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Hardie I, Murray A, King J, Hall HA, Okelo K, Luedecke E, Marryat L, Thompson L, Minnis H, Lombardo M, Wilson P, Auyeung B. Investigating low birth weight and preterm birth as potential mediators in the relationship between prenatal infections and early child development: a linked administrative health data analysis. J Epidemiol Community Health 2024; 78:585-590. [PMID: 38834230 PMCID: PMC11347972 DOI: 10.1136/jech-2023-221826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/24/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Prenatal infections are associated with childhood developmental outcomes such as reduced cognitive abilities, emotional problems and other developmental vulnerabilities. However, there is currently a lack of research examining whether this arises due to potential intermediary variables like low birth weight or preterm birth, or due to some other mechanisms of maternal immune activation arising from prenatal infections. METHODS Administrative data from the National Health Service health board of Greater Glasgow & Clyde, Scotland, were used, linking birth records to hospital records and universal child health review records for 55 534 children born from 2011 to 2015, and their mothers. Causal mediation analysis was conducted to examine the extent to which low birth weight and preterm birth mediate the relationship between hospital-diagnosed prenatal infections and having developmental concern(s) identified by a health visitor during 6-8 weeks or 27-30 months child health reviews. RESULTS Model estimates suggest that 5.18% (95% CI 3.77% to 7.65%) of the positive association observed between hospital-diagnosed prenatal infections and developmental concern(s) was mediated by low birth weight, while 7.37% (95% CI 5.36 to 10.88%) was mediated by preterm birth. CONCLUSION Low birth weight and preterm birth appear to mediate the relationship between prenatal infections and childhood development, but only to a small extent. Maternal immune activation mechanisms unrelated to low birth weight and preterm birth remain the most likely explanation for associations observed between prenatal infections and child developmental outcomes, although other factors (for example, genetic factors) may also be involved.
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Affiliation(s)
- Iain Hardie
- Department of Psychology, School of Philosophy Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Aja Murray
- Department of Psychology, School of Philosophy Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Josiah King
- Department of Psychology, School of Philosophy Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Hildigunnar Anna Hall
- Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
| | - Kenneth Okelo
- Department of Psychology, School of Philosophy Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Emily Luedecke
- Department of Psychology, School of Philosophy Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Lucy Thompson
- Centre for Rural Health, University of Aberdeen, Inverness, UK
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gotherburg, Sweden
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Lombardo
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems, Istituto Italiano di Tecnologia, Rovereto, Italy
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Inverness, UK
- Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Bonnie Auyeung
- Department of Psychology, School of Philosophy Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
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He B, Kwok MK, Chan II, Schooling CM. Maternal respiratory health and intrauterine exposure-driven birthweight: a two-sample Mendelian randomization study. Int J Epidemiol 2021; 51:958-963. [PMID: 34931235 DOI: 10.1093/ije/dyab263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Observationally, poorer maternal respiratory health is associated with poorer birth outcomes, possibly confounded by socioeconomic position and other maternal attributes. We used multivariable Mendelian randomization (MR) to obtain unconfounded estimates of effect of maternal lung function on birthweight, independent of maternal height. METHODS Single nucleotide polymorphisms (SNPs) for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in women were obtained from publicly available summary statistics from the UK Biobank. SNPs for asthma were obtained from the Trans-National Asthma Genetic consortium. SNPs for height in women were obtained from the Genetic Investigation of Anthropometric Traits consortium and the genetic estimates were obtained the UK Biobank. The genetic associations with maternally-driven birthweight were obtained from the Early Growth Genetics consortium. Multivariable MR estimates were obtained using inverse variance weighting with multivariable MR-Egger as sensitivity analysis. RESULTS Maternal lung capacity, as indicated by FVC, was positively associated with maternally-driven birthweight (0.08 per standard deviation, 95% confidence interval 0.01 to 0.15) independent of maternal height, whereas no clear such associations were shown for maternal airway function, indicated by FEV1 and peak expiratory flow, or for asthma, on maternally-driven birthweight. Similar findings were shown using MR-Egger. CONCLUSIONS These findings suggest that maternal lung function, especially lung capacity independent of maternal height, is directly associated with maternally-driven birthweight, and highlights the importance of maternal respiratory health in fetal growth.
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Affiliation(s)
- Baoting He
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Io Ieong Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, People's Republic of China.,School of Public Health and Health Policy, City University of New York, New York, USA
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Deji-Abiodun O, Ferrandiz-Mont D, Mishra V, Chiao C. A multilevel analysis of the social determinants associated with symptoms of acute respiratory infection among preschool age children in Pakistan: A population-based survey. PLoS One 2021; 16:e0260658. [PMID: 34914709 PMCID: PMC8675759 DOI: 10.1371/journal.pone.0260658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As advocated by WHO in "Closing the Health Gap in a Generation", dramatic differences in child health are closely linked to degrees of social disadvantage, both within and between communities. Nevertheless, research has not examined whether child health inequalities include, but are not confined to, worse acute respiratory infection (ARI) symptoms among the socioeconomic disadvantaged in Pakistan. In addition to such disadvantages as the child's gender, maternal education, and household poverty, the present study also examined the linkages between the community environment and ARI symptoms among Pakistan children under five. Furthermore, we have assessed gender contingencies related to the aforementioned associations. METHODS Using data from the nationally representative 2017-2018 Pakistan Demographic and Health Survey, a total of 11,908 surviving preschool age children (0-59 months old) living in 561 communities were analyzed. We employed two-level multilevel logistic regressions to model the relationship between ARI symptoms and individual-level and community-level social factors. RESULTS The social factors at individual and community levels were found to be significantly associated with an increased risk of the child suffering from ARI symptoms. A particularly higher risk was observed among girls who resided in urban areas (AOR = 1.42; p<0.01) and who had a birth order of three or greater. DISCUSSIONS Our results underscore the need for socioeconomic interventions in Pakistan that are targeted at densely populated households and communities within urban areas, with a particular emphasis on out-migration, in order to improve unequal economic underdevelopment. This could be done by targeting improvements in socio-economic structures, including maternal education.
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Affiliation(s)
- Oluwafunmilade Deji-Abiodun
- Department of Medicine and Center for Global Health, University of Chicago, Chicago, IL, United States of America
| | - David Ferrandiz-Mont
- Public Health Surveillance and Emergency Response Department of Vallès Occidental and Vallès Oriental, Public Health Agency of Catalonia, Sant Cugat del Vallès, Barcelona, Spain
| | - Vinod Mishra
- United Nations Population Division, New York City, NY, United States of America
| | - Chi Chiao
- Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Rani Balaji VC, Saraswathi K, Manikandan S. Periodontal heath in first trimester of pregnancy and birth weight outcomes. Indian J Dent Res 2021; 32:181-186. [PMID: 34810386 DOI: 10.4103/ijdr.ijdr_94_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The oral microbiome is influenced by numerous immediate environmental factors including pH, anaerobic conditions, nutrition, and hormone levels. During pregnancy, due to the associated hormonal changes, periodontal tissues show an enhanced inflammatory response to plaque microbiome. This is mediated by female sex hormones that are drastically altered in pregnancy. This study was undertaken to estimate the association of birth weight and the influence of the oral periodontal health in pregnant women in Chennai, South India and correlate the same with education and body mass index (BMI). Methods This was a controlled, minimal interventional, prospective, observational study to identify the relationship of gingival health in the first trimester of pregnancy and on birth weight. Potential participants were referred by health-care providers. Pregnant women (≥18 years and ≤25 years) in the first trimester were enrolled for this study. Results : Of the 165 pregnant women, 121 pregnant women formed the study group. Conclusion It was found that low birth weight could be a consequence of several modifiable and non-modifiable factors. This study shows the association of oral health of the mother in the first trimester with low birth weight. The findings of this study need to be confirmed with a large-scale, multi-centric study accounting for all known confounders. Till such a study is performed, the need for optimal oral health of an expectant mother cannot be discounted and there is no absolute harm in having good oral hygiene.
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Affiliation(s)
- Varsha Christy Rani Balaji
- Department of Obstetrics and Gynecology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - K Saraswathi
- Department of Obstetrics and Gynecology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - S Manikandan
- Department of Dental Department, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
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Propensity Score-Matched Analysis on the Association Between Pregnancy Infections and Adverse Birth Outcomes in Rural Northwestern China. Sci Rep 2018; 8:5154. [PMID: 29581446 PMCID: PMC5979963 DOI: 10.1038/s41598-018-23306-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/08/2018] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study is to examine the relationship between infections and birth outcomes in pregnant Chinese women by using propensity score (PS) matching. The data used here was from a large population-based cross-sectional epidemiological survey on birth defects in Shaanxi province, Northwest China. The babies born during 2010–2013 and their mothers were selected with a stratified multistage sampling method. We used PS-matched (1:1) analysis to match participants with infections to participants without infections. Of 22916 rural participants, the overall prevalence of infection was about 39.96%. 5381 pairs were matched. We observed increased risks of birth defects with infections, respiratory infections and genitourinary infections during the pregnancy (OR, 1.59; 95% CI: 1.21–2.08; OR, 1.44; 95% CI: 1.10–1.87; OR, 3.11; 95% CI: 1.75–5.54). There was also a significant increase of low birth weight associated with respiratory infections (1.13(1.01–1.27)). The association of birth defect with the infection could be relatively stable but the effect could be mediated by some important factors such as mother’s age, education level and economic level. The infection during pregnancy is common in Chinese women and might increase the risk of offspring birth defects and low birth weight, especially in younger, lower education, poor pregnant women.
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