Efficient linking of birth certificate and newborn screening databases for laboratory investigation of congenital cytomegalovirus infection and preterm birth: Florida, 2008

The objectives of this study are (1) to design an accurate method for linking newborn screening (NBS) and state birth certificate databases to create a de-identified study database; (2) To assess maternal cytomegalovirus (CMV) seroprevalence by measuring CMV IgG in newborn dried blood spots; (3) To assess congenital CMV infection among newborns and possible association with preterm birth. NBS and birth databases were linked and patient records were de-identified. A stratified random sample of records based on gestational age was selected and used to retrieve blood spots from the state NBS laboratory. Serum containing maternal antibodies was eluted from blood spots and tested for the presence of CMV IgG. DNA was extracted from blood spots and tested for the presence of CMV DNA. Analyses were performed with bivariable and multivariable logistic regression models. Linkage rates and specimen collection exceeded 98% of the total possible yielding a final database with 3,101 newborn blood spots. CMV seroprevalence was 91% among Black mothers, 83% among Hispanic mothers, 59% among White mothers, and decreased with increasing amounts of education. The prevalence of CMV infection in newborns was 0.45% and did not vary significantly by gestational age. Successful methods for database linkage, newborn blood spots collection, and de-identification of records can serve as a model for future congenital exposure surveillance projects. Maternal CMV seroprevalence was strongly associated with race/ethnicity and educational level. Congenital CMV infection rates were lower than those reported by other studies and lacked statistical power to examine associations with preterm birth.     

Maternal vaginal colonisation by Staphylococcus aureus and newborn acquisition at delivery

Bourgeois‐Nicolaos N, Lucet J‐C, Daubié C, Benchaba F, Rajguru M, Ruimy R, Andremont A, Armand‐Lefèvre L. Maternal vaginal colonisation by Staphylococcus aureus and newborn acquisition at delivery. Paediatric and Perinatal Epidemiology 2010. We studied 1139 mother–infant pairs where the mother had had at least one vaginal swab in the month before delivery and their babies had had gastric and ear swabs taken immediately after delivery. The prevalence of vaginal carriage of Staphylococcus aureus was 5.9% among 1139 pregnant women within 1 month of delivery. The colonisation rate of S. aureus in newborns was tenfold higher when the mother was a vaginal carrier than when she was not (31.3% vs. 2.7%; relative risk 11.6 [95% CI 7.0, 19.2]; P < 0.05). Among carriers, delivery by caesarean section compared with the vaginal route, significantly decreased the likelihood of S. aureus colonisation in the newborns (15.4% vs. 41.5%; relative risk 0.35 [95% CI 0.14, 0.98]; P < 0.03). No S. aureus colonisation was detected in the mothers of 58% of the colonised newborns suggesting extra‐delivery colonisation routes. Consequences for newborns were unclear as only one case of S. aureus neonatal sepsis was observed.     

妊娠期乙型肝炎对围产儿的影响

目的:探讨妊娠期乙型肝炎对围产儿的影响。方法:观察280例乙型肝炎孕妇所生新生儿的Apgar评分、出生体重、新生儿黄疸、羊水胎粪污染、胎儿宫内窘迫情况,以119例正常孕妇所生新生儿为对照组进行比较分析。结果:乙型肝炎孕妇所生新生儿的Apgar评分、出生体重、羊水Ⅲ度污染、胎儿宫内窘迫与对照组差异显著(均P<0.05),羊水Ⅰ度与Ⅱ度污染及新生儿黄疸指数与对照组无显著性差异(均P>0.05)。结论:妊娠期乙型肝炎对围产儿生长发育和出生时状态有明显影响。     

The Independent Importance of Pre-pregnancy Weight and Gestational Weight Gain for the Prevention of Large-for Gestational Age Brazilian Newborns

Objectives To study the independent effect of pre-pregnancy weight, gestational weight gain (GWG), and other important risk factors on newborn birth weight. Methods Baseline data of 435 adult women and their singletons born between January and February 2012 at a public hospital in Brazil were used. Logistic regression was applied to determine the independent importance of pre-pregnancy weight and GWG for large for gestational age (LGA) newborns. Results Among all mothers, 37.9 % were overweight and obese before pregnancy and 45.3 % experienced excessive GWG. Among the newborns, 24.4 % were classified as LGA. Univariate analysis showed an association of family income, GWG, pre-pregnancy BMI and excessive GWG with LGA newborns. Smoking before and during pregnancy was associated with a decreased likelihood of giving birth to an LGA newborn compared to mothers who did not smoke. After adjustment for confounding variables, age at birth of first child, GWG, HbA1c and pre-pregnancy weight-GWG were significant and independent determinants of giving birth to an LGA newborn. Mothers with pre-pregnancy overweight and excessive GWG were more likely to deliver an LGA newborn (OR 2.54, P < 0.05) compared to mothers who were normal weight and experienced adequate GWG. Conclusions for Practice Age at first birth of child, GWG, HbA1c and pre-pregnancy overweight combined with excessive GWG are independent determinants of LGA newborns. The results of this study suggest that both primary prevention of overweight in women of childbearing age and management of GWG may be important strategies to reduce the number of LGA newborns and, consequently, the long-term public health burden of obesity.     

正常足月分娩母亲及新生儿血清中GM-CSF与SIL-2R的表达

目的:探讨正常足月分娩母亲及新生儿血清中GM-CSF、SIL-2R表达水平,为围产期母亲及新生儿系统保键提供基础免疫数据。方法:无菌采集正常足月分娩母亲静脉、出生5min新生儿脐静脉及3天新生儿股静脉血,用美国RD有限公司提供的试剂,采用双抗体夹心ABC-ELISA法检测GM-CSF、SIL-2R表达水平。结果:①出生5min新生儿GM-CSF、SIL-2R及出生3天新生儿SIL-2R与母亲表达水平比较,无统计学意义(P>0.05)。②出生3天新生儿GM-CSF与母亲表达水平比较,差异有非常显著性(P<0.01)。结论:深圳正常足月分娩母亲及新生儿血清中GM-CSF、SIL-2R的表达水平以出生3天新生儿GM-CSF表达水平升高,是新生儿在新环境中生长发育的生理性需求;为围产期母亲及新生儿系统保健提供了基础免疫数据。     

Newborn Care Practices in Urban Slums of Lucknow City, UP

Objectives:

To study the knowledge and practices related to newborn care in urban slums of Lucknow city, UP, and to identify critical behaviors, practices, and barriers that influence the survival of newborns.

Materials and Methods:

A cross-sectional study in urban slums of Lucknow city, UP, included 524 women who had a live birth during last 1 year preceding data collection. Data were analyzed using statistical software SPSS 10.0 for windows.

Results:

Study findings showed that about half of the deliveries took place at home. Majority (77.1%) of the mothers believed that baby should be bathed with warm water and dried with clean cloth and 79.7% mothers practiced it. Only 36.6% mothers initiated breast-feeding within 1 h of birth and 30.2% initiated after 1 day. The mothers who have not given colostrum to their baby, in majority the reason was customs.

Conclusion:

In majority of cases, correct knowledge and correct practices regarding newborn care were lacking among mothers and this should be promoted through improved coverage with existing health services.     

Effects of health insurance on birth weight in Mexico

This paper estimates the effect of mother's insurance coverage on neonatal outcomes in Mexico using hospital‐based administrative data. Using an instrumental variable approach to identify the causal effects of health insurance on infant health, we find that mother's insurance coverage has positive impacts on neonatal outcomes. Children born to insured mothers weighed 108 g higher and had reduced probability of low birth weight by 7.5 percentage points. These effects appear to be stronger for mothers with higher levels of education and in municipalities with a higher development index. Findings indicate that expanding insurance coverage could be helpful in improving neonatal outcomes in resource‐constrained countries.     

Lack of HTLV-II infection in newborns born from HIV-1 infected mothers in Southern Italy

In order to evaluate the presence of HTLV-II infection in a cohort of newborns born from HIV-1 infected mothers, a retrospective study was conducted on 80 newborns. Only 1 birth serum sample (1.25%) was found seropositive for HTLV-II by Western Blot suggesting a transplacental transmission of anti-HTLV-II antibodies. Two consecutive PCR performed on PBMCs of the seropositive newborn resulted negative suggesting the absence of the infection. More extensive studies are needed to assess the risk of transmission in areas with a higher prevalence of HTLV-II infection.     

Evaluation of a universal hepatitis B vaccination program and antenatal screening for hepatitis B surface antigen: Results from a real-world study 2015–2016

Background and AimsUniversal vaccination against hepatitis B virus (HBV) in infancy was implemented in Israel in 1992. This population-based study aimed to evaluate the coverage rate and cost-benefit of the HBV vaccination program among infants in Israel and the Hepatitis B surface antigen (HBsAg) status in their mothers.MethodsUsing the database of a health maintenance organization with 2 million members, we retrospectively identified, all the infants born in 2015–2016 and their mothers. Maternal data collected included age, ethnicity, country of birth and HBsAg status during pregnancy. HBV vaccination coverage among infants was calculated. A cost-benefit analysis of the HBV vaccination program was conducted based on the actual costs of HBV infection treatments in all HBsAg positive mothers.ResultsOur cohort included 72,792 mothers who gave birth to 77,572 live infants. A total of 71,107 (97.7%) mothers were screened for HBV during pregnancy, of them 124 (0.2%), who gave birth to 132 infants were HBsAg positive. HBV vaccination coverage rates were 94%, 93% and 89%, for the first, second and third dose, respectively. Birth dose coverage of 95% among infants born to HBsAg positive mothers was significantly higher compared to HBsAg negative or unscreened mothers (p < 0.001). The percentage of HBsAg positivity among mothers who were born in Israel, the Former Soviet Union or Ethiopia, were 0.1%, 0.8% and 5%, respectively (p < 0.001). Ethnic differences were not found between HBsAg positive and HBsAg negative mothers. Calculated benefit-to-cost ratios were 1.24:1 and 4.15:1, with and without antenatal HBsAg screening, respectively.ConclusionsThe Israeli vaccination program against HBV infection is epidemiologically and economically justified. High coverage rates among infants born to HBsAg positive mothers reflect very good adherence to the vaccination program and antenatal screening. Higher HBsAg positivity rates among immigrant mothers identify a high-risk population for HBV infection.     

Changing maternity leave policy: Short-term effects on fertility rates and demographic variables in Germany

Changes in reproductive behaviour and decreasing fertility rates have recently led to policy actions that attempt to counteract these developments. Evidence on the efficacy of such policy interventions, however, is limited. The present analysis examines fertility rates and demographic variables of a population in Germany in response to new maternity leave regulations, which were introduced in January 2007. As part of a population-based survey of neonates in Pomerania (SNiP), all births in the study region from the period 23 months prior to January 1st, 2007 until 23 months afterwards were examined. Crude Birth Rates (CBR) per month, General Fertility Rates (GFR) per month, parity and sociodemographic variables were compared using bivariate techniques. Logistic regression analysis was performed. No statistically significant difference in the CBR or GFR after Jan. 1st, 2007 was found. There were statistically significant differences in other demographic variables, however. The proportion of mothers who (a) were employed full-time before pregnancy; (b) came from a higher socioeconomic status; and (c) had higher income levels all increased after January 1st, 2007. The magnitude of these effects was higher in multigravid women. Forward stepwise logistic regression found an odds ratio of 1.79 for women with a family income of more than 3000€ to give birth after the new law was introduced. This is the first analysis of population-based data that examines fertility rates and sociodemographic variables in response to new legal regulations. No short-term effects on birth rates were detected, but there was a differential effect on the subgroup of multigravidae. The focus of this policy was to provide financial support, which is certainly important, but the complexity of having a child suggests that attitudinal and motivational aspects also need to be taken into account. Furthermore, these analyses were only able to evaluate the short-term consequences of the policy; further studies are needed to assess for different, long-term effects.     

Factors influencing childhood immunisation in an urban area of Brazil.

STUDY OBJECTIVE--The aim was to examine the factors associated with incomplete vaccination in an urban area in Sao Paulo, Brazil; and to explore whether differences in vaccine coverage in the catchment area of health centres remain after the demographic constitution of the population in these areas is controlled for. DESIGN--The children were selected as controls for a case-control study. 455 children were selected at random (but age matched) from the health centre registries. Data was collected from the health centre records and from home interviews. SETTING--All children were registered in FAISA, a municipal health service comprising a large network of health centres and hospitals. FAISA's services are free at the point of delivery, and over 85% of the city's children are registered. PARTICIPANTS--Participants were selected to represent, except in their age distribution, all children registered in the municipal health service. MEASUREMENTS AND MAIN RESULTS--Information was collected on subjects' vaccine history, year of birth, sex, birth order and birth weight, and health centre of registration; their mothers' age, education, and marital status; and the family's income per capita and history of migration. Analysis was undertaken to identify risk factors for vaccination and whether the differential coverage in health centres' catchment areas remained after demographic characteristics of the population were controlled for. The high coverage for DPT and polio vaccines suggests that low overall coverage was not simply a result of mothers failing to bring children for vaccination. The variable that best predicted vaccine coverage was year of birth. Children born to immigrant mothers or into large families had lower vaccine uptake. The characteristics of children and their mothers did not account for the variation in vaccination coverage in catchment areas of different health centres. CONCLUSIONS--It is likely that in this area vaccination completeness was associated mainly with the health centre's ability to deliver vaccination to the target population.     

肿瘤坏死因子在正常足月分娩母亲及新生儿的表达

目的:探讨正常足月分娩母亲及新生儿肿瘤坏死因子(TNF)的表达水平,为围产期母亲及新生儿系统保健提供基础免疫数据。方法:无菌采集正常足月分娩母亲静脉血、出生5min新生儿脐静脉血及3天新生儿股静脉血,用美国RD有限公司提供的试剂,采用双抗体夹心ABC-ELISA法测定肿瘤坏死因子的表达水平。结果:①正常足月分娩出生5min、3天健康新生儿TNF-α、TNF-β表达水平较高,并随着出生天数的递增而升高(P<0.01)。②与母亲比较差异均有非常显著性(P<0.01)。结论:了解了深圳正常足月分娩母亲及新生儿TNF的表达水平;新生儿随着出生天数的递增,体内TNF表达水平增高,这是人体生长、发育时间段的生理性需要;为围产期母亲及新生儿系统保健提供了基础免疫数据。     

Perinatal Disparities for Black Mothers and Their Newborns

Objectives In the United States, significant ethnic and racial health and healthcare disparities exist among our most vulnerable populations, new mothers and newborns. We sought to determine disparities in socioeconomic status, perinatal health, and perinatal healthcare for black mothers and their newborns cared for in well-baby nurseries compared with white mother/baby pairs in Pennsylvania. Methods A retrospective analysis of a merged data set containing birth and clinical discharge records was conducted. Perinatal data from 44,105 black mothers and their singleton newborns, >/=35 weeks gestational age cared for in Pennsylvania well-baby nurseries from 1998-2002 were compared with 88,210 white mother/baby pairs. Results Black mothers were younger and were much more likely to receive Medicaid or be uninsured compared with white mothers. They were less likely to be college-educated, married, or have prenatal care beginning in the first trimester. Infants born to black mothers were less likely to be delivered via Cesarean section, but were more likely to be born between 35 and 38 weeks gestation and be of low birth weight. Conclusions Numerous significant disparities exist for black mothers and their newborns cared for in well-baby nurseries in Pennsylvania. Since most newborns are cared for in this setting as opposed to intensive care environments, recognition of the differences that exist for this group when compared to well newborns of white mothers can help to improve healthcare and its delivery to this population. Federal and local initiatives must continue efforts to eliminate racial disparities.     

Methods for detecting interactions between genetic polymorphisms and prenatal environment exposure with a mother‐child design

Prenatal exposures such as polycyclic aromatic hydrocarbons and early postnatal environmental exposures are of particular concern because of the heightened susceptibility of the fetus and infant to diverse environmental pollutants. Marked inter‐individual variation in response to the same level of exposure was observed in both mothers and their newborns, indicating that susceptibility might be due to genetic factors. With the mother‐child pair design, existing methods developed for parent‐child trio data or random sample data are either not applicable or not designed to optimally use the information. To take full advantage of this unique design, which provides partial information on genetic transmission and has both maternal and newborn outcome status collected, we developed a likelihood‐based method that uses both the maternal and the newborn information together and jointly models gene‐environment interactions on maternal and newborn outcomes. Through intensive simulation studies, the proposed method has demonstrated much improved power in detecting gene‐environment interactions. The application on a real mother‐child pair data from a study conducted in Krakow, Poland, suggested four significant gene‐environment interactions after multiple comparisons adjustment. Genet. Epidemiol. 34: 125–132, 2010. © 2009 Wiley‐Liss, Inc.     

A Genome‐Wide Association Study of Early Spontaneous Preterm Delivery

Preterm birth is the leading cause of infant morbidity and mortality. Despite extensive research, the genetic contributions to spontaneous preterm birth (SPTB) are not well understood. Term controls were matched with cases by race/ethnicity, maternal age, and parity prior to recruitment. Genotyping was performed using Affymetrix SNP Array 6.0 assays. Statistical analyses utilized PLINK to compare allele occurrence rates between case and control groups, and incorporated quality control and multiple‐testing adjustments. We analyzed DNA samples from mother–infant pairs from early SPTB cases (20^0/7–33^6/7 weeks, 959 women and 979 neonates) and term delivery controls (39^0/7–41^6/7 weeks, 960 women and 985 neonates). For validation purposes, we included an independent validation cohort consisting of early SPTB cases (293 mothers and 243 infants) and term controls (200 mothers and 149 infants). Clustering analysis revealed no population stratification. Multiple maternal SNPs were identified with association P‐values between 10 × 10^–5 and 10 × 10^–6. The most significant maternal SNP was rs17053026 on chromosome 3 with an odds ratio (OR) 0.44 with a P‐value of 1.0 × 10^–6. Two neonatal SNPs reached the genome‐wide significance threshold, including rs17527054 on chromosome 6p22 with a P‐value of 2.7 × 10^–12 and rs3777722 on chromosome 6q27 with a P‐value of 1.4 × 10^–10. However, we could not replicate these findings after adjusting for multiple comparisons in a validation cohort. This is the first report of a genome‐wide case‐control study to identify single nucleotide polymorphisms (SNPs) that correlate with SPTB.     

Which newborns in New York City are at risk for special education placement?

In this study of 162 third graders in New York City public schools, we found that slightly over half of the children in special education were males who had Medicaid coverage at birth and mothers with medical conditions or adverse health habits noted on the birth certificate; two thirds of the children with this combination of characteristics actually were placed in special education. These findings suggest that newborns at risk for later learning disabilities can be targeted to receive preventive interventions.     

健康足月分娩母亲及新生儿血清中EGF的表达水平

目的:探讨健康足月分娩母亲及新生儿表皮生长因子(EGF)在血清中的表达水平,为围产期母亲及新生儿保健提供基础免疫数据。方法:无菌采集健康足月分娩母亲静脉血、出生5min新生儿脐静脉血及3天新生儿股静脉血,均分离血清。由美国RD有限公司提供试剂,采用双抗体夹心ABC-ELISA法,测定EGF的表达水平。结果:①健康足月分娩出生5min、3天新生儿EGF表达水平较高,随着出生天数递增而升高。②与母亲比较,EGF表达水平差异有非常显著性(P<0.01)。结论:掌握了深圳健康足月分娩母亲及新生儿EGF表达水平;新生儿随着出生天数的递增EGF水平升高,是机体生长发育的生理性需要;为围产期母亲、新生儿系统保健提供了基础免疫数据。     

新生儿6162例健康状况及影响因素分析

目的了解新生儿健康状况,掌握新生儿常见疾病的发病率、死亡率、死亡原因及影响因素。方法以人群为基础整群分层抽样横断面抽取沈阳市2010年10月1日-2011年9月30日出生的6 162例新生儿进行调查。结果新生儿出生体重均值为(3 399.24±459.69)g;不同性别及胎龄婴儿出生体重均值比较差异有统计学意义(P0.01);母亲孕期体重增长越多,婴儿出生体重越大(r=0.15,P0.001);父、母亲吸烟、被动吸烟或饮酒均可导致低体重发生率增高(P0.01);低出生体重儿在新生儿期就出现追赶增长趋势。早产儿发生率为5.37%,低出生体重儿发生率为3.55%,巨大儿发生率为10.68%;剖宫产率为69.96%;新生儿死亡率为3.8‰,第一位死因是早产低出生体重。结论应加强孕产期及新生儿保健工作,控制孕期体重增长在正常范围,消除父母亲不良生活嗜好,可降低早产、低体重和巨大儿的发生,进一步降低剖宫产率及新生儿死亡率;应重点加强新生儿的发育监测和管理,是提高儿童健康水平的关键。     

Survey of Neonates in Pomerania (SniP): A population based analysis of the mothers’ quality of life after delivery with special relations to their social integration

Summary Objectives: Women’s overall quality of life prior to delivery and the changes expected by the mothers within the near future have been analyzed addressing items like employment, finances, housing and relationships to family, friends and neighbours. Methods: Population based women were asked to answer a questionnaire (Survey of Neonates in Pomerania – SNiP) during their stay at the hospital after delivery. The area studied is North-East Germany. Results: The study included 1 553 women with 1 122 questionnaires (72.3 %) analyzed. Positive assessment concerning the quality of life was observed in 91.2 % without expecting serious worsening after delivery. Negative assessments were found within the categories employment (23.3 %) and fi nances (26.3 %). Worsening was expected within employment (34 %), finances (52.1 %) and shortening of spare time (39.6 %). Within all other categories no changes or even an improvement after delivery were expected. The overall assessment was correlated to the mothers’ social relationship. Conclusion: Most women stated their own quality of life as positive, none expected serious worsening. Employment, finances and social bindings are factors with strong relationship on the mothers’ self-assessment. Submitted: 07 December 2006; Revised: 01 January 2007; Accepted: 15 January 2008     

Measles susceptibility in maternal-infant dyads—Bamako,Mali

Measles is endemic in Africa; measles mortality is highest among infants. Infant measles antibody titer at birth is related to maternal immune status. Older mothers are likelier to have had measles infection, which provides higher antibody titers than vaccine-induced immunity. We investigated the relationship between maternal age and measles susceptibility in mother-infant pairs in Mali through six months of infancy.We measured serum measles antibodies in 340 mother-infant pairs by plaque reduction neutralization test (PRNT) and calculated the proportion of mothers with protective titers (>120 mIU/mL) at delivery and the proportion of infants with protective titers at birth, and at three and six months of age. We explored associations between maternal age and measles antibodies in mothers and infants at the timepoints noted.Ten percent of Malian newborns were susceptible to measles; by six months nearly all were. Maternal and infant antibody titers were highly correlated. At delivery, 11% of mothers and 10% of newborns were susceptible to measles. By three and six months, infant susceptibility increased to 72% and 98%, respectively. Infants born to younger mothers were most susceptible at birth and three months. Time to susceptibility was 6.6 weeks in infants born to mothers with measles titer >120–<430 mIU/mL versus 15.4 weeks when mothers had titers ≥430 mIU/mL.Maternal and newborn seroprotective status were positively correlated. Improved strategies are needed to protect susceptible infants from measles infection and death. Increasing measles immunization coverage in vaccine eligible populations, including nonimmune reproductive-aged women and older children should be considered.