RESUMO
OBJECTIVE: To investigate the risk of adverse neonatal events after a pregnancy complicated by severe maternal morbidity. STUDY DESIGN: We analyzed a population-based cohort of deliveries in Quebec, Canada, between 2006 and 2021. The main exposure measure was severe maternal morbidity, comprising life-threatening conditions such as severe hemorrhage, cardiac complications, and eclampsia. The outcome included adverse neonatal events such as very preterm birth (gestational age <32 weeks), bronchopulmonary dysplasia, hypoxic ischemic encephalopathy, and neonatal death. Using log-binomial regression models, we estimated adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the association between severe maternal morbidity and adverse neonatal events. RESULTS: Among 1â199â112 deliveries, 29â992 (2.5%) were complicated by severe maternal morbidity and 83â367 (7.0%) had adverse neonatal events. Severe maternal morbidity was associated with 2.96 times the risk of adverse neonatal events compared with no morbidity (95% CI 2.90-3.03). Associations were greatest for mothers who required assisted ventilation (RR 5.86, 95% CI 5.34-6.44), experienced uterine rupture (RR 4.54, 95% CI 3.73-5.51), or had cardiac complications (RR 4.39, 95% CI 3.98-4.84). Severe maternal morbidity was associated with ≥3 times the risk of neonatal death and hypoxic-ischemic encephalopathy and ≥10 times the risk of very preterm birth and bronchopulmonary dysplasia. CONCLUSIONS: Severe maternal morbidity is associated with an elevated risk of adverse neonatal events. Better prevention of severe maternal morbidity may help reduce burden of severe neonatal morbidity.
Assuntos
Complicações na Gravidez , Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Quebeque/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto Jovem , Estudos de Coortes , Nascimento Prematuro/epidemiologia , Resultado da Gravidez/epidemiologia , Fatores de RiscoRESUMO
BACKGROUND: Preterm birth (PTB, birth before 37 weeks of gestation) has been associated with adverse health outcomes across the lifespan. Evidence on the association between PTB and prenatal exposure to air pollutants is inconsistent, and is especially lacking for ethnic/racial minority populations. METHODS: We obtained data on maternal characteristics and behaviors and PTB and other birth outcomes for women participating in the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) cohort, who lived in municipalities located along the North Coast of Puerto Rico. We assessed pre-natal PM2.5 exposures for each infant based on the nearest US Environmental Protection Agency monitor. We estimated prenatal phthalate exposures as the geometric mean of urinary measurements obtained during pregnancy. We then examined the association between PM2.5 and PTB using modified Poisson regression and assessed modification of the association by phthalate exposure levels and sociodemographic factors such as maternal age and infant gender. RESULTS: Among 1092 singleton births, 9.1% of infants were born preterm and 92.9% of mothers had at least a high school education. Mothers had a mean (standard deviation) age of 26.9 (5.5) years and a median (range) of 2.0 (1.0-8.0) pregnancies. Nearly all women were Hispanic white, black, or mixed race. Median (range) prenatal PM2.5 concentrations were 6.0 (3.1-19.8) µ g/m3. Median (interquartile range) prenatal phthalate levels were 14.9 (8.9-26.0) and 14.5 (8.4-26.0), respectively, for di-n-butyl phthalate (DBP) and di-isobutyl phthalate (DiBP). An interquartile range increase in PM2.5 was associated with a 1.2% (95% CI 0.4, 2.1%) higher risk of PTB. There was little difference in PTB risk in strata of infant sex, mother's age, family income, history of adverse birth outcome, parity, and pre-pregnancy body mass index. Pregnancy urinary phthalate metabolite levels did not modify the PM2.5-PTB association. CONCLUSION: Among ethnic minority women in Puerto Rico, prenatal PM2.5 exposure is associated with a small but significant increase in risk of PTB.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Exposição Materna/efeitos adversos , Material Particulado/efeitos adversos , Ácidos Ftálicos/urina , Nascimento Prematuro , Adulto , Poluentes Atmosféricos/análise , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Troca Materno-Fetal , Grupos Minoritários , Material Particulado/análise , Gravidez , Porto Rico , Adulto JovemRESUMO
Prenatal exposure to mercury, stress, and depression may have adverse effects on birth outcomes. Little is known on the influence of chemical and non-chemical stressors on birth outcomes in the country of Suriname. We assessed the influence of prenatal exposure to mercury, perceived stress, and depression on adverse birth outcomes in 1143 pregnant Surinamese women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between mercury (≥1.1 µg/g hair, USEPA action level/top versus bottom quartile), probable depression (Edinburgh Depression Scale ≥12), high perceived stress (Cohen's Perceived Stress Scale ≥20), and adverse birth outcomes (low birthweight (<2500 g), preterm birth (<37 completed weeks of gestation), and low Apgar score (<7 at 5 min)) were assessed using bivariate and multivariate logistic regressions. Prevalence of elevated mercury levels, high perceived stress, and probable depression were 37.5%, 27.2%, and 22.4%, respectively. Mercury exposure was significantly associated with preterm birth in the overall study cohort (OR 2.47; 95% CI 1.05-5.83) and perceived stress with a low Apgar score (OR 9.73; 95% CI 2.03-46.70). Depression was not associated with any birth outcomes. These findings can inform policy- and practice-oriented solutions to improve maternal and child health in Suriname.
Assuntos
Depressão , Mercúrio , Nascimento Prematuro , Efeitos Tardios da Exposição Pré-Natal , Estresse Psicológico , Adulto , Região do Caribe , Criança , Feminino , Humanos , Recém-Nascido , Mercúrio/toxicidade , Gravidez , Estudos Prospectivos , Suriname , Adulto JovemRESUMO
Latinos are the largest growing population and have the highest fertility rates in the US. In response, this study assessed if late initiation of or no prenatal care (PNC) mediated the relationship among adverse birth outcomes and interactions between immigrant and insurance status. This study used cross-sectional data (2002-2004) limited to 109,399 women of Mexican ethnicity who had singleton births in the San Joaquin Valley, California. We conducted hierarchical mediation analyses. US-born Mexican women who used private or public insurance for PNC were more likely to have infants born at low-birth weight and premature compared to Mexican first generation immigrant women. Nonetheless, initiation of late or no PNC positively mediated the relationship between infants born premature to Mexican first generation immigrant women who used public insurance (ab/se(ab) = 2.123, p = .034). Findings from this study support acculturation theory and the need for multilevel approaches to address PNC among women of Mexican ethnicity.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , Nascimento Prematuro/etnologia , Cuidado Pré-Natal/estatística & dados numéricos , Aculturação , Adulto , California/epidemiologia , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Assistência Médica/estatística & dados numéricos , Gravidez , Resultado da Gravidez/etnologiaRESUMO
OBJECTIVES: To identify postnatal predictors of malnutrition among 7- to 10-year-old children and to assess the long-term effects of antenatal micronutrient supplementation on malnutrition. STUDY DESIGN: A follow-up study was conducted to assess the nutritional status of 7- to 10-year-olds (1747 children) whose mothers participated in a cluster-randomized double-blind controlled trial from 2002 to 2006. RESULTS: The rate of malnourished 7- to 10-year-olds was 11.1%. A mixed-effects logistic regression model adjusted for the cluster-sampling design indicated that mothers with low prepregnant midupper arm circumference had boys with an increased risk of thinness (aOR 2.05, 95% CI 1.11, 3.79) and girls who were more likely to be underweight (aOR 2.01, 95% CI 1.05, 3.85). Antenatal micronutrient supplementation was not significantly associated with malnutrition. Low birth weight was significantly associated with increased odds of malnutrition among boys (aOR 4.34, 95% CI 1.82, 10.39) and girls (aOR 7.50, 95% CI 3.48, 16.13). Being small for gestational age significantly increased the odds of malnutrition among boys (aOR 1.75, 95% CI 1.01, 3.04) and girls (aOR 4.20, 95% CI 2.39, 7.39). In addition, household wealth, parental height, being picky eater, and illness frequency also predicted malnutrition. CONCLUSIONS: Both maternal prenatal nutrition and adverse birth outcomes are strong predictors of malnutrition among early school-aged children. Currently, available evidence is insufficient to support long-term effects of antenatal micronutrient supplementation on children's nutrition. TRIAL REGISTRATION: www.isrctn.com: ISRCTN08850194.