Dataset Information

Spatiotemporal Trends of Birth Defects in North Carolina, 2003-2015.

ABSTRACT: Birth defects are a leading cause of infant mortality in the United States, but little is known about causes of many types of birth defects. Spatiotemporal disease mapping to identify high-prevalence areas, is a potential strategy to narrow the search for potential environmental and other causes that aggregate over space and time. We described the spatial and temporal trends of the prevalence of birth defects in North Carolina during 2003-2015, using data on live births obtained from the North Carolina Birth Defects Monitoring Program. By employing a Bayesian space-time Poisson model, we estimated spatial and temporal trends of non-chromosomal and chromosomal birth defects. During 2003-2015, 52,524 (3.3%) of 1,598,807 live births had at least one recorded birth defect. The prevalence of non-chromosomal birth defects decreased from 3.8% in 2003 to 2.9% in 2015. Spatial modeling suggested a large geographic variation in non-chromosomal birth defects at census-tract level, with the highest prevalence in southeastern North Carolina. The strong spatial heterogeneity revealed in this work allowed to identify geographic areas with higher prevalence of non-chromosomal birth defects in North Carolina. This variation will help inform future research focused on epidemiologic studies of birth defects to identify etiologic factors.

SUBMITTER: Lu H

PROVIDER: S-EPMC11343242 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Spatiotemporal Trends of Birth Defects in North Carolina, 2003-2015.

Lu Haidong H Olshan Andrew F AF Serre Marc L ML Anthony Kurtis M KM Fry Rebecca C RC Forestieri Nina E NE Keil Alexander P AP

medRxiv : the preprint server for health sciences 20240813

Birth defects are a leading cause of infant mortality in the United States, but little is known about causes of many types of birth defects. Spatiotemporal disease mapping to identify high-prevalence areas, is a potential strategy to narrow the search for potential environmental and other causes that aggregate over space and time. We described the spatial and temporal trends of the prevalence of birth defects in North Carolina during 2003-2015, using data on live births obtained from the North C ...[more]

PMID: 39185511

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Project description:BackgroundPreterm birth (PTB) and term low birth weight (LBW) have been associated with pollution and other environmental exposures, but the relationship between these adverse outcomes and specific characteristics of polluted sites is not well studied.ObjectivesWe conducted a retrospective cohort study to examine relationships between residential proximity to polluted sites in North Carolina (NC) and PTB and LBW. We further stratified exposure to polluted sites by route of contaminant emissions and specific contaminants released at each site.MethodsWe created an integrated exposure geodatabase of polluted sites in NC from 2002 to 2015 including all landfills, Superfund sites, and industrial sites. Using birth certificates, we assembled a cohort of 1,494,651 singleton births in NC from 2003 to 2015. We geocoded the gestational parent residential address on the birth certificate, and defined exposure to polluted sites as residence within one mile of a site. We used log-binomial regression models to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Binomial models were used to estimate adjusted risk differences (aRD) per 10,000 births and 95% CIs for associations between exposure to polluted sites and PTB or LBW.ResultsWe observed weak associations between residential proximity to polluted sites and PTB [aRR(95% CI): 1.07(1.06,1.09); aRD(95% CI): 61(48,74)] and LBW [aRR(95% CI): 1.09(1.06,1.12); aRD(95% CI): 24(17,31)]. Secondary analyses showed increased risk of both PTB and LBW among births exposed to sites characterized by water emissions, air emissions, and land impoundment. In analyses of specific contaminants, increased risk of PTB was associated with proximity to sites containing arsenic, benzene, cadmium, lead, mercury, and polycyclic aromatic hydrocarbons. LBW was associated with exposure to arsenic, benzene, cadmium, lead, and mercury.SignificanceThis study provides evidence for potential reproductive health effects of polluted sites, and underscores the importance of accounting for heterogeneity between polluted sites when considering these exposures.Impact statementWe documented an overall increased risk of both PTB and LBW in births with gestational exposure to polluted sites using a harmonized geodatabase of three site types, and further examined exposures stratified by site characteristics (route of emission, specific contaminants present). We observed increased risk of both PTB and LBW among births exposed to sites with water emissions or air emissions, across site types. Increased risk of PTB was associated with gestational proximity to sites containing arsenic, benzene, cadmium, lead, mercury, and polycyclic aromatic hydrocarbons; increased risk of LBW was associated with exposure to arsenic, benzene, cadmium, lead, and mercury.

Project description:ObjectivesTo compare receipt of contraception and method effectiveness in the early postpartum period among women with and without a recent preterm birth (PTB).MethodsWe used data from North Carolina birth certificates linked to Medicaid claims. We assessed contraceptive claims with dates of service within 90 days of delivery among a retrospective cohort of women who had a live birth covered by Medicaid between September 2011 and 2012 (n = 58,201). To estimate the odds of receipt of contraception by PTB status (24-36 weeks compared to 37-42 weeks [referent]), we used logistic regression and tested for interaction by parity. To estimate the relationship between PTB and method effectiveness based on the Center for Disease Control and Prevention Levels of Effectiveness of Family Planning Methods (most, moderate and least effective [referent]), we used multinomial logistic regression.ResultsLess than half of all women with a live birth covered by Medicaid in North Carolina had a contraceptive claim within 90 days postpartum. Women with a recent PTB had a lower prevalence of contraceptive receipt compared to women with a term birth (45.7% vs. 49.6%). Women who experienced a PTB had a lower odds of receiving contraception. When we stratified by parity, women with a PTB had a lower odds of contraceptive receipt among women with more than two births (0.79, 95% CI 0.74-0.85), but not among women with two births or fewer. One-fourth of women received a most effective method. Women with a preterm birth had a lower odds of receiving a most effective method (0.83, 95% CI 0.77-0.88) compared to women with a term birth.Conclusions for practiceContraceptive receipt was low among women with a live birth covered by Medicaid in North Carolina. To optimize contraceptive use among women at risk for subsequent preterm birth, family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed.SignificanceAccess to free or affordable highly effective contraception is associated with reductions in preterm birth. Self-report data indicate that women with a very preterm birth (PTB) are less likely to use highly or moderately effective contraception postpartum compared to women delivering at later gestational ages. Using Medicaid claims data, we found that less than half of all women with a Medicaid covered delivery in North Carolina in 2011-2012 had a contraceptive claim within 90 days postpartum, and one fourth received a most effective method. Women with a PTB and more than two children were least likely to receive any method. Family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed so that women may access their contraceptive method of choice in the postpartum period.

Dataset Information

Spatiotemporal Trends of Birth Defects in North Carolina, 2003-2015.

Publications

Spatiotemporal Trends of Birth Defects in North Carolina, 2003-2015.

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