Is increased size at birth associated with longevity on the population level? – A historical and comparative analysis of regions in Sweden

Increased population longevity could be influenced by early life factors. Some areas have long-lived populations, also in a historical perspective. We aimed to study these factors in Halland, an area with the highest life expectancy in Sweden. We collected archival data on gestational age and birth characteristics from 995 live singleton full-term births at the Halmstad Hospital, Halland, from the period 1936 to 1938 and compared these to 3364 births from three hospitals in nearby Scania for the period 1935–1945. In addition, data were obtained on maternal and offspring characteristics from the national Swedish Medical Birth Register during 1973–2013. The results show that when controlling for background maternal and offspring characteristics, mean birth weight (BW) and mean birth length were higher in Halland than in Scania, but the proportion of low birth weight (LBW) and small for gestational age (SGA) was lower. However, mean BW for Halland did not differ from the rest of Sweden in recent years 2004–2013. We also conducted a mortality follow-up for children born in Scania, which showed that LBW, being born SGA, or short birth length reduced survival. In conclusion, the high mean life expectancy in Halland compared to the rest of Sweden could have been associated with beneficial early life factors influencing birth size in the past. In more recent decades the mean BW of Halland is not different from the national mean. Thus, longevity could be expected to become more equal to the national mean in the future.

The role of cardiovascular risk factors in maternal cardiovascular disease according to offspring birth characteristics in the HUNT study

A history of preterm or small (SGA) or large (LGA) for gestational age offspring is associated with smoking and unfavorable levels of BMI, blood pressure, glucose and lipids. Whether and to what extent the excess cardiovascular risk observed in women with these pregnancy complications is explained by conventional cardiovascular risk factors (CVRFs) is not known. We examined the association between a history of SGA, LGA or preterm birth and cardiovascular disease among 23,284 parous women and quantified the contribution of individual CVRFs to the excess cardiovascular risk using an inverse odds weighting approach. The hazard ratios (HR) between SGA and LGA offspring and CVD were 1.30 (95% confidence interval (CI) 1.15, 1.48) and 0.89 (95% CI 0.76, 1.03), respectively. Smoking explained 49% and blood pressure may have explained ≈12% of the excess cardiovascular risk in women with SGA offspring. Women with preterm birth had a 24% increased risk of CVD (HR 1.24, 95% CI 1.06, 1.45), but we found no evidence for CVRFs explaining any of this excess cardiovascular risk. While smoking explains a substantial proportion of excess cardiovascular risk in women with SGA offspring and blood pressure may explain a small proportion in these women, we found no evidence that conventional CVRFs explain any of the excess cardiovascular risk in women with preterm birth.

Funnel Plots for Assessing Institutional Performance

<p>This thesis presents a comparison of maternal outcomes for births in New Zealand District Health Boards (DHBs).This is carried out through analysis of the National Minimum Dataset collected by the Ministry of Health for 2007. The outcome compared is postpartum haemorrhage (PPH) the results are displayed using funnel plots, a useful tool for displaying unbiased information on performance outcomes when comparing institutions. Exploration of the data found that there are differences in the demographics, maternal and birth characteristics among DHBs. The rates of PPH are different and the population mixes are made up of a range of different proportions of ethnic groups, ages and deprivation indexes. The exploratory analysis found that a large number of factors are associated with PPH. And that birth weight, parity and gestation had a large number of missing observations. These factors are not missing at random and require imputing prior to constructing the funnel plots. Results show that there is divergence amongst DHBs in the postpartum haemorrhage rate. First a raw PPH rate was plotted and the results indicated there were differences among DHBs. As there are many potential predictors for PPHa logistic regression model was applied to find the most important factors related to PPH. This allows us to apply an adjusted rate for the funnel plot. The risk adjusted funnel plot also indicated differences among DHBs. Two approaches are taken to account for the overdispersion. A winsorised estimate and a winsorised estimate with a random effects term are applied to the data. The approaches produced different results. The winsorised estimate widened the control limits and the random effects term narrowed the control limits. All four plots identified an extreme outlier and this was later removed from the analysis and the winsorisation funnel plots were rerun. The influential outlier made a difference and from this we can concluded that 2 out 20 DHBs lie outside the 95% control limits. These two DHBs could be stated as having a very low rate of PPH.</p>

Funnel Plots for Assessing Institutional Performance

<p>This thesis presents a comparison of maternal outcomes for births in New Zealand District Health Boards (DHBs).This is carried out through analysis of the National Minimum Dataset collected by the Ministry of Health for 2007. The outcome compared is postpartum haemorrhage (PPH) the results are displayed using funnel plots, a useful tool for displaying unbiased information on performance outcomes when comparing institutions. Exploration of the data found that there are differences in the demographics, maternal and birth characteristics among DHBs. The rates of PPH are different and the population mixes are made up of a range of different proportions of ethnic groups, ages and deprivation indexes. The exploratory analysis found that a large number of factors are associated with PPH. And that birth weight, parity and gestation had a large number of missing observations. These factors are not missing at random and require imputing prior to constructing the funnel plots. Results show that there is divergence amongst DHBs in the postpartum haemorrhage rate. First a raw PPH rate was plotted and the results indicated there were differences among DHBs. As there are many potential predictors for PPHa logistic regression model was applied to find the most important factors related to PPH. This allows us to apply an adjusted rate for the funnel plot. The risk adjusted funnel plot also indicated differences among DHBs. Two approaches are taken to account for the overdispersion. A winsorised estimate and a winsorised estimate with a random effects term are applied to the data. The approaches produced different results. The winsorised estimate widened the control limits and the random effects term narrowed the control limits. All four plots identified an extreme outlier and this was later removed from the analysis and the winsorisation funnel plots were rerun. The influential outlier made a difference and from this we can concluded that 2 out 20 DHBs lie outside the 95% control limits. These two DHBs could be stated as having a very low rate of PPH.</p>

Secular trends in early motor development between 1980 and 2010 in Japan

ObjectiveRecent changes in birth characteristics in Japan may have a potential influence on children’s developments. Therefore, we investigated secular trends in gross motor milestones.DesignData were collected from an official Japanese nationwide serial cross-sectional survey conducted every 10 years since 1960. 22 320 participants aged 2–18 months were identified from the four surveys from 1980 to 2010.OutcomesWe assessed whether or not a child achieved four gross motor milestones including rolling over (rolling), sitting without support (sitting), standing with support (standing) and walking alone (walking). The target age was defined as the age when the attainment rate ranged from >5% to >95% of the total. Multivariate logistic regression models were fitted.ResultsThe final cohort included 20 570 children. The target ages were determined as follows: 3–6 months for rolling; 5–9 months for sitting; 6–11 months for standing; and 9–15 months for walking. The attainment rates of sitting, standing and walking in 1990 were higher than those in 2010, even after adjusting for child characteristics (sitting: adjusted OR (aOR)=2.07 (95% CI 1.62 to 2.65); standing: aOR=1.63 (95% CI 1.32 to 2.02); and walking: aOR=1.61 (95% CI 1.34 to 1.95)).ConclusionsThe proportion of children who attained three motor milestones (sitting, standing and walking) by set target ages decreased between 1990 and 2010. The contribution of birth characteristics including a decrease in gestational age and fetal growth, as well as changes in other child characteristics, failed to explain why this decrease occurred.

Personality impacts fear of childbirth and subjective birth experiences: A prospective-longitudinal study

Background Previous research suggests that less emotionally stable, less conscientious, less extraverted, and less agreeable women tend to suffer from higher fear of childbirth and experience their delivery as worse. Moreover, there is evidence that birth characteristics and unexpected incidents during delivery may impact women’s birth experiences. However, it remains unknown whether the role of personality in subjective birth experiences varies between women with different birth characteristics. Methods We used data from the Maternal Anxiety in Relation to Infant Development (MARI) Study, a regional-epidemiological study among pregnant women, who were prospectively followed up in multiple waves across the peripartum period. During pregnancy, personality was assessed with the short version of the Big Five Inventory. The Wijma Delivery Expectancy/ Experience Questionnaire was used to measure fear of childbirth (version A) during pregnancy and subjective birth experiences (version B) within the first 10 days after delivery. Results Linear regressions revealed that lower levels of emotional stability, agreeableness, and extraversion predicted higher fear of childbirth during pregnancy. Moreover, personality affected subjective birth experiences especially in women with specific birth characteristics: Lower emotional stability predicted worse subjective birth experiences in women with (vs. without) a preterm delivery, and higher conscientiousness predicted worse subjective birth experiences in women with an emergency cesarean section (vs. spontaneous delivery). Subjective birth experiences were also worse in less emotionally stable and less open women with (general) anesthesia (vs. no anesthesia) during delivery. Finally, higher emotional stability predicted a subjective birth experience that was worse than expected, particularly in multiparous women and women without anesthesia during delivery. Conclusions These findings suggest that less emotionally stable, less conscientious, and less open women tend to experience their delivery as worse particularly in case of unexpected incidents (i.e., preterm delivery, emergency cesarean section, and necessity of anesthetics) and might thus profit from early targeted interventions.

SARS-CoV-2 infections among neonates born to women with SARS-CoV-2 infection: maternal, pregnancy and birth characteristics

Background: Multiple reports have described neonatal SARS-CoV-2 infection, including likely in utero transmission and early postnatal infection. Most neonatal infections reported to date have been asymptomatic or mild disease; however, severe cases, including respiratory failure requiring intensive care unit admission, have been described.Objectives: To describe maternal, pregnancy and infant characteristics among neonates born to women with SARS-CoV-2 infection during pregnancy by neonatal SARS-CoV-2 testing results.Methods: Using aggregated data from the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) from March 29, 2020–August 6, 2021, we identified neonates who were: 1) born to women who were SARS-CoV-2 positive by RT-PCR at any time during their pregnancy, and 2) tested for SARS-CoV-2 by RT-PCR during the birth hospitalization. Results: Among 25,896 neonates of mothers with SARS-CoV-2-infection, 3,381 (13%) underwent PCR testing. One hundred thirty-six neonates (4%) were PCR-positive. Neonates testing positive were born to both symptomatic and asymptomatic women, and 95% were born to women with infection identified ≤ with 14 days of delivery.Conclusions: While perinatal SARS-CoV-2 infection was uncommon among neonates born to women with SARS-CoV-2 infection during pregnancy, nearly all cases of neonatal infection occurred in pregnant women infected around the time of delivery. These findings underline the need for infection prevention and control measures in delivery and outpatient pediatric settings, as well as counselling for persons who acquire COVID-19 during pregnancy about potential risk to their neonates. Moreover, pregnant people and those wanting to become pregnant should be vaccinated against COVID-19 in order to protect themselves and their infants.

Associations of maternal bisphenol urine concentrations during pregnancy with neonatal metabolomic profiles

Background Fetal exposure to bisphenols is associated with altered fetal growth, adverse birth outcomes and childhood cardio-metabolic risk factors. Metabolomics may serve as a tool to identify the mechanisms underlying these associations. We examined the associations of maternal bisphenol urinary concentrations in pregnancy with neonatal metabolite profiles from cord blood. Methods In a population-based prospective cohort study among 225 mother–child pairs, maternal urinary bisphenol A, S and F concentrations in first, second and third trimester were measured. LC–MS/MS was used to determine neonatal concentrations of amino acids, non-esterified fatty acids (NEFA), phospholipids (PL), and carnitines in cord blood. Results No associations of maternal total bisphenol concentrations with neonatal metabolite profiles were present. Higher maternal average BPA concentrations were associated with higher neonatal mono-unsaturated alkyl-lysophosphatidylcholine concentrations, whereas higher maternal average BPS was associated with lower neonatal overall and saturated alkyl-lysophosphatidylcholine (p-values < 0.05).Trimester-specific analyses showed that higher maternal BPA, BPS and BPF were associated with alterations in neonatal NEFA, diacyl-phosphatidylcholines, acyl-alkyl-phosphatidylcholines, alkyl-lysophosphatidylcholine, sphingomyelines and acyl-carnitines, with the strongest effects for third trimester maternal bisphenol and neonatal diacyl-phosphatidylcholine, sphingomyeline and acyl-carnitine metabolites (p-values < 0.05). Associations were not explained by maternal socio-demographic and lifestyle characteristics or birth characteristics. Discussion Higher maternal bisphenol A, F and S concentrations in pregnancy are associated with alterations in neonatal metabolite profile, mainly in NEFA, PL and carnitines concentrations. These findings provide novel insight into potential mechanisms underlying associations of maternal bisphenol exposure during pregnancy with adverse offspring outcomes but need to be replicated among larger, diverse populations.