related to unique inflammatory transcriptome profiles at the maternal fetal interface

Bukowski

Sadovsky

Goodarzi

et al. 2017

PeerJ

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BackgroundPreterm birth is a main determinant of neonatal mortality and morbidity and a major contributor to the overall mortality and burden of disease. However, research of the preterm birth is hindered by the imprecise definition of the clinical phenotype and complexity of the molecular phenotype due to multiple pregnancy tissue types and molecular processes that may contribute to the preterm birth. Here we comprehensively evaluate the mRNA transcriptome that characterizes preterm and term labor in tissues comprising the pregnancy using precisely phenotyped samples. The four complementary phenotypes together provide comprehensive insight into preterm and term parturition.MethodsSamples of maternal blood, chorion, amnion, placenta, decidua, fetal blood, and myometrium from the uterine fundus and lower segment (n = 183) were obtained during cesarean delivery from women with four complementary phenotypes: delivering preterm with (PL) and without labor (PNL), term with (TL) and without labor (TNL). Enrolled were 35 pregnant women with four precisely and prospectively defined phenotypes: PL (n = 8), PNL (n = 10), TL (n = 7) and TNL (n = 10). Gene expression data were analyzed using shrunken centroid analysis to identify a minimal set of genes that uniquely characterizes each of the four phenotypes. Expression profiles of 73 genes and non-coding RNA sequences uniquely identified each of the four phenotypes. The shrunken centroid analysis and 10 times 10-fold cross-validation was also used to minimize false positive finings and overfitting. Identified were the pathways and molecular processes associated with and the cis-regulatory elements in gene’s 5′ promoter or 3′-UTR regions of the set of genes which expression uniquely characterized the four phenotypes.ResultsThe largest differences in gene expression among the four groups occurred at maternal fetal interface in decidua, chorion and amnion. The gene expression profiles showed suppression of chemokines expression in TNL, withdrawal of this suppression in TL, activation of multiple pathways of inflammation in PL, and an immune rejection profile in PNL. The genes constituting expression signatures showed over-representation of three putative regulatory elements in their 5′and 3′ UTR regions.ConclusionsThe results suggest that pregnancy is maintained by downregulation of chemokines at the maternal-fetal interface. Withdrawal of this downregulation results in the term birth and its overriding by the activation of multiple pathways of the immune system in the preterm birth. Complications of the pregnancy associated with impairment of placental function, which necessitated premature delivery of the fetus in the absence of labor, show gene expression patterns associated with immune rejection.

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“…Better perinatal medical care accounted for the majority of the improvement, with a consequent reduction in mortality rates and a complete change in previously established epidemiological associations and known risk factors for morbidity in this population . Therefore, while mean birth weight varied little across the years in different continents, perinatal survival drastically improved mainly due to reductions in birth weight–specific neonatal mortality, both in developed and developing countries in the last 50 years, which intriguingly preceded the worldwide rise of adult chronic noncommunicable diseases . In low‐ and middle‐income countries, infectious disease, undernutrition, and a rapid upsurge in noncommunicable disease risk factors, such as obesity and overweight, coexist in the same setting.…”

Section: Understanding Vulnerability—the Size Of the Problemmentioning

confidence: 99%

Neurobehavioral determinants of nutritional security in fetal growth–restricted individuals

Portella¹,

Silveira

2014

Annals of the New York Academy of Sciences

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Fetal growth restriction results from a failure to achieve a higher growth potential and has been associated with many maternal conditions, such as chronic diseases (infections, hypertension, and some cases of diabetes and obesity), exposures (tobacco smoke, drugs), and malnutrition. This early adversity induces a series of adaptive physiological responses aimed at improving survival, but imposing increased risk for developing chronic nontransmittable diseases (obesity, type II diabetes, cardiovascular disease) in the long term. Recently, mounting evidence has shown that fetal growth impairment is related to altered feeding behavior and preferences through the life course. When living in countries undergoing nutritional transition, in which individuals experience the coexistence of underweight and overweight problems (the "double burden of malnutrition"), fetal growth-restricted children can be simultaneously growth restricted and overweight-a double burden of malnutrition at the individual level. Considering food preferences as an important aspect of nutrition security, we will summarize the putative neurobiological mechanisms at the core of the relationship between fetal growth and nutrition security over the life course and the evidence linking early life adversity to later food preferences.

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Neonatal Mortality Risk Related to Birth Weight and Gestational Age in British Columbia

Cited by 3 publications

References 19 publications

Association of Epidural Analgesia During Labor and Delivery With Autism Spectrum Disorder in Offspring

Association of Epidural Analgesia During Labor and Delivery With Autism Spectrum Disorder in Offspring

Onset of human preterm and term birth is related to unique inflammatory transcriptome profiles at the maternal fetal interface

Neurobehavioral determinants of nutritional security in fetal growth–restricted individuals

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