scholarly journals Preterm birth and risk for language delays before school entry: A sibling-control study

Author(s):  
Imac Maria Zambrana ◽  
Margarete E. Vollrath ◽  
Bo Jacobsson ◽  
Verena Sengpiel ◽  
Eivind Ystrom

Abstract We investigated whether children born preterm are at risk for language delay using a sibling-control design in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. Participants included 26,769 siblings born between gestational weeks 23 and 42. Language delay was assessed when the children were 1.5, 3, and 5 years old. To adjust for familial risk factors, comparisons were conducted between preterm and full-term siblings. Pregnancy-specific risk factors were controlled for by means of observed variables. Findings showed that preterm children born before week 37 had increased risk for language delays at 1.5 years. At 3 and 5 years, only children born before week 34 had increased risk for language delay. Children born weeks 29–33 and before week 29 had increased risk for language delay at 1.5 years (RR = 4.51, 95% CI [3.45, 5.88]; RR = 10.32, 95% CI [6.7, 15.80]), 3 years (RR = 1.50, 95% CI [1.02, 2.21]; RR = 2.78, 95% CI [1.09, 7.07]), and 5 years (RR = 1.63, 95% CI [1.06, 2.51]; RR = 2.98, 95% CI [0.87, 10.26]), respectively. In conclusion, children born preterm are at risk for language delays, with familial confounders only explaining a moderate share of the association. This suggests a cause-effect relationship between early preterm birth and risk for language delay in preschool children.

2019 ◽  
Vol 50 (11) ◽  
pp. 1862-1871 ◽  
Author(s):  
E. Appiah-Kusi ◽  
R. Wilson ◽  
M. Colizzi ◽  
E. Foglia ◽  
E. Klamerus ◽  
...  

AbstractBackgroundEvidence has been accumulating regarding alterations in components of the endocannabinoid system in patients with psychosis. Of all the putative risk factors associated with psychosis, being at clinical high-risk for psychosis (CHR) has the strongest association with the onset of psychosis, and exposure to childhood trauma has been linked to an increased risk of development of psychotic disorder. We aimed to investigate whether being at-risk for psychosis and exposure to childhood trauma were associated with altered endocannabinoid levels.MethodWe compared 33 CHR participants with 58 healthy controls (HC) and collected information about previous exposure to childhood trauma as well as plasma samples to analyse endocannabinoid levels.ResultsIndividuals with both CHR and experience of childhood trauma had higher N-palmitoylethanolamine (p < 0.001) and anandamide (p < 0.001) levels in peripheral blood compared to HC and those with no childhood trauma. There was also a significant correlation between N-palmitoylethanolamine levels and symptoms as well as childhood trauma.ConclusionsOur results suggest an association between CHR and/or childhood maltreatment and elevated endocannabinoid levels in peripheral blood, with a greater alteration in those with both CHR status and history of childhood maltreatment compared to those with either of those risks alone. Furthermore, endocannabinoid levels increased linearly with the number of risk factors and elevated endocannabinoid levels correlated with the severity of CHR symptoms and extent of childhood maltreatment. Further studies in larger cohorts, employing longitudinal designs are needed to confirm these findings and delineate the precise role of endocannabinoid alterations in the pathophysiology of psychosis.


Author(s):  
Alberto Muniz Rodriguez ◽  
Andrew Pastor ◽  
Nathan S. Fox

Objective The aim of this study was to estimate if preterm premature rupture of membranes in women with cerclage is due to the cerclage itself or rather the underlying risk factors for preterm birth in this population. Study Design This was a retrospective cohort study of singleton pregnancies who underwent Shirodkar cerclage by a single maternal–fetal medicine practice between 2005 and 2019. The control group was an equal number of randomly selected women with a singleton gestation who had a prior preterm birth and were treated with 17-OH-progesterone but no cerclage. Patients with major uterine anomalies or fetal anomalies were excluded. The primary outcome was preterm premature rupture of membranes prior to 34 weeks. Chi-square and logistic regression were used. Results A total of 350 women with cerclage (154 [44%] history-indicated, 137 [39%] ultrasound-indicated, and 59 [17%] exam-indicated) and 350 controls were included. Preterm premature rupture of membranes prior to 34 weeks did not differ between the groups (8.9% in cerclage vs. 6.0% in controls, p = 0.149, adjusted odds ratio 0.62, 95% confidence interval: 0.24–1.64) nor between the different cerclage indications (9.1% of history-indicated, 7.3% of ultrasound-indicated, and 11.9% of exam-indicated, p = 0.582). This study had 80% power with an α error of 0.05 to detect an increase in preterm premature rupture of membranes prior to 34 weeks from 6.0% in the control group to 12.0% in the cerclage group. Conclusion Cerclage does not increase the risk of preterm premature rupture of membranes prior to 34 weeks compared with other women at increased risk of preterm birth. The observed association between cerclage and preterm premature rupture of membranes is likely due to underlying risk factors and not the cerclage itself. The risk of preterm premature rupture of membranes prior to 34 weeks in women with cerclage is 10% or less and does not appear to differ based on cerclage indication. Key Points


Author(s):  
P Bachkangi ◽  
AH Taylor ◽  
JC Konje

Preterm birth (PTB) affects 9.6% of pregnancies worldwide and is associated with a very high perinatal mortality that depends on the gestational age at delivery. As a result, PTB has a significant health and financial impact on health systems, families and societies. Its aetiology is not fully understood, but in most cases it is multifactorial, with several maternal, paternal, and epidemiological factors associated with increased risk. Other factors include parental ethnicity, maternal age and body mass index, socioeconomic status, and where the families live. This review examines the influence of ethnicity as an individual risk factor for PTB. It also explores its influence on the epidemiology of PTB and demonstrates that data on certain ethnicities are lacking, despite the fact that these ethnic clusters are within the very ‘high-risk groups’ that are adequately represented in some Western societies. This review examines the influence of ethnicity as an individual risk factor for PTB and also explores its influence on the different epidemiological aspects. A thorough revisit of the ethnic epidemiology unveiled other unnoticed risk factors that if addressed appropriately prematurity can be prevented. Moreover, certain ethnicities were not within the attention of researchers, despite the facts that they are very ‘high-risk groups’ and are also adequately represented in some Western societies.


2021 ◽  
Author(s):  
Jian Li ◽  
Jinhua Shen ◽  
Xiaoli Zhang ◽  
Yangqin Peng ◽  
Qin Zhang ◽  
...  

Abstract In vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).is associated with an increased risk of preterm (33rd - 37th gestational week), and early preterm birth (20th - 32nd gestational week). The underlying general and procedure related risk factors are not well understood so far. 4,328 infertile women undergoing IVF/ICSI were entered into this study. The study population was divided into three groups: a) early preterm birth group (n=66), b) preterm birth group (n=675 ) and c) full-term birth group (n=3653). Odds for preterm birth were calculated by stepwise multivariate logistic regression analysis. We identified seven independent risk factors for preterm birth and four independent risk factors for early preterm birth. Older (>39) or younger (<25) maternal age (OR:1.504, 95%CI: 1.108-2.042,P=0.009; OR: 2.125, 95%CI: 1.049-4.304,P=0.036, respectively), multiple pregnancy (OR: 9.780, 95%CI: 8.014-11.935,P<0.001; OR: 8.588, 95%CI: 4.866-15.157,P<0.001, respectively), placenta previa (OR: 14.954, 95%CI: 8.053-27.767,P<0.001; OR: 16.479, 95%CI: 4.381-61.976,P<0.001, respectively), and embryo reduction (OR: 3.547, 95%CI: 1.736-7.249,P=0.001; OR: 7.145, 95%CI: 1.990-25.663,P=0.003, respectively) were associated with preterm birth and early preterm birth, whereas gestational hypertension (OR: 2.494, 95%CI: 1.770-3.514,P<0.001), elevated triglycerides (OR: 1.120, 95%CI: 1.011-1.240,P=0.030) and shorter activated partial thromboplastin time (OR: 0.967, 95%CI: 0.949-0.985,P<0.001) were associated only with preterm birth. In conclusion, preterm and early preterm birth risk factors in patients undergoing assisted IVF/ICSI are in general similar to those in natural pregnancy. The lack of some associations in the early preterm group was most likely due to the lower number of early preterm birth cases. Only embryo reduction represents an IVF/ICSI specific risk factor.


2019 ◽  
Author(s):  
Andrea Pfennig ◽  
Karolina Leopold ◽  
Julia Martini ◽  
Anne Boehme ◽  
Martin Lambert ◽  
...  

Abstract Background Bipolar disorders (BD) belong to the most severe mental disorders, characterized by an early onset, predominantly recurrent/chronic course and poor psychosocial functioning. Many patients with BD experience substantial symptomatology months or even years before full BD manifestation. Adequate diagnosis and treatment is often delayed, which is associated with a worse outcome. This study aims to prospectively evaluate and improve early recognition and intervention strategies for persons at-risk for BD. Methods and Results Early-BipoLife is a prospective-longitudinal cohort study of 1419 participants (aged 15-35 years) with at least five waves of assessment over a period of at least 2 years (baseline, 6, 12, 18 and 24 months). A research consortium of ten university and teaching hospitals across Germany conducts this study. The following risk groups (RGs) were recruited: RG I: help-seeking youth & young adults consulting early recognition centres/facilities presenting ≥1 of the proposed risk factors for BD, RG II: in-/outpatients with unipolar depressive syndrome, and RG III: in-/ outpatients with attention-deficit/hyperactivity disorder (ADHD). The reference cohort was selected from the German representative IMAGEN cohort. Over the study period, the natural course of risk and resilience factors, early symptoms of BD and changes of symptom severity (including conversion to manifest BD) are observed. Psychometric properties of recently developed, structured instruments on potential risk factors for conversion to BD and subsyndromal symptomatology (Bipolar Prodrome Symptom Scale, Bipolar at-risk criteria, EPI bipolar ) and biomarkers that potentially improve prediction are investigated. Moreover, actual treatment recommendations are monitored in the participating specialized services and compared to recently postulated clinical categorization and treatment guidance in the field of early BD. Conclusion Findings from this study will contribute to an improved knowledge about the natural course of BD, from the onset of first noticeable symptoms (precursors) to fully developed BD, and about mechanisms of conversion from subthreshold to manifest BD. Moreover, these generated data will provide information for the development of evidence-based guidelines for early-targeted detection and preventive intervention for people at risk for BD.


2018 ◽  
Vol 4 (2) ◽  
pp. 50 ◽  
Author(s):  
Rebecca J. Baer ◽  
Lauren Lessard ◽  
Marta Jankowska ◽  
James G. Anderson ◽  
Jessica Block ◽  
...  

Preterm birth (PTB, < 37 weeks’ gestation) may impose lifelong sequelae or death. Fresno County reports the highest rate of PTB in California. A place-based approach investigating local risk factors for PTB may provide important opportunities for intervention and prevention. In this study, we examine risk and protective factors for PTB in rural, suburban, and urban Fresno County, California. The sample was drawn from Fresno County, California singleton births 2007-2012 (n = 81,021). Multivariate models of maternal risk and protective factors for PTB were stratified by rural, suburban, and urban residence. Women with diabetes, hypertension, infection, fewer than three prenatal care visits, previous PTB, interpregnancy interval less than six months, or were of Black race/ethnicity were at increased risk of PTB. The risk of PTB was highest for women residing in rural locations with preeclampsia superimposed on preexisting hypertension (adjusted relative risk (aRR) 5.7, 95% confidence interval (CI) 4.4-7.4). For women living in urban residences, maternal birth in Mexico and overweight body mass index (BMI) offered protection from PTB (aRRs 0.9), whereas participation in the Women, Infants and Children program was protective for women in either urban or rural residences (aRRs 0.8). Public insurance, <12 year of education,  underweight BMI, and interpregnancy interval of five years or more were risk factors only for women in urban residences. These findings may provide important opportunities for local intervention. 


BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034145
Author(s):  
Anne B. Rohlfing ◽  
Gregory Nah ◽  
Kelli K. Ryckman ◽  
Brittney D. Snyder ◽  
Deborah Kasarek ◽  
...  

ObjectiveTo determine whether maternal cardiovascular disease (CVD) risk factors predict preterm birth.DesignCase control.SettingCalifornia hospitals.Participants868 mothers with linked demographic information and biospecimens who delivered singleton births from July 2009 to December 2010.MethodsLogistic regression analysis was employed to calculate odds ratios for the associations between maternal CVD risk factors before and during pregnancy (including diabetes, hypertensive disorders and cholesterol levels) and preterm birth outcomes.Primary outcomePreterm delivery status.ResultsAdjusting for the other maternal CVD risk factors of interest, all categories of hypertension led to increased odds of preterm birth, with the strongest magnitude observed in the pre-eclampsia group (adjusted OR (aOR), 13.49; 95% CI 6.01 to 30.27 for preterm birth; aOR, 10.62; 95% CI 4.58 to 24.60 for late preterm birth; aOR, 17.98; 95% CI 7.55 to 42.82 for early preterm birth) and chronic hypertension alone for early preterm birth (aOR, 4.58; 95% CI 1.40 to 15.05). Diabetes (types 1 and 2 and gestational) was also associated with threefold increased risk for preterm birth (aOR, 3.06; 95% CI 1.12 to 8.41). A significant and linear dose response was found between total and low-density lipoprotein (LDL) cholesterol and aORs for late and early preterm birth, with increasing cholesterol values associated with increased risk (likelihood χ2 differences of 8.422 and 8.019 for total cholesterol for late and early, and 9.169 and 10.896 for LDL for late and early, respectively). Receiver operating characteristic curves using these risk factors to predict late and early preterm birth produced C statistics of 0.601 and 0.686.ConclusionTraditional CVD risk factors are significantly associated with an increased risk of preterm birth; these findings reinforce the clinical importance of integrating obstetric and cardiovascular risk assessment across the healthcare continuum in women.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4740-4740
Author(s):  
Frederick R Rickles ◽  
Gregory A Maynard ◽  
Richard J Friedman ◽  
Alan P Brownstein ◽  
Elizabeth A Varga ◽  
...  

Abstract Abstract 4740 Deep vein thrombosis (DVT) and pulmonary embolism (PE) affect up to 600,000 individuals and account for ~100,000 deaths in the United States each year, according to The Surgeon General's Call to Action (CTA) To Prevent Deep Vein Thrombosis and Pulmonary Embolism (2008). Oncology patients, particularly those who are hospitalized or undergo chemotherapy, are at increased risk for DVT/PE. Mortality is greater among patients with cancer and venous thromboembolism (VTE) than among those with cancer alone. In response to the Surgeon General's CTA, the National Blood Clot Alliance (NBCA), a national, community-based, non-profit organization dedicated to the prevention, diagnosis, and treatment of thrombosis and thrombophilia, conducted a survey to benchmark DVT/PE awareness among the general public and several at-risk patient groups, including oncology patients. The literature contains little information about at-risk patient knowledge, and almost no information about general public knowledge of VTE, making this the first, large survey of both public and at-risk patient awareness of DVT/PE. The survey was conducted in November 2009, among a representative cross-section of 500 adults, >20 years, participating in online research panels. For comparison, the identical survey was conducted among a sample of 500 adults, >20 years, screened from an online research panel, who had received a cancer diagnosis or experienced recurrence of cancer within the past 6 months, or who were on active cancer treatment. Evaluations comparing survey responses provided by oncology patients who, in connection with their treatment, did require a hospital stay versus those who did not require a hospital stay showed no statistically significant differences in DVT/PE awareness between the two subgroups. Among all oncology patients surveyed, 24% said that they had heard of a medical condition called DVT, compared to 21% of the general public. Among all respondents who said that they knew what a DVT was (unaided) or who were able to correctly identify DVT on an aided checklist, 61% of oncology and 53% of national respondents said they could name DVT risk factors. The most frequently mentioned DVT risk factor was “sitting for a long time” among both the oncology (45%) and national (28%) samples. Among oncology patients who could name DVT risk factors (n=155), 8% named surgery, 1% named cancer treatment. Among national respondents who could name DVT risk factors (n=109), significantly more (79%) said they could name DVT signs/symptoms compared to oncology respondents (63%) who said the same. While not statistically significant, the national sample did show greater recognition of certain DVT signs/symptoms: skin redness/discoloration, 41% national, 21% oncology; leg swelling, 50% national, 31% oncology; and, leg pain, 37% national, 27% oncology. PE awareness was low among both groups, with 15% of all oncology and 16% of all national respondents saying that they had heard of PE. Of those who what said they knew what a PE was (unaided) or identified it correctly from an aided checklist, about one-third of both groups said they could name PE signs/symptoms, with “breathing difficulties” cited most frequently by oncology (69%) and national (73%) respondents. Significantly fewer oncology patients (28%) mentioned chest pain/tightness as a PE sign/symptom, compared to the national sample (57%). About 8 in 10 oncology and national respondents said that they did know what a blood clot is, and virtually all respondents (98%) recognized blood clots as life threatening. DVT/PE awareness/knowledge was low. Despite increased risk, oncology patients demonstrated no greater awareness of DVT/PE than the general public. DVT/PE education, utilizing interventions identified in the Surgeon General's DVT/PE CTA, should target the general public, with special emphasis on at-risk oncology patients to fill gaps relative to increased DVT/PE risks and signs/symptoms. Terms should be further simplified for future public awareness and patient education initiatives. Disclosures: Brownstein: Ortho-McNeil, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.: Data reported from project supported by Ortho-McNeil, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. Ansell:Bayer, Inc: Consultancy; Bristol Myers Squibb: Consultancy, Data Safety Monitoring Boards; Daiichi Sankyo: Consultancy; Boehringer Ingleheim: Consultancy; Ortho McNeil: Consultancy; Sanofi Aventis: Speakers Bureau.


2020 ◽  
Vol 41 (S1) ◽  
pp. s294-s294
Author(s):  
Verinsa Mouajou ◽  
Lucila Baldassarre

Background: Recurrence rates and risk factors of Clostridium difficile infection (CDI) are well established in adults, though little is known about the rate of recurrent CDI (rCDI) within the pediatric population. The purpose of this study was to identify rates and risk factors of rCDI in pediatric at-risk groups to guide the optimization of targeted prevention efforts against disease recurrence. Methods: We report on the ongoing retrospective cohort study of pediatric patients at the CHU Sainte-Justine with a laboratory confirmed diagnosis of CDI between April 1, 2012, and March 31, 2017. Incidence rates of rCDI were obtained per 100 cases. Frequencies of rCDI were compared using the Fisher exact test. Univariate and multivariate logistic regression were used to identify risk factors for rCDI. Two-tailed P < .05 was considered significant. All statistical calculations were performed using R version 3.5.2 software. Results: Of 80 patients analyzed with CDI, 16 had rCDI, for a rCDI rate in this population of 20%. Most recurrences were observed in secondarily immunosuppressed patients including, but not limited to, oncology patients undergoing chemotherapy and/or radiotherapy (30.4%) and patients with inflammatory bowel disease (IBD, 29.2%). Patients that were administered vancomycin orally (PO) had recurrent infection less often than patients that administered metronidazole PO or IV (8.3% vs 23.4%, respectively). This trend was observed in all at-risk patient groups. Patients with secondary immunodeficiency had 7.4 times increased odds of recurrence compared to nonimmunodeficient patients (adjusted OR, 7.43,; 95% CI, 1.84–50.4; P = .0126). Conclusions: Initial vancomycin PO therapy seems to be associated with a lower risk of recurrence. Pediatric patients with IBD and with secondary immunodeficiency are at increased risk of rCDI. Given that these populations have an increased underlying risk of diarrhea, it would be worthwhile to determine whether toxin is actually produced (EIA testing) and to prioritize prevention efforts.Funding: NoneDisclosures: None


2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 94-95
Author(s):  
K Leung ◽  
P Tandon ◽  
V Govardhanam ◽  
C Maxwell ◽  
V Huang

Abstract Background Inflammatory bowel disease (IBD) often affects women in their child-bearing years. These women may be at an increased risk of adverse neonatal outcomes. Aims The aim of this study was to evaluate the risk of these outcomes in this population of patients, with an emphasis of determining risk factors for development of these conditions. Methods Medline, Embase, and Cochrane library were searched through to May 2019 for studies reporting adverse neonatal outcomes in IBD patients. Weighted odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the risk of these outcomes in patients with IBD compared to healthy controls, with risk factors such as disease activity and medication exposure also being assessed. Results Sixty studies were included (8194 pregnancies with inflammatory bowel disease and 3253 healthy pregnancies). Compared to healthy controls, patients with inflammatory bowel disease were more likely to deliver infants with low birth weight (LBW) (OR 2.78, 95% CI 1.16–6.66) and infants who were admitted to the neonatal intensive care unit (NICU) (OR 3.33, 95% CI 1.83–6.05). Patients with Crohn’s disease had an increased risk of infants born with congenital anomalies (OR 3.03, 95% CI, 1.43–6.42), whereas patients with ulcerative colitis had an increased risk of preterm delivery (OR 2.68, 95% CI, 1.12–6.43). Active disease increased the risk of preterm birth (OR 2.06, 95% CI 1.21–3.51), LBW (OR 2.96, 95% CI 1.54–5.70), and small for gestation age (OR 2.62, 95% CI 1.18–5.83) compared to disease in remission. Tumor necrosis factor antagonists was associated with increased risk of NICU admission (OR 2.42, 95% CI 1.31–4.45) and LBW (OR 1.54, 95% CI, 1.01–2.35). Conclusions Patients with inflammatory bowel disease are at an increased risk of developing adverse neonatal outcomes such as preterm birth, LBW, congenital anomalies, and NICU admissions. Patients with clinically active disease and those exposed to anti-TNF therapy may be at higher risk of developing these adverse outcomes. The findings of this study are important to communicate to patients and healthcare providers alike. Furthermore, this information may help to mitigate these risks through collaborative specialized care during pregnancy in order to reduce the overall morbidity and mortality for both mother and baby. Funding Agencies None


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