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Spatiotemporal Patterns of Small for Gestational Age and Low Birth Weight Births and Associations With Land Use and Socioeconomic Status.

ABSTRACT: In addition to small for gestational age (SGA) and low birth weight at term (LBWT), critically ill cases of SGA/LBWT are significant events from outcomes and economic perspectives that require further understanding of risk factors. We aimed to assess the spatiotemporal distribution of locations where there were consistently higher numbers of critically ill SGA/LBWT (hot spots) in comparison with all SGA/LBWT and all births. We focused on Edmonton (2008-2010) and Calgary (2006-2010), Alberta, and used a geographical information system to apply emerging hot spot analysis, as a new approach for understanding SGA, LBWT, and the critically ill counterparts (ciSGA or ciLBWT). We also compared the resulting aggregated categorical patterns with proportions of land use and socioeconomic status (SES) using Spearman correlation and logistic regression. There was an overall increasing trend in all space-time clusters. Whole period emerging hot spot patterns among births and SGA generally coincided, but SGA with ciSGA and LBWT with ciLBWT did not. Regression coefficients were highest for low SES with SGA and LBWT, but not with ciSGA and ciLBWT. Open areas and industrial land use were most associated with ciLBWT but not with ciSGA, SGA, or LBWT. Differences in the space-time hot spot patterns and the associations with ciSGA and ciLBWT indicate further need to research the interplay of maternal and environmental influences. We demonstrated the novel application of emerging hot spot analysis for small newborns and spatially related them to the surrounding environment.

SUBMITTER: Nielsen CC

PROVIDER: S-EPMC6709433 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Spatiotemporal Patterns of Small for Gestational Age and Low Birth Weight Births and Associations With Land Use and Socioeconomic Status.

Nielsen Charlene C CC Amrhein Carl G CG Shah Prakesh S PS Aziz Khalid K Osornio-Vargas Alvaro R AR

Environmental health insights 20190822

In addition to small for gestational age (SGA) and low birth weight at term (LBWT), critically ill cases of SGA/LBWT are significant events from outcomes and economic perspectives that require further understanding of risk factors. We aimed to assess the spatiotemporal distribution of locations where there were consistently higher numbers of critically ill SGA/LBWT (hot spots) in comparison with all SGA/LBWT and all births. We focused on Edmonton (2008-2010) and Calgary (2006-2010), Alberta, and ...[more]

PMID: 31488949

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Project description:BackgroundIt is unclear whether the socioeconomic status (SES) of the community of residence has a substantial association with infant birth weight. We used multilevel models to examine associations of birth weight with family- and community-level SES in the Cape Cod Family Health Study. Data were collected retrospectively on births to women between 1969 and 1983 living on Cape Cod, Massachusetts. The sample included siblings born in different residences with differing community-level SES.MethodsWe used cross-classified models to account for multiple levels of correlation in a non-hierarchical data structure. We accounted for clustering at family- and community-levels. Models included extensive individual- and family-level covariates. SES variables of interest were maternal education; paternal occupation; percent adults living in poverty; percent adults with a four year college degree; community mean family income; and percent adult unemployment.ResultsResidual correlation was detected at the family- but not the community-level. Substantial effects sizes were observed for family-level SES while smaller magnitudes were observed for community-level SES. Overall, higher SES corresponded to increased birth weight though neither family- nor community-level variables had significant associations with the outcome. In a model applied to a reduced sample that included a single child per family, enforcing a hierarchical data structure, paternal occupation was found to have a significant association with birth weight (p = 0.033). Larger effect sizes for community SES appeared in models applied to the full sample that contained limited covariates, such as those typically found on birth certificates.ConclusionsCross-classified models allowed us to include more than one child per family even when families moved between births. There was evidence of mild associations between family SES and birth weight. Stronger associations between paternal occupation and birth weight were observed in models applied to reduced samples with hierarchical data structures, illustrating consequences of excluding observations from the cross-classified analysis. Models with limited covariates showed associations of birth weight with community SES. In models adjusting for a complete set of individual- and family-level covariates, community SES was not as important.

Project description:BACKGROUND:Among highly exposed populations, arsenic exposure in utero may be associated with decreased birth weight, however less is known about potential effects of arsenic exposure in urban communities without contaminated sources such as drinking water. OBJECTIVE:Investigate the association of blood arsenic levels with birth weight-for-gestational age categories within a prospective birth cohort study. DESIGN/METHODS:We analyzed 730 mother-infant dyads within the Programming Research in Obesity, GRowth, Environment and Social Stressors (PROGRESS) cohort in Mexico City. Total arsenic was measured in maternal blood samples from the 2nd and 3rd trimesters, at delivery, as well as from infant umbilical cord blood samples. Multivariable, multinomial logistic regression models adjusting for maternal age at enrollment, pre-pregnancy body mass index, parity, infant sex, socioeconomic position, and prenatal environmental tobacco smoke exposure were used to calculate odds ratios of small-for-gestational age (<10th percentile, SGA) and large-for-gestational age (>90th percentile, LGA) compared to appropriate-for-gestational age (AGA) per unit increase of log-transformed arsenic. RESULTS:Median (IQR) blood arsenic levels for maternal second trimester were 0.72 (0.33) ?g/L, maternal third trimester 0.75 (0.41) ?g/L, maternal at delivery 0.85 (0.70) ?g/L, and infant cord 0.78 (0.65) ?g/L. Maternal delivery and infant cord blood samples were most strongly correlated (spearman r?=?0.65, p?<?0.0001). Maternal arsenic levels at delivery were associated with significantly higher odds of both SGA (adj. OR?=?1.44, 95% CI: 1.08-1.93) and LGA (adj. OR?=?2.03, 95% CI: 1.12-3.67) compared to AGA. Results were similar for cord blood. There were 130 SGA infants and 22 LGA infants. Earlier in pregnancy, there were no significant associations of arsenic and birth weight-for-gestational age. However, we observed non-significantly higher odds of LGA among women with higher arsenic levels in the 3rd trimester (adj. OR?=?1.46, 95% CI: 0.67-3.12). CONCLUSION:We found that in a Mexico City birth cohort, higher maternal blood arsenic levels at delivery were associated with higher odds of both SGA and LGA. However, sources and species of arsenic were not known and the number of LGA infants was small, limiting the interpretation of this finding and highlighting the importance of future large studies to incorporate arsenic speciation. If our findings were confirmed in studies that addressed these limitations, determining modifiable factors that could be mitigated, such as sources of arsenic exposure, may be important for optimizing fetal growth to improve long-term health of children.

Project description:BackgroundPM2.5 have been associated with weight change in animal models and non-pregnant populations. Evidence of associations between PM2.5 and gestational weight gain (GWG), an important determinant of course and outcomes of pregnancy, and subsequent birth outcomes is limited.MethodsThe study was conducted among a subset of participants from the Omega Study, a prospective pregnancy cohort. Exposure to PM2.5 (μg/m3) was ascertained for participants (N = 855) based on their residential address using a validated national spatiotemporal model. Adjusted multivariable linear regression models were used to estimate associations of trimester-specific and pregnancy-month PM2.5 exposures with early (<20 weeks gestation), late (≥20 weeks gestation), and total GWG and infant birth weight. Stratified models and product terms were used to examine whether pre-pregnancy BMI (ppBMI) and infant sex modified the associations.ResultsAverage monthly PM2.5 exposure during the first, second, and third trimesters were 7.3 μg/m3, 7.9 μg/m3, and 7.7 μg/m3, respectively. Higher third trimester PM2.5 exposure was associated with higher late (0.40 kg per 5 μg/m (McDowell et al., 2018); 95%CI: 0.12, 0.67) and total (0.35 kg; 95%CI: 0.01, 0.70) GWG among participants with normal ppBMI. Higher second month PM2.5 exposure was associated with lower early (-0.70 kg; 95%CI: 1.22, -0.18), late (-0.84 kg; 95% CI: 1.54, -0.14), and total (-1.70 kg; 95%CI: 2.57, -0.82) GWG among participants with overweight/obese ppBMI. Product terms between PM2.5 and ppBMI were significant for second month PM2.5 exposure and early (p-value = 0.01) and total GWG (p-value<0.01). Higher third trimester PM2.5 exposure was associated with higher birth weight, though higher fourth month PM2.5 exposure was associated with lower birth weight, particularly among those with normal ppBMI and male infants.ConclusionsAssociations of PM2.5 with GWG vary by exposure window and ppBMI, while associations of PM2.5 with birth weight potentially vary by exposure window, ppBMI and infant sex. Further exploration of associations between PM2.5 and maternal/child health outcomes are needed.

Project description:BACKGROUND:During pregnancy, a mother's nutritional needs increase to meet the added nutrient demands for fetal growth and development. An enhanced understanding of adequate nutrition and sufficient weight gain during pregnancy can guide development of policies and strategies for maternal nutrition care, actions that will ultimately promote better pregnancy outcomes. In a sample of pregnant women in Vietnam, this study characterized maternal nutrition status and gestational weight gain at a mid-pregnancy baseline, then examined the association of these variables with specific birth outcomes. METHODS:The study used baseline data from a randomized, controlled trial that compared pregnant Vietnamese women who received a nutritional intervention group with those who received only standard dietary counseling (control group). At baseline (26-29 weeks gestation), mothers' dietary reports were collected, and intake of 10 macro- and micronutrients was estimated; data for baseline gestational weight gain was collected for all pregnant women enrolled into the study (n = 228). This analysis also used weights, lengths, and head circumferences at birth for infants of mothers in the control group. RESULTS:At baseline, 95% of the pregnant women had concurrent inadequacies for more than five nutrients, and nearly half had concurrent inadequacies for more than ten nutrients. Almost two-thirds of the pregnant women did not meet recommendations for gestational weight gain. We found a significant, inverse association between the number of nutrient inadequacies and gestational weight gain (overall p ≤ 0.045). After adjusting for potential confounders, gestational weight gain was positively associated with birth weight, length at birth, birth weight-for-age z-score and length-for-age z-score (all p ≤ 0.006). CONCLUSIONS:Our findings raise concern over the high proportion of pregnant women in Vietnam who have multiple concurrent nutrient inadequacies and who fall short of meeting recommended gestational weight gain standards. To ensure better birth outcomes in this population, policies and strategies to improve the status of maternal nutrition are greatly needed. TRIAL REGISTRATION:The trial was retrospectively registered at clinicaltrials.gov on December 20, 2013, registration identifier: NCT02016586.

Project description:BackgroundAs multiple pregnancies show a higher incidence of complications than singletons and carry a higher perinatal risk, the calculation of birth weight - and gestational age (GA)-specific perinatal mortality rates (PMR) for multiple births is necessary in order to estimate the lowest PMR for these groups.MethodsDetails of all reported twins (192,987 live births, 5,539 stillbirths and 1,830 early neonatal deaths) in Japan between 1990 and 1999 were analyzed and compared with singletons (10,021,275 live births, 63,972 fetal deaths and 16,862 early neonatal deaths) in the annual report of vital statistics of Japan. The fetal death rate (FDR) and PMR were calculated for each category of birth weight at 500-gram intervals and GA at four-week intervals. The FDR according to birth weight and GA category was calculated as fetal deaths/(fetal deaths + live births) x 1000. The perinatal mortality rate (PMR) according to birth weight and GA category, was calculated as (fetal deaths + early neonatal deaths)/(fetal deaths + live births) x 1000. Within each category, the lowest FDR and PMR were assigned with a relative risk (RR) of 1.0 as a reference and all other rates within each category were compared to this lowest rate.ResultsThe overall PMR per 1,000 births for singletons was 6.9, and the lowest PMR was 1.1 for birth weight (3.5-4.0 kg) and GA (40-weeks). For twins, the overall PMR per 1,000 births was 36.8, and the lowest PMR was 3.9 for birth weight (2.5-3.0 kg) and GA (36-39 weeks). At optimal birth weight and GA, the PMR was reduced to 15.9 percent for singletons, and 10.6 percent for twins, compared to the overall PMR. The risk of perinatal mortality was greater in twins than in singletons at the same deviation from the ideal category of each plurality.ConclusionPMRs are potentially reduced by attaining the ideal birth weight and GA. More than 90 percent of mortality could be reduced by attaining the optimal GA and birth weight in twins by taking particular care to ensure appropriate pregnancy weight gain, as well as adequate control for obstetric complications.

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Spatiotemporal Patterns of Small for Gestational Age and Low Birth Weight Births and Associations With Land Use and Socioeconomic Status.

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Spatiotemporal Patterns of Small for Gestational Age and Low Birth Weight Births and Associations With Land Use and Socioeconomic Status.

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