Paediatric and perinatal epidemiology最新文献

{"title":"Fenton Third-Generation Growth Charts of Preterm Infants Without Abnormal Fetal Growth: A Systematic Review and Meta-Analysis.","authors":"Tanis R Fenton, Seham Elmrayed, Belal N Alshaikh","doi":"10.1111/ppe.70035","DOIUrl":"https://doi.org/10.1111/ppe.70035","url":null,"abstract":"<p><strong>Background: </strong>Experts recommend assessing preterm infant growth against fetal growth patterns. However, obtaining accurate estimates of healthy fetal growth from preterm infants is challenging as many had intrauterine faltering growth.</p><p><strong>Objectives: </strong>To improve preterm infant growth assessments by developing Fenton third-generation sex-specific preterm growth charts based on anthropometric distributions of preterm infants without abnormal fetal growth. We also aimed to evaluate the consistency of the new charts' growth velocities.</p><p><strong>Data sources: </strong>From the last search for the 2013 Fenton growth charts to November 2024, MEDLINE and EMBASE databases, grey literature, as well as US Vital statistics and iNeo Consortium.</p><p><strong>Study selection and data extraction: </strong>We followed systematic review methodology to identify population-based sex-specific anthropometric estimates of preterm cohorts without abnormal fetal growth beginning ≤ 24 weeks of gestation. Specified a priori, outcomes included newborn sex-specific estimates of birthweight, length, and head circumference.</p><p><strong>Synthesis: </strong>We followed PRISMA guidelines. Literature screening and quality assessment were performed in duplicate. We harmonised weight, length, and head circumference weighted-average meta-analyses with the World Health Organization growth standard and rescaled the charts' x-axis from completed gestational weeks to exact gestational age (weeks and days).</p><p><strong>Results: </strong>Seven studies from 15 countries (Australia, Brazil, Canada, China, Finland, Israel, Italy, Japan, Netherlands, New Zealand, Sweden, Switzerland, Spain, United Kingdom and United States) were included, representing 4.8 million births 22-42 weeks of gestation. 174,184 were < 30 weeks gestational age. The Fenton third-generation preterm growth charts' weights showed improved growth velocity across percentiles with consistent declines for weight, length and head circumference velocity as post-menstrual age increased. The birthweight meta-analysis curves had similar shapes to fetal ultrasound estimates.</p><p><strong>Conclusions: </strong>The Fenton third-generation preterm infant growth chart curves demonstrate improved and more uniform slopes across percentiles and closer alignment with fetal ultrasound estimates, offering a growth standard for preterm infants.</p><p><strong>Prospero registration: </strong>CRD42024589756.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-Onset Neonatal Infection and Attention Deficit Hyperactivity and Autism Spectrum Disorder: A Nationwide Cohort Study.","authors":"Mads Andersen, Niels Bjerregård Matthiesen, May Murra, Stine Yde Nielsen, Tine Brink Henriksen","doi":"10.1111/ppe.70036","DOIUrl":"https://doi.org/10.1111/ppe.70036","url":null,"abstract":"<p><strong>Background: </strong>Early-onset neonatal infections are among the most common neonatal diseases. However, the long-term outcomes of the infections are not well understood.</p><p><strong>Objective: </strong>To study the association between early-onset neonatal infection and attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).</p><p><strong>Methods: </strong>A nationwide register-based cohort study was conducted, including near-term and term children born between 1997 and 2013 with follow-up until 2021. An early-onset infection was defined as an invasive bacterial infection occurring within the first week of life, including both physician-assigned diagnoses and positive bacterial cultures. ADHD and ASD were defined by diagnoses or prescriptions of relevant medication. Associations between sepsis and the neurodevelopmental disorders were investigated using multivariable Cox regression to estimate adjusted hazard ratios (HR), whereas associations with meningitis were examined using person-time incidence rate ratios (IRR). Sibling-matched analyses were also conducted for associations with sepsis.</p><p><strong>Results: </strong>A total of 981,869 children were included, with 8154 defined as having sepsis and 152 defined as having meningitis. Among these, only 257 children had culture-positive sepsis, whereas 32 had culture-positive meningitis. The incidence rate of ADHD and ASD for children with sepsis was 4.5 per 1000 and 3.3 per 1000 person-years, respectively. Sepsis was associated with an increased adjusted likelihood of both ADHD (HR 1.28, 95% CI 1.17, 1.39) and ASD (HR 1.43, 95% CI 1.30, 1.58). However, sibling-matched analyses especially attenuated the association with ADHD (HR 1.12, 95% CI 0.93, 1.34). Point estimates suggested that children with meningitis also had an increased likelihood of both ADHD (IRR 1.77, 95% CI 0.88, 3.17) and ASD (IRR 2.05, 95% CI 0.89, 4.04).</p><p><strong>Conclusions: </strong>Early-onset sepsis was associated with an increased likelihood of ASD, whereas the majority of the association with ADHD could be explained by unmeasured shared familial confounding.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-Varying Associations Between Physical Activity and Injury Risk Among Children.","authors":"Chinchin Wang, Michal Abrahamowicz, Marie-Eve Beauchamp, Jay S Kaufman, Russell J Steele, Eva Jespersen, Niels Wedderkopp, Ian Shrier","doi":"10.1111/ppe.70040","DOIUrl":"https://doi.org/10.1111/ppe.70040","url":null,"abstract":"<p><strong>Background: </strong>Physical activity has time-varying associations with injury risk among children. While previous activity may predispose to injury through tissue damage, fatigue and insufficient recovery, it may protect against injury by strengthening tissues and improving fitness and skills. It is unclear what the relevant time window and relative importance of past activity are with regard to current injury risk in children.</p><p><strong>Objectives: </strong>The objectives of this study were to assess how previous activity patterns are associated with injury risk among children.</p><p><strong>Methods: </strong>Our data source was the Childhood Health, Activity, and Motor Performance School Study Denmark (CHAMPS-DK), a prospective cohort study of Danish school children conducted between 2008 and 2014. We applied flexible weighted cumulative exposure methods within a Cox proportional hazards model to estimate the time-varying association between the number of weekly activity sessions and time-to-first injury in each school year. We estimated several models with varying time windows and compared goodness-of-fit.</p><p><strong>Results: </strong>Out of 1667 study participants, 986 (59.1%) were injured at least once, with a total of 1752 first injuries across school years. The best-fitting model included 20 weeks of past physical activity. Higher levels of activity performed 10-20 weeks ago were associated with decreased injury risk, while higher levels of activity performed 2-9 weeks ago were associated with higher injury risks. Compared to those who remained minimally active for the entire past 20-week period, children who were highly active in the past 10 weeks after being minimally active 11-20 weeks ago had an injury hazard ratio of 1.63 (95% confidence interval 1.18, 2.23).</p><p><strong>Conclusions: </strong>Flexible weighted cumulative exposure methods suggest a complex temporal relationship between past physical activity history and injury in children.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Value of Population-Level Data and Looking Toward the Future.","authors":"Eric Rubenstein, Stephanie L Santoro","doi":"10.1111/ppe.70038","DOIUrl":"https://doi.org/10.1111/ppe.70038","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Adolescence a Window of Opportunity for Prepregnancy Obesity Prevention?","authors":"Romy Gaillard","doi":"10.1111/ppe.70037","DOIUrl":"https://doi.org/10.1111/ppe.70037","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Changes in the Contribution of Chronic Disease to Maternal Mortality in the United States.","authors":"Yasser Sabr, Sarka Lisonkova, Chantal Mayer, K S Joseph","doi":"10.1111/ppe.70034","DOIUrl":"https://doi.org/10.1111/ppe.70034","url":null,"abstract":"<p><strong>Background: </strong>Increases in maternal age, obesity and other factors have led to an increase in hypertension, diabetes, and other chronic diseases among pregnant women. However, the impact of chronic diseases on maternal mortality has not been adequately studied.</p><p><strong>Objectives: </strong>To quantify the contribution of maternal mortality associated with chronic disease to maternal mortality in the United States in 1999-2002 and 2018-2022.</p><p><strong>Methods: </strong>The study was based on maternal deaths in the United States in 1999-2002 and 2018-2022, with data obtained from the mortality and live birth files of the National Center for Health Statistics. Maternal deaths and maternal deaths associated with chronic disease were identified based on the presence of pregnancy-related causes and chronic diseases among the multiple causes of death. Maternal mortality ratios (MMR) and ratios of MMRs and their 95% confidence intervals (CI) were estimated to assess period change. Temporal changes in MMRs were adjusted for maternal age using direct standardisation.</p><p><strong>Results: </strong>Although overall MMRs were stable, direct obstetrical deaths decreased by 14% (95% CI 9, 23) from 1999-2002 to 2018-2022. Maternal deaths associated with chronic disease increased by 28% (95% CI 17, 40) from 5.41 in 1999-2002 to 6.92 per 100,000 live births in 2018-2022. The temporal increases in chronic disease-related maternal deaths were attenuated but not abolished following adjustment for maternal age (age-adjusted increase 16%, 95% CI 10, 23). MMRs associated with chronic disease increased in all age groups, especially among women aged < 20 and 30-39 years (57% and 17% increase, respectively). Non-Hispanic Black women had the highest MMRs associated with chronic disease (15.8 per 100,000 live births in 2018-2022), while age-adjusted MMRs increased among non-Hispanic White women (45% increase, 95% CI 33, 59).</p><p><strong>Conclusions: </strong>A substantial fraction of maternal deaths in the United States is associated with chronic disease, although patterns vary by race/ethnicity.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placental Abruption and Perinatal Mortality: Abnormal Placentation and Spontaneous Abortion as Contributors to Left Truncation Bias.","authors":"Alan C Kinlaw, Hillary L Graham, Cande V Ananth","doi":"10.1111/ppe.70010","DOIUrl":"https://doi.org/10.1111/ppe.70010","url":null,"abstract":"<p><strong>Background: </strong>Generally, studies in perinatal epidemiology restrict cohort entry to 20 weeks of gestation, but exposures and outcomes may occur earlier. This restriction may introduce left truncation bias.</p><p><strong>Objectives: </strong>To examine the impact of left truncation bias when estimating the causal effect of abruption on perinatal mortality in the context of abnormal placentation, with spontaneous abortion (SAB) as a censoring event.</p><p><strong>Methods: </strong>Through 80 Monte Carlo simulation scenarios based on realistic clinical assumptions, we estimated risk differences (RD), risk ratios (RR) and bias parameters for the abruption-perinatal mortality association.</p><p><strong>Results: </strong>Censoring by SAB ranged from 5.6% to 7.6% across simulation setups. The risk of mortality was underestimated in observable (left-truncated) data at ≥ 20 weeks compared to an unobservable cohort starting follow-up at placental implantation (conception cohort). Underestimation of risks was stronger among abruption pregnancies. RDs for the abruption-mortality association were biased by +1% to +3% among conceptions with normal implantation and by +5% to +43% among abnormal placentation. Due to the disproportionate underestimation of mortality among nonabruption pregnancies, RRs were overestimated by 1.1 to 1.2-fold for normal implantations and by 1.1 to 8.4-fold for abnormal implantations.</p><p><strong>Conclusions: </strong>The findings of this simulation study highlight the critical importance of placentation in successful pregnancy. Abnormal placentation has profound consequences for unsuccessful pregnancies, remarkably increasing the risks of early losses, placental abruption and other obstetrical complications. This study underscores that left truncation can bias the abruption-perinatal mortality association, differentially by whether the placentation was normal or abnormal. However, defining the causal question regarding the abruption-perinatal mortality association requires consideration of the target population, which may include all conceptions. In studies of these effects, outcome follow-up capability may introduce left truncation bias. We do not prescribe one analytic approach to account for left truncation, but rather, the approach should be guided by the causal question.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertensive Disorders of Pregnancy, Preterm Delivery, and Infant Size: Which Mothers Have Highest Cardiovascular Disease Mortality?","authors":"Sage Wyatt, Rolv Skjærven, Lars Vatten, Allen J Wilcox, Aditi Singh, Kari Klungsøyr, Suzan L Carmichael, Nils-Halvdan Morken, Rolv Terje Lie, Liv Grimstvedt Kvalvik","doi":"10.1111/ppe.70033","DOIUrl":"https://doi.org/10.1111/ppe.70033","url":null,"abstract":"<p><strong>Background: </strong>Research on new-onset hypertensive disorders of pregnancy (HDP) and long-term maternal cardiovascular disease (CVD) death has focused on mothers of small-for-gestational-age infants rather than large-for-gestational-age infants.</p><p><strong>Objectives: </strong>We further explored this focus by investigating CVD death in mothers with HDP by gestational age at delivery across the full spectrum of infant birth size.</p><p><strong>Methods: </strong>We used data from the Medical Birth Registry of Norway, the Norwegian National Population Register, and the Norwegian Cause of Death Registry, with information on mothers giving birth 1967-2020. This data was used to predict CVD death in the decades following pregnancy.</p><p><strong>Results: </strong>We found the lowest CVD mortality among mothers with no HDP, term delivery, and a first infant with birthweight above average. These women constituted our reference group in the analyses. We found the highest risk of CVD death among mothers with preterm HDP and infants with above average birthweight for gestational age (HR 6.87, 95% CI 4.98, 9.48), not with infants below average birthweight for gestational age (HR 3.06, 95% CI 2.37, 3.93).</p><p><strong>Conclusions: </strong>There is an interactive association between HDP and large infant birthweight in preterm first births. The high risk associated with the particular combination of HDP, preterm birth, and high infant birthweight for gestational age warrants further research to understand its causal underpinnings.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weighted Cumulative Exposure Modelling to Assess the Association Between Reproductive Factors and Future Cardiovascular Disease in Women.","authors":"Natalie Dayan, Marie-Eve Beauchamp, Melia Alcantara, Gabriel D Shapiro, Michal Abrahamowicz","doi":"10.1111/ppe.70029","DOIUrl":"https://doi.org/10.1111/ppe.70029","url":null,"abstract":"<p><strong>Background: </strong>The occurrence of reproductive or pregnancy events, such as severe maternal morbidity (SMM), may reveal a predisposition to chronic disease and premature mortality. However, most studies have examined these exposures without considering their timing, severity, or recurrence.</p><p><strong>Objectives: </strong>We propose using a weighted cumulative exposure (WCE) modelling approach to flexibly describe the relationship between reproductive events and longer-term health outcomes in a longitudinal cohort of pregnant women.</p><p><strong>Methods: </strong>Application of the WCE modelling approach is accomplished in three steps. First, relative weights are estimated from a multivariable Cox proportional hazards model corresponding to the association of each reproductive risk factor with a given health outcome. Then, a longitudinal dataset is constructed in which all reproductive predictors are recorded at regular intervals (every 3 months), beginning 42 days after each woman's first birth in the cohort and ending at an outcome or censoring event. A new multivariable Cox model applied to this longitudinal dataset, incorporating time-varying WCE-derived reproductive risk scores along with simple time-varying reproductive and non-reproductive predictors, is estimated. Finally, adjusted WCE-based hazard ratios (HR) associated with different reproductive event exposure histories are calculated.</p><p><strong>Results: </strong>In the cohort of 1,992,972 births in Canada (excluding Quebec), 2008-2021, with mean (SD) follow-up time in the longitudinal dataset of 7.3 ± 3.8 years, we propose to use the WCE approach to predict outcomes such as premature cardiovascular disease (16,846 cardiovascular hospitalisations observed, or 1.19 per 1000 person-years).</p><p><strong>Conclusions: </strong>Use of flexible WCE modelling to quantify risks of pregnancy events such as SMM, adjusted for reproductive and non-reproductive CVD risk factors, will account for variation in timing and severity of these events and will capture their cumulative effects across a woman's reproductive trajectory. This approach can refine estimates of etiologic associations and inform novel clinical prediction models with the potential to predict postpartum long-term health outcomes for a given woman based on her unique reproductive history.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Risk Factors and Outcomes of SARS-CoV-2 Infection in Pregnant Women: The COROPREG Population-Based Study.","authors":"Caroline Diguisto, Pierre-Yves Ancel, Aurélien Seco, Nathalie Baunot, Cecile Caze, Catherine Crenn-Hébert, Corinne Dupont, Charles Garabedian, Cécile Lebeaux, Camille Le Ray, Mathilde Letouzey, Elsa Lorthe, Emilie Marrer, Valérie Rouger, Christophe Vayssière, Christelle Vauloup Fellous, Marie-Pierre Bonnet, Catherine Deneux-Tharaux","doi":"10.1111/ppe.70028","DOIUrl":"https://doi.org/10.1111/ppe.70028","url":null,"abstract":"<p><strong>Background: </strong>Population-based data are needed to reliably assess the impact of SARS-CoV-2 infection during pregnancy.</p><p><strong>Objectives: </strong>To estimate the population-based incidence of SARS-CoV-2 infection and its severe forms in the obstetric population, identify risk factors of severe SARS-CoV-2 infection (severe COVID-19) and describe delivery, maternal and neonatal outcomes by disease severity, using a definition of severity based on organ dysfunction.</p><p><strong>Methods: </strong>A prospective population-based study conducted over the three first pandemic waves between March 2020 and April 2021 in 281 maternity hospitals in six French regions included all women with SARS-CoV-2 infection during pregnancy or within 7 days post-partum, whether symptomatic or not, hospitalised or not. Severe COVID-19 forms were defined a priori using clinical, biological and management criteria of organ dysfunction. We calculated infection and severe infection rates and studied associations between sociodemographic, medical and pregnancy characteristics and severe COVID-19 by univariate and multivariate modified Poisson regression modelling.</p><p><strong>Results: </strong>From a population of 385,214 deliveries in the participating regions, 6015 women with SARS-CoV-2 infection were identified, including 337 severe cases. The rates of severe COVID-19 were 1.1, 0.9 and 3.6 per 1000 deliveries during the first, second and third pandemic waves, respectively, and the proportions of severe COVID-19 were 8.6%, 3.4% and 9.3%, respectively. On multivariate analysis, the risk of severe COVID-19 was associated with younger and older age, migrant status, living with > 4 people, overweight or obesity, chronic hypertension or diabetes and infection ≥ 22 weeks of gestation rather than earlier in pregnancy. Neonatal morbidity occurred mostly with severe maternal infection.</p><p><strong>Conclusion: </strong>Using an organ-based definition of severity and population-based data, rates of severe COVID-19 appeared lower than in previous studies. A permanent perinatal surveillance system is needed to assess efficiently and rapidly the impact of future pandemics.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}