scholarly journals The Association Between Delivery of Small-for-Gestational-Age Neonate and Their Risk for Long-Term Neurological Morbidity

2020 ◽  
Vol 9 (10) ◽  
pp. 3199
Author(s):  
Omer Hadar ◽  
Eyal Sheiner ◽  
Tamar Wainstock
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Developmental Disorders ◽  
Proportional Hazards Model ◽  
Survival Curve ◽  
Cohort Analysis ◽  
Cox Proportional Hazards Model ◽  
Increased Risk ◽  
Neurological Morbidity

Small-for-gestational-age (SGA) is defined as a birth weight below the 10th or below the 5th percentile for a specific gestational age and sex. Previous studies have demonstrated an association between SGA neonates and long-term pediatric morbidity. In this research, we aim to evaluate the possible association between small-for-gestational-age (SGA) and long-term pediatric neurological morbidity. A population-based retrospective cohort analysis was performed, comparing the risk of long-term neurological morbidities in SGA and non-SGA newborns delivered between the years 1991 to 2014 at a single regional medical center. The neurological morbidities included hospitalizations as recorded in hospital records. Neurological hospitalization rate was significantly higher in the SGA group (3.7% vs. 3.1%, OR = 1.2, 95% CI 1.1–1.3, p < 0.001). A significant association was noted between neonates born SGA and developmental disorders (0.2% vs. 0.1%, OR = 2.5, 95% CI 1.7–3.8, p < 0.001). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of neurological morbidity in the SGA group (log-rank p < 0.001). In the Cox proportional hazards model, which controlled for various Confounders, SGA was found to be an independent risk factor for long-term neurological morbidity (adjusted hazard ratio( HR) = 1.18, 95% CI 1.07–1.31, p < 0. 001). In conclusion, we found that SGA newborns are at an increased risk for long-term pediatric neurological morbidity.

scholarly journals Identifying the Critical Threshold for Long-Term Pediatric Neurological Hospitalizations of the Offspring in Preterm Delivery

2021 ◽  
Vol 10 (13) ◽  
pp. 2919
Author(s):  
Shiran Zer ◽  
Tamar Wainstock ◽  
Eyal Sheiner ◽  
Shayna Miodownik ◽  
Gali Pariente
Keyword(s):  
Preterm Delivery ◽  
Gestational Age ◽  
Cox Model ◽  
Survival Curve ◽  
Cohort Analysis ◽  
Critical Threshold ◽  
Kaplan Meier ◽  
Neurological Morbidity ◽  
Meier Survival Curve

We opted to investigate whether a critical threshold exists for long-term pediatric neurological morbidity, and cerebral palsy (CP), in preterm delivery, via a population-based cohort analysis. Four study groups were classified according to their gestational age at birth: 24–27.6, 28–31.6, 32–36.6 weeks and term deliveries, evaluating the incidence of long-term hospitalizations of the offspring due to neurological morbidity. Cox proportional hazard models were performed to control for confounders. A Kaplan–Meier survival curve was used to compare the cumulative neurological morbidity incidence for each group. A total of 220,563 deliveries were included: 0.1% (118) occurred at 24–27.6 weeks of gestation, 0.4% (776) occurred at 28–31.6 weeks of gestation, 6% (13,308) occurred at 32–36.6 weeks of gestation and 93% (206,361) at term. In a Cox model, while adjusting for confounders, delivery before 25 weeks had a 3.9-fold risk for long-term neurological morbidity (adjusted HR (hazard ratio) = 3.9, 95% CI (confidence interval) 2.3–6.6; p < 0.001). The Kaplan–Meier survival curve demonstrated a linear association between long-term neurological morbidity and decreasing gestational age. In a second Cox model, adjusted for confounders, infants born before 25 weeks of gestation had increased rates of CP (adjusted HR = 62.495% CI 25.6–152.4; p < 0.001). In our population, the critical cut-off for long-term neurological complications is delivery before 25 weeks gestation.

scholarly journals Metabolic implications of GH treatment in small for gestational age

2007 ◽  
Vol 157 (suppl_1) ◽  
pp. S47-S50 ◽  
Author(s):  
E M Delemarre ◽  
J Rotteveel ◽  
H A Delemarre-van de Waal
Keyword(s):  
Lipid Metabolism ◽  
Gestational Age ◽  
Growth Retardation ◽  
Small For Gestational Age ◽  
Postnatal Growth ◽  
Gh Treatment ◽  
Increased Risk ◽  
Igf I

Fetal growth retardation is associated with decreased postnatal growth, resulting in a lower adult height. In addition, a low birth weight is associated with an increased risk of developing diseases during adulthood, such as insulin resistance, type 2 diabetes mellitus, hypertension, dyslipidemia, and cardiovascular diseases. Children with persistent postnatal growth retardation, i.e., incomplete catchup growth, can be treated with human GH. The GH/IGF-I axis is involved in the regulation of carbohydrate and lipid metabolism. The question of whether treatment with GH in children born small for gestational age (SGA) has long-term implications with respect to glucose/insulin and lipid metabolism has not been answered yet. In this article, the available data are reviewed.

Maternal Hypothyroidism during Pregnancy and the Risk for Infectious Morbidity of the Offspring

2019 ◽  
Vol 37 (03) ◽  
pp. 291-295 ◽  
Author(s):  
Ofer Beharier ◽  
Asnat Walfisch ◽  
Tamar Wainstock ◽  
Irit Szaingurten-Solodkin ◽  
Daniela Landau ◽  
...  
Keyword(s):  
Animal Studies ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Infectious Morbidity ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Increased Risk

Abstract Objective Animal studies indicate a possible intrauterine immunological imprinting in pregnancies complicated by hypothyroidism. We aimed to evaluate whether exposure to maternal hypothyroidism during pregnancy increases the risk of long-term infectious morbidity of the offspring. Study Design A retrospective cohort study compared the long-term risk of hospitalization associated with infectious morbidity in children exposed and unexposed in utero to maternal hypothyroidism. Outcome measures included infectious diagnoses obtained during any hospitalization of the offspring (up to the age of 18 years). Results The study included 224,950 deliveries. Of them, 1.1% (n = 2,481) were diagnosed with maternal hypothyroidism. Children exposed to maternal hypothyroidism had a significantly higher rate of hospitalizations related to infectious morbidity (13.2 vs. 11.2% for control; odds ratio: 1.2; 95% confidence interval: 1.08–1.36; p = 0.002). Specifically, incidences of ear, nose, and throat; respiratory; and ophthalmic infections were significantly higher among the exposed group. The Kaplan–Meier curve indicated that children exposed to maternal hypothyroidism had higher cumulative rates of long-term infectious morbidity. In the Cox proportional hazards model, maternal hypothyroidism remained independently associated with an increased risk of infectious morbidity in the offspring while adjusting for confounders. Conclusion Maternal hypothyroidism during pregnancy is associated with significant pediatric infectious morbidity of the offspring.

scholarly journals 856A gestational age specific prognostic model for adverse perinatal events in obese women

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Jeffrey Bone ◽  
Sarka Lisonkova
Keyword(s):  
Risk Factors ◽  
British Columbia ◽  
Gestational Age ◽  
Proportional Hazards Model ◽  
Perinatal Outcomes ◽  
Cox Proportional Hazards Model ◽  
Prognostic Models ◽  
Chronic Hypertension ◽  
Obese Women ◽  
Increased Risk

Abstract Background Obesity is one of the most preventable pre-pregnancy risk factors for adverse perinatal events. Despite this, there are few body-mass-index (BMI) specific prognostic models for timing of delivery associated with the lowest number of adverse perinatal events. Our aim was to build a predictive model to quantify gestational age-specific rates of adverse birth outcomes in obese women with and without additional risk factors. Methods All singleton births at ≥ 34 weeks’ gestation in British Columbia, Canada, 2008-2017 (n = 283,697) were included and data were obtained from the British Columbia Perinatal Database Registry. A multivariable Cox proportional hazards model including demographic and obstetric risk factors was used to estimate gestational age specific risk of composite perinatal mortality and severe morbidity. Results Among all women, 13.1% were obese (pre-pregnancy BMI ≥30m/kg2), 60.1% had normal BMI (18.5-24.9 m/kg2). In high-risk obese women (nulliparous with chronic hypertension, and diabetes), adjusted outcome rates (per 1000 ongoing pregnancies) were 7.5 at 34-36 weeks, 20.4 at 37-39 weeks, and 83.5 at ≥ 40 weeks’ gestation. In all obese women, the rates were 1.93, 6.27, and 18.5 per 1000 ongoing pregnancies, respectively. In contrast, on average these rates were 1.14, 4.03 and 11.6 per 1000 ongoing pregnancies, respectively, among women with normal BMI. Conclusions Obese women are at increased risk of poor perinatal outcomes at all gestational ages. These risks are compounded by other conditions known to effect perinatal outcomes. Key messages Obese women require specific guidelines for timing of optimal delivery.

Isolated oligohydramnios and long-term neurological morbidity of the offspring

2019 ◽  
Vol 11 (6) ◽  
pp. 648-652
Author(s):  
Avital Dorot ◽  
Tamar Wainstock ◽  
Eyal Sheiner ◽  
Asnat Walfisch ◽  
Daniella Landau ◽  
...  
Keyword(s):  
Developmental Disorders ◽  
Medical Center ◽  
Survival Curve ◽  
Neurological Complications ◽  
Population Based ◽  
Exposed Group ◽  
Kaplan Meier ◽  
Neurological Morbidity ◽  
Independent Association

AbstractThis study aimed to assess the association between maternal-isolated oligohydramnios (IO) and offspring long-term neurological complications. A population-based retrospective cohort study was conducted, including all births at a single tertiary medical center in Israel between the years 1991 and 2014. Multiple pregnancies and potential pregnancy complications associated with oligohydramnios were excluded. The computerized obstetrical database was linked with the computerized dataset of all pediatric hospitalizations of the same medical center. Evaluation of cumulative neurological-associated hospitalizations rate over time was compared using a Kaplan–Meier survival curve. The Weibull survival parametric model was conducted to assess the neurological-associated hospitalization risk in the presence of IO, while accounting for potential confounders. A total of 190,259 pregnancies were included in the study, of which 4063 (2.13%) pregnancies were complicated with IO. Total neurological-related hospitalizations were significantly more common in the IO group (3.7% in the IO group and 3.0% in the comparison group, p = 0.005). Pervasive developmental disorder, movement disorders, developmental disorders, and degenerative and demyelization disorders were all specific neurological diagnoses significantly more common in the exposed group. The survival curve demonstrated a significantly higher cumulative hospitalization rate in the exposed group (log-rank p = 0.001). Using a multivariate model adjusting for gestational age, maternal age, and labor induction, an independent association between IO and long-term neurological morbidity of the offspring was observed (adjusted hazard ratio 1.203; 95% CI 1.02–1.42). In summary, a significant association was found between pregnancies complicated by IO and long-term neurological morbidity of the offspring.

scholarly journals Maternal Obesity and Offspring Long-Term Infectious Morbidity

2019 ◽  
Vol 8 (9) ◽  
pp. 1466 ◽  
Author(s):  
Gil Gutvirtz ◽  
Tamar Wainstock ◽  
Daniella Landau ◽  
Eyal Sheiner
Keyword(s):  
Maternal Obesity ◽  
Cox Regression ◽  
Survival Curve ◽  
Cohort Analysis ◽  
Cox Proportional Hazards Model ◽  
Obese Patients ◽  
Infectious Morbidity ◽  
Kaplan Meier ◽  
Meier Survival Curve

Obesity is a leading cause of morbidity world-wide. Maternal obesity is associated with adverse perinatal outcomes. Furthermore, Obesity has been associated with increased susceptibility to infections. The purpose of this study was to evaluate long-term pediatric infectious morbidity of children born to obese mothers. This population-based cohort analysis compared deliveries of obese (maternal pre-pregnancy BMI ≥ 30 kg/m2) and non-obese patients at a single tertiary medical center. Hospitalizations of the offspring up to the age of 18 years involving infectious morbidities were evaluated according to a predefined set of ICD-9 codes. A Kaplan–Meier survival curve was used to compare cumulative hospitalization incidence between the groups and Cox proportional hazards model was used to control for possible confounders. 249,840 deliveries were included. Of them, 3399 were children of obese mothers. Hospitalizations involving infectious morbidity were significantly more common in children born to obese mothers compared with non-obese patients (12.5% vs. 11.0%, p < 0.01). The Kaplan–Meier survival curve demonstrated a significantly higher cumulative incidence of infectious-related hospitalizations in the obese group (log rank p = 0.03). Using the Cox regression model, maternal obesity was found to be an independent risk factor for long-term infectious morbidity of the offspring (adjusted HR = 1.125, 95% CI 1.021–1.238, p = 0.017).

scholarly journals Maternal hepatitis B or C carrier status and long-term risk for offspring neurological morbidity: a population-based cohort study

2021 ◽  
pp. 1-5
Author(s):  
Israel Yoles ◽  
Eyal Sheiner ◽  
Naim Abu-Freha ◽  
Tamar Wainstock
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Survival Curve ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Carrier Status ◽  
Hazards Model ◽  
Kaplan Meier

Abstract Hepatitis B and hepatitis C (HBV/HCV) are important global public health concerns. We aimed to evaluate the association between maternal HBV/HCV carrier status and long-term offspring neurological hospitalisations. A population-based cohort analysis compared the risk for long-term childhood neurological hospitalisations in offspring born to HBV/HCV carrier vs. non-carrier mothers in a large tertiary medical centre between 1991 and 2014. Childhood neurological diseases, such as cerebral palsy, movement disorders or developmental disorders, were pre-defined based on ICD-9 codes as recorded in hospital medical files. Offspring with congenital malformations and multiple gestations were excluded from the study. A Kaplan–Meier survival curve was constructed to compare cumulative neurological hospitalisations over time, and a Cox proportional hazards model was used to control for confounders. During the study period (1991–2014), 243,682 newborns met the inclusion criteria, and 777 (0.3%) newborns were born to HBV/HCV mothers. The median follow-up was 10.51 years (0–18 years). The offspring from HBV/HCV mothers had higher incidence of neurological hospitalisations (4.5 vs. 3.1%, hazard ratio (HR) = 1.91, 95% CI 1.37–2.67). Similarly, the cumulative incidence of neurological hospitalisations was higher in children born to HBV/HCV carrier mothers (Kaplan–Meier survival curve log-rank test p < 0.001). The increased risk remained significant in a Cox proportional hazards model, which adjusted for gestational age, mode of delivery and pregnancy complications (adjusted HR = 1.40, 1.01–1.95, p = 0.049). We conclude that maternal HBV or HCV carrier status is an independent risk factor for the long-term neurological hospitalisation of offspring regardless of gestational age and other adverse perinatal outcomes.

scholarly journals Perinatal Outcome and Long-Term Infectious Morbidity of Offspring Born to Women with Known Tuberculosis

2020 ◽  
Vol 9 (9) ◽  
pp. 2768
Author(s):  
Shanny Sade ◽  
Tamar Wainstock ◽  
Eyal Sheiner ◽  
Gali Pariente
Keyword(s):  
Perinatal Outcome ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Very Low Birth Weight ◽  
Survival Curve ◽  
Study Groups ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Infectious Morbidity

Objective: To evaluate the perinatal outcome of women with tuberculosis and to assess a possible association between maternal tuberculosis and long-term infectious morbidity of the offspring. Study design: Perinatal outcome and long-term infectious morbidity of offspring of mothers with and without tuberculosis were assessed. The study groups were followed until 18 years of age tracking infectious-related morbidity and infectious-related hospitalizations and then compared. For perinatal outcome, generalized estimation equation models were used. A Kaplan-Meier survival curve was used to compare cumulative incidence of long-term infectious morbidity. A Cox proportional hazards model was conducted to control for confounders. Results: During the study period, 243,682 deliveries were included, of which 46 (0.018%) occurred in women with tuberculosis. Maternal tuberculosis was found to be independently associated with placental abruption, cesarean deliveries, and very low birth weight. However, offspring born to mothers with tuberculosis did not demonstrate higher rates of infectious-related morbidity. Maternal tuberculosis was not noted as an independent risk factor for long-term infectious morbidity of the offspring. Conclusion: In our study, maternal tuberculosis was found to be independently associated with adverse perinatal outcomes. However, higher risk for long-term infectious morbidity of the offspring was not demonstrated. Careful surveillance of these women is required.

Long-Term Outcomes of Small for Gestational Age Twins Born at 34 Weeks or Later

2017 ◽  
Vol 35 (03) ◽  
pp. 254-261 ◽  
Author(s):  
Nola Herlihy ◽  
Elizabeth Odom ◽  
Natalie Cohen ◽  
Annemarie Stroustrup ◽  
Andrei Rebarber ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Cardiac Disease ◽  
Speech Therapy ◽  
Absolute Risk ◽  
Adverse Outcomes ◽  
Long Term Outcomes ◽  
Increased Risk

Objective This article aims to compare long-term neurodevelopmental and health outcomes of twins born at 34 weeks or later, based on the presence of small for gestational age (SGA). Study Design This study is a mail-based survey of twin gestations delivered by a single practice. We compared twins with and without SGA delivered at ≥34 weeks. There were two primary outcomes for this study: a composite of major adverse outcomes (death; cerebral palsy; necrotizing enterocolitis; chronic renal, heart, or lung disease) and a composite of minor adverse outcomes (learning disability, speech therapy, occupational therapy, physical therapy). Regression analysis was performed to control for clustering of outcomes within twin pairs. Results A total of 712 children were included. Comparing twins with birthweights <10% to ≥10%, there were no significant differences in rates of composite major morbidities (3.2 vs. 1.4%, p = 0.109) or composite minor morbidities (43.6 vs. 39.3%, p = 0.279). Comparing twins with birthweights <5% to ≥5%, the rates of major morbidities were low in both groups, but significantly higher in the group with birthweights <5% (4.4 vs. 1.6%, p = 0.046). There were no significant differences seen in the composite minor morbidities (46.7 vs. 39.7%, p = 0.134). Twins with birthweights <5% were significantly more likely to have childhood cardiac disease (2.9 vs. 0.7%, p = 0.041). Conclusion Twins with SGA <10% born at ≥34 weeks have similar long-term neurodevelopmental and health outcomes compared with twins with normal birthweights. Birthweight less than 5th percentile is associated with an increased risk of major morbidity, specifically cardiac disease, but the absolute risk is low.

scholarly journals Long-Term Infectious Morbidity of Premature Infants: Is There a Critical Threshold?

2020 ◽  
Vol 9 (9) ◽  
pp. 3008
Author(s):  
Sharon Davidesko ◽  
Tamar Wainstock ◽  
Eyal Sheiner ◽  
Gali Pariente
Keyword(s):  
Preterm Birth ◽  
Survival Curve ◽  
Cohort Analysis ◽  
Preterm Births ◽  
Cox Proportional Hazards Model ◽  
Late Preterm ◽  
Critical Threshold ◽  
Very Preterm ◽  
Infectious Morbidity

In this study, we sought to ascertain a relationship between gestational age at birth and infectious morbidity of the offspring via population-based cohort analysis comparing the long-term incidence of infectious morbidity in infants born preterm and stratified by extremity of prematurity (extreme preterm birth: 24 + 0–27 + 6, very preterm birth: 28 + 0–31 + 6, moderate to late preterm birth: 32 + 0−36 + 6 weeks of gestation, and term deliveries). Infectious morbidity included hospitalizations involving a predefined set of International Classification of Diseases 9 (ICD9) codes, as recorded in hospital records. A Kaplan–Meier survival curve compared cumulative incidence of infectious-related morbidity. A Cox proportional hazards model controlled for confounders and time to event. The study included 220,594 patients: 125 (0.1%) extreme preterm births, 784 (0.4%) very preterm births, 13,323 (6.0%) moderate to late preterm births, and 206,362 term deliveries. Offspring born preterm had significantly more infection-related hospitalizations (18.4%, 19.8%, 14.9%, and 11.0% for the aforementioned stratification, respectively, p < 0.001). Multivariate analysis found being born very or late to moderate preterm was independently associated with long-term infectious morbidity (adjusted hazard ratio (aHR) 1.5, 95% confidence interval (CI) 1.27–1.77 and aHR 1.23, 95% CI 1.17–1.3, respectively, p < 0.001). A comparable risk of long-term infectious morbidity was found in the two groups of premature births prior to 32 weeks gestation. In our population, a cutoff from 32 weeks and below demarks a significant increase in the risk of long-term infectious morbidity of the offspring.

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