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L SI, H B, Eo O, M CB. Maternal Risk Factors for Small-for-Gestational-Age Newborns in Mexico: Analysis of a Nationwide Representative Cohort. Front Public Health 2022; 9:707078. [PMID: 35004559 PMCID: PMC8732993 DOI: 10.3389/fpubh.2021.707078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Small for gestational age (SGA) is a key contributor to premature deaths and long-term complications in life. Improved characterization of maternal risk factors associated with this adverse outcome is needed to inform the development of interventions, track progress, and reduce the disease burden. This study aimed to identify socioeconomic, demographic, and clinical factors associated with SGA in Mexico. Methods: We analyzed administrative data from 1,841,477 singletons collected by the National Information Subsystem of Livebirths during 2017. Small-for-gestational-age was defined as being <10th centiles according to the INTERGROWTH-21st standards. The comparison group was defined as being in ≥10th centiles. We fitted logistic regression models to determine odds ratios for the maternal factors associated with SGA. Results: Among the 1,841,477 singletons, 51% were male, 6.7% were SGA, 6.1% were term-SGA, and 0.5% were preterm-SGA. Maternal education presented a protective gradient of being SGA among mothers who achieved 1 to 6 years of education (adjusted odds ratio (aOR)0.95; 95% CI:0.91,0.99), 7 to 9 years (aOR 0.86; 95% CI:0.83,0.89), 10 to 12 years (aOR 0.75; 95% CI: 0.72, 0.79) and > 12 years (aOR 0.63; 95% CI:0.6,0.66) compared with those without education. SGA was particularly likely to occur among primiparous (aOR 1.42; 95% CI: 1.39, 1.43), mothers living in very high deprivation localities (aOR 1.39; 95% CI: 1.36, 1.43), young (aOR 1.04; 95% CI: 1.02, 1.06), advanced age (aOR 1.14; 95% CI 1.09, 1.19), and mothers living in areas above 2,000 m (aOR 1.69; 95% CI: 1.65, 1.73). Antenatal care was associated with a reduced risk of SGA by 30% (aOR 0.7; 95% CI:0.67,0.73), 23% (OR 0.77; 95% CI:0.74,0.8), and 21% (OR 0.79; 95% CI:0.75,0.83), compared with those mothers who never received antenatal care, when women visited the clinic at the first, second and third trimester, respectively. Conclusion: Almost 7% of live births were found to be SGA. Parity, maternal age, education, place of residence, and social deprivation were significantly associated with this outcome. Antenatal care was protective. These findings imply that interventions focusing on early and adequate contact with health care facilities, reproductive health counseling, and maternal education should reduce SGA in Mexico.
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Affiliation(s)
- Suárez-Idueta L
- Population, Policy, and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Bedford H
- Population, Policy, and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Ohuma Eo
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cortina-Borja M
- Population, Policy, and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Ruiz M, Goldblatt P, Morrison J, Porta D, Forastiere F, Hryhorczuk D, Antipkin Y, Saurel-Cubizolles MJ, Lioret S, Vrijheid M, Torrent M, Iñiguez C, Larrañaga I, Bakoula C, Veltsista A, van Eijsden M, Vrijkotte TGM, Andrýsková L, Dušek L, Barros H, Correia S, Järvelin MR, Taanila A, Ludvigsson J, Faresjö T, Marmot M, Pikhart H. Impact of Low Maternal Education on Early Childhood Overweight and Obesity in Europe. Paediatr Perinat Epidemiol 2016; 30:274-84. [PMID: 26945670 DOI: 10.1111/ppe.12285] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Comparable evidence on adiposity inequalities in early life is lacking across a range of European countries. This study investigates whether low maternal education is associated with overweight and obesity risk in children from distinct European settings during early childhood. METHODS Prospective data of 45 413 children from 11 European cohorts were used. Children's height and weight obtained at ages 4-7 years were used to assess prevalent overweight and obesity according to the International Obesity Task Force definition. The Relative/Slope Indices of Inequality (RII/SII) were estimated within each cohort and by gender to investigate adiposity risk among children born to mothers with low education as compared to counterparts born to mothers with high education. Individual-data meta-analyses were conducted to obtain aggregate estimates and to assess heterogeneity between cohorts. RESULTS Low maternal education yielded a substantial risk of early childhood adiposity across 11 European countries. Low maternal education yielded a mean risk ratio of 1.58 (95% confidence interval (CI) 1.34, 1.85) and a mean risk difference of 7.78% (5.34, 10.22) in early childhood overweight, respectively, measured by the RII and SII. Early childhood obesity risk by low maternal education was as substantial for all cohorts combined (RII = 2.61 (2.10, 3.23)) and (SII = 4.01% (3.14, 4.88)). Inequalities in early childhood adiposity were consistent among boys, but varied among girls in a few cohorts. CONCLUSIONS Considerable inequalities in overweight and obesity are evident among European children in early life. Tackling early childhood adiposity is necessary to promote children's immediate health and well-being and throughout the life course.
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Affiliation(s)
- Milagros Ruiz
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Peter Goldblatt
- Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK
| | - Joana Morrison
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health System, Rome, Italy
| | | | - Daniel Hryhorczuk
- Center for Global Health, University of Illinois College of Medicine, Chicago, IL, USA
| | - Youriy Antipkin
- Institute of Pediatrics, Obstetrics, and Gynecology, Kyiv, Ukraine
| | - Marie-Josèphe Saurel-Cubizolles
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Sandrine Lioret
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Early Origin of the Child's Health and Development Team (ORCHAD), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Martine Vrijheid
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Maties Torrent
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,IB-Salut Menorca Health Area, Balearic Islands, Spain
| | - Carmen Iñiguez
- FISABIO - Universitat Jaume I - Universitat de València Joint Research Unit of Epidemiology and Environmental Health, Castellón de la Plana, Spain
| | - Isabel Larrañaga
- Public Health Department of Gipuzkoa, Gipuzkoa, Spain.,BIODONOSTIA Health Research Institute, San Sebastian, Spain
| | - Chryssa Bakoula
- First Department of Paediatrics, Aghia Sophia Children's Hospital, University of Athens, Athens, Greece
| | - Alexandra Veltsista
- First Department of Paediatrics, Aghia Sophia Children's Hospital, University of Athens, Athens, Greece
| | - Manon van Eijsden
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lenka Andrýsková
- Faculty of Science, Research Centre of Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic
| | - Ladislav Dušek
- Faculty of Science, Research Centre of Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic.,Institute of Biostatistics & Analyses (IBA), Masaryk University, Brno, Czech Republic
| | - Henrique Barros
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Sofia Correia
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE), Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Unit of Primary Care, Oulu University Hospital, Oulu, Finland.,Faculty of Medicine, Center for Life Course Epidemiology, University of Oulu, Oulu, Finland
| | - Anja Taanila
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Johnny Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Tomas Faresjö
- Department of Medicine and Health, Community Medicine/General Practice Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Michael Marmot
- Research Department of Epidemiology and Public Health, University College London, London, UK.,Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK
| | - Hynek Pikhart
- Research Department of Epidemiology and Public Health, University College London, London, UK
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