Paediatric and perinatal epidemiology最新文献

{"title":"Haemoglobin Concentrations and Maternal and Neonatal Outcomes: Identifying Optimal Haemoglobin Ranges.","authors":"Hong-Zhao Yu, Chang-Dong Dong, Yang Liu, Ying Zhu, Chuan-Zhen Wang, Hong-Tian Li","doi":"10.1111/ppe.70142","DOIUrl":"https://doi.org/10.1111/ppe.70142","url":null,"abstract":"<p><strong>Background: </strong>Both low and high haemoglobin (Hb) concentrations associate with increased risks of adverse pregnancy outcomes, with the optimal Hb concentrations remaining elusive.</p><p><strong>Objectives: </strong>This study investigated the associations between Hb concentrations and maternal/neonatal outcomes and determined optimal Hb ranges during the second and third trimesters.</p><p><strong>Methods: </strong>Retrospectively, data from 41,956 singleton live births delivered at Fuyang Women and Children's Hospital, a tertiary hospital in China, from 2018 to 2023, were analysed. Poisson regression with restricted cubic splines was employed to associate Hb concentrations with maternal (gestational diabetes mellitus [GDM], preeclampsia, and postpartum haemorrhage [PPH]) and neonatal outcomes (preterm birth [PTB], small for gestational age [SGA] birth, and neonatal asphyxia), applying generalised estimating equations to account for repeated measures. Optimal Hb ranges were determined using interquartile ranges from a low-risk subgroup and thresholds identified via the combined risk curve method, incorporating PPH and neonatal outcomes.</p><p><strong>Results: </strong>A total of 120,263 Hb measurements were analysed. U-shaped relationships emerged between Hb concentration and preeclampsia, PPH, PTB, SGA and neonatal asphyxia, whereas that with GDM was nearly linear. These patterns were consistent in both the second and third trimesters. The optimal ranges of 10.6-11.8 and 10.7-12.1 g/dL were identified by the low-risk subgroup approach for the second and third trimesters, respectively, whereas those by the combined risk curve method yielded slightly broader ranges of 9.6-11.7 g/dL and 9.9-12.0 g/dL, respectively.</p><p><strong>Conclusions: </strong>The findings of this study reveal U-shaped relationships between maternal Hb concentrations and maternal/neonatal outcomes, with 10.5-12.5 g/dL as the optimal Hb concentration during the second and third trimesters, considering combined risks and clinical feasibility. Future multicentre studies are warranted to validate these ranges in broader populations.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574999","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":"Associations Between Mental Health Conditions and Adverse Pregnancy Outcomes Among Active-Duty Servicewomen.","authors":"Laura L Manzo, Clinton Hall, Joan Combellick, Ilan Harpaz-Rotem, Angela K Phillips, Monica T Burrell, Chrystelle Kiang, Julie A Womack","doi":"10.1111/ppe.70139","DOIUrl":"10.1111/ppe.70139","url":null,"abstract":"<p><strong>Background: </strong>Active-duty servicewomen (ADSW) are at increased risk for mental health conditions compared to civilian women. Research suggests women with mental health conditions experience serious pregnancy complications at rates 50% higher than those without mental health conditions; yet research in military populations is limited.</p><p><strong>Objective: </strong>To explore associations between mental health conditions and adverse pregnancy outcomes among ADSW.</p><p><strong>Methods: </strong>Department of Defence data were used to identify a cohort of live birth pregnancies among ADSW that started and ended between October 2016 and December 2021. Mental health conditions diagnosed in the year prior to or during pregnancy (trauma/stressor-related disorders, anxiety/panic, depression, eating disorders and suicidal ideation/attempt) and adverse pregnancy outcomes (hypertensive disorders of pregnancy, gestational diabetes, peripartum cardiomyopathy, postpartum haemorrhage and preterm birth) were identified using ICD-10-CM codes. Mental health conditions were assessed as any diagnosis or none, and as a count of comorbid diagnoses (1, 2 or 3+). Modified Poisson regression models estimated adjusted risk ratios (RR) with 95% confidence intervals (CI) to quantify associations of mental health diagnoses with adverse pregnancy outcomes, overall and stratified by demographic characteristics.</p><p><strong>Results: </strong>Overall, 62,729 deliveries among 54,471 ADSW were included. Deliveries among ADSW with diagnosed mental health conditions relative to those with none demonstrated increased risk for adverse pregnancy outcomes (RR 1.07, 95% CI 1.04, 1.11). Deliveries among ADSW with 3+ mental health conditions had the highest risk for an adverse pregnancy outcome (RR 1.17, 95% CI 1.10, 1.25). Individually, mental health conditions were associated with increased risk of preterm birth (RR 1.18, 95% CI 1.10, 1.26) and gestational diabetes (RR 1.14, 95% CI 1.06, 1.22).</p><p><strong>Conclusions: </strong>This study highlights the increased risk for adverse pregnancy outcomes among ADSW with mental health conditions. Enhanced screening and subsequent treatment of these mental health diagnoses can be a mechanism to decrease adverse pregnancy outcomes.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513715","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":"Impact of Major Congenital Malformation Algorithms on Their Prevalence in Large Population-Based Mother-Child Cohorts.","authors":"Gabra Nohmie, Younes Bousbaa, Odile Sheehy, Anick Bérard","doi":"10.1111/ppe.70129","DOIUrl":"https://doi.org/10.1111/ppe.70129","url":null,"abstract":"<p><strong>Background: </strong>Major congenital malformations (MCM) affect 2%-6% of pregnancies globally. Identifying MCM using real-world data is essential, but various definitions exist with differing performances and case ascertainment criteria, limiting collaborations.</p><p><strong>Objective: </strong>To compare published definitions and algorithms to identify MCM using data from the Québec Pregnancy Cohort (QPC).</p><p><strong>Methods: </strong>We conducted a comparative study of 10 algorithms for identifying MCM using QPC, a pre-established population-based cohort of pregnancies covered by Québec's public drug insurance plan between 1998 and 2015. We included infants from singleton pregnancies (live or stillbirth) who met the minimum postnatal follow-up duration required by the applied algorithm. Infants were excluded if they had an isolated major chromosomal congenital malformation or a gestational age ≤ 20 weeks. Algorithms varied by time window of detection (28 days, 6 months, 1 year), data source considered (inpatient, outpatient), diagnostic codes (ICD-9, ICD-10) and procedural codes requirements. The prevalence of global MCM and organ-specific malformation was calculated and compared to North American prevalence.</p><p><strong>Results: </strong>Among 233,338 infants meeting inclusion criteria, global MCM prevalence ranged from 2.9% to 9.0%. Across all algorithms, the most prevalent malformations were musculoskeletal and circulatory anomalies, with prevalence ranging from 0.9% to 3.3% and from 0.4% to 2.4%, respectively. Using ≥ 1 diagnostic code in the first year of life overestimated the prevalence, whereas using ≥ 1 inpatient or ≥ 2 outpatient codes for the same organ system on different days yielded a prevalence of 5.0%, which is close to what is expected compared to international prevalences. Considering this algorithm appears well-suited to the QPC setting, where inpatient diagnostic codes have been shown to be more reliable.</p><p><strong>Conclusions: </strong>Algorithm choice substantially impacts MCM prevalence estimates. Transparent definitions enhance reproducibility and cross-study comparability in pharmacoepidemiologic research.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468880","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":"Inflated Denominators, Selection In Utero, and the Black Male Neonatal Death Paradox.","authors":"Ralph Catalano, Brenda Bustos, Emtiaz Hritan, Joan A Casey, Alison Gemmill, Hedwig Lee, Dana Sarnak, Tim Bruckner","doi":"10.1111/ppe.70127","DOIUrl":"https://doi.org/10.1111/ppe.70127","url":null,"abstract":"<p><strong>Background: </strong>Epidemiologists speculate that comparatively high rates of fetal death among males conceived by non-Hispanic Black (NHB) women in the United States (USA) could explain the unexpectedly low neonatal death rate among extremely preterm (ePTB) NHB males. Consistent with this 'selection in utero' argument, conception cohorts exhibiting high sex ratios (M:F) of NHB stillbirths reportedly exhibit greater NHB advantages in ePTB male neonatal death rates. Sceptics, however, attribute this association to an artefact that spuriously inflates the denominators of neonatal death rates in highly stressed populations.</p><p><strong>Objective: </strong>To determine whether the positive association over conception cohorts between the NHB male neonatal death advantage and the sex ratio of NHB stillbirths survives correction for inflated denominators.</p><p><strong>Methods: </strong>We retrieved vital statistics for NHB and non-Hispanic white (NHW) singleton ePTB infants born in the USA from 1995 through 2018. We aggregated these data into 282 monthly conception cohorts. We avoided the inflated denominator problem by substituting a 'NHB share of burden' variable for the difference between NHB and NHW neonatal death rates. We specify this variable as the NHB proportion of neonatal deaths among NHB and NHW ePTB males born from each conception cohort. We determined, using Box-Jenkins methods, whether cohorts exhibiting unusually high sex ratios of NHB stillbirths also exhibited unusually low NHB shares of the burden of ePTB male neonatal death.</p><p><strong>Results: </strong>Consistent with the selection in utero argument, the NHB share of neonatal deaths among ePTB males fell 7% below expected among the cohorts exhibiting unusually high sex ratios of NH Black stillbirths.</p><p><strong>Conclusions: </strong>Stillbirth affects the composition of birth cohorts by selecting against less fit males in conception cohorts. Although clinical manifestations of this bias remain largely unexplored, they likely include the Black male neonatal death paradox.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378351","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":"Postpartum Depression in Fathers Following Medically Assisted Reproduction: A Register-Based Cohort Study.","authors":"Mette Bliddal, Trine Munk-Olsen, Xiaoqin Liu, Sofie Egsgaard","doi":"10.1111/ppe.70107","DOIUrl":"10.1111/ppe.70107","url":null,"abstract":"<p><strong>Background: </strong>Undergoing medically assisted reproduction (MAR) has been linked to adverse mental health outcomes, yet research examining whether MAR is associated with paternal postpartum depression (PPD) remains sparse. We investigated the risk of PPD among fathers of children conceived with MAR compared to fathers of children conceived unassisted.</p><p><strong>Methods: </strong>Using the nationwide health registers, we included all fathers of children born in Denmark between 2010 and 2019. We categorised children as conceived unassisted or by MAR, linking childbirths to MAR treatments and further classified MAR conception according to the type and duration of treatment, and by indication for MAR. PPD was identified using a hospital depression diagnosis or antidepressant prescriptions within 12 months postpartum. We conducted adjusted Poisson regression analyses accounting for relevant covariates, including socioeconomic factors and clustering due to multiple children born to the same fathers.</p><p><strong>Results: </strong>The study population included 413,682 births, of which 31,128 (7.5%) were conceived with MAR. Fathers in the MAR group were older, more often first-time parents, and had higher education and income levels. Within each group, 0.9% (270 with MAR conception, 3542 with unassisted conception) experienced PPD. We observed a 22% higher risk of PPD among fathers with MAR conception compared to unassisted conception after adjustment (adjusted relative risk [aRR] 1.22, 95% confidence interval [CI] 1.07, 1.38). Elevated risks were consistent across MAR types, treatment duration, and infertility indications, with the highest risk associated with treatment durations exceeding 12 months (aRR 1.42, CI 1.11, 1.80).</p><p><strong>Conclusions: </strong>We observed an increased risk of PPD among fathers of children conceived with MAR compared to fathers of children conceived unassisted. These findings suggest the need for greater awareness and targeted support for this group in early parenthood.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"321-325"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687767","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":"Fertility Rates in Women With Intellectual and Developmental Disabilities: New Evidence and Ongoing Gaps.","authors":"Hilary K Brown","doi":"10.1111/ppe.70133","DOIUrl":"10.1111/ppe.70133","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"318-320"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434119","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":"Response to: Is the Most Likely Value Also the Best Imputation?","authors":"Takamasa Sakai, Hedvig Nordeng, Marleen M H J van Gelder","doi":"10.1111/ppe.70119","DOIUrl":"10.1111/ppe.70119","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"429-430"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113771","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":"Estimating Causal Effects of Third-Stage Management on Postpartum Haemorrhage in a Midwifery Context: An Evidence Synthesis Approach for Constructing Directed Acyclic Graphs.","authors":"Vanessa Hébert, Irina I Oltean, Giulia M Muraca, Nancy Santesso, Elizabeth K Darling","doi":"10.1111/ppe.70072","DOIUrl":"10.1111/ppe.70072","url":null,"abstract":"<p><strong>Background: </strong>Estimating the causal effect of third-stage management approaches on preventing postpartum haemorrhage (PPH) in the context of physiologic birth using observational data requires conditioning on specific variables, with selection relying on assumptions about their roles in the exposure-outcome pathway that are rarely made explicit.</p><p><strong>Objectives: </strong>To apply the evidence synthesis for constructing DAGs approach, incorporating findings from a systematic review, to develop a causal directed acyclic graph (DAG) that clarifies these assumptions and identifies the minimum set of variables needed to reduce bias in estimating the causal effects of physiologic third-stage care versus oxytocin prophylaxis on PPH.</p><p><strong>Data sources: </strong>MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials (to December 15, 2023), ClinicalTrials.gov (to July 8, 2024), and reference lists of eligible studies.</p><p><strong>Study selection and data extraction: </strong>The systematic review included randomised and non-randomised studies involving individuals with physiologic birth or minimal obstetric interventions. Two authors independently screened studies. DAG development was based on the subset of non-randomised studies. For each, one reviewer extracted outcome, exposure, control variables and mediators.</p><p><strong>Synthesis: </strong>Eligible studies were analysed in three stages: (i) mapping each study's saturated implied graph; (ii) translating each posited connection using causal criteria to create study-specific DAGs; (iii) synthesising individual DAGs into an integrated DAG. The assumptions underlying this process were specific to the midwifery context in Ontario, Canada and translation was guided by midwifery expertise and existing literature.</p><p><strong>Results: </strong>Four non-randomised studies were included. Expert consultation identified 20 factors influencing third-stage management. The integrated DAG comprised 339 directed edges connecting 35 covariates, yielding four minimal sufficient adjustment sets.</p><p><strong>Conclusions: </strong>The integrated DAG and minimal sufficient adjustment sets are valuable tools for informing future study design and analysis, helping to minimise bias in estimating the causal effect of physiologic third-stage care versus oxytocin prophylaxis on PPH in the context of physiologic birth, while also exposing the assumptions about causal relationships between variables to scrutiny.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"388-396"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081002","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}

{"title":"Are We Finally Bending the Curve? Paediatric Antibiotic Use in Australia and the Next Frontier for Stewardship.","authors":"Jan Y Verbakel","doi":"10.1111/ppe.70103","DOIUrl":"10.1111/ppe.70103","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"349-351"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649193","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":"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":"342-348"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124673/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}