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The association between parity and birthweight in a longitudinal consecutive pregnancy cohort.

ABSTRACT: BACKGROUND:Nulliparity is associated with lower birthweight, but few studies have examined how within-mother changes in risk factors impact this association. METHODS:We used longitudinal electronic medical record data from a hospital-based cohort of consecutive singleton live births from 2002-2010 in Utah. To reduce bias from unobserved pregnancies, primary analyses were limited to 9484 women who entered nulliparous from 2002-2004, with 23,380 pregnancies up to parity 3. Unrestricted secondary analyses used 101,225 pregnancies from 45,212 women with pregnancies up to parity 7. We calculated gestational age and sex-specific birthweight z-scores with nulliparas as the reference. Using linear mixed models, we estimated birthweight z-score by parity adjusting for pregnancy-specific sociodemographics, smoking, alcohol, prepregnancy body mass index, gestational weight gain, and medical conditions. RESULTS:Compared with nulliparas', infants of primiparas were larger by 0.20 unadjusted z-score units [95% confidence interval (CI) 0.18, 0.22]; the adjusted increase was similar at 0.18 z-score units [95% CI 0.15, 0.20]. Birthweight continued to increase up to parity 3, but with a smaller difference (parity 3 vs. 0 ? = 0.27 [95% CI 0.20, 0.34]). In the unrestricted secondary sample, there was significant departure in linearity from parity 1 to 7 (P < 0.001); birthweight increased only up to parity 4 (parity 4 vs. 0 ? = 0.34 [95% CI 0.31, 0.37]). CONCLUSIONS:The association between parity and birthweight was non-linear with the greatest increase observed between first- and second-born infants of the same mother. Adjustment for changes in weight or chronic diseases did not change the relationship between parity and birthweight.

SUBMITTER: Hinkle SN

PROVIDER: S-EPMC3922415 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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The association between parity and birthweight in a longitudinal consecutive pregnancy cohort.

Hinkle Stefanie N SN Albert Paul S PS Mendola Pauline P Sjaarda Lindsey A LA Yeung Edwina E Boghossian Nansi S NS Laughon S Katherine SK

Paediatric and perinatal epidemiology 20131209 2

<h4>Background</h4>Nulliparity is associated with lower birthweight, but few studies have examined how within-mother changes in risk factors impact this association.<h4>Methods</h4>We used longitudinal electronic medical record data from a hospital-based cohort of consecutive singleton live births from 2002-2010 in Utah. To reduce bias from unobserved pregnancies, primary analyses were limited to 9484 women who entered nulliparous from 2002-2004, with 23,380 pregnancies up to parity 3. Unrestric ...[more]

PMID: 24320682

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Project description:INTRODUCTION:The objective was to evaluate the association between fetal sex and adverse pregnancy outcome, while correcting for fetal growth and gestational age at delivery. MATERIAL AND METHODS:Data from the Netherlands Perinatal Registry (1999-2010) were used. The study population comprised all white European women with a singleton delivery between 25+0 and 42+6 weeks of gestation. Fetuses with structural or chromosomal abnormalities were excluded. Outcomes were antepartum death, intrapartum/neonatal death (from onset of labor until 28 days after birth), perinatal death (antepartum death or intrapartum/neonatal death), a composite of neonatal morbidity (including infant respiratory distress syndrome, sepsis, necrotizing enterocolitis, meconium aspiration, persistent pulmonary hypertension of the newborn, periventricular leukomalacia, Apgar score <7 at 5 minutes, and intracranial hemorrhage) and a composite adverse neonatal outcome (perinatal death or neonatal morbidity). Outcomes were expressed stratified by birthweight percentile (<p10 [small for gestation], p10-90 [normal weight], >p90 [large for gestation]) and gestational age at delivery (25+0 -27+6 , 28+0 -31+6 , 32+0 -36+6 , 37+0 -42+6 weeks). The association between fetal sex and outcome was assessed using the fetus at risk approach. RESULTS:We studied 1 742 831 pregnant women. We found no increased risk of antepartum, intrapartum/neonatal and perinatal death in normal weight and large-for-gestation males born after 28+0 weeks compared with females. We found an increased risk of antepartum death among small-for-gestation males born after 28+0 weeks (relative risk [RR] 1.16-1.40). All males born after 32+0 weeks of gestation suffered more neonatal morbidity than females regardless of birthweight percentile (RR 1.07-1.34). Infant respiratory distress syndrome, sepsis, persistent pulmonary hypertension of the newborn, Apgar score <7 at 5 minutes, and intracranial hemorrhage all occurred more often in males than in females. CONCLUSIONS:Small-for-gestation males have an increased risk of antepartum death and all males born after 32+0 weeks of gestation have an increased risk of neonatal morbidity compared with females. In contrast to findings in previous studies we found no increased risk of antepartum, intrapartum/neonatal or perinatal death in normal weight and large-for-gestation males born after 28+0 weeks.

Project description:Background: Sex-related differences in cardiovascular parameters have been well documented in adults, and the impact of birthweight on cardiovascular health in later life has been acknowledged. However, data was limited regarding the association between birthweight and cardiovascular outcomes at an early age, and the sex-disparity in the association remained unclear. Objective: To investigate the association between birthweight and cardiovascular parameters in 4-year-old children. Furthermore, to explore whether sex-disparity exist in this association or in cardiovascular risk. Methods: Follow-up data from the Shanghai Birth Cohort (SBC) was analyzed. Detailed perinatal information including both maternal and offspring datum were recorded. Blood pressure, echocardiography, and anthropometry assessment were conducted during the follow-up of 4-year-old children. Linear regression models were used to analyze the association between birthweight and left ventricle (LV) structure and function changes in each sex and birthweight category. Multivariable logistic regression models were used to compare risk of left ventricular hypertrophy (LVH) in different birthweight subgroups. Results: Overall, macrosomia was significantly associated with thickened LV posterior wall thickness in systole [LVPWs, (β = 0.26, 95% CI: 0.06, 0.45)] and diastole [LVPWd, (β = 0.18, 95% CI: 0.06, 0.30)], and thickened interventricular septal thickness in diastole [IVSd, (β = 0.16, 95% CI: 0.05, 0.28)]. Boys with macrosomia showed a higher left ventricle mass index [LVMI, (β = 1.29, 95% CI: 0.14, 2.43)], thickened LVPWs (β = 0.30, 95% CI: 0.05, 0.56) and LVPWd (β = 0.21, 95% CI: 0.06, 0.36), and thickened IVSd (β = 0.23, 95% CI: 0.09, 0.36). However, no significant association of structural changes was found in girls. Furthermore, an increased risk of LVH was found solely in macrosomic boys (OR = 2.79, 95% CI: 1.17, 6.63). Conclusion: Children with macrosomia developed cardiovascular changes as early as 4 years of age. Macrosomia was associated with LV structural changes and higher LVH risk in pre-school-aged boys, while no association was found in girls.

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The association between parity and birthweight in a longitudinal consecutive pregnancy cohort.

Publications

The association between parity and birthweight in a longitudinal consecutive pregnancy cohort.

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