scholarly journals Economic costs at age five associated with very preterm birth: multinational European cohort study

2021 ◽  
Author(s):  
Sung Wook Kim ◽  
Lazaros Andronis ◽  
Anna-Veera Seppänen ◽  
Adrien M. Aubert ◽  
Jennifer Zeitlin ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
European Countries ◽  
List Type ◽  
Economic Costs ◽  
Societal Costs ◽  
Cost Drivers ◽  
Very Preterm ◽  
The Impact ◽  
New Evidence

Abstract Background This study aims to estimate the economic costs of care provided to children born very preterm and extremely preterm across 11 European countries, and to understand what perinatal and socioeconomic factors contribute to higher costs. Methods Generalised linear modelling was used to explore the association between perinatal and sociodemographic characteristics and total economic costs (€, 2016 prices) during the fifth year of life. Results Lower gestational age was associated with increased mean societal costs of €2755 (p < 0.001), €752 (p < 0.01) and €657 (p < 0.01) for children born at < 26, 26–27 and 28–29 weeks, respectively, in comparison to the reference group born at 30–31 weeks. A sensitivity analyses that excluded variables (BPD, any neonatal morbidity and presence of congenital anomaly) plausibly lying on the causal pathway between gestational age at birth and economic outcomes elevated incremental societal costs by €1482, €763 and €144 at < 26, 26–27 and 28–29 weeks, respectively, in comparison to the baseline model. Conclusion This study provides new evidence about the main cost drivers associated with preterm birth in European countries. Evidence identified by this study can act as inputs within cost-effectiveness models for preventive or treatment interventions for preterm birth. Impact What is the key message of your article? This study provides new evidence about the magnitude and drivers of economic costs associated with preterm birth in European countries. What does it add to the existing literature? Lower gestational age is associated with increased mean societal costs during mid-childhood with indirect costs representing a key driver of increased costs. What is the impact? For policy makers, this study adds to sparse evidence about the main cost drivers associated with preterm birth in European countries beyond the first 2 years of life.

scholarly journals Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stephanie Polus ◽  
Jacob Burns ◽  
Sabine Hoffmann ◽  
Tim Mathes ◽  
Ulrich Mansmann ◽  
...  
Keyword(s):  
Time Series ◽  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Preterm Births ◽  
Interrupted Time Series ◽  
Federal States ◽  
Very Preterm ◽  
The Impact

AbstractIn 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation.

scholarly journals Birth outcomes, pregnancy complications, and postpartum mental health after the 2013 Calgary flood: A difference in difference analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246670
Author(s):  
Erin Hetherington ◽  
Kamala Adhikari ◽  
Lianne Tomfohr-Madsen ◽  
Scott Patten ◽  
Amy Metcalfe
Keyword(s):  
Mental Health ◽  
Preterm Birth ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Gestational Hypertension ◽  
Difference In Difference ◽  
Postpartum Mental Health ◽  
Nulliparous Women ◽  
The Impact

Background In June 2013, the city of Calgary, Alberta and surrounding areas sustained significant flooding which resulted in large scale evacuations and closure of businesses and schools. Floods can increase stress which may negatively impact perinatal outcomes and mental health, but previous research is inconsistent. The objectives of this study are to examine the impact of the flood on pregnancy health, birth outcomes and postpartum mental health. Methods Linked administrative data from the province of Alberta were used. Outcomes included preterm birth, small for gestational age, a new diagnoses of preeclampsia or gestational hypertension, and a diagnosis of, or drug prescription for, depression or anxiety. Data were analyzed using a quasi-experimental difference in difference design, comparing flooded and non-flooded areas and in affected and unaffected time periods. Multivariable log binomial regression models were used to estimate risk ratios, adjusted for maternal age. Marginal probabilities for the difference in difference term were used to show the potential effect of the flood. Results Participants included 18,266 nulliparous women for the pregnancy outcomes, and 26,956 women with infants for the mental health analysis. There were no effects for preterm birth (DID 0.00, CI: -0.02, 0.02), small for gestational age (DID 0.00, CI: -0.02, 0.02), or new cases of preeclampsia (DID 0.00, CI: -0.01, 0.01). There was a small increase in new cases of gestational hypertension (DID 0.02, CI: 0.01, 0.03) in flood affected areas. There were no differences in postpartum anxiety or depression prescriptions or diagnoses. Conclusion The Calgary 2013 flood was associated with a minor increase in gestational hypertension and not other health outcomes. Universal prenatal care and magnitude of the disaster may have minimized impacts of the flood on pregnant women.

Fasting during Ramadan Increases Risk of Very Preterm Birth among Arabic-Speaking Women

2019 ◽  
Vol 149 (10) ◽  
pp. 1826-1832 ◽  
Author(s):  
Rasmi M Tith ◽  
Marianne Bilodeau-Bertrand ◽  
Ga Eun Lee ◽  
Jessica Healy-Profitós ◽  
Nathalie Auger
Keyword(s):  
Preterm Birth ◽  
Birth Certificates ◽  
Second Trimester ◽  
Ramadan Fasting ◽  
Maternal Characteristics ◽  
Very Preterm ◽  
Arabic Speakers ◽  
Very Preterm Birth ◽  
Arabic Speaking ◽  
The Impact

ABSTRACT Background The impact of fasting on risk of preterm birth during Ramadan is unclear. Objectives We evaluated the association between Ramadan fasting during pregnancy and risk of preterm birth for Arab women in Canada. Methods We analyzed birth certificates from 3,123,508 deliveries in Quebec, Canada, from 1981 to 2017. We identified 78,109 births of Arabic-speaking women and determined if Ramadan occurred during any trimester of pregnancy. We calculated rates of extreme (22–27 wk), very (28–31 wk), and late (32–36 wk) preterm birth and estimated RRs and 95% CIs for the association of Ramadan fasting with risk of preterm birth by pregnancy trimester, using log-binomial regression models adjusted for maternal characteristics. Results Arabic speakers had an overall preterm birth rate of 5.53 per 100 births, but rates varied with timing of Ramadan. Among Arabic speakers, fasting during Ramadan between weeks 15–21 of the second trimester was associated with 1.33 times the risk of very preterm birth relative to no fasting (95% CI: 1.06, 1.68). Between weeks 22 and 27 of the second trimester, fasting during Ramadan was associated with 1.53 times the risk of very preterm birth (95% CI: 1.21, 1.93). Ramadan fasting was not associated with extreme or late preterm birth regardless of the trimester of pregnancy. Conclusions In this study of 78,109 births to Arabic-speaking women in Quebec, Ramadan fasting during the second pregnancy trimester was associated with the risk of very preterm birth. Optimal prenatal education about nutritional needs in the second trimester of pregnancy is recommended.

scholarly journals Spatial Variation in Very Preterm Birth to Hispanic Women Across the United States: The Role of Intensified Immigration Enforcement

2021 ◽  
Vol 31 (Suppl) ◽  
pp. 333-344
Author(s):  
Kaitlyn K. Stanhope ◽  
Shakira F. Suglia ◽  
Carol J.R. Hogue ◽  
Juan S. Leon ◽  
Dawn L. Comeau ◽  
...  
Keyword(s):  
South Carolina ◽  
Preterm Birth ◽  
Hispanic Women ◽  
The United States ◽  
Future Research ◽  
County Level ◽  
Immigration Enforcement ◽  
Very Preterm ◽  
Very Preterm Birth ◽  
The Impact

Introduction: Limited existing research suggests that immigration climate and enforcement practices represent a social determinant of health for immigrants, their families, and communities. However, national research on the impact of specific policies is limited. The goal of this article is to estimate the effect of county-level participation in a 287(g) immigration enforcement agreement on very preterm birth (VPTB, <32 weeks’ gestation) rates between 2005-2016 among US-born and foreign-born Hispanic women across the United States.Methods: We fit spatial Bayesian models to estimate the effect of local participa­tion in a 287(g) program on county VPTB rates, accounting for variation by mater­nal nativity, county ethnic density, and controlling for individual specific Hispanic background and nativity and county-level confounders.Results: While there was no global ef­fect of county participation in a 287(g) program on county VPTB rates, rates were slightly increased in some counties, primarily in the Southeast (Virginia, North Carolina, South Carolina).Future Directions: Future research should consider the mechanisms through which immigration policies and enforce­ment may impact health of both immi­grants and wider communities.Ethn Dis. 2021;31(Suppl 1):333-344; doi:10.18865/ed.31.S1.333

Cohort study from 11 European countries highlighted differences in the use and efficacy of hypothermia prevention strategies after very preterm birth

2018 ◽  
Vol 107 (6) ◽  
pp. 958-966 ◽  
Author(s):  
Emilija Wilson ◽  
Jennifer Zeitlin ◽  
Aurélie Piedvache ◽  
Bjoern Misselwitz ◽  
Kyllike Christensson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
European Countries ◽  
Prevention Strategies ◽  
Very Preterm ◽  
Very Preterm Birth

scholarly journals Critical window variable selection: estimating the impact of air pollution on very preterm birth

Biostatistics ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 790-806 ◽  
Author(s):  
Joshua L Warren ◽  
Wenjing Kong ◽  
Thomas J Luben ◽  
Howard H Chang
Keyword(s):  
Preterm Birth ◽  
Variable Selection ◽  
Primary Objective ◽  
Control Analysis ◽  
Critical Window ◽  
Very Preterm ◽  
Very Preterm Birth ◽  
Windows Of Susceptibility ◽  
Risk Parameters ◽  
The Impact

Summary Understanding the impact that environmental exposure during different stages of pregnancy has on the risk of adverse birth outcomes is vital for protection of the fetus and for the development of mechanistic explanations of exposure–disease relationships. As a result, statistical models to estimate critical windows of susceptibility have been developed for several different reproductive outcomes and pollutants. However, these current methods fail to adequately address the primary objective of this line of research; how to statistically identify a critical window of susceptibility. In this article, we introduce critical window variable selection (CWVS), a hierarchical Bayesian framework that directly addresses this question while simultaneously providing improved estimation of the risk parameters. Through simulation, we show that CWVS outperforms existing competing techniques in the setting of highly temporally correlated exposures in terms of (i) correctly identifying critical windows and (ii) accurately estimating risk parameters. We apply all competing methods to a case/control analysis of pregnant women in North Carolina, 2005–2008, with respect to the development of very preterm birth and exposure to ambient ozone and particulate matter $&lt;$ 2.5 $\mu$m in aerodynamic diameter, and identify/estimate the critical windows of susceptibility. The newly developed method is implemented in the R package CWVS.

scholarly journals Opioid Therapy Pharmacogenomics for Noncancer Pain: Efficacy, Adverse Events, and Costs

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Yan Xu ◽  
Ana Johnson
Keyword(s):  
Adverse Events ◽  
Clinical Medicine ◽  
Cost Effective ◽  
Opioid Therapy ◽  
Considerable Proportion ◽  
Economic Costs ◽  
Societal Costs ◽  
Cost Effective Treatment ◽  
Noncancer Pain ◽  
The Impact

Chronic non-cancer pain is a debilitating condition associated with high individual and societal costs. While opioid treatment for pain has been available for centuries, it is associated with high variability in outcome, and a considerable proportion of patients is unable to attain relief from symptoms while suffering adverse events and developing medication dependence. We performed a review of the efficacy of pharmacogenomic markers and their abilities to predict adverse events, dependence, and associated economic costs, focusing on two genes: OPRM1 and CYP2D6. Data sources were articles indexed by PubMed on or before August 6, 2013. Articles were first selected after review of their titles and abstracts, and full papers were read to confirm eligibility. Initially, fifty-two articles were identified. Of these, 17 were relevant to biological actions of pharmacogenomic markers and their effect on therapeutic efficacy, 16 to adverse events, 15 to opioid dependence, and eight to economic costs. In conclusion, increasing costs of opioid therapy have made the advances in pharmacogenomics an attractive solution to personalize care with unclear repercussions related to the impact on costs, morbidity, and outcomes. This intersection of pharmacoeconomics and pharmacogenomics presents a unique platform to further examine current advances in clinical medicine and their utility in cost-effective treatment of chronic pain.

scholarly journals Variations in Brain Morphometry Among Healthy Preschoolers Born Very Preterm

2019 ◽  
Author(s):  
Holly M. Hasler ◽  
Timothy T. Brown ◽  
Natacha Akshoomoff
Keyword(s):  
Preterm Birth ◽  
Surface Area ◽  
Cortical Thickness ◽  
Gray Matter ◽  
Gestational Age ◽  
Brain Maturation ◽  
Healthy Children ◽  
Very Preterm ◽  
Increased Risk ◽  
Sulcal Depth

AbstractBackgroundPreterm birth is associated with an increased risk of neonatal brain injury, which can lead to alterations in brain maturation. Advances in neonatal care have dramatically reduced the incidence of the most significant medical consequences of preterm birth. Relatively healthy preterm infants remain at increased risk for subtle injuries that impact future neurodevelopmental and functioning.AimsTo investigate the gray matter morphometry measures of cortical thickness, surface area, and sulcal depth in the brain using magnetic resonance imaging at 5 years of age in healthy children born very preterm.Study designCohort studySubjectsParticipants were 52 children born very preterm (VPT; less than 33 weeks gestational age) and 37 children born full term.Outcome measuresCortical segmentation and calculation of morphometry measures were completed using FreeSurfer version 5.3.0 and compared between groups using voxel-wise, surface-based analyses.ResultsThe VPT group had a significantly thinner cortex in temporal and parietal regions as well as thicker gray matter in the occipital and inferior frontal regions. Reduced surface area was found in the fusiform area in the VPT group. Sulcal depth was also lower in the VPT group within the posterior parietal and inferior temporal regions and greater sulcal depth was found in the middle temporal and medial parietal regions. Results in some of these regions were correlated with gestational age at birth in the VPT group.ConclusionsThe most widespread differences between the VPT and FT groups were found in cortical thickness. These findings may represent a combination of delayed maturation and permanent alterations caused by the perinatal processes associated with very preterm birth.

scholarly journals Multiparametric Analysis of Cerebral Development in Preterm Infants Using Magnetic Resonance Imaging

2021 ◽  
Vol 15 ◽  
Author(s):  
Marine Dubois ◽  
Antoine Legouhy ◽  
Isabelle Corouge ◽  
Olivier Commowick ◽  
Baptiste Morel ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Preterm Infants ◽  
Gestational Age ◽  
Brain Maturation ◽  
Resonance Imaging ◽  
Equivalent Age ◽  
Very Preterm ◽  
Extremely Preterm ◽  
The Impact

ObjectivesThe severity of neurocognitive impairment increases with prematurity. However, its mechanisms remain poorly understood. Our aim was firstly to identify multiparametric magnetic resonance imaging (MRI) markers that differ according to the degree of prematurity, and secondly to evaluate the impact of clinical complications on these markers.Materials and MethodsWe prospectively enrolled preterm infants who were divided into two groups according to their degree of prematurity: extremely preterm (&lt;28 weeks’ gestational age) and very preterm (28–32 weeks’ gestational age). They underwent a multiparametric brain MRI scan at term-equivalent age including morphological, diffusion tensor and arterial spin labeling (ASL) perfusion sequences. We quantified overall and regional volumes, diffusion parameters, and cerebral blood flow (CBF). We then compared the parameters for the two groups. We also assessed the effects of clinical data and potential MRI morphological abnormalities on those parameters.ResultsThirty-four preterm infants were included. Extremely preterm infants (n = 13) had significantly higher frontal relative volumes (p = 0.04), frontal GM relative volumes (p = 0.03), and regional CBF than very preterm infants, but they had lower brainstem and insular relative volumes (respectively p = 0.008 and 0.04). Preterm infants with WM lesions on MRI had significantly lower overall GM CBF (13.3 ± 2 ml/100 g/min versus 17.7 ± 2.5, &lt; ml/100 g/min p = 0.03).ConclusionMagnetic resonance imaging brain scans performed at term-equivalent age in preterm infants provide quantitative imaging parameters that differ with respect to the degree of prematurity, related to brain maturation.

scholarly journals Language function following preterm birth: prediction using machine learning

2021 ◽  
Author(s):  
Evdoxia Valavani ◽  
Manuel Blesa ◽  
Paola Galdi ◽  
Gemma Sullivan ◽  
Bethan Dean ◽  
...  
Keyword(s):  
At Risk ◽  
Preterm Birth ◽  
Language Development ◽  
Gestational Age ◽  
Accurate Prediction ◽  
Language Delay ◽  
Preterm Neonates ◽  
Early Interventions ◽  
List Type ◽  
Mri Features

Abstract Background Preterm birth can lead to impaired language development. This study aimed to predict language outcomes at 2 years corrected gestational age (CGA) for children born preterm. Methods We analysed data from 89 preterm neonates (median GA 29 weeks) who underwent diffusion MRI (dMRI) at term-equivalent age and language assessment at 2 years CGA using the Bayley-III. Feature selection and a random forests classifier were used to differentiate typical versus delayed (Bayley-III language composite score <85) language development. Results The model achieved balanced accuracy: 91%, sensitivity: 86%, and specificity: 96%. The probability of language delay at 2 years CGA is increased with: increasing values of peak width of skeletonized fractional anisotropy (PSFA), radial diffusivity (PSRD), and axial diffusivity (PSAD) derived from dMRI; among twins; and after an incomplete course of, or no exposure to, antenatal corticosteroids. Female sex and breastfeeding during the neonatal period reduced the risk of language delay. Conclusions The combination of perinatal clinical information and MRI features leads to accurate prediction of preterm infants who are likely to develop language deficits in early childhood. This model could potentially enable stratification of preterm children at risk of language dysfunction who may benefit from targeted early interventions. Impact A combination of clinical perinatal factors and neonatal DTI measures of white matter microstructure leads to accurate prediction of language outcome at 2 years corrected gestational age following preterm birth. A model that comprises clinical and MRI features that has potential to be scalable across centres. It offers a basis for enhancing the power and generalizability of diagnostic and prognostic studies of neurodevelopmental disorders associated with language impairment. Early identification of infants who are at risk of language delay, facilitating targeted early interventions and support services, which could improve the quality of life for children born preterm.

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