المؤلفون: Yim, Gyeyoon^1,2 (AUTHOR), Roberts, Andrea² (AUTHOR), Wypij, David^3,4,5 (AUTHOR), Kioumourtzoglou, Marianthi-Anna⁶ (AUTHOR), Weisskopf, Marc G^1,2 (AUTHOR) mweissko@hsph.harvard.edu

المصدر: International Journal of Epidemiology. Dec2021, Vol. 50 Issue 6, p1886-1896. 11p.

مصطلحات موضوعية: *LOW birth weight, *PREMATURE labor, *CHILDBIRTH, *PREGNANCY complications, *PREGNANCY

مستخلص: Background: Diethylstilbestrol (DES) is an endocrine-disrupting pharmaceutical prescribed to pregnant women to prevent pregnancy complications between the 1940s and 1970s. Although DES has been shown in animal studies to have multigenerational effects, only two studies have investigated potential multigenerational effects in humans on preterm birth (PTB), and none on low birthweight (LBW)-major determinants of later life health.Methods: Nurses' Health Study (NHS) II participants (G1; born 1946-64) reported their mothers' (G0) use of DES while pregnant with them. We used cluster-weighted generalized estimating equations to estimate odds ratios (OR) and 95% confidence intervals (CI) for risk of LBW and PTB among the grandchildren by grandmother use of DES. G1 birthweight and gestational age were considered to explore confounding by indication.Results: Among 54 334 G0-G1/grandmother-mother pairs, 973 (1.8%) G0 used DES during pregnancy with G1. Of the 128 275 G2 children, 4369 (3.4%) were LBW and 7976 (6.2%) premature. Grandmother (G0) use of DES during pregnancy was associated with an increased risk of G2 LBW [adjusted OR (aOR) = 3.09; 95% CI: 2.57, 3.72], that was reduced when restricted to term births (aOR = 1.59; 95% CI: 1.08, 2.36). The aOR for PTB was 2.88 (95% CI: 2.46, 3.37). Results were essentially unchanged when G1 birthweight and gestational age were included in the model, as well as after adjusting for other potential intermediate variables, such as G2 pregnancy-related factors.Conclusions: Grandmother use of DES during pregnancy is associated with an increased risk of LBW, predominantly through an increased risk of PTB. Results when considering G1 birth outcomes suggest this does not result from confounding by indication. [ABSTRACT FROM AUTHOR]

المؤلفون: Pradhan, Dinesh¹ (AUTHOR) dinesh.bhutan@gmail.com, Nishizawa, Yoriko¹ (AUTHOR), Chhetri, Hari P² (AUTHOR)

المصدر: Journal of Tropical Pediatrics. Apr2020, Vol. 66 Issue 2, p163-170. 8p.

مصطلحات موضوعية: *PREMATURE labor, *PREMATURE infants, *NEONATAL mortality, *CHILDBIRTH, *BIRTH rate, *PUBLIC hospitals, *CESAREAN section, *RESEARCH, *NEONATAL intensive care, *NEONATAL diseases, *RESEARCH methodology, *NEONATAL intensive care units, *FETAL growth retardation, *DISEASES, *EVALUATION research, *MEDICAL cooperation, *COMPARATIVE studies, *PREGNANCY complications, *MEDICAL referrals, *DISEASE prevalence, *INFANT mortality, *SMALL for gestational age

مصطلحات جغرافية: BHUTAN

مستخلص: Introduction: Preterm birth-related complications are the leading cause of under-5 mortality globally. Bhutan does not have a reliable preterm birth rate or data regarding outcome of preterm babies.Aim: To determine the preterm birth rate at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu, Bhutan, and assess their outcomes.Methods: All live preterm births at JDWNRH from 1 January 2017 to 31 December 2017 were followed from birth till hospital discharge. Maternal demographic data, pregnancy details and delivery details were collected. Morbidity and mortality information as well as discharge outcome were collected on babies admitted to neonatal intensive care unit (NICU).Results: Preterm birth rate among live births was 6.4%. Most mothers were younger than 30 years, housewives and had secondary education. Pregnancy registration rate and adequacy of antenatal visits were high. Most preterm births were singleton and the predominant mode of delivery was cesarean section. More than half of the births were initiated spontaneously, and the male:female ratio was 1.2:1. Most babies were late preterm and low birth weight. Half of them required NICU admission. Overall mortality rate was 11% and 21.6% for admitted preterm neonates. Preterm small-for-gestational-age neonates, and those born after provider-initiated preterm birth had significantly increased risk of mortality. Most preterm neonates were discharged without complications. The rate of extrauterine growth restriction was high.Conclusion: This is the first study on the prevalence of preterm births and their outcomes in the largest tertiary-care hospital in Bhutan. [ABSTRACT FROM AUTHOR]

المؤلفون: Crump, Casey^1,2 (AUTHOR) casey.crump@mssm.edu, Friberg, Danielle³ (AUTHOR), Li, Xinjun⁴ (AUTHOR), Sundquist, Jan^1,2,4 (AUTHOR), Sundquist, Kristina^1,2,4 (AUTHOR)

المصدر: International Journal of Epidemiology. Dec2019, Vol. 48 Issue 6, p2039-2049. 11p.

مصطلحات موضوعية: *PREMATURE labor, *SLEEP apnea syndromes, *CHILDBIRTH, *GESTATIONAL age, *NEUROBEHAVIORAL disorders, *COMPARATIVE studies, *PREMATURE infants, *LONGITUDINAL method, *RESEARCH methodology, *MEDICAL cooperation, *RESEARCH, *RESEARCH funding, *EVALUATION research, *PROPORTIONAL hazards models

مصطلحات جغرافية: SWEDEN

مستخلص: Background: Preterm birth (gestational age <37 weeks) has previously been associated with cardiometabolic and neuropsychiatric disorders into adulthood, but has seldom been examined in relation to sleep disorders. We conducted the first population-based study of preterm birth in relation to sleep-disordered breathing (SDB) from childhood into mid-adulthood.Methods: A national cohort study was conducted of all 4 186 615 singleton live births in Sweden during 1973-2014, who were followed for SDB ascertained from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth in relation to SDB while adjusting for other perinatal and maternal factors, and co-sibling analyses assessed for potential confounding by unmeasured shared familial factors.Results: There were 171 100 (4.1%) persons diagnosed with SDB in 86.0 million person-years of follow-up. Preterm birth was associated with increased risk of SDB from childhood into mid-adulthood, relative to full-term birth (39-41 weeks) [adjusted hazard ratio (aHR), ages 0-43 years: 1.43; 95% confidence interval (CI), 1.40, 1.46; P <0.001; ages 30-43 years: 1.40; 95% CI, 1.34, 1.47; P <0.001]. Persons born extremely preterm (<28 weeks) had more than 2-fold risks (aHR, ages 0-43 years: 2.63; 95% CI, 2.41, 2.87; P <0.001; ages 30-43 years: 2.22; 95% CI, 1.64, 3.01; P <0.001). These associations affected both males and females, but accounted for more SDB cases among males (additive interaction, P = 0.003). Co-sibling analyses suggested that these findings were only partly due to shared genetic or environmental factors in families.Conclusions: Preterm-born children and adults need long-term follow-up for anticipatory screening and potential treatment of SDB. [ABSTRACT FROM AUTHOR]

المؤلفون: Bruckner, Tim A¹ (AUTHOR) tim.bruckner@uci.edu, Lebreton, Élodie² (AUTHOR), Perrone, Natalie³ (AUTHOR), Mortensen, Laust H⁴ (AUTHOR), Blondel, Béatrice⁵ (AUTHOR)

المصدر: International Journal of Epidemiology. Oct2019, Vol. 48 Issue 5, p1614-1622. 9p.

مصطلحات موضوعية: *PREMATURE labor, *CHILDBIRTH, *PARTURITION, *MALES, *EXPECTED returns, *TERRORISM

مصطلحات جغرافية: PARIS (France)

مستخلص: Background: On 13 November 2015, coordinated terrorist attacks swept through Paris. This large stressor, like earlier terrorist attacks in the USA, may have perturbed the health of pregnant women. We test whether the attacks preceded an increase in the risk of preterm parturition among live-born males as well as excess male loss in utero. We focused on males on the basis of previous findings of elevated male frailty following population stressors.Methods: We examined live births in the Paris region (n = 1 049 057) over 70 months, from January 2011 to October 2016. Interrupted time-series methods identified and removed serial correlation in the monthly risk of preterm birth; these methods employed non-linear least-squares estimation. We also repeated analyses using month of conception, and performed sensitivity tests among females as well as among male births outside Paris.Results: Males exhibited an elevated incidence of preterm birth in November 2015 and January 2016 [risk difference for November 2015 = 0.006, 95% confidence interval (CI): 0.0002-0.012; risk difference for January 2016 = 0.010, 95% CI: 0.004-0.016], which equates to an 11% increase in the count of preterm births. Females, as well as males born outside Paris, showed no change in preterm delivery. The sex ratio also fell below expected values in December 2015, January 2016 and February 2016.Conclusions: Among males, more preterm births, but fewer live births, occurred after the November 2015 Paris attacks. Future examinations of perinatal health responses to unexpected stressors may benefit from sex-specific analyses. [ABSTRACT FROM AUTHOR]

المؤلفون: Silveira, Mariangela F¹ (AUTHOR) mariangelafreitassilveira@gmail.com, Victora, Cesar G² (AUTHOR), Horta, Bernardo L² (AUTHOR), Silva, Bruna G C da² (AUTHOR), Matijasevich, Alicia³ (AUTHOR), Barros, Fernando C⁴ (AUTHOR), da Silva, Bruna G C² (AUTHOR), Pelotas Cohorts Study Group (CORPORATE AUTHOR)

المصدر: International Journal of Epidemiology. 2019 Supplement 1, Vol. 48, pi46-i53. 8p.

مصطلحات موضوعية: *PREMATURE labor, *BIRTH weight, *CHILDBIRTH, *MOTHER-child relationship, *INCOME, *FETAL macrosomia

مصطلحات جغرافية: BRAZIL

مستخلص: Background: Despite positive changes in most maternal risk factors in Brazil, previous studies did not show reductions in preterm birth and low birthweight. We analysed trends and inequalities in these outcomes over a 33-year period in a Brazilian city.Methods: Four population-based birth cohort studies were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, with samples ranging from 4231 to 5914 liveborn children. Low birthweight (LBW) was defined as <2500 g, and preterm birth as less than 37 weeks of gestation. Information was collected on family income, maternal skin colour and other risk factors for low birthweight. Multivariable linear regression was used to estimate the contribution of risk factors to time trends in birthweight.Results: Preterm births increased from 5.8% (1982) to 13.8% (2015), and LBW prevalence increased from 9.0% to 10.1%, being higher for boys and for children born to mothers with low income and brown or black skin colour. Mean birthweight remained stable, around 3200 g, but increased from 3058 to 3146 g in the poorest quintile and decreased from 3307 to 3227 g in the richest quintile. After adjustment for risk factors for LBW, mean birthweight was estimated to have declined by 160 g over 1982-2015 (reductions of 103 g in the poorest and 213 g in the richest quintiles).Conclusions: Data from four birth cohorts show that preterm births increased markedly. Mean birthweights remained stable over a 33-year period. Increased prevalence of preterm and early term births, associated with high levels of obstetric interventions, has offset the expected improvements due to reduction in risk factors for low birthweight. [ABSTRACT FROM AUTHOR]

المؤلفون: Sunkara, Sesh Kamal¹ sesh.sunkara1@nhs.net, LaMarca, Antonio², Polyzos, Nikolaos P.³, Seed, Paul T.⁴, Khalaf, Yakoub⁵

المصدر: Human Reproduction. Oct2016, Vol. 31 Issue 10, p2261-2267. 7p. 1 Diagram, 2 Charts, 2 Graphs.

مصطلحات موضوعية: *CHILDBIRTH, *PREMATURE labor, *PREGNANCY complications, *FERTILIZATION in vitro, *HEALTH outcome assessment, *LOW birth weight, *BIRTH rate, *GESTATIONAL age, *PREMATURE infants, *EVALUATION of medical care, *INDUCED ovulation, *PREGNANCY, PERINATAL care

مستخلص: Study Question: Does ovarian stimulation affect perinatal outcomes of preterm birth (PTB) and low birth weight (LBW) following IVF treatment.Summary Answer: Despite no significant differences in the risks of PTB and LBW between stimulated and unstimulated IVF in the present study, the study cannot exclude the effect of ovarian stimulation on the perinatal outcomes following IVF.What Is Already Known: Pregnancies resulting from assisted reproductive treatments (ART) are associated with a higher risk of pregnancy complications compared to spontaneously conceived pregnancies attributed to the underlying infertility and the in vitro fertilization techniques. It is of interest to determine the effect size of ovarian stimulation use in achieving a live birth and whether ovarian stimulation that is routinely used in IVF, affects perinatal outcomes of birth weight and gestational age at delivery compared to unstimulated IVF.Study Design, Size, Duration: Anonymous data were obtained from the Human Fertilisation and Embryology Authority (HFEA), the statutory regulator of ART in the UK. The HFEA has collected data prospectively on all ART performed in the UK since 1991. Data from 1991 to 2011 comprising a total of 591 003 fresh IVF ± ICSI cycles involving 584 835 stimulated IVF cycles and 6168 unstimulated IVF cycles were analyzed.Participants/materials, Setting, Methods: Data on all women undergoing either stimulated or unstimulated fresh IVF ± ICSI cycles during the period from 1991 to 2011 were analyzed to compare live birth rates, singleton live birth rates, perinatal outcomes of PTB, early PTB (<32 weeks), LBW and very LBW (<1500 grams) among singleton live births. Adjusted logistic regression was performed for each perinatal outcome for confounding factors: female age, period of treatment, cause of infertility, number of previous IVF cycles and previous live birth.Main Results and the Role Of Chance: Analysis of the large nationwide data demonstrated 3.5 times (95% confidence interval (CI): 3.1-3.9) as many unstimulated IVF cycles being required to achieve one live birth compared to stimulated IVF and 2.9 times (95% CI: 2.6-3.2) as many unstimulated IVF cycles being required to achieve one singleton live birth compared to stimulated IVF. There was no significant difference in the unadjusted odds for PTB (odds ratio (OR) 1.27, 95% CI: 0.80-2.00) and LBW (OR 1.48, 95% CI: 0.90-2.42) between stimulated and unstimulated IVF cycles. There was no significant difference in the risk of the adverse perinatal outcomes after adjusting for potential confounders; PTB (adjusted odds ratio (aOR) 1.43, 95% CI: 0.91-2.26) and LBW (aOR 1.58, 95% CI: 0.96-2.58).Limitations, Reasons For Caution: Although the analysis was adjusted for a number of important confounders, the dataset had no information on smoking, body mass index (BMI) and the medical history of women during pregnancy to allow adjustment. Anonymized nature of the dataset did not make it permissible to analyse one cycle per woman. Given the smaller number of perinatal events with unstimulated IVF, a larger study is needed to investigate further.Wider Implications Of the Findings: Analysis of this large dataset demonstrates that ovarian stimulation has a vital role in maximizing efficacy of IVF. Although there were no significant differences for PTB and LBW following stimulated compared to unstimulated IVF, the CIs were wide enough to include possible clinically important effects.Study Funding/competing Interests: No funding was obtained. There are no competing interests to declare. [ABSTRACT FROM AUTHOR]

المؤلفون: Sunkara, Sesh Kamal¹ sksunkara@hotmail.com, La Marca, Antonio², Seed, Paul T.³, Khalaf, Yacoub³

المصدر: Human Reproduction. Jun2015, Vol. 30 Issue 6, p1473-1480. 8p. 1 Diagram, 5 Charts, 2 Graphs.

مصطلحات موضوعية: *RISK factors in premature labor, *PREGNANCY complications, *BIRTH weight, *PREMATURE infants, *HUMAN in vitro fertilization, *CHILDBIRTH, *OVUM, *HEALTH outcome assessment

مستخلص: STUDY QUESTION: Is there a relation between the number of oocytes retrieved following ovarian stimulation and obstetric outcomes of preterm birth (PTB) and low birthweight (LBW) following IVF treatment? SUMMARY ANSWER: There is an increased risk of PTB (<37 weeks gestation) and LBW (<2500 g) following IVF in women with a high number (>20) of oocytes retrieved. WHAT IS KNOWN ALREADY: Pregnancies resulting from assisted reproductive treatments (ART) are associated with a higher risk of pregnancy complications compared with spontaneously conceived pregnancies. Whether ovarian ageing in women with poor ovarian response is associated with an increased risk of adverse obstetric outcomes is debated. It is also unclear if an excessive response and high egg numbers following ovarian stimulation have an association with adverse obstetric outcomes. STUDY DESIGN, SIZE, DURATION: Observational study using anonymized data on all IVF cycles performed in the UK from August 1991 to June 2008. Data from 402 185 IVF cycles and 65 868 singleton live birth outcomes were analysed. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data on all women undergoing a stimulated fresh IVF cycle with at least one oocyte retrieved between 1991 and June 2008 were analysed for birth outcomes. Logistic regression analysis of the association between ovarian response (quantified as number of oocytes retrieved) and outcomes of PTB and LBW was performed. MAIN RESULTS AND THE ROLE Of CHANCE: There was a significantly higher risk of adverse obstetric outcomes of PTB and LBW among women with an excessive response (>20 oocytes) compared with women with a normal response (10-15 oocytes): adjusted odds ratio (OR) 1.15, 95% confidence interval (CI) 1.03-1.28 for PTB, adjusted OR 1.17, 95% CI 1.05-1.30 for LBW, respectively. There was no increased risk of the adverse outcomes among women with a poor ovarian response (≤3 oocytes) compared with women with a normal response: adjusted OR0.88, 95% CI 0.76- 1.01 for PTB, adjusted OR0.92, 95% CI 0.79-1.06 for LBW, respectively. LIMITATIONS, REASONS FOR CAUTION: Although the analysis was adjusted for a number of potential confounders, the dataset had no information on other important confounders such as smoking, BMI and the medical history of women during pregnancy. Furthermore, the dataset did not allow specific identification of women with PCOS and its anonymized nature did not make it permissible to analyse one cycle per woman. WIDER IMPLICATIONS Of THE FINDINGS: Analysis of this large dataset suggests that a high oocyte number (>20) following IVF is associated with a higher risk of PTB and LBW. These findings lead to speculation whether ovarian dysfunction and/or an altered endometrial milieu resulting from supraphysiological steroid levels underlie the unfavourable outcomes and warrant further research. Ovarian stimulation regimens should optimize the number of oocytes retrieved to avoid the risk of adverse outcomes associated with very high numbers of oocytes. STUDY FUNDING/COMPETING INTEREST(S): No funding was obtained. There are no competing interests to declare. [ABSTRACT FROM AUTHOR]

المؤلفون: Barbuscia, Anna, Martikainen, Pekka, Myrskylä, Mikko, Remes, Hanna, Somigliana, Edgardo, Klemetti, Reija, Goisis, Alice

المصدر: Human Reproduction; Jan2020, Vol. 35 Issue 1, p212-220, 9p, 3 Charts, 2 Graphs

مصطلحات موضوعية: MATERNAL age, REPRODUCTIVE technology, PREMATURE labor, CHILDBIRTH, LOW birth weight, RESEARCH, PREMATURE infants, RESEARCH methodology, ACQUISITION of data, MEDICAL cooperation, EVALUATION research, COMPARATIVE studies

مصطلحات جغرافية: FINLAND

مستخلص: Study Question: Does the risk of low birth weight and premature birth increase with age among mothers who conceive through medically assisted reproduction (MAR)?Summary Answer: Among MAR mothers, the risk of poorer birth outcomes does not increase with maternal age at birth except at very advanced maternal ages (40+).What Is Known Already: The use of MAR treatments has been increasing over the last few decades and is especially diffused among women who conceive at older ages. Although advanced maternal age is a well-known risk factor for adverse birth outcomes in natural pregnancies, only a few studies have directly analysed the maternal age gradient in birth outcomes for MAR mothers.Study Design, Size, Duration: The base dataset was a 20% random sample of households with at least one child aged 0-14 at the end of 2000, drawn from the Finnish population register and other administrative registers. This study included children who were born in 1995-2000, because the information on whether a child was conceived through MAR or naturally was available only from 1995 onwards.Participants/materials, Setting, Methods: The outcome measures were whether the child had low birth weight (LBW, <2500 g at birth) and whether the child was delivered preterm (<37 weeks of gestation). Conceptions through MAR were identified by examining data on purchases of prescription medication from the National Prescription Register. Linear probability models were used to analyse and compare the maternal age gradients in birth outcomes of mothers who conceived through MAR or naturally before and after adjustment for maternal characteristics (i.e. whether the mother suffered from acute/chronic conditions before the pregnancy, household income and whether the mother smoked during pregnancy).Main Results and the Role Of Chance: A total of 56 026 children, 2624 of whom were conceived through MAR treatments, were included in the study. Among the mothers who used MAR to conceive, maternal age was not associated with an increased risk of LBW (the overall prevalence was 12.6%) at ages 25-39. For example, compared to the risk of LBW at ages 30-34, the risk was 0.22 percentage points lower (95% CI: -3.2, 2.8) at ages 25-29 and was 1.34 percentage points lower (95% CI: -4.5, 1.0) at ages 35-39. The risk of LBW was increased only at maternal ages ≥40 (six percentage points, 95% CI: 0.2, 12). Adjustment for maternal characteristics only marginally attenuated these associations. In contrast, among the mothers who conceived naturally, the results showed a clear age gradient. For example, compared to the risk of LBW (the overall prevalence was 3.3%) at maternal ages 30-34, the risk was 1.1 percentage points higher (95% CI: 0.6, 1.6) at ages 35-39 and was 1.5 percentage points higher (95% CI: 0.5, 2.6) at ages ≥40. The results were similar for preterm births.Limitations, Reason For Caution: A limited number of confounders were included in the study because of the administrative nature of the data used. Our ability to reliably distinguish mothers based on MAR treatment type was also limited.Wider Implications Of the Findings: This is the first study to analyse the maternal age gradient in the risk of adverse birth outcomes among children conceived through MAR using data from a nationally representative sample and controlling for important maternal health and socio-economic characteristics. This topic is of considerable importance in light of the widespread and increasing use of MAR treatments.Study Funding/competing Interest(s): Funding for this project was provided by the European Research Council (grant no. 803959 MARTE to Alice Goisis and grant no. 336475 COSTPOST to Mikko Myrskylä). E.S. reports personal fees from Theramex, personal fees from Merck Serono, personal fees from Health Reimbursement Arrangement, non-financial support from Merck Serono and grants from Ferring, grants from Theramex, outside the submitted work. The remaining authors have no competing interests.Trial Registrtion Number: N/A. [ABSTRACT FROM AUTHOR]

: Copyright of Human Reproduction is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Marconi, Nicola, Raja, Edwin Amalraj, Bhattacharya, Siladitya, Maheshwari, Abha

المصدر: Human Reproduction; Sep2019, Vol. 34 Issue 9, p1716-1725, 10p, 1 Diagram, 3 Charts, 1 Graph

مصطلحات موضوعية: CHILDBIRTH, EMBRYO transfer, BIRTH weight, BODY mass index, PREMATURE labor

مصطلحات جغرافية: ITALY, UNITED Kingdom

مستخلص: Study Question: Are perinatal outcomes different between singleton live births conceived from fresh blastocyst transfer and those following the transfer of fresh cleavage-stage embryos?Summary Answer: Fresh blastocyst transfer does not increase risks of preterm birth (PTB), low/high birth weight or congenital anomaly and does not alter the sex ratio at birth or prejudice the chance of having a healthy baby.What Is Known Already: Extended embryo culture is currently considered the best option for embryo selection, but concerns have been raised about increased risks of preterm delivery and large-for-gestational-age (LGA) babies.Study Design, Size, Duration: We conducted a retrospective cohort study based on data from the Human Fertilisation and Embryology Authority (HFEA) anonymised and cycle-based dataset in the UK between 1999 and 2011.Participants/materials, Setting, Methods: Baseline characteristics were compared between in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) blastocyst-stage and cleavage-stage embryo transfer cycles using the χ2 test for categorical/dichotomised covariates and the Mann-Whitney test for continuous covariates. Statistical significance was set at <0.005. Poisson regression and multinomial logistic regression were used to establish relationships between perinatal outcomes and blastocyst-stage embryo transfer or cleavage-stage embryo transfer. Risk ratios (RRs), adjusted risk ratios (aRRs) and their 99.5% confidence intervals (CIs) were calculated as a measure of strength of associations. Results were adjusted for clinically relevant covariates. A sub-group analysis included women undergoing their first IVF/ICSI treatment. The level of significance was set at <0.05, and 95% CIs were calculated in the sub-group analysis.Main Results and the Role Of Chance: Of a total of 67 147 IVF/ICSI cycles, 11 152 involved blastocyst-stage embryo(s) and 55 995 involved cleavage-stage embryo(s). The two groups were comparable with regards to the risk of PTB (aRR, 1.00; 99.5% CI, 0.79-1.25), very-preterm birth (VPTB) (aRR, 1.00; 99.5% CI, 0.63-1.54), very-low birth weight (VLBW) (aRR, 0.84; 99.5% CI, 0.53-1.34), low birth weight (LBW) (aRR, 0.92; 99.5% CI, 0.73-1.16), high birth weight (HBW) (aRR, 0.94; 99.5% CI, 0.75-1.18) and very-high birth weight (VHBW) (aRR, 1.05; 99.5% CI, 0.66-1.65). The risk of congenital anomaly was 16% higher in the blastocyst-stage group than in the cleavage-stage group, but this was not statistically significant (aRR, 1.16; 99.5% CI, 0.90-1.49). The chance of having a healthy baby (born at term, with a normal birth weight and no congenital anomalies) was not altered by extended culture (aRR, 1.00; 99.5% CI, 0.93-1.07). Extended culture was associated with a marginal increase in the chance having a male baby in the main cycle-based analysis (aRR, 1.04; 99.5% CI, 1.01-1.09) but not in the sub-group analysis of women undergoing their first cycle of treatment (aRR, 1.04; 95% CI, 1.00-1.08). In the sub-group analysis, the risk of congenital anomalies was significantly higher after blastocyst-stage embryo transfer (aRR, 1.42; 95% CI, 1.12-1.81).Limitations, Reasons For Caution: This study is limited by the use of observational data and inability to adjust for key confounders, such as maternal smoking status and body mass index (BMI), which were not recorded in the HFEA dataset. As the main analysis was cycle-based and we were unable to link cycles within women undergoing more than one IVF/ICSI cycle, we undertook a sub-group analysis on women undergoing their first treatment cycle.Wider Implications Of the Findings: Our findings should reassure women undergoing blastocyst-stage embryo transfer. For the first time, we have shown that babies born after blastocyst transfer have a similar chance of being healthy as those born after cleavage-stage embryos transfer.Study Funding/competing Interest(s): The research activity of Dr Nicola Marconi was funded by the scholarship 'A. Griffini-J. Miglierina', Fondazione Comunitaria del Varesotto, Provincia di Varese, Italy. The authors do not have any competing interests to disclose.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

: Copyright of Human Reproduction is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Matijasevich, Alicia, Victora, Cesar G, Silveira, Mariangela F, Wehrmeister, Fernando C, Horta, Bernardo L, Barros, Fernando C, Pelotas Cohorts Study Group

المصدر: International Journal of Epidemiology; 2019 Supplement 1, Vol. 48, pi16-i25, 10p

مصطلحات موضوعية: REPRODUCTIVE history, MULTIPLE birth, BIRTH intervals, CHILDBIRTH, PREMATURE labor, COLOR vision

مصطلحات جغرافية: BRAZIL

مستخلص: Background: Brazil experienced important progress in maternal and child health in recent decades. We aimed at describing secular trends as well as socioeconomic and ethnic inequalities in reproductive history indicators (birth spacing, previous adverse perinatal outcome, parity and multiple births) over a 33-year span.Methods: Four population-based birth cohort studies included all hospital births in 1982, 1993, 2004 and 2015 in Pelotas, Southern Brazil. Information on reproductive history was collected through interviews. Indicators were stratified by family income quintiles and skin colour. Absolute and relative measures of inequality were calculated.Results: From 1982 to 2015, the proportion of primiparae increased from 39.2% to 49.6%, and median birth interval increased by 23.2 months. Poor women were more likely to report short intervals and higher parity, although reductions were observed in all income and ethnic groups. History of previous low birthweight was inversely related to income and increased by 7.7% points (pp) over time-more rapidly in the richest (12.1 pp) than in the poorest quintile (0.4 pp). Multiple births increased from 1.7% to 2.7%, with the highest increase observed among the richest quintile and for white women (220% and 70% increase, respectively). Absolute and relative income and ethnic-related inequalities for short birth intervals increased, whereas inequalities for previous low birthweight decreased over time.Conclusions: In this 33-year period there were increases in birth intervals, multiple births and reports of previous low-birthweight infants. These trends may be explained by increased family planning coverage, assisted reproduction and a rise in preterm births, respectively. Our results show that socioeconomic and ethnic inequalities in health are dynamic and vary over time, within the same location. [ABSTRACT FROM AUTHOR]

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