scholarly journals Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245064
Author(s):  
Anne L. Dunlop ◽  
Alicynne Glazier Essalmi ◽  
Lyndsay Alvalos ◽  
Carrie Breton ◽  
Carlos A. Camargo ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Maternal Education ◽  
Bachelor's Degree ◽  
Race Ethnicity ◽  
Gestational Age At Birth ◽  
Age At Birth ◽  
Neighborhood Level ◽  
Hispanic White ◽  
Maternal Race

Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate’s degree, vocational or technical training [reference category]; bachelor’s degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor’s degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61–0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00–1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor’s degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography.

scholarly journals Maternal biological age assessed in early pregnancy is associated with gestational age at birth

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eva E. Lancaster ◽  
Dana M. Lapato ◽  
Colleen Jackson-Cook ◽  
Jerome F. Strauss ◽  
Roxann Roberson-Nay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Cellular Aging ◽  
Biological Age ◽  
Potential Candidate ◽  
A Genome ◽  
Gestational Age At Birth ◽  
Age At Birth

AbstractMaternal age is an established predictor of preterm birth independent of other recognized risk factors. The use of chronological age makes the assumption that individuals age at a similar rate. Therefore, it does not capture interindividual differences that may exist due to genetic background and environmental exposures. As a result, there is a need to identify biomarkers that more closely index the rate of cellular aging. One potential candidate is biological age (BA) estimated by the DNA methylome. This study investigated whether maternal BA, estimated in either early and/or late pregnancy, predicts gestational age at birth. BA was estimated from a genome-wide DNA methylation platform using the Horvath algorithm. Linear regression methods assessed the relationship between BA and pregnancy outcomes, including gestational age at birth and prenatal perceived stress, in a primary and replication cohort. Prenatal BA estimates from early pregnancy explained variance in gestational age at birth above and beyond the influence of other recognized preterm birth risk factors. Sensitivity analyses indicated that this signal was driven primarily by self-identified African American participants. This predictive relationship was sensitive to small variations in the BA estimation algorithm. Benefits and limitations of using BA in translational research and clinical applications for preterm birth are considered.

scholarly journals Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study

BMJ ◽  
2019 ◽  
pp. l1346 ◽  
Author(s):  
Casey Crump ◽  
Jan Sundquist ◽  
Marilyn A Winkleby ◽  
Kristina Sundquist
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Environmental Factors ◽  
Gestational Age ◽  
Early Term ◽  
Extremely Preterm ◽  
National Cohort ◽  
Gestational Age At Birth ◽  
Age At Birth

Abstract Objective To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood. Design National cohort study. Setting Sweden. Participants 4 186 615 singleton live births in Sweden during 1973-2014. Exposures Gestational age at birth, identified from nationwide birth records in the Swedish birth registry. Main outcome measures CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors. Results 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families. Conclusions Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.

scholarly journals Risk of hypertension into adulthood in persons born prematurely: a national cohort study

2019 ◽  
Vol 41 (16) ◽  
pp. 1542-1550 ◽  
Author(s):  
Casey Crump ◽  
Jan Sundquist ◽  
Kristina Sundquist
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Environmental Factors ◽  
Gestational Age ◽  
Large Population ◽  
Increased Risk ◽  
Extremely Preterm ◽  
National Cohort ◽  
Gestational Age At Birth ◽  
Age At Birth

Abstract Aims Preterm birth has been associated with elevated blood pressure early in life; however, hypertension risks from childhood into adulthood remain unclear. We conducted a large population-based study to examine gestational age at birth in relation to hypertension risks from childhood into adulthood. Methods and results A national cohort study was conducted of all 4 193 069 singleton live births in Sweden during 1973–2014, who were followed up for hypertension identified from nationwide inpatient and outpatient (specialty and primary care) diagnoses from any health care encounters through 2015 (maximum age 43 years; median 22.5). Cox regression was used to examine gestational age at birth in relation to hypertension risk while adjusting for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. In 86.8 million person-years of follow-up, 62 424 (1.5%) persons were identified with hypertension (median age 29.8 years at diagnosis). Adjusted hazard ratios for new-onset hypertension at ages 18–29 years associated with preterm (&lt;37 weeks) and extremely preterm (22–27 weeks) birth were 1.28 [95% confidence interval (CI), 1.21–1.36] and 2.45 (1.82–3.31), respectively, and at ages 30–43 years were 1.25 (1.18–1.31) and 1.68 (1.12–2.53), respectively, compared with full-term birth (39–41 weeks). These associations affected males and females similarly and appeared substantially related to shared genetic or environmental factors in families. Conclusions In this large national cohort, preterm birth was associated with increased risk of hypertension into early adulthood. Persons born prematurely may need early preventive evaluation and long-term monitoring for the development of hypertension.

Effects of Antenatal Depression and Antidepressant Treatment on Gestational Age at Birth and Risk of Preterm Birth

2007 ◽  
Vol 164 (8) ◽  
pp. 1206-1213 ◽  
Author(s):  
Rita Suri ◽  
Lori Altshuler ◽  
Gerhard Hellemann ◽  
Vivien K. Burt ◽  
Ana Aquino ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Antidepressant Treatment ◽  
Antenatal Depression ◽  
Gestational Age At Birth ◽  
Age At Birth

scholarly journals Uterine distention as a factor in birth timing: retrospective nationwide cohort study in Sweden

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022929 ◽  
Author(s):  
Jonas Bacelis ◽  
Julius Juodakis ◽  
Kristina M Adams Waldorf ◽  
Verena Sengpiel ◽  
Louis J Muglia ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Fetal Growth ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Maternal Height ◽  
Birth Timing ◽  
Gestational Age At Birth ◽  
Age At Birth ◽  
Singleton Pregnancies

ObjectivesTo determine whether uterine distention is associated with human pregnancy duration in a non-invasive observational setting.DesignRetrospective cohort study modelling uterine distention by interaction between maternal height and uterine load.SettingThe study is based on the 1990–2013 population data from all delivery units in Sweden.ParticipantsUncomplicated first pregnancies of healthy Nordic-born mothers with spontaneous onset of labour. Pregnancies were classified as twin (n=2846) or singleton (n=527 868). Singleton pregnancies were further classified as carrying a large for gestational age fetus (LGA, n=24 286) or small for gestational age fetus (SGA, n=33 780).Outcome measuresStatistical interaction between maternal height and uterine load categories (twin vs singleton pregnancies, and LGA vs SGA singleton pregnancies), where the outcome is pregnancy duration.ResultsIn all models, statistically significant interaction was found. Mothers carrying twins had 2.9 times larger positive linear effect of maternal height on gestational age than mothers carrying singletons (interaction p=5e−14). Similarly, the effect of maternal height was strongly modulated by the fetal growth rate in singleton pregnancies: the effect size of maternal height on gestational age in LGA pregnancies was 2.1 times larger than that in SGA pregnancies (interaction p<1e−11). Preterm birth OR was 1.4 when the mother was short, and 2.8 when the fetus was extremely large for its gestational age; however, when both risk factors were present together, the OR for preterm birth was larger than expected, 10.2 (interaction p<0.0005).ConclusionsAcross all classes, maternal height was significantly associated with child’s gestational age at birth. Interestingly, in short-statured women with large uterine load (twins, LGA), spontaneous delivery occurred much earlier than expected. The interaction between maternal height, uterine load size and gestational age at birth strongly suggests the effect of uterine distention imposed by fetal growth on birth timing.

scholarly journals Do maternal demographics and prenatal history impact the efficacy of betamethasone therapy for threatened preterm labor?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mary T. Kinney ◽  
Sara K. Quinney ◽  
Hayley K. Trussell ◽  
Larissa L. Silva ◽  
Sherrine A. Ibrahim ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Race And Ethnicity ◽  
Fetal Lung ◽  
Control Analysis ◽  
Lung Maturation ◽  
Maternal Characteristics ◽  
Individualization Of Therapy ◽  
Gestational Age At Birth ◽  
Age At Birth

Abstract Background Betamethasone (BMZ) is used to accelerate fetal lung maturation in women with threatened preterm birth, but its efficacy is variable and limited by the lack of patient individualization in its dosing and administration. To determine sources of variability and potential opportunities for individualization of therapy, the objective of this study was to evaluate maternal factors associated with development of neonatal respiratory distress syndrome (RDS) in a cohort of women who received betamethasone. Methods This study prospectively enrolled women, gestational ages 23–34 weeks, who received betamethasone for threatened preterm birth. Maternal demographics, prenatal history, and neonatal outcomes were abstracted from hospital records. RDS was the primary outcome. Associations between RDS diagnosis and maternal demographics, prenatal history, and betamethasone dosing were evaluated in a case-control analysis and multivariable regression adjusted for gestational age at delivery. Secondary analyses limited the cohort to women who delivered within 1 or 2 weeks of betamethasone dosing. Results Of 209 deliveries, 90 (43 %) resulted in neonatal RDS. Within the overall cohort and controlling for gestational age at birth, RDS was only associated with cesarean births compared to vaginal births (adjusted OR 1.17 [1.06–1.29]). Route of delivery was also the only significant factor related to RDS in the 83 neonates delivered within 7 days of BMZ dosing. However, among 101 deliveries within 14 days of betamethasone dosing and controlling for gestational age at birth, women who experienced preterm premature rupture of membranes (PPROM) had lower RDS rates than those without PPROM (57.9 % vs. 80.2 %, adjusted OR 0.81 [0.67–0.99]). Maternal age, BMI, race, and ethnicity were not associated with RDS in the regression models. Conclusions Of maternal characteristics analyzed, only delivery by cesarean was associated with neonatal RDS after antenatal betamethasone use.

scholarly journals Group antenatal care versus standard antenatal care and effect on mean gestational age at birth in Rwanda: protocol for a cluster randomized controlled trial

2019 ◽  
Vol 3 ◽  
pp. 1548 ◽  
Author(s):  
Sabine Furere Musange ◽  
Elizabeth Butrick ◽  
Tiffany Lundeen ◽  
Nicole Santos ◽  
Hana Azman Firdaus ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Preterm Birth ◽  
Antenatal Care ◽  
Gestational Age ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
Gestational Age At Birth ◽  
Age At Birth

Background: Group antenatal care has demonstrated promise as a service delivery model that may result in improved outcomes compared to standard antenatal care in socio-demographic populations at disparately high risk for poor perinatal outcomes. Intrigued by results from the United States showing lower preterm birth rates among high-risk women who participate in group antenatal care, partners working together as the Preterm Birth Initiative - Rwanda designed a trial to assess the impact of group antenatal care on gestational age at birth. Methods: This study is a pair-matched cluster randomized controlled trial with four arms. Pairs randomized to group or standard care were further matched with other pairs into quadruples, within which one pair was assigned to implement basic obstetric ultrasound at the health center and early pregnancy testing at the community. At facilities randomized to group care, this will follow the opt-out model of service delivery and individual visits will always be available for those who need or prefer them. The primary outcome of interest is mean gestational age at birth among women who presented for antenatal care before 24 completed weeks of pregnancy and attended more than one antenatal care visit. Secondary outcomes of interest include attendance at antenatal and postnatal care, preterm birth rates, satisfaction of mothers and providers, and feasibility. A convenience sample of women will be recruited to participate in a longitudinal survey in which they will report such indicators as self-reported health-related behaviors and depressive symptoms. Providers will be surveyed about satisfaction and stress. Discussion: This is the largest cluster randomized controlled trial of group antenatal and postnatal care ever conducted, and the first in a low- or middle-income country to examine the effect of this model on gestational age at birth. Trial registration: This study is registered on ClinicalTrials.gov as NCT03154177 May 16, 2017.

scholarly journals Related Factors For Preterm Birth in Twins After Single Intrauterine Death：a case control study

2021 ◽  
Author(s):  
Jingyi Liu ◽  
Na Li ◽  
Na Shin ◽  
Sishi Liu ◽  
Caixia Liu ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Case Control Study ◽  
Case Control ◽  
Intrauterine Death ◽  
Related Factors ◽  
Gestational Age At Birth ◽  
Age At Birth ◽  
Control Study ◽  
Length Of Gestation

Abstract Background Single intrauterine death in twin pregnancy has become a relatively frequent complication of twin pregnancy. Preterm delivery is one of the complications with high incidence, and is closely related to the prognosis of the surviving fetus. However, studies about preterm delivery related to single intrauterine death are limited. The purpose of this paper is to analyze the factors associated with preterm birth in twins after single intrauterine death.Methods This was a case-control study of single intrauterine death in twins delivered at Shengjing Hospital over a 12-year period, from January 1, 2008, to November 30, 2020. We classified these cases into the preterm birth group and full-term birth group according to gestational age at birth. We selected age, gestational age at Single intrauterine death, and parity, etc, as related factors of the preterm birth group. Logistic regression analyses were performed to determine the relevance and importance of related factors and their association with preterm birth. We divided the preterm birth group into four smaller groups according to gestational age at single intrauterine death (14-19 weeks, 20-24 weeks, 25-30 weeks, and 31-36 weeks) and compared them. To exclude human intervention, we analyzed the spontaneous delivery cases as well.Results The analysis included 175 twins (mean [SD] gestational age at single intrauterine death, 27.0 [5.8] weeks; mean [SD] gestational age at birth, 33.8 [3.2] weeks ) with single intrauterine death. A total of 139 (79.4%) were cases of preterm birth. A significant risk factor associated with preterm birth was gestational age at single intrauterine death (odds ratio [OR], 2.89; 95% CI, 1.90-4.39). We found that the 14- to 19-week age group had the oldest gestational age at birth (37.25 [1.29]weeks ). The length of gestation in 14-19 weeks group, 20-24 weeks group, 25-30 weeks group and 31-36 weeks group were 20.5 weeks, 11.0 weeks, 4.77 weeks and 1.12 weeks respectivelyConclusion The fetus’ gestational age at single intrauterine death was a risk factor for preterm birth in their twin. The length of gestation was inversely proportional to increasing gestational age at single intrauterine death.

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