Paediatric and perinatal epidemiology最新文献

{"title":"Do Birthweight-For-Gestational Age Centiles Predict Serious Neonatal Morbidity and Neonatal Mortality?","authors":"Sid John, K S Joseph, John Fahey, Shiliang Liu, Sarka Lisonkova, Michael S Kramer","doi":"10.1111/ppe.70065","DOIUrl":"https://doi.org/10.1111/ppe.70065","url":null,"abstract":"<p><strong>Background: </strong>Studies show that foetal and birthweight-for-gestational age centiles are poor predictors of serious neonatal morbidity and neonatal mortality (SNMM) in univariable models.</p><p><strong>Objective: </strong>We assessed the predictive performance of multivariable SNMM models based on maternal/pregnancy characteristics, with and without birthweight centiles.</p><p><strong>Methods: </strong>The study was based on all live births in the United States, 2019-2021, with data obtained from the period live birth-infant death files of the National Center for Health Statistics. SNMM was defined as any one or more of the following: 5-minute Apgar score < 4, seizures, assisted ventilation for> 30 or neonatal death. SNMM was modelled by log-linear regression on maternal/pregnancy characteristics as predictors, with and without birthweight centiles. Models were developed for live births at 24-42 weeks' and 39 weeks' gestation to all women and those with hypertensive disorders or pre-existing diabetes. Model performance was assessed using area under the curve (AUC).</p><p><strong>Results: </strong>The study population included 10,487,243 live births and 221,728 SNMM cases (2.1 per 100 live births). The models with all live births at 24-42 weeks' gestation had AUCs of 0.83 (95% confidence interval [CI] 0.82, 0.83) based on maternal/pregnancy characteristics and 0.83 (95% CI 0.83, 0.84) based on maternal/pregnancy characteristics and birthweight centiles. However, AUCs of models based on all live births at 39 weeks' gestation were 0.66 (95% CI 0.64, 0.68) with maternal/pregnancy characteristics and 0.69 (95% CI 0.68, 0.71) with maternal/pregnancy characteristics and birthweight centiles. AUCs of the models with live births at 39 weeks' gestation to women with pre-existing diabetes were 0.69 (95% CI 0.66, 0.72) based on maternal/pregnancy characteristics, and 0.77 (95% CI 0.74, 0.79) with the addition of birthweight centiles.</p><p><strong>Conclusions: </strong>Birthweight centiles improve multivariable SNMM predictive performance in specific subpopulations, although evaluation of decision thresholds is required to determine the clinical importance of improvement in predictive ability.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023905","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":"Association of PM_2.5 Exposure on Birthweight: Racial and Ethnic Disparities.","authors":"Wei-Jen Chen, Elaine Symanski, Kristina W Whitworth","doi":"10.1111/ppe.70070","DOIUrl":"https://doi.org/10.1111/ppe.70070","url":null,"abstract":"<p><strong>Background: </strong>The few studies that have examined the impact of PM_2.5 on reduced birthweight across different percentiles of the conditional birthweight distribution have produced equivocal findings, and only two assessed whether these associations varied by race/ethnicity or by racial/ethnic composition of the neighbourhood where mothers lived.</p><p><strong>Objective: </strong>We evaluated racial/ethnic differences in the association between prenatal PM_2.5 exposure and birthweight across the birthweight distribution in a retrospective cohort study comprising 102,986 full-term singleton births in Harris County, Texas (2019-2020).</p><p><strong>Methods: </strong>Census tract-level daily PM_2.5 concentrations were estimated using 'XGBoost-IDW Synthesis', and averaged exposures over pregnancy. Neighbourhood racial/ethnic composition was defined by whether ≥ 50% (i.e., majority) of non-Hispanic white residents lived in a census tract. Quantile regression models, adjusted for covariates, were applied to examine changes in birthweight [ <math> <semantics> <mrow><mover><mi>β</mi> <mo>̂</mo></mover> </mrow> <annotation>$$ hat{beta} $$</annotation></semantics> </math> and 95% confidence interval (CI)] associated with an interquartile range increase in ambient air levels of PM_2.5 at selected percentiles of the conditional birthweight distribution. Stratified analyses explored differential associations by maternal race/ethnicity and neighbourhood racial/ethnic composition.</p><p><strong>Results: </strong>An inverted hook pattern was observed in the associations between prenatal PM_2.5 exposure and reduced birthweight, with the strongest among infants born at the lowest ( <math> <semantics> <mrow><mover><mi>β</mi> <mo>̂</mo></mover> </mrow> <annotation>$$ hat{beta} $$</annotation></semantics> </math>  = -14 g, 95% CI: -20, -8; 10th percentile) and highest ( <math> <semantics> <mrow><mover><mi>β</mi> <mo>̂</mo></mover> </mrow> <annotation>$$ hat{beta} $$</annotation></semantics> </math>  = -11 g, 95% CI: -19, -4; 90th percentile) percentiles of the birthweight distribution, and a weaker association at the 75th percentile. In stratified analyses, the strongest association at the lowest percentile was observed among infants of Hispanic mothers or those living in neighbourhoods with less than a majority of non-Hispanic white residents.</p><p><strong>Conclusions: </strong>This study provides evidence that associations of prenatal PM_2.5 exposure with reductions in birthweight varied among infants at the lowest, middle and highest percentiles of the conditional birthweight distribution; further, these associations varied by maternal race/ethnicity and neighbourhood racial/ethnic composition.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006429","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":"Changes in the Dispensing of Antibiotics to Australian Children Between 2013 and 2023: Are We Heading in the Right Direction?","authors":"Erin Kelty, Ella Tairy, Scott Sims, Carol Orr, Amy Page, David B Preen, Frank M Sanfilippo, Christopher Etherton-Beer, Ebony Quintrell","doi":"10.1111/ppe.70068","DOIUrl":"https://doi.org/10.1111/ppe.70068","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) poses a critical public health issue, exacerbated by the overuse and misuse of antibiotics. Children are particularly susceptible to bacterial infections and are frequently prescribed antibiotics.</p><p><strong>Objective: </strong>This study examined trends in antibiotic dispensing to children aged under 13 years in Australia between 2013 and 2023.</p><p><strong>Methods: </strong>This retrospective observational study used a 10% random sample of dispensing records for nationally subsidised prescription antibiotics. The number of children dispensed an antibiotic was calculated for each year and expressed per 100 children. Trends were analysed using joinpoint regression overall and by age group, sex, the World Health Organisation's Access, Watch, Reserve (AWaRe) system of antibiotic classification and antibiotic subtype.</p><p><strong>Results: </strong>Between 2013 and 2023, 3,406,208 antibiotic prescriptions were dispensed to 554,837 children. There was a decrease in the total number of antibiotic prescriptions dispensed, falling from 103 prescriptions dispensed for every 100 children in 2013 to 63 prescriptions in 2023 (annual percent change [APC]: -6.9, 95% CI: -9.8, -4.4). While decreases were observed for medications classified as 'Access' (APC: -5.8, 95% CI: -8.7, -3.1), the largest decrease was observed in 'Watch' medications (APC: -15.0, 95% CI: -19.4, -11.7). Decreases were observed in the proportion of children dispensed an antibiotic, declining from 45.7% in 2013 to 33.6% in 2023 (APC: -4.7%, 95% CI: -7.1%, -2.5%). Reductions in dispensing were observed overall and by sex, age groups and most antibiotic types.</p><p><strong>Conclusions: </strong>Antibiotic dispensing in Australian children has decreased over the past decade, for all ages, sexes and antibiotic sub-classes, likely reflecting implemented policies and efforts to curb overuse of antibiotic medicines and AMR during this period.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006504","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":"Major Causes of Perinatal and Paediatric Mortality in Sub-Saharan Africa and South Asia: Adjustment for Selection Bias in the CHAMPS Network.","authors":"Kartavya J Vyas, Jonathan A Muir, Zachary J Madewell, Priya M Gupta, Dianna M Blau, Shams E Arifeen, Emily S Gurley, Atique I Chowdhury, Kazi M Islam, Afruna Rahman, J Anthony G Scott, Nega Assefa, Lola Madrid, Yohanis A Asefa, Yasir Y Abdullahi, Dickens Onyango, Victor Akelo, Beth A Tippett-Barr, George Aol, Samba O Sow, Karen L Kotloff, Milagritos D Tapia, Adama M Keita, Kiranpreet Chawla, Quique Bassat, Inacio Mandomando, Ariel Nhacolo, Charfudin Sacoor, Ikechukwu Ogbuanu, Dickens Kowuor, Babatunde Duduyemi, Andrew Moseray, James S Squire, Shabir Madhi, Sana Mahtab, Yasmin Adam, Amy Wise, Takwanisa Machemedza, Cynthia G Whitney","doi":"10.1111/ppe.70067","DOIUrl":"https://doi.org/10.1111/ppe.70067","url":null,"abstract":"<p><strong>Background: </strong>Studies of child mortality that employ minimally invasive tissue sampling (MITS) produce highly accurate cause of death data; however, selection bias may render these as non-representative of their underlying populations.</p><p><strong>Objectives: </strong>Estimate cause-specific mortality fractions and rates for the five most frequent causes-underlying and others in the chain of events leading to death-among stillbirths, neonatal, infant and child deaths-in Sub-Saharan Africa and South Asia, adjusted for any identified selection biases.</p><p><strong>Methods: </strong>The Child Health and Mortality Prevention Surveillance (CHAMPS) Network collects standardised, population-based, longitudinal data on causes of death among stillbirths and under-five children in 12 catchments in seven countries in Sub-Saharan Africa and South Asia. Cause-specific mortality fractions and rates were calculated for the five most frequent causes among stillbirths, neonatal, infant and child deaths, and for the five most frequent maternal conditions among perinatal deaths; all estimates were subsequently adjusted for selection bias. Selection probabilities were estimated from membership in subgroups defined by factors hypothesised to affect selection.</p><p><strong>Results: </strong>In 2017-2020, of 10,122 deaths ascertained, 5847 (57.8%) were enrolled in CHAMPS and 2654 (26.2%) additionally consented to MITS. Estimates were calculated for 265 and 65 site/age-specific causes of death and maternal conditions, respectively; five (1.9%) and four (6.2%) required adjustment, respectively, but they did not meaningfully change. Estimates were calculated for 34 site-specific causes of death among all stillbirths and under-five deaths combined; 28 (82.4%) required adjustment (all included age at death), and change-in-estimates demonstrated considerable variability.</p><p><strong>Conclusions: </strong>Selection bias is not a concern in the CHAMPS Network. Deaths where MITS were performed accurately represent the distribution of causes of death in their respective target populations, specifically when stratified by age or adjusted accordingly. Future studies of child mortality that employ MITS should consider adjusting for age at death for their measures of frequency.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992979","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":"Global, Regional, and National Burden of Lower Respiratory Infections in Children: A Systematic Analysis for the Global Burden of Disease Study, 2021.","authors":"Weimin Zhu, Xiaxia He, Shasha Xiang, Qingqing Lv, Nanjin Chen, Dongqing Lv, Yinghe Xu, Yongpo Jiang","doi":"10.1111/ppe.70064","DOIUrl":"https://doi.org/10.1111/ppe.70064","url":null,"abstract":"<p><strong>Background: </strong>Lower respiratory infections (LRI) are a leading cause of death among children aged 0 to 14 globally. LRI burden estimates remain incomplete, especially in resource-limited settings.</p><p><strong>Objective: </strong>To assess the global, regional, and national burden of LRI in children, analyse trends in incidence, mortality, and disability-adjusted life-years (DALYs), and predict future burden projections from 2022 to 2035, exploring variations in major bacterial pathogens.</p><p><strong>Methods: </strong>This study utilises data from the 2021 Global Burden of Disease Study to analyse child LRI burden across 204 countries and regions. It assesses incidence, mortality, and DALYs, employing refined methods and forecasting future burdens using the Bayesian Age-Period-Cohort (BAPC) model, while examining variations in major bacterial pathogens affecting children's health.</p><p><strong>Results: </strong>From 1990 to 2021, global child LRI incidence declined from 144.6 million infections to 69.9 million (estimated annual percentage change [EAPC] -2.4). Deaths fell from 2,033,975 to 1,271,013, with a mortality rate decline from 117 to 27.1 per 100,000 (EAPC -4.0). DALYs decreased from 180.7 million to 48.4 million, with the rate dropping from 10,389.6 to 2403.9 per 100,000 (EAPC -4.0). Western sub-Saharan Africa and South Asia reported the highest burdens, while East Asia showed the most reductions. Low- and middle-income countries faced greater burdens than high-income nations. Streptococcus pneumoniae remained the leading cause of LRI-related deaths in 2021. Projections indicate a further marked decline in child LRI deaths and age-standardised mortality rates globally by 2035, with under five mortality rates expected to remain the highest.</p><p><strong>Conclusions: </strong>Despite reductions in LRI burden, it continues to threaten child health, particularly in resource-limited settings. Effective public health interventions and vaccination efforts are essential, with future research needed on evolving trends of bacterial pathogens to enhance child health outcomes.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993073","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 Effect of Intertwined Epidemiologic Concepts on Answerable Research Questions in Perinatal Epidemiology.","authors":"Penelope P Howards, W Dana Flanders","doi":"10.1111/ppe.70062","DOIUrl":"10.1111/ppe.70062","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963751","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":"Maternal Acetaminophen Use and Offspring's Neurodevelopmental Outcome: A Nationwide Birth Cohort Study.","authors":"Yusuke Okubo, Itaru Hayakawa, Ryo Sugitate, Hiroki Nariai","doi":"10.1111/ppe.70071","DOIUrl":"10.1111/ppe.70071","url":null,"abstract":"<p><strong>Background: </strong>Maternal acetaminophen use during pregnancy is common globally. However, its potential risks for neurodevelopmental disorders in offspring, including attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID), remain uncertain in Asian populations.</p><p><strong>Objective: </strong>We examined the association between maternal acetaminophen use during pregnancy and diagnoses of neurodevelopmental disorders in offspring.</p><p><strong>Methods: </strong>This nationwide birth cohort study included 217,602 children contributing 966,546 person-years using a nationwide administrative database from 2005 to 2022. We investigated the association between maternal acetaminophen use during pregnancy and offspring's neurodevelopmental outcomes using Cox proportional hazards models, with primary analyses based on 1:1 propensity score (PS) matching. The robustness of the primary findings was evaluated through alternative statistical approaches (adjusted model and inverse probability of treatment weighting [IPTW]), sibling comparison, probabilistic bias analyses for exposure misclassification, and negative exposure control methods.</p><p><strong>Results: </strong>Of the 217,602 children, 85,853 (39.5%) were exposed to acetaminophen during pregnancy. PS-matched analyses (N = 42,123 children per comparator) yielded hazard ratios of 1.08 (95% CI: 1.00, 1.16) for composite neurodevelopmental outcomes, 1.22 (95% CI: 1.09, 1.36) for ADHD, 1.06 (95% CI: 0.98, 1.15) for ASD, and 1.02 (95% CI: 0.90, 1.19) for ID. Similar findings were observed in adjusted models and IPTW methods. Sibling comparisons (n = 23,593) showed point estimates in the opposite direction (e.g., HR of ADHD, 0.86; 95% CI, 0.52, 1.44). Probabilistic bias analysis for exposure misclassification suggested overestimation due to unrecorded over-the-counter acetaminophen use, with effect estimates shifting towards the null as misclassification increased. Negative exposure controls (e.g., NSAIDs and acetaminophen use after pregnancy) indicated potential positive bias in the observed associations.</p><p><strong>Conclusions: </strong>Although PS-matched analyses indicated small increases in risk, sensitivity analyses suggested that unmeasured confounding, misclassification and other biases may partially explain these associations.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963754","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":"How Good Are We at Intuiting the Impact of Misclassification on Study Results?","authors":"Matthew P Fox, Lauren A Wise","doi":"10.1111/ppe.70061","DOIUrl":"https://doi.org/10.1111/ppe.70061","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963595","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":"Residential Socio-Demographic Scoring and Child Growth.","authors":"Ornit Cohen, Natalya Bilenko, Eytan Israel, Sharon Daniel","doi":"10.1111/ppe.70053","DOIUrl":"https://doi.org/10.1111/ppe.70053","url":null,"abstract":"<p><strong>Background: </strong>While individual socioeconomic attributes have been widely studied in relation to child growth, the associations with broader, area-level socio-demographic characteristics of residential areas have not been thoroughly assessed.</p><p><strong>Objectives: </strong>To examine the associations between area-level socio-demographic features of small residential areas and child growth trajectories.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study, including all children born in Israel from 2004 to 2018, who underwent postnatal follow-up in the Mother and Child Health Clinics (MCHC) of the Ministry of Health. The MCHC network covers a significant proportion of the Israeli paediatric population, providing vaccination and developmental assessments to children up to 6 years old. Socio-demographic scoring was retrieved from the Israel Bureau of Statistics' geographical unit grading system, established for 990 rural areas and 1629 micro-geographical areas in 81 cities, using various population measurements. Height-for-age (HAZ) and weight-for-age (WAZ) z-scores were calculated using data from MCHC visits at birth and specific intervals.</p><p><strong>Results: </strong>A total of 1,485,198 children were included (51.3% male). The mean birthweight and length were 3210 ± 52.2 g (z = -0.22) and 49.4 ± 3.33 cm (z = -0.06), respectively. Children resided in low (47%), intermediate (24.4%) and high (28.5%) socioeconomic areas. Throughout follow-up, children from low SES areas had consistently lower HAZ and WAZ scores across all birthweight groups, particularly among those with normal and high birthweight. In linear mixed-effects models, birth HAZ and WAZ scores were higher in high vs. low SES areas (β = 0.3 and β = 0.1, respectively), with non-linear growth trajectories characterised by early advantages in higher SES groups, a plateau in mid-childhood and renewed growth acceleration later in childhood.</p><p><strong>Conclusions: </strong>The study provides evidence of impaired child growth in lower socio-demographic areas. This underscores the importance of identifying areas based on global attributes to identify regions predisposed to child growth impairment, particularly in developed nations.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768911","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":"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":"527-539"},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391851/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}