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A national cohort study evaluating infant and fetal mortality caused by birth defects in Korea.

ABSTRACT: OBJECTIVE:To analyse the prevalence of fetal and infant deaths due to birth defects in Korea and those trends according to maternal age. DESIGN:Retrospective national cohort study SETTING: Korean Vital Statistics database of the Korean Statistical Information Service, between 2009 and 2015. PARTICIPANTS:2176 infant deaths and 4343 fetal deaths caused by birth defects, among 3 181 145 total live births and 43?385 fetal deaths during the study periods. METHODS:Infant and fetal mortality rates (IMRs and FMRs) by birth defects, from deaths caused by birth defects, were analysed. They were compared, according to maternal age groups: (I) '10-19?years'; (II) '20-29?years'; (III) '30-34?years'; (IV) '35-39?years'; and (V) '40-55?years'. MAIN OUTCOME MEASURES:IMRs and FMRs by birth defects and comparison according to maternal age group. RESULTS:IMRs and FMRs by birth defects were 6.84 per 10?000 live births and 13.47 per 10?000 total births. The most common causes of infant deaths and fetal deaths by birth defect were anomaly of the circulatory system (51.1%, IMR 3.5) and chromosomal abnormality (33.1%, FMR 4.46), respectively. Among groups by maternal age, FMRs by birth defects were significantly higher in groups I and V compared with group III (OR 6.59, 95%?CI 3.49 to 12.43; and OR 3.46, 95%?CI 1.77 to 6.78, respectively). IMR and FMR by nervous system anomaly were significantly higher in group I at 3.63 (OR 2.0, 95%?CI 1.97 to 2.03) and 29.84 (OR 15.04, 95%?CI 3.59 to 62.96) compared with 0.32 and 1.97 in group III. CONCLUSION:FMRs by birth defects were the highest in the extreme maternal age groups. Severe anomalies, except for chromosomal abnormality, were most prevalent in teenage pregnancies.

SUBMITTER: Ko HS

PROVIDER: S-EPMC5695452 | biostudies-other | 2017 Nov

REPOSITORIES: biostudies-other

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A national cohort study evaluating infant and fetal mortality caused by birth defects in Korea.

Ko Hyun Sun HS Ko Hyun Sun HS Kim Dong Joo DJ Chung Yoohyun Y Wie Jeong Ha JH Choi Sae Kyung SK Park In Yarg IY Park Yong Gyu YG Shin Jong Chul JC

BMJ open 20171115 11

<h4>Objective</h4>To analyse the prevalence of fetal and infant deaths due to birth defects in Korea and those trends according to maternal age.<h4>Design</h4>Retrospective national cohort study SETTING: Korean Vital Statistics database of the Korean Statistical Information Service, between 2009 and 2015.<h4>Participants</h4>2176 infant deaths and 4343 fetal deaths caused by birth defects, among 3 181 145 total live births and 43 385 fetal deaths during the study periods.<h4>Methods</h4>Infant a ...[more]

PMID: 29146644

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Project description:BackgroundSocioeconomic disparities in infant mortality have persisted for decades in high-income countries and may have become stronger in some populations. Therefore, new understandings of the mechanisms that underlie socioeconomic differences in infant deaths are essential for creating and implementing health initiatives to reduce these deaths. We aimed to explore whether and the extent to which preterm birth (PTB) and small for gestational age (SGA) at birth mediate the association between maternal education and infant mortality.Methods and findingsWe developed a population-based cohort study to include all 1,994,618 live singletons born in Denmark in 1981-2015. Infants were followed from birth until death, emigration, or the day before the first birthday, whichever came first. Maternal education at childbirth was categorized as low, medium, or high. An inverse probability weighting of marginal structural models was used to estimate the controlled direct effect (CDE) of maternal education on offspring infant mortality, further split into neonatal (0-27 days) and postneonatal (28-364 days) deaths, and portion eliminated (PE) by eliminating mediation by PTB and SGA. The proportion eliminated by eliminating mediation by PTB and SGA was reported if the mortality rate ratios (MRRs) of CDE and PE were in the same direction. The MRRs between maternal education and infant mortality were 1.63 (95% CI 1.48-1.80, P < 0.001) and 1.19 (95% CI 1.08-1.31, P < 0.001) for low and medium versus high education, respectively. The estimated proportions of these total associations eliminated by reducing PTB and SGA together were 55% (MRRPE = 1.27, 95% CI 1.15-1.40, P < 0.001) for low and 60% (MRRPE = 1.11, 95% CI 1.01-1.22, P = 0.037) for medium versus high education. The proportions eliminated by eliminating PTB and SGA separately were, respectively, 46% and 11% for low education (versus high education) and 48% and 13% for medium education (versus high education). PTB and SGA together contributed more to the association of maternal educational disparities with neonatal mortality (proportion eliminated: 75%-81%) than with postneonatal mortality (proportion eliminated: 21%-23%). Limitations of the study include the untestable assumption of no unmeasured confounders for the causal mediation analysis, and the limited generalizability of the findings to other countries with varying disparities in access and quality of perinatal healthcare.ConclusionsPTB and SGA may play substantial roles in the relationship between low maternal education and infant mortality, especially for neonatal mortality. The mediating role of PTB appeared to be much stronger than that of SGA. Public health strategies aimed at reducing neonatal mortality in high-income countries may need to address socially related prenatal risk factors of PTB and impaired fetal growth. The substantial association of maternal education with postneonatal mortality not accounted for by PTB or SGA could reflect unaddressed educational disparities in infant care or other factors.

Dataset Information

A national cohort study evaluating infant and fetal mortality caused by birth defects in Korea.

Publications

A national cohort study evaluating infant and fetal mortality caused by birth defects in Korea.

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