RESUMO
BACKGROUND: Medical advancements have resulted in better survival and life expectancy among those with spina bifida, but a significantly increased risk of perinatal and postnatal mortality for individuals with spina bifida remains. OBJECTIVES: To examine stillbirth and infant and child mortality among those affected by spina bifida using data from multiple countries. METHODS: We conducted an observational study, using data from 24 population- and hospital-based surveillance registries in 18 countries contributing as members of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Cases of spina bifida that resulted in livebirths or stillbirths from 20 weeks' gestation or elective termination of pregnancy for fetal anomaly (ETOPFA) were included. Among liveborn spina bifida cases, we calculated mortality at different ages as number of deaths among liveborn cases divided by total number of liveborn cases with spina bifida. As a secondary outcome measure, we estimated the prevalence of spina bifida per 10 000 total births. The 95% confidence interval for the prevalence estimate was estimated using the Poisson approximation of binomial distribution. RESULTS: Between years 2001 and 2012, the overall first-week mortality proportion was 6.9% (95% CI 6.3, 7.7) and was lower in programmes operating in countries with policies that allowed ETOPFA compared with their counterparts (5.9% vs. 8.4%). The majority of first-week mortality occurred on the first day of life. In programmes where information on long-term mortality was available through linkage to administrative databases, survival at 5 years of age was 90%-96% in Europe, and 86%-96% in North America. CONCLUSIONS: Our multi-country study showed a high proportion of stillbirth and infant and child deaths among those with spina bifida. Effective folic acid interventions could prevent many cases of spina bifida, thereby preventing associated childhood morbidity and mortality.
Assuntos
Mortalidade da Criança , Mortalidade Infantil , Nascido Vivo/epidemiologia , Disrafismo Espinal/mortalidade , Natimorto/epidemiologia , Ásia/epidemiologia , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , América do Norte/epidemiologia , Prevalência , Sistema de Registros , América do Sul/epidemiologia , Disrafismo Espinal/epidemiologiaRESUMO
OBJECTIVE: To determine the risk of long-term cardiovascular disease (CVD) among children born following in vitro fertilization (IVF) and compared with spontaneous pregnancies. STUDY DESIGN: A population-based cohort study including all singleton deliveries occurring between 1991and 2014 at a tertiary medical center was performed. Hospitalizations up to the age of 18 years involving CVD were evaluated in children delivered following IVF, ovulation induction, and spontaneous pregnancies. CVD included valvular disorders, hypertension, arrhythmias, rheumatic disease, cardiomyopathy, ischemic heart disease, and heart failure. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence, and a Cox regression model controlled for confounders. RESULTS: During the study period, 242 187 singleton deliveries met the inclusion criteria; 1.1% following IVF (n = 2603), and 0.7% following ovulation induction (n = 1721). Hospitalizations up to the age of 18 years involving CVD (n = 1503) were comparable in children delivered following IVF (0.6%), ovulation induction (0.7%), and spontaneous pregnancies (0.6%; P = .884). No significant difference in the cumulative incidence of CVD was noted between the groups (log rank P = .781). Controlling for maternal age, gestational age, birthweight, maternal diabetes, and hypertensive disorders in pregnancy, fertility treatment was not noted as a risk factor for long-term pediatric CVD (IVF adjusted hazard ratio 1.05, 95% CI 0.63-1.74, P = .86; ovulation induction adjusted hazard ratio 0.97, CI 95% 0.55-1.71, P = .92). CONCLUSIONS: Singletons conceived via fertility treatments do not appear to be at an increased risk of long-term pediatric CVD.
Assuntos
Doenças Cardiovasculares/epidemiologia , Hospitalização/estatística & dados numéricos , Técnicas de Reprodução Assistida/efeitos adversos , Adolescente , Adulto , Doenças Cardiovasculares/etiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Israel/epidemiologia , Masculino , Gravidez , Estudos Retrospectivos , Fatores de Risco , Análise de SobrevidaRESUMO
OBJECTIVE: To determine whether early term delivery (at 370/7-386/7 weeks of gestation) is associated with long-term pediatric cardiovascular morbidity of the offspring. STUDY DESIGN: A population-based cohort analysis was performed including all term deliveries occurring between 1991 and 2014 at a single tertiary medical center. Gestational age at delivery was subdivided into early term (370/7-386/7), full term (390/7-406/7), late term (410/7-416/7) and post term (≥420/7) delivery. Hospitalizations of children up to the age of 18 years involving cardiovascular morbidity were evaluated, including structural valvular disease, hypertension, arrhythmias, rheumatic fever, ischemic heart disease, pulmonary heart disease, perimyoendocarditis, congestive heart failure, and others. Kaplan-Meier survival curves were used to compare cumulative hospitalization incidence between groups. A multivariable Weibull parametric model was used to control for confounders. RESULTS: During the study period, 223 242 term singleton deliveries met the inclusion criteria. Of them, 24% (n = 53 501) occurred at early term. Hospitalizations involving cardiovascular morbidity were significantly more common in children delivered at early term (0.7%) as compared with those born at full (0.6%), late (0.6%), or post term (0.5%; P = .01). The survival curve demonstrated a significantly higher cumulative incidence of cardiovascular-related hospitalizations in the early term group (log-rank P <.001). In the Weibull model, early term delivery was found to be an independent risk factor for cardiovascular-related hospitalization as compared with full term delivery (adjusted HR, 1.16; 95% CI, 1.01-1.32; P = .02). CONCLUSION: Early term delivery is independently associated with pediatric cardiovascular morbidity of the offspring as compared with offspring born at full term.
Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças do Prematuro/epidemiologia , Estudos de Coortes , Feminino , Idade Gestacional , Hospitalização , Humanos , Recém-Nascido , Recém-Nascido Prematuro , MasculinoRESUMO
OBJECTIVE: To evaluate the association between sex and long-term pediatric cardiovascular morbidity. STUDY DESIGN: A population-based cohort study was performed that compared the risk of long-term cardiovascular morbidity (up to the age of 18 years) of children according to sex. Deliveries occurred between the years 1991 and 2013 in a tertiary medical center. Multiple pregnancies and fetal congenital malformations were excluded. Kaplan-Meier survival curves were constructed to compare cumulative cardiovascular morbidity incidence. A Cox proportional hazards model was used to control for confounders, including gestational age at birth, birth weight, and maternal factors. RESULTS: During the study period, 240 953 newborns met the inclusion criteria and were included in the long-term analysis. Of them, 51.0% (n = 122 840) were male and 49.0% (n = 118 113) female. Cardiovascular morbidity up to the age of 18 years was significantly more common in male as compared with female newborns (0.3% vs 0.2%, OR 1.33, 95% CI 1.12-1.57, P = .001). In the Cox regression model, male sex exhibited an independent association with long-term cardiovascular morbidity with an adjusted hazard ratio of 1.37 (95% CI 1.16-1.63, P <.001). CONCLUSION: Male newborns are at an increased risk for pediatric cardiovascular morbidity independent of gestational age at birth and birth weight.