RESUMEN
In a retrospective study of 19 171 mother-child dyads, elevated random plasma glucose values during early pregnancy were directly correlated with increased risk for congenital heart disease in offspring. Plasma glucose levels proximal to the period of cardiac development may represent a modifiable risk factor for congenital heart disease in expectant mothers without diabetes.
Asunto(s)
Glucemia/metabolismo , Cardiopatías Congénitas/etiología , Hiperglucemia/diagnóstico , Complicaciones del Embarazo/diagnóstico , Primer Trimestre del Embarazo/sangre , Adolescente , Adulto , Biomarcadores/sangre , Femenino , Humanos , Hiperglucemia/sangre , Recién Nacido , Embarazo , Complicaciones del Embarazo/sangre , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To examine linkages between mitochondrial genetics and preterm birth by assessing the risk for preterm birth associated with the inheritance of nuclear haplotypes that are ancestrally distinct from mitochondrial haplogroup. STUDY DESIGN: Genome-wide genotyping studies of cohorts of preterm and term individuals were evaluated. We determined the mitochondrial haplogroup and nuclear ancestry for individuals and developed a scoring for the degree to which mitochondrial ancestry is divergent from nuclear ancestry. RESULTS: Infants with higher degrees of divergent mitochondrial ancestry were at increased risk for preterm birth (0.124 for preterm vs 0.105 for term infants; P< .05). This finding was validated in 1 of 2 replication cohorts. We also observed that greater degrees of divergent ancestry correlated with earlier delivery within the primary study population, but this finding was not replicated in secondary cohorts born preterm. CONCLUSIONS: Individuals with divergent patterns of mitochondrial and nuclear ancestry are at increased risk for preterm birth. These findings may in part explain the higher rates of preterm birth in African Americans and in individuals with a matrilineal family history of preterm birth.
Asunto(s)
Etnicidad/genética , Haplotipos/genética , Nacimiento Prematuro/genética , Población Blanca/genética , Estudios de Casos y Controles , Femenino , Humanos , Recien Nacido Prematuro , Embarazo , Nacimiento Prematuro/epidemiología , Factores Socioeconómicos , Estados Unidos/epidemiologíaAsunto(s)
Conducta Cooperativa , Comunicación Interdisciplinaria , Ciencia/métodos , Ciencia/tendencias , Relaciones Comunidad-Institución , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/terapia , National Institutes of Health (U.S.) , Política Pública , Riesgo , Estados Unidos , UniversidadesRESUMEN
This study investigated the relationship between birth defects and cancer in adolescents and very young adults using California's population-based registries. Although overall cancer risk was elevated among individuals with chromosomal birth defects, this was not observed in those with nonchromosomal birth defects, as was demonstrated previously in younger children.
Asunto(s)
Aberraciones Cromosómicas , Anomalías Congénitas/epidemiología , Neoplasias/epidemiología , Adolescente , Adulto , California/epidemiología , Femenino , Humanos , Incidencia , Masculino , Sistema de Registros , Adulto JovenRESUMEN
OBJECTIVE: To examine whether recent reductions in rates of nosocomial infection have contributed to changes in rates of bronchopulmonary dysplasia (BPD) in a population-based cohort. STUDY DESIGN: This was a retrospective, population-based cohort study that used the California Perinatal Quality Care Collaborative database from 2006 to 2013. Eligible infants included those less than 30 weeks' gestational age and less than 1500 g who survived to 3 days of life. Primary variables of interest were rates of nosocomial infections and BPD. Adjusted rates of nosocomial infections and BPD from a baseline period (2006-2010) were compared with a later period (2011-2013). The correlation of changes in rates across periods for both variables was assessed by hospital of care. RESULTS: A total of 22 967 infants from 129 hospitals were included in the study. From the first to second time period, the incidence of nosocomial infections declined from 24.7% to 15% and BPD declined from 35% to 30%. Adjusted hospital rates of BPD and nosocomial infections were correlated positively with a calculated 8% reduction of BPD rates attributable to reductions in nosocomial infections. CONCLUSIONS: Successful interventions to reduce rates of nosocomial infections may have a positive impact on other comorbidities such as BPD. The prevention of nosocomial infections should be viewed as a significant component in avoiding long-term neonatal morbidities.
Asunto(s)
Displasia Broncopulmonar/epidemiología , Displasia Broncopulmonar/etiología , Infección Hospitalaria/complicaciones , Infección Hospitalaria/prevención & control , Displasia Broncopulmonar/prevención & control , Estudios de Cohortes , Infección Hospitalaria/epidemiología , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate the association between newborn acylcarnitine profiles and the subsequent development of necrotizing enterocolitis (NEC) with the use of routinely collected newborn screening data in infants born preterm. STUDY DESIGN: A retrospective cohort study was conducted with the use of discharge records for infants born preterm admitted to neonatal intensive care units in California from 2005 to 2009 who had linked state newborn screening results. A model-development cohort of 94 110 preterm births from 2005 to 2008 was used to develop a risk-stratification model that was then applied to a validation cohort of 22 992 births from 2009. RESULTS: Fourteen acylcarnitine levels and acylcarnitine ratios were associated with increased risk of developing NEC. Each log unit increase in C5 and free carnitine /(C16 + 18:1) was associated with a 78% and a 76% increased risk for developing NEC, respectively (OR 1.78, 95% CI 1.53-2.02, and OR 1.76, 95% CI 1.51-2.06). Six acylcarnitine levels, along with birth weight and total parenteral nutrition, identified 89.8% of newborns with NEC in the model-development cohort (area under the curve 0.898, 95% CI 0.889-0.907) and 90.8% of the newborns with NEC in the validation cohort (area under the curve 0.908, 95% CI 0.901-0.930). CONCLUSIONS: Abnormal fatty acid metabolism was associated with prematurity and the development of NEC. Metabolic profiling through newborn screening may serve as an objective biologic surrogate of risk for the development of disease and thus facilitate disease-prevention strategies.
Asunto(s)
Carnitina/análogos & derivados , Enterocolitis Necrotizante/diagnóstico , Enterocolitis Necrotizante/metabolismo , Recien Nacido Prematuro , Biomarcadores/análisis , California , Carnitina/análisis , Carnitina/sangre , Estudios de Cohortes , Intervalos de Confianza , Enterocolitis Necrotizante/epidemiología , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Incidencia , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Análisis Multivariante , Tamizaje Neonatal/métodos , Oportunidad Relativa , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo , Poblaciones VulnerablesRESUMEN
OBJECTIVE: To study the relationship between maternal asthma and the development of bronchopulmonary dysplasia (BPD). STUDY DESIGN: Using a large population-based California cohort, we investigated associations between maternal asthma and preterm birth subtype, as well as maternal asthma and BPD. We used data from 2007-2010 maternal delivery discharge records of 2â009â511 pregnancies and International Classification of Diseases, Ninth Revision codes. Preterm birth was defined as <37 weeks gestational age (GA), with subgroups of <28 weeks, 28-32 weeks, and 33-37 weeks GA, as well as preterm subtype, defined as spontaneous, medically indicated, or unknown. Linkage between the 2 California-wide datasets yielded 21â944 singleton preterm infants linked to their mother's records, allowing estimation of the risk of BPD in mothers with asthma and those without asthma. RESULTS: Maternal asthma was associated with increased odds (OR, 1.42; 95% CI, 1.38-1.46) of preterm birth at <37 weeks GA, with the greatest risk for 28-32 GA (aOR, 1.60; 95% CI, 1.47-1.74). Among 21â944 preterm infants, we did not observe an elevated risk for BPD in infants born to mothers with asthma (aOR, 1.03; 95% CI, 0.9-1.2). Stratification by maternal treatment with antenatal steroids revealed increased odds of BPD in infants whose mothers had asthma but did not receive antenatal steroids (aOR, 1.54; 95% CI, 1.15-2.06), but not in infants whose mothers had asthma and were treated with antenatal steroids (aOR, 0.85; 95% CI, 0.67-1.07). CONCLUSION: Asthma in mothers who did not receive antenatal steroid treatment is associated with an increased risk of BPD in their preterm infants.
Asunto(s)
Asma/epidemiología , Displasia Broncopulmonar/epidemiología , Madres , Complicaciones del Embarazo/tratamiento farmacológico , Nacimiento Prematuro/epidemiología , Esteroides/uso terapéutico , Adolescente , Adulto , Asma/fisiopatología , Peso al Nacer , Índice de Masa Corporal , California , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Edad Materna , Exposición Materna , Persona de Mediana Edad , Oportunidad Relativa , Alta del Paciente , Embarazo , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To evaluate trends in survival among children with spina bifida by race/ethnicity and possible prognostic factors in 10 regions of the United States. STUDY DESIGN: A retrospective cohort study was conducted of 5165 infants with spina bifida born during 1979-2003, identified by 10 birth defects registries in the United States. Survival probabilities and adjusted hazard ratios were estimated for race/ethnicity and other characteristics using the Cox proportional hazard model. RESULTS: During the study period, the 1-year survival probability among infants with spina bifida showed improvements for whites (from 88% to 96%), blacks (from 79% to 88%), and Hispanics (from 88% to 93%). The impact of race/ethnicity on survival varied by birth weight, which was the strongest predictor of survival through age 8. There was little racial/ethnic variation in survival among children born of very low birth weight. Among children born of low birth weight, the increased risk of mortality to Hispanics was approximately 4-6 times that of whites. The black-white disparity was greatest among children born of normal birth weight. Congenital heart defects did not affect the risk of mortality among very low birth weight children but increased the risk of mortality 4-fold among children born of normal birth weight. CONCLUSIONS: The survival of infants born with spina bifida has improved; however, improvements in survival varied by race/ethnicity, and blacks and Hispanics continued to have poorer survival than whites in the most recent birth cohort from 1998-2002. Further studies are warranted to elucidate possible reasons for the observed differences in survival.
Asunto(s)
Disparidades en el Estado de Salud , Disrafia Espinal/mortalidad , Adolescente , Negro o Afroamericano , Peso al Nacer , Niño , Preescolar , Estudios de Cohortes , Femenino , Hispánicos o Latinos , Humanos , Lactante , Recién Nacido , Estimación de Kaplan-Meier , Masculino , Pronóstico , Modelos de Riesgos Proporcionales , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Disrafia Espinal/etnología , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiología , Población Blanca , Adulto JovenRESUMEN
OBJECTIVE: To examine whether the incidence of childhood cancer is elevated in children with birth defects but no chromosomal anomalies. STUDY DESIGN: We examined cancer risk in a population-based cohort of children with and without major birth defects born between 1988 and 2004, by linking data from the California Birth Defects Monitoring Program, the California Cancer Registry, and birth certificates. Cox proportional hazards models generated hazard ratios (HRs) and 95% CIs based on person-years at risk. We compared the risk of childhood cancer in infants born with and without specific types of birth defects, excluding infants with chromosomal anomalies. RESULTS: Of the 4869 children in the birth cohort with cancer, 222 had a major birth defect. Although the expected elevation in cancer risk was observed in children with chromosomal birth defects (HR, 12.44; 95% CI, 10.10-15.32), especially for the leukemias (HR, 28.99; 95% CI, 23.07-36.42), children with nonchromosomal birth defects also had an increased risk of cancer (HR, 1.58; 95% CI, 1.33-1.87), but instead for brain tumors, lymphomas, neuroblastoma, and germ cell tumors. CONCLUSION: Children with nonchromosomal birth defects are at increased risk for solid tumors, but not leukemias. Dysregulation of early human development likely plays an important role in the etiology of childhood cancer.
Asunto(s)
Anomalías Congénitas/epidemiología , Neoplasias/epidemiología , Sistema de Registros , California/epidemiología , Mapeo Cromosómico , Anomalías Congénitas/genética , Humanos , Incidencia , Recién Nacido , Neoplasias/complicaciones , Pronóstico , Modelos de Riesgos Proporcionales , Factores de RiesgoRESUMEN
OBJECTIVE: To explore whether women who reported corticosteroid use during pregnancy were more likely to deliver an infant with hypospadias than women who did not. STUDY DESIGN: The analysis encompassed data on deliveries with an estimated due date between 1997 and 2004 from the National Birth Defects Prevention Study, a large population-based, case-control study conducted in the United States. Included were 1165 cases of moderate to severe hypospadias and 3000 nonmalformed male controls. RESULTS: The mothers of 39 cases (3.3%) and 62 controls (2.1%) reported using a corticosteroid medication during the period extending from 4 weeks before conception to 14 weeks after conception. The odds ratio (OR) for any corticosteroid exposure versus no corticosteroid exposure was 1.6 (95% confidence interval [CI] = 1.1 to 2.5); after adjustment for maternal race/ethnicity, education, age, and study site, it was 1.3 (95% CI = 0.8 to 2.0). Analyses by route of administration and specific component suggest that elevated ORs occurred only for nasal spray/inhaled corticosteroids (OR = 1.5; 95% CI = 0.9 to 2.6). CONCLUSIONS: Maternal use of corticosteroid medications was weakly associated with risk of hypospadias, but the association was negligible after adjustment for potential confounders.
Asunto(s)
Corticoesteroides/efectos adversos , Hipospadias/inducido químicamente , Intercambio Materno-Fetal , Administración por Inhalación , Corticoesteroides/administración & dosificación , Estudios de Casos y Controles , Suplementos Dietéticos , Femenino , Ácido Fólico/administración & dosificación , Encuestas Epidemiológicas , Humanos , Recién Nacido , Masculino , Embarazo , Estados Unidos , Complejo Vitamínico B/administración & dosificaciónRESUMEN
OBJECTIVE: Past studies of cigarette smoking as a contributor to orofacial clefts and neural tube defects (NTDs) used self-reports of smoke exposures. We have correlated measurements of cotinine (a nicotine metabolite) in mid-pregnancy sera with clefts and NTDs. STUDY DESIGN: From a repository of >180 000 mid-pregnancy serum specimens collected in California from 2003 to 2005 and linked to delivery outcome information, we identified 89 orofacial cleft-associated pregnancies, 80 NTD-affected pregnancies, and randomly selected 409 pregnancy specimens that corresponded to infants without malformations as control subjects. Cotinine was measured by liquid chromatography-mass spectrometry. No smoke exposure was defined as cotinine values <2 ng/mL, and any exposure was defined as >or=2 ng/mL. RESULTS: We observed odds ratios of 2.1 (95% CI, 1.0-4.4) for clefts and 0.4 (95% CI, 0.1-1.7) for NTDs associated with exposure. After adjusting for race/ethnicity, age, and serum folate levels, odds ratios were 2.4 (95% CI, 1.1-5.3) and 0.6 (95% CI, 0.1-2.5). We explored 2 cotinine levels, 2 to 10 ng/mL and >10 ng/mL for clefts (data were too sparse for NTDs). Odds ratios for these levels were 3.3 (95% CI, 0.9-11.9) and 1.7 (95% CI, 0.7-4.2), respectively. CONCLUSION: Smoking exposures, as measured with cotinine levels during mid-pregnancy, were associated with increased risks of clefts and possibly reduced risks of NTDs.
Asunto(s)
Labio Leporino/epidemiología , Fisura del Paladar/epidemiología , Cotinina/sangre , Defectos del Tubo Neural/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Fumar/epidemiología , Adulto , Femenino , Humanos , Oportunidad Relativa , Embarazo , Segundo Trimestre del Embarazo , Estudios ProspectivosRESUMEN
OBJECTIVE: To evaluate time trend of gastroschisis and examine the epidemiological risk factors for gastroschisis. STUDY DESIGN: This population-based study analyzed the active surveillance data from the California Birth Defects Monitoring Program from 1987 to 2003. RESULTS: The overall birth prevalence of gastroschisis was 2.6 cases per 10,000 births (908 cases in >3.5 million births). In the adjusted analysis, by using the age of 25 to 29 years as the reference, mothers aged 12 to 15 years had a 4.2-times greater birth prevalence (95% CI, 2.5-7.0), and fathers aged 16 to 19 years and 20 to 24 years had 1.6- and 1.5-times greater birth prevalence (95% CI, 1.1-2.1 and 1.2-1.8), respectively. Compared with non-Hispanic whites and US-born Hispanic, both foreign-born Hispanics and blacks had adjusted prevalence ratio of 0.6 (95% CI, 0.5-0.7 and 0.4-0.9, respectively). In addition, nulliparity was also associated with gastroschisis. Independent of maternal age, paternal age, and maternal ethnicity, the birth prevalence increased 3.2-fold (95% CI, 2.3-4.3) during the 17-year study period. CONCLUSIONS: The birth prevalence of gastroschisis continues to increase in California, and young, nulliparous women are at the greatest risk of having a child with gastroschisis.
Asunto(s)
Gastrosquisis/epidemiología , California/epidemiología , Femenino , Humanos , Recién Nacido , Masculino , Edad Materna , Edad Paterna , Prevalencia , Factores de RiesgoRESUMEN
Mexico-born women in the United States have an unexplained twofold increased risk of neural tube defect (NTD)-affected pregnancies. We examined whether immigration characteristics were associated with the NTD risk and whether anthropometric factors contributed to the increased risk among Mexico-born women. Data were derived from a large population-based case-control study in California. In-person interviews were conducted with mothers of 538 (88% of eligible) NTD-affected fetuses/infants and mothers of 539 (88%) randomly selected non-malformed control infants. The crude odds ratio (OR) for NTDs among all Mexico-born women, women residing <2 years in the US, and women >16 years old at immigration compared with non-Hispanic white women was 2.4 [95% confidence interval (CI) = 1.8, 3.3], 7.2 [95% CI = 3.7, 14.0] and 3.0 [95% CI = 2.0, 4.4], respectively. Risk for second- or third-generation Mexican-Americans was similar to that of white women. The crude OR for all Mexico-born women was reduced from 2.4 to 2.0 [95% CI = 1.3, 3.0] and for those residing <2 years in the US from 8.4 to 7.1 [95% CI = 3.2, 15.3] after adjustment for maternal body mass index (BMI), height, compromised diet, diabetes, and other known risk factors. In term pregnancies, additional adjustment for pregnancy weight gain reduced the OR in all Mexico-born women and recent immigrants by 16% and 25%, respectively. Low pregnancy weight gain (<10 vs. 10-14 kg) was particularly associated with increased NTD risk among Mexico-born women (OR(ADJ) = 5.8; 95% CI = 2.1, 15.8). Findings indicate that recent Mexican immigrants have a sevenfold increased risk for NTDs. Maternal BMI and height contributed very little, and inadequate weight gain contributed modestly to the NTD risk disparity for Mexican immigrants.