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JAMA Network Open Jul 2023Neurocutaneous syndromes are associated with cancer predisposition and sometimes associated with perinatal factors. A better understanding of the association between...
IMPORTANCE
Neurocutaneous syndromes are associated with cancer predisposition and sometimes associated with perinatal factors. A better understanding of the association between neurocutaneous syndromes, perinatal factors, and childhood cancer is key for earlier cancer detection.
OBJECTIVE
To evaluate the association of neurocutaneous syndromes and perinatal factors with childhood cancer risk in a cohort of Swedish children.
DESIGN, SETTING, AND PARTICIPANTS
In this nationwide cohort study, all children and adolescents up to age 20 years, from 1973 to 2015, were identified through the Swedish National Medical Birth Register (MBR), provided they had information on both biological parents. Analyses were conducted from April 2021 through May 2023.
EXPOSURES
Diagnoses of neurocutaneous syndromes were obtained from the MBR, National Patient Register, and Cause of Death register. Perinatal factors (birth weight, gestational age, birth weight by gestational age, 5-minute Apgar score, and head circumference) were obtained from the MBR.
MAIN OUTCOMES AND MEASURES
Childhood cancer risk (<20 years at diagnosis; identified from the National Cancer Register), including leukemia, lymphoma, and central nervous system (CNS) tumors.
RESULTS
Among 4 173 108 included children (2 143 133 [51.4%] male, median [IQR] follow-up 20 [9.7-20] years), 1783 had neurofibromatosis type 1 (NF1), 444 tuberous sclerosis, 63 von Hippel-Lindau disease, and 39 ataxia-telangiectasia. An increased cancer risk was observed among children with any neurocutaneous syndrome (HR, 34.9; 95% CI, 30.8-39.6) and was particularly pronounced for CNS tumors (HR, 111.7; 95% CI, 96.8-128.8), except among children with ataxia-telangiectasia, where the increased risk was associated with lymphomas (HR, 233.1; 95% CI, 75.0-724.1). Leukemia risk was increased only among children with NF1 (HR, 4.1; 95% CI, 1.7-9.8). Several perinatal factors, including high birth weight, being born large for gestational age, preterm birth, low 5-minute Apgar score, and large head circumference had lesser associations with childhood cancer. Adjusting for neurocutaneous syndromes did not affect these associations.
CONCLUSIONS AND RELEVANCE
In this nationwide cohort study, neurocutaneous syndromes were associated with an increased risk of childhood cancer, especially CNS tumors. Several perinatal factors had lesser associations with childhood cancer, independently of the presence of neurocutaneous syndromes. Other biological mechanisms likely underlie the association between perinatal factors and childhood cancer.
Topics: Child; Infant, Newborn; Adolescent; Female; Pregnancy; Male; Humans; Child, Preschool; Young Adult; Adult; Neoplasms; Neurocutaneous Syndromes; Sweden; Birth Weight; Ataxia Telangiectasia; Cohort Studies; Premature Birth; Leukemia
PubMed: 37490289
DOI: 10.1001/jamanetworkopen.2023.25482 -
American Journal of Epidemiology Aug 2023Knowledge on the association between offspring birth weight and long-term risk of maternal cardiovascular disease (CVD) mortality is often based on firstborn infants...
Knowledge on the association between offspring birth weight and long-term risk of maternal cardiovascular disease (CVD) mortality is often based on firstborn infants without consideration of women's consecutive births. We studied long-term CVD mortality according to offspring birth weight patterns among women with spontaneous and iatrogenic term deliveries in Norway (1967-2020). We constructed birth weight quartiles (Qs) by combining standardized birth weight with gestational age in quartiles (Q1, Q2/Q3, and Q4) for the women's first 2 births. Mortality was estimated using Cox regression and expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). Changes in offspring birth weight quartiles were associated with long-term maternal CVD mortality. Compared with women who had 2 term infants in Q2/Q3, women with a first offspring in Q2/Q3 and a second in Q1 had higher mortality risk (HR = 1.33, 95% CI: 1.18, 1.50), while risk was lower if the second offspring was in Q4 (HR = 0.78, 95% CI: 0.67, 0.91). The risk increase associated with having a first infant in Q1 was eliminated if the second offspring was in Q4 (HR = 0.99, 95% CI: 0.75, 1.31). These patterns were similar for women with iatrogenic and spontaneous deliveries. Inclusion of information from subsequent births revealed heterogeneity in maternal CVD mortality which was not captured when using only information based on the first offspring.
Topics: Pregnancy; Infant; Humans; Female; Birth Weight; Cardiovascular Diseases; Cohort Studies; Term Birth; Iatrogenic Disease
PubMed: 37249253
DOI: 10.1093/aje/kwad075 -
Pediatrics and Neonatology Sep 2023
Topics: Infant; Infant, Newborn; Humans; Infant, Premature; Infant, Very Low Birth Weight; Gestational Age; Birth Weight
PubMed: 37612206
DOI: 10.1016/j.pedneo.2023.08.001 -
JAMA Network Open Aug 2023Birth weight percentiles (BWPs) are often dichotomized at the 10th percentile and show statistically significant association with later cognitive performance, for both... (Observational Study)
Observational Study
IMPORTANCE
Birth weight percentiles (BWPs) are often dichotomized at the 10th percentile and show statistically significant association with later cognitive performance, for both preterm and term-born children. However, research testing nonlinear associations between BWPs and cognitive performance is scarce.
OBJECTIVE
To investigate culturally invariant, nonlinear associations of BWPs and gestational age with later cognitive performance.
DESIGN, SETTING, AND PARTICIPANTS
In this cohort study, participants with valid neonatal and cognitive data were combined from 4 observational cohorts, including the Millennium Cohort Study, the National Longitudinal Survey of Youth 1979 Child and Young Adult cohort, Growing Up in Ireland, and the Longitudinal Study of Australian Children, with children born between 2000 and 2002, 1980 and 2010, 2007 and 2008, and 2003 and 2004, respectively. Neonatal data were parent reported before age 1 year. At approximately 5 years of age, multiple cognitive tests were performed. Follow-up at 5 years of age was the predominant focus. Data were analyzed July 17, 2023.
EXPOSURE
The parent-reported neonatal data were used to calculate BWPs according to the Fenton growth chart.
MAIN OUTCOME AND MEASURE
Scores for IQ were created from multiple measures of cognition, which were z standardized separately within each cohort.
RESULTS
Of 30 643 participants (50.8% male), 7.5% were born preterm (before 37 weeks gestation) and 92.5% were term born (between 37 and 42 weeks gestation). In the pooled data using multivariate adaptive regression splines, IQ linearly increased by 4.2 points as BWPs increased from the first to the 69th percentile before completely plateauing. For gestational age, IQ linearly increased by 1.3 points per week up until 32 weeks, with the association reducing to 0.3 points per week after 32 weeks. The association of BWP with IQ was not moderated by gestational age. For term-born infants, the estimated IQ score was only clinically meaningfully lower than average when birth weight was below the third percentile. Consistent results were found when instead using multivariable regression where gestational age and BWPs were categorized into groups.
CONCLUSIONS AND RELEVANCE
In this cohort study, lower BWPs and gestational age were independently associated with lower IQ. For term-born infants, a cutoff of the third percentile would be more appropriate than the traditionally used 10th percentile when the aim is estimating meaningful cognitive differences.
Topics: Child; Infant; Infant, Newborn; Young Adult; Adolescent; Female; Humans; Male; Child, Preschool; Birth Weight; Cohort Studies; Longitudinal Studies; Australia; Gestational Age; Cognition
PubMed: 37651137
DOI: 10.1001/jamanetworkopen.2023.31815 -
JAMA Network Open Nov 2023An extrauterine placental perfusion (EPP) approach for physiological-based cord clamping (PBCC) may support infants with very low birth weight (VLBW) during transition... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
An extrauterine placental perfusion (EPP) approach for physiological-based cord clamping (PBCC) may support infants with very low birth weight (VLBW) during transition without delaying measures of support.
OBJECTIVE
To test whether EPP in resuscitation of infants with VLBW results in higher hematocrit levels, better oxygenation, or improved infant outcomes compared with delayed cord clamping (DCC).
DESIGN, SETTING, AND PARTICIPANTS
This nonblinded, single-center randomized clinical trial was conducted at a tertiary care neonatal intensive care unit. Infants with a gestational age greater than 23 weeks and birth weight less than 1500 g born by cesarean delivery between May 2019 and June 2021 were included. Data were analyzed from October through December 2021.
INTERVENTION
Prior to cesarean delivery, participants were allocated to receive EPP or DCC. In the EPP group, infant and placenta, connected by an intact umbilical cord, were detached from the uterus and transferred to the resuscitation unit. Respiratory support was initiated while holding the placenta over the infant. The umbilical cord was clamped when infants showed regular spontaneous breathing, stable heart rates greater than 100 beats/min, and adequate oxygen saturations. In the DCC group, cords were clamped 30 to 60 seconds after birth before infants were transferred to the resuscitation unit, where respiratory support was started.
MAIN OUTCOMES AND MEASURE
The primary outcome was the mean hematocrit level in the first 24 hours after birth. Secondary prespecified outcome parameters comprised oxygenation during transition and short-term neonatal outcome.
RESULTS
Among 60 infants randomized and included, 1 infant was excluded after randomization; there were 29 infants in the EPP group (mean [SD] gestational age, 27 weeks 6 days [15.0 days]; 14 females [48.3%]) and 30 infants in the DCC group (mean [SD] gestational age, 28 weeks 1 day [17.1 days]; 17 females [56.7%]). The mean (SD) birth weight was 982.8 (276.6) g and 970.2 (323.0) g in the EPP and DCC group, respectively. Intention-to-treat analysis revealed no significant difference in mean hematocrit level (mean difference [MD], 2.1 percentage points; [95% CI, -2.2 to 6.4 percentage points]). During transition, infants in the EPP group had significantly higher peripheral oxygen saturation as measured by pulse oximetry (adjusted MD at 5 minutes, 15.3 percentage points [95% CI, 2.0 to 28.6 percentage points]) and regional cerebral oxygen saturation (adjusted MD at 5 minutes, 11.3 percentage points [95% CI, 2.0 to 20.6 percentage points]). Neonatal outcome parameters were similar in the 2 groups.
CONCLUSIONS AND RELEVANCE
This study found that EPP resulted in similar hematocrit levels as DCC, with improved cerebral and peripheral oxygenation during transition. These findings suggest that EPP may be an alternative procedure for PBCC in infants with VLBW.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03916159.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Birth Weight; Infant, Premature; Infant, Very Low Birth Weight; Perfusion; Placenta; Male
PubMed: 37921769
DOI: 10.1001/jamanetworkopen.2023.40597 -
RMD Open Nov 2023Based on Barker's hypothesis, some studies investigated the associations between birth weight and several disorders. Apart from issues with statistical power and... (Observational Study)
Observational Study
BACKGROUND
Based on Barker's hypothesis, some studies investigated the associations between birth weight and several disorders. Apart from issues with statistical power and well-known shortcomings of the observational study design, there are no studies accounting for changes in weight-related body size over the life course regarding rheumatoid arthritis, psoriasis, psoriatic arthritis and multiple sclerosis.
METHODS
Using genetic information of up to 806 834 participants, this study investigated the associations between time-varying weight-related body size from birth to adulthood and the mentioned autoimmune diseases. Performing Mendelian randomisation (MR), the radial inverse-variance weighted approach was used iteratively in primary analyses. Robustness of the results was confirmed in several sensitivity analyses. Potential time-dependent mediation mechanisms were identified through network-clustering and assessed using multivariable MR.
RESULTS
Genetically predicted birth weight (fetal effect) was positively associated with rheumatoid arthritis (OR 1.44; 95% CI 1.17 to 1.77; P =0.005) but not with psoriasis, psoriatic arthritis or multiple sclerosis. This association was found to be mediated by body mass index (BMI) in adulthood (OR 1.45; 95% CI 1.14 to 1.84; P =0.019) rather than childhood. The direct effect of birth weight attenuated (OR 1.19; 95% CI 0.88 to 1.62); P =1) after adjustment for time-varying BMI.
CONCLUSION
Increased birth weight appears to be a risk factor for later manifestation of rheumatoid arthritis due to both fetal genetic components and high BMI persisting into adulthood. Approaches to prevent and minimise the risk of rheumatoid arthritis could include preventing obesity in adults with high birth weight.
Topics: Adult; Child; Humans; Arthritis, Psoriatic; Arthritis, Rheumatoid; Birth Weight; Life Change Events; Multiple Sclerosis; Psoriasis; Mendelian Randomization Analysis
PubMed: 37963678
DOI: 10.1136/rmdopen-2023-003633 -
Pediatric Research Nov 2023Paracetamol is commonly used for analgesia and patent ductus arteriosus (PDA) treatment in preterm infants. We aimed to evaluate early neurodevelopmental outcomes of... (Observational Study)
Observational Study
BACKGROUND
Paracetamol is commonly used for analgesia and patent ductus arteriosus (PDA) treatment in preterm infants. We aimed to evaluate early neurodevelopmental outcomes of extreme preterm infants exposed to paracetamol during their neonatal admission.
METHODS
This retrospective cohort study included surviving infants born at <29 weeks gestation, or with a birth weight of <1000 grams. Neurodevelopmental outcomes studied were early cerebral palsy (CP) or high risk of CP diagnosis, Hammersmith Infant Neurological Examination (HINE) score and Prechtl General Movement Assessment (GMA) at 3-4 months corrected age.
RESULTS
Two hundred and forty-two infants were included, of which 123 were exposed to paracetamol. After adjusting for birth weight, sex and chronic lung disease, there were no significant associations between paracetamol exposure and early CP or high risk of CP diagnosis (aOR 1.46, 95% CI 0.61, 3.5), abnormal or absent GMA (aOR 0.82, 95% CI 0.37, 1.79) or HINE score (adjusted β -0.19, 95% CI -2.39, 2.01). Subgroup analysis stratifying paracetamol exposure into <180 mg/kg or ≥180 mg/kg cumulative dose found that neither had significant effects on outcomes.
CONCLUSIONS
In this cohort of extreme preterm infants, no significant association was found between exposure to paracetamol during the neonatal admission and adverse early neurodevelopment.
IMPACT
Paracetamol is commonly used in the neonatal period for analgesia and patent ductus arteriosus treatment in preterm infants, although prenatal paracetamol use has been associated with adverse neurodevelopmental outcomes. Exposure to paracetamol during the neonatal admission was not associated with adverse early neurodevelopment at 3-4 months corrected age in this cohort of extreme preterm infants. The findings from this observational study is consistent with the small body of literature supporting the lack of association between neonatal paracetamol exposure and adverse neurodevelopmental outcomes in preterm infants.
Topics: Infant; Pregnancy; Female; Infant, Newborn; Humans; Infant, Premature; Acetaminophen; Ductus Arteriosus, Patent; Birth Weight; Retrospective Studies; Ibuprofen; Persistent Fetal Circulation Syndrome
PubMed: 37198403
DOI: 10.1038/s41390-023-02649-4 -
BMC Pregnancy and Childbirth Jun 2023Childhood mortality and morbidity has become a major public health issue in low-middle-income countries. However, evidence suggested that Low birth weight(LBW) is one of...
BACKGROUND
Childhood mortality and morbidity has become a major public health issue in low-middle-income countries. However, evidence suggested that Low birth weight(LBW) is one of the most important risk factors for childhood deaths and disability.This study is designed to estimate the prevalence of low birth weight (LBW) in India and to identify maternal correlates associated with LBW.
METHODS
Data has been taken from National Family Health Survey 5 (2019-2021) for analysis. 149,279 women belonging to reproductive age group (15-49) year who had last recent most delivery preceding the NFHS-5 survey.
RESULTS
Mother's age, female child, birth interval of less than 24 months, their low educational level, low wealth index, rural residence, lack of insurance coverage, women with low BMI, anaemia, and no ANC visits during pregnancy are predictors that contribute to LBW in India. After adjusting for covariates, smoking and alcohol consupmtion is strongly correlated with LBW.
CONCLUSION
Mother's age, educational attainment and socioeconomic status of living has a highly significant with LBW in India. However, consumption of tobacco and cigarrettes are also associated with LBW.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Birth Weight; Educational Status; Health Surveys; India; Infant, Low Birth Weight; Prevalence; Risk Factors; Adolescent; Young Adult; Adult; Middle Aged
PubMed: 37340388
DOI: 10.1186/s12884-023-05726-y -
Theriogenology Nov 2023Great attention has been given in the last years to the protein source of dog food, and commercial limited-ingredient diets with a single protein are available also for...
Great attention has been given in the last years to the protein source of dog food, and commercial limited-ingredient diets with a single protein are available also for late pregnancy. This work compared the effect of a fish-based limited ingredient diet (LID), and of a standard mixed-protein diet (Mixed), fed to the bitches from the last three weeks of pregnancy and to the puppies at weaning, on birth weight, growth and health of the puppies. From a breeder's records, the weight of 22 Lagotto Romagnolo (LR) and 10 Appenzeller Cattle Dog (ACD) bitches on the day of mating, and of their 199 puppies, were extracted. The effect of diet on puppies' weight on day 0, 6, 30 and 60 was analyzed, considering litter size and sex. The analyses were repeated on puppies' weights normalized on the relative dam's non-pregnant bodyweight. Birth weight was available for 146 puppies, 82 LR and 64 ACD. Median birth weight of LR puppies was 287.5 g (170-400 g); sex ratio was 1.11 (males/females, N = 80). Median birth weight of ACD puppies was 390 g (240-525 g); sex ratio 1.15 (males/females, N = 58). Diet did not significantly affect birth weight in both breeds; however, it showed a significant effect on normalized birth weights (LR, P = 0.016; ACD, P = 0.034), with higher values for LID. At day 30, ACD puppies showed significantly higher weights with the Mixed diet (P = 0.002), and, at day 60, diet significantly affected the normalized weight in both breeds (LR, P = 0.019; ACD, P = 0.001), with higher values for the Mixed type. LID may help the dam to invest the energy in the growth of her litter, however, the same diet resulted in lower puppies' weights around weaning, compared to the Mixed diet. Although our results should be confirmed with larger numbers of animals and more breeds, they set some points worth to be further investigated. The choice of a limited-ingredient single-protein diet can affect litter weight and weight at weaning. Whether, administered to dams and puppies, it can prevent later pathologies, like chronic gastrointestinal diseases or food allergies, is a field of research deserving full attention.
Topics: Female; Male; Pregnancy; Dogs; Animals; Cattle; Birth Weight; Canidae; Reproduction; Litter Size; Cell Communication
PubMed: 37647814
DOI: 10.1016/j.theriogenology.2023.08.019 -
The Journal of Maternal-fetal &... Dec 2023Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. However, little is known regarding the influence of...
BACKGROUND
Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. However, little is known regarding the influence of prepregnancy dietary patterns.
OBJECTIVES
This study aimed to explore the effects between prepregnancy dietary patterns on birth weight.
METHODS
This study included 911 singleton live-born infants from the Taicang and Wuqiang Mother-Child Cohort Study (TAWS). Baseline information and prepregnancy diet data were collected during early pregnancy. Newborn birth information was obtained from the Wuqiang County Hospital. Macrosomia, defined as a birth weight of ≥4000 g, and large for gestational age (LGA), defined as a birth weight higher than the 90th percentile for the same sex and gestational age, were the outcomes of interest. The dietary patterns were extracted using principal component analysis. Logistic regression models were used to investigate the association between prepregnancy dietary patterns (in tertiles) and macrosomia and LGA, and subgroup analysis was further explored by pre-pregnancy body mass index (BMI).
RESULTS
Four dietary patterns were identified based on 15 food groups. These patterns were named as "cereals-vegetables-fruits," "vegetables-poultry-aquatic products," "milk-meat-eggs," and "nuts-aquatic products-snacks." After adjusting for sociodemographic characteristics, pregnancy complications, and other dietary patterns, greater adherence to the "cereals-vegetables-fruits" pattern before pregnancy was associated with a higher risk of macrosomia (adjusted OR = 2.220, 95% CI: 1.018, 4.843), while greater adherence to the "nuts-aquatic products-snacks" pattern was associated with a lower risk of macrosomia (adjusted OR = 0.357, 95% CI: 0.175, 0.725) compared to the lowest tertile. No significant association was observed between prepregnancy dietary patterns and LGA. However, after subgroup analysis of pre-pregnancy BMI, "cereals-vegetables-fruits" pattern was associated with an increased risk of LGA in overweight and obese mothers (adjusted OR = 2.353, 95% CI: 1.010, 5.480).
CONCLUSIONS
An unbalanced pre-pregnancy diet increases the risk of macrosomia and LGA, especially in overweight or obese women before pre-pregnancy.
Topics: Pregnancy; Infant, Newborn; Infant; Female; Humans; Birth Weight; Fetal Macrosomia; Cohort Studies; Overweight; Prospective Studies; Risk Factors; Obesity; Weight Gain; Body Mass Index
PubMed: 37904502
DOI: 10.1080/14767058.2023.2273216