Immunogenicity of a liquid hexavalent DTaP-IPV-HB-PRP∼T vaccine after primary and booster vaccination of term and preterm infants born to women vaccinated with Tdap during pregnancy

BackgroundVaccination during pregnancy with tetanus, diphtheria, acellular pertussis (aP) (Tdap) antigens is important for early protection of newborn infants against pertussis, particularly for preterm infants. This study evaluated the effect of Tdap vaccination during pregnancy on the immunogenicity of a diphtheria (D), tetanus (T), aP, inactivated poliovirus (IPV), hepatitis B (HB), and Haemophilus influenzae type b (PRP ～ T) vaccine in term and preterm populations.MethodsA prospective, observational study (NCT02511327) recruited women and their infants based on delivery (term or preterm) and vaccination status (vaccinated with a Tdap vaccine [Boostrix?, GlaxoSmithKline] during pregnancy or not vaccinated in the last 5 years). All infants received licensed DTaP-IPV-HB-PRP ～ T (Hexyon?, Sanofi) (8, 12, 16 week primary series and booster at 13 months of age [preterm infants] or 15 months of age [term infants]). Immunogenicity was evaluated using validated assays. Data were pooled into term (N = 127) and preterm infants (N = 105), and infants of women who received a Tdap vaccine during pregnancy (N = 199) or not (N = 33).ResultsBefore primary vaccination, antibody levels were higher for term than preterm infants for anti-D, anti-polio 1, 2, 3, anti-PT, anti-FHA, and anti-PRP, and similar for anti-HBs and anti-T. At this time, infants of Tdap-vaccinated women had higher anti-D, anti-T, anti-PT, anti-FHA, and anti-PRP antibody levels than infants of Tdap-unvaccinated women; anti-HBs and anti-polio antibody levels were similar in both groups. Post-primary, pre-booster, and post-booster, there were only small differences in seroprotection rates (anti-D, anti-T, anti-polio 1, 2, 3, anti-HBs, anti-PRP) and seroconversion rates (anti-PT, anti-FHA), except for anti-HBs ≥ 10 mIU/mL and anti-PRP ≥ 0.15 µg/mL post-primary vaccination (higher for term [98.31 % and 90.91 %, respectively] versus preterm infants [89.80 % and 79.41 %, respectively]).ConclusionsThese data support the use of DTaP-IPV-HB-PRP ～ T vaccine for primary and booster vaccination in term and preterm born infants and in infants born to Tdap-vaccinated or Tdap-unvaccinated women.     

Serum cotinine and whole blood folate concentrations in pregnancy

PurposePrenatal tobacco smoke exposure may be associated with low maternal folate levels that increase the risk of adverse infant and child health outcomes by reducing folate availability during fetal development.MethodsUsing data from the Health Outcomes and Measures of the Environment Study, we examined the relationship between secondhand or active tobacco smoke exposure and whole blood folate concentrations in pregnant women from Cincinnati, Ohio (n = 362) at approximately 16-week gestation. We used multivariable linear regression to examine the association between continuous or categorical serum cotinine levels and whole blood folate levels, adjusting for sociodemographic, dietary, and perinatal variables.ResultsAfter adjustment for potential confounders, an interquartile range increases in serum cotinine concentration (0.012–0.224 ng/mL) was suggestively associated with decreased whole blood folate levels (β, −23 nmol/L; 95% confidence interval (CI), −49, 3; P value = .08). Compared with unexposed women, reductions in mean whole blood folate were observed among active smokers (β, −94, 95% CI, 195, 6 nmol/L; P value = .40); smaller reductions were observed among women with secondhand exposure (β, 26; CI, 84, 32 nmol/L; P value = .07).ConclusionsConsistent with prior studies, active smoking was associated with reduced whole blood folate levels among these pregnant women. Secondhand tobacco smoke exposures were associated with small and imprecise reductions in whole blood folate levels.     

妊娠期糖尿病与早产亚型之间的关联研究

目的 探讨妊娠期糖尿病（GDM）与早产亚型之间的关联。方法 招募孕早、中期在安徽省安庆市立医院产前筛查的孕妇,进行基线调查和生物标本采集,随访孕妇至分娩或妊娠终止,通过医院电子病历系统、问卷调查等获取孕妇孕期情况、妊娠结局等信息,建设孕妇队列。采用log-binomial回归模型探讨GDM与早产［医源性早产和自发性早产（未足月胎膜早破和早产临产）］之间的关联;对于多个混杂因素,采用倾向性评分校正法构建模型计算调整后的关联。结果 在2 031例分娩单胎的孕妇中,GDM和早产的发生比例分别为10.0%（204例）和4.4%（90例）;其中,GDM组（n=204）孕妇发生医源性早产和自发性早产的比例分别为1.5%和5.9%,非GDM组（n=1 827）孕妇发生医源性早产、自发性早产的比例分别为0.9%和3.2%,两组自发性早产的比例差异有统计学意义（P=0.048）。进一步细化自发性早产亚型,结果显示GDM组发生未足月胎膜早破、早产临产的比例分别为4.9%和1.0%,非GDM组发生未足月胎膜早破、早产临产的比例分别为2.1%和1.1%。GDM孕妇发生未足月胎膜早破的风险是非GDM孕妇的2.34倍（aRR=2.34,95%CI：1.16~4.69）。结论 GDM可能增加未足月胎膜早破的发生风险,未发现GDM孕妇早产临产发生比例显著增加。     

Traffic-related air pollution and risk of preterm birth in the San Joaquin Valley of California

PurposeTo evaluate associations between traffic-related air pollution during pregnancy and preterm birth in births in four counties in California during years 2000 to 2006.MethodsWe used logistic regression to examine the association between the highest quartile of ambient air pollutants (carbon monoxide, nitrogen dioxide, particulate matter <10 and 2.5 μm) and traffic density during pregnancy and each of five levels of prematurity based on gestational age at birth (20–23, 24–27, 28–31, 32–33, and 34–36 weeks) versus term (37–42 weeks). We examined trimester averages and the last month and the last 6 weeks of pregnancy. Models were adjusted for birthweight, maternal age, race/ethnicity, education, prenatal care, and birth costs payment. Neighborhood socioeconomic status (SES) was evaluated as a potential effect modifier.ResultsThere were increased odds ratios (ORs) for early preterm birth for those exposed to the highest quartile of each pollutant during the second trimester and the end of pregnancy (adjusted OR, 1.4–2.8). Associations were stronger among mothers living in low SES neighborhoods (adjusted OR, 2.1–4.3). We observed exposure–response associations for multiple pollutant exposures and early preterm birth. Inverse associations during the first trimester were observed.ConclusionsThe results confirm associations between traffic-related air pollution and prematurity, particularly among very early preterm births and low SES neighborhoods.     

Bipolar disorder and leisure-time physical activity: Results from a national survey of Canadians

PurposeThe aim of this study was to compare patterns of PA and its potential correlates in individuals with BD to the general population using a representative sample of Canadians.MethodsWe used data from the 2002 Canadian Community Health Survey 1.2, a national, cross-sectional survey focusing on mental health and addiction (n = 36,984). We compared PA levels among individuals with BD (n = 831) to those diagnosed with major depression (n = 4713) and those with no identified mood disorder (n = 31,834). Using multivariable logistic regression, we then compared independent effects of sociodemographic and clinical factors in active and inactive BD individuals stratified by relative weight status.ResultsThere were no differences in the proportion of individuals characterized as active, moderately active or inactive among individuals with BD, major depressive disorder or the general population. No sociodemographic or clinical variables were related to PA in individuals with BD, and the relationships between these variables and PA level were not different than those observed in the general population. BD status was independently associated with being overweight (OR = 1.26, p = 0.03). An interaction between BD status and PA was also observed (OR = 1.12, p = 0.005), suggesting a reduced role for PA in reducing the risk of being overweight in person with BD.ConclusionsThe results suggest that levels of self-reported PA are not lower among people with BD living in the community than in the general population. Future research should assess levels of PA using objective measures and determine whether PA improves psychosocial outcomes in this population.     

Physical activity and loneliness among adolescents with disabilities: Examining the quality of physical activity experiences as a possible moderator

BackgroundAdolescents with disabilities (AWD) often report higher loneliness levels than adolescents without disabilities, as they frequently encounter barriers to social participation. A negative relationship between physical activity (PA) and loneliness has been established outside of AWD populations, while few studies have examined this association among AWD. Research investigating the relationship between PA and loneliness has not systematically examined aspects of PA experiences that may influence this relationship.ObjectivesThe objectives of this study were to: a) examine the direct relationship between PA and loneliness among AWD, and b) examine the quality of PA experiences, as framed within a quality participation conceptualization, as a possible moderator of the relationship between PA and loneliness.MethodsThis study was a cross-sectional sub-analysis of data from The National Physical Activity Measurement Study. Participants included 40 Canadian adolescents, age 10-17, with any type of disability who completed a series of questionnaires either online or via telephone/video interview.ResultsPA and loneliness were not significantly related at the bivariate level (r = ?0.10, p = .54), but quality of PA participation significantly moderated the relationship between PA and loneliness (95% C.I. = 0.002–0.019, p = .02). These results suggest that greater PA rates were significantly and negatively associated with loneliness among AWD who reported experiencing high quality PA experiences.ConclusionsThis research can be used as evidence to inform mechanistic studies with causal data to provide more robust findings on the possible value of high-quality PA experiences to mitigate feelings of loneliness among AWD.     

Theory of planned behavior to promote physical activity of adults with physical disabilities: Meta-analytic structural equation modeling

BackgroundAdults with physical disabilities experience lower physical activity (PA) engagement. The theory of planned behavior (TPB) has been one of dominant theories in understanding and promoting PA. There is no previous meta-analysis examining the use of the TPB on PA of adults with physical disabilities.ObjectiveThe purposes of this review were 1) to conduct meta-analysis to examine predictive effects of TPB on PA behavior of adults with physical disabilities and 2) to investigate a possible moderator among components of TPB.MethodsOne-stage meta-analytic structural equation modeling was used to conduct meta-analysis. Type of physical disability was examined as a moderator.ResultsIntention had moderate effect on PA (β = 0.37, p < .001), attitude had a moderate effect on intention (β = 0.30, p < .001), SN had a non-significant effect on intention (β = 0.03, p = .75), and PBC had a moderate effect on intention (β = 0.43, p < .001) and a non-significant direct effect on PA (β = 0.09, p = .18). The studies conducted with only participants with SCI lowered the predictive effect (β = ?0.12, p = .02) of PBC on PA.ConclusionsPredictive effects of component of TPB were slightly different from those of individuals without disabilities. Type of physical disability can be a critical factor determining the impact of perceived control on PA behavior. Attitude and PBC can be targets for promoting PA of adults with physical disabilities.     

Inverse Dose-Response Relationship Between Home Health Care Services and Rehospitalization in Older Adults

Objectives(1) To examine the impact of specific services [skilled nursing (SN), physical therapy (PT), occupational therapy (OT), and home health aide (HA)] in Medicare-certified home health care (HHC) on subsequent rehospitalization among older patients during a 60-day HHC episode and (2) to test the moderating effect of functional limitation on these services.DesignSecondary analysis of data from the Outcome and Assessment Information Set (OASIS) and HHC administrative records of a statewide not-for-profit HHC agency from January 1, 2016, to December 31, 2016.Setting and ParticipantsParticipants were ≥65 years old and were admitted to HHC within 48 hours of hospital discharge.MeasuresOutcome was time to rehospitalization during the 60-day HHC episode (ie, number of days). Independent variables were visit intensity (number of visits/week) of SN, PT, OT, and HA, respectively. Functional limitation was measured by a composite score generated from 9 OASIS items on physical function. Multivariate Cox Proportional hazard analyses were conducted. Subgroup analysis (high vs low functional limitation) was conducted to examine the moderating effect of functional limitation on specific HHC services. Ad hoc analysis was conducted to examine potential interaction between specific HHC services that were significantly related to rehospitalization.ResultsThe sample included 1377 participants, among whom 11.5% were rehospitalized during the 60-day HHC episode. At the threshold dose of 1 PT or 2 SN visits/week, higher visit intensity significantly reduced the hazard of rehospitalization in these patients by up to 82% for PT (2.30 visits/week; hazard ratio [HR] = 0.18, P value < .001) and 48% for SN visits (2.51 visits/week; HR = 0.52, P value < .05). The effect of PT on reducing the risk of rehospitalization was more pronounced in patients with low versus high functional limitation (2.30 visits/week, HR = 0.08 vs 0.24, both P < .001). SN was only effective in reducing the hazard of rehospitalization in the low functional limitation group (1.70 visits/week, HR = 0.41, P < .05; 2.51 visits/week, HR = 0.29, P < .05), but not in the high functional limitation group (P > .05 at all intensity levels). Visit intensity of HA or OT was not significantly related to rehospitalization.Conclusions/RelevanceAt a threshold of 1 PT visit or 2 SN visits/week, HHC lowered the risk of rehospitalization in older patients by up to 82% and 48%, respectively. Both PT and SN were more effective in avoiding rehospitalization in patients with low functional limitation than in those with high functional limitation. Older patients should receive enough HHC services (especially PT and SN) to avoid rehospitalizations with consideration of their functional limitation.     

Seroprevalance of pertussis antibodies in maternal and cord blood of preterm and term infants

Background

The resurgence of pertussis has resulted in an increased morbidity and mortality, especially among young infants. The aim of our study was to determine the antibody concentrations against pertussis antigens in cord and maternal blood in both preterm and term infant–mother pairs and to evaluate the efficacy of transplacental antibody transfer.

Methods

Antibodies to pertussis toxin (PT) and filamentous hemagglutinin (FHA) in maternal and cord blood samples were measured by in-house enzyme linked immunosorbent assay (ELISA) in 100 preterm infant–mother and 100 term infant–mother pairs. Geometric mean concentrations (GMCs) of pertussis antibodies and cord:maternal GMC ratios were calculated.

Results

Cord GMCs for anti-PT and anti-FHA in the preterm group were 13.15 and 14.55 ELISA U/ml (EU/ml), respectively. Cord GMCs for anti-PT and anti-FHA in the term group were 19.46 and 19.18 EU/ml, respectively. Cord anti-PT GMC was significanlty lower in the preterm group (p = 0.037). There were no differences between the groups with regard to maternal anti-PT and anti-FHA GMC. Placental transfer ratios for anti-PT and anti-FHA in preterms were 68% and 72%, respectively. The same ratios in terms were 107% and 120%, respectively and were significantly higher than those of preterms (p < 0.001). Placental transfer ratios were even lower in preterms <32 weeks when compared to preterms ≥32 weeks and terms. There was a strong correlation between maternal and cord anti-pertussis antibody levels both in preterm and term infants.

Conclusions

Anti-pertussis antibody levels were generally low in infant–mother pairs and would not be adequate to confer protection until the onset of primary immunization series. Transplacental anti-pertussis antibody transfers and antibody levels were lower in the cord blood of preterm infants, especially in those <32 weeks. These findings support the rationale for maternal immunization, which in combination with cocooning, could be a better option for preterm infants.     

Validation of handgrip strength and endurance as a measure of physical function and quality of life in healthy subjects and patients

ObjectiveHandgrip strength (HGS) is often used as a bedside measurement of muscle function in the hospital setting. The aim of this study was to investigate the extent to which HGS, endurance, and work (force during endurance × time) are related to physical function as measured by mobility and physical activity (PA) in young, healthy volunteers. Further, the relations between HGS, mobility, PA and quality of life (QoL) in patients were investigated.MethodsNinety-two healthy subjects (45% men, mean age 30 y) and 45 patients (56% men, mean age 55 y) were assessed for HGS, handgrip endurance, and handgrip work, mobility (timed up-and-go test), and PA (Baecke questionnaire or Bouchard activity diary). The patients were further assessed for QoL (SF-36).ResultsThere was a correlation between HGS and mobility in healthy subjects (r = ?0.31, P = 0.0028) and patients (r = ?0.59, P < 0.0001). Further, HGS and mobility were related to physical and mental component summary scores of QoL in patients. There was also a relation between HGS and PA in healthy female subjects and male patients.ConclusionHandgrip strength is a valid measurement of mobility and QoL in patients and of PA in healthy female subjects and male patients. Handgrip endurance and work were not found to be valid measurements of mobility and PA in healthy subjects or of QoL in patients.     

Correlates of Physical Activity Engagement among Pregnant Women with Overweight and Obesity

BackgroundExcess weight during pregnancy increases risk for adverse obstetrical outcomes. Physical activity (PA) may buffer these effects, although it is unclear what factors are associated with PA in women who begin pregnancy with overweight/obesity. The present study sought to characterize the demographic and psychological correlates of PA among women with prepregnancy overweight/obesity.MethodsPregnant women (N = 249; mean age, 28.48 ± 5.48 years; mean body mass index, 34.13 ± 7.07 kg/m²) at 12–20 weeks of gestation (mean, 15.68 ± 2.44 weeks of gestation) completed ratings of perceived stress and depressive symptoms and were interviewed using the pregnancy version of the Eating Disorders Examination. The Paffenbarger Physical Activity Survey was administered via interview to estimate energy expenditure. Continuous outcomes were evaluated via linear regression, while logistic regression was conducted to assess likelihood of meeting PA guidelines.ResultsMean weekly duration of moderate to vigorous PA was 109.50 ± 248.17 minutes, with 21% of women meeting federal PA guidelines of 150 minutes or more. Higher perceived stress (β = –0.217; p = .02) and eating psychopathology (β = –0.213; p < .01) were associated with lower total energy expenditure. Black women reported lower expenditure specifically from walking compared with White women (β = –0.180; p = .03). Depressive symptoms were not associated with PA. No estimate of PA predicted body mass index.ConclusionsPregnant women with overweight/obesity engage in modest amounts of PA early in pregnancy, although few meet PA guidelines. Greater perceived stress and eating psychopathology were associated with lower PA engagement. These factors should be monitored by obstetrics providers to identify women who may particularly benefit from counseling about PA during pregnancy.     

Physical activity of patients with schizophrenia in Nigeria: Distribution and correlates

BackgroundExcess morbidity among patients with schizophrenia has been linked to physical inactivity. Unfortunately, very few patients with schizophrenia engage in a health-enhancing level of physical activity (PA). There are geographic and cultural variations in levels of PA. The aim of this study was to examine PA levels in Nigerian patients with schizophrenia and to identify the clinical as well as sociodemographic correlates of PA in such patients.MethodsThe patients were recruited from the Department of Psychiatry, University College Hospital, Ibadan, and the Psychiatry Unit of the State Hospital, Adeoyo, Ibadan, Nigeria. We assessed their physical activity (PA) with the International Physical Activity Questionnaire (IPAQ) Short Form. The symptom severity of patients with schizophrenia was assessed with the Positive and Negative Syndrome Scale (PANSS). Anthropometric measures such as waist circumference, weight and height were also taken. We then explored the factors that were independently associated with PA using binary logistic regression models.ResultsTwo hundred and fifteen patients with schizophrenia were included in the study. The majority of the participants 143 (67.1%) had a low level of PA. Physical activity was associated with the remission status of the participants (P = 0.03). The level of education (r = −0.18 p = 0.01), waist circumference (r = −0.17p = 0.02) and the severity of depression (r = −0.15 p = 0.03), were inversely correlated with the level of physical activity. Social and occupational functioning were positively correlated with the level of physical activity (r = 0.24 p < 0.01). Psychopathology, namely excitement (P4) on the PANSS scale was positively correlated with PA (r = 0.18 p = 0.01), while a lack of judgment and lack of insight were negatively correlated with PA (r = −0.14 p = 0.04). The level of education, waist circumference, social and occupational functioning were independently associated with PA (all p < 0.05).ConclusionThe level of physical activity in the majority of patients with schizophrenia from Nigeria is low. Such physical activity is associated with certain sociodemographic and clinical correlates. These can be foci of targeted intervention to improve PA.     

母亲身高与早产的相关分析

目的 探讨母亲身高与早产的关系。方法 研究数据来自武汉健康宝贝出生队列。2012年9月至2014年10月,该队列招募11 311名在武汉市妇女儿童医疗保健中心分娩单胎活产儿的孕妇。通过问卷调查、查阅保健手册和病历记录收集资料。共选取11 070名孕妇作为研究对象。根据身高的四分位数将研究对象分为4组（<158、158～、160～以及>164 cm）。依据末次月经确定孕周,并将妊娠满28周至不足37周间的分娩定义为早产。采用logistic回归分析计算身高与早产的OR值以及95% CI。结果 11 070名孕妇早产发生率为5.9%（650/11 070）。控制了可能的混杂因素后,logistic回归分析显示,身高<158 cm组发生早产的风险较身高>164 cm组增加46%（OR=1.46,95% CI：1.16～1.83）。身高每增加1 cm,早产的风险减少3%（OR=0.97,95% CI：0.95～0.99）。结论 身高较矮的孕妇其早产风险增加,应加强对该类型孕妇的监测,降低早产的发生风险。     

Physical activity in persons with late effects of polio: A descriptive study

BackgroundTo promote a healthy and active lifestyle there is a need to increase our knowledge of the level of physical activity (PA) among people with late effects of polio.ObjectivesTo examine PA in people with late effects of polio and to assess the relationship between PA, life satisfaction and various sociodemographic factors.MethodsPA was assessed in 81 persons with late effects of polio using the Physical Activity and Disability Survey (PADS) and by a pedometer. Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11).ResultsThe amount of PA varied considerably but on average the participants were physically active almost 3 h per day, mostly in household activities. The mean value of the pedometer counts was 6212 steps per day (SD = 3208). Sixty-nine percent of the participants rated themselves as satisfied with life as a whole. The sum of PADS was positively and significantly related to the number of steps (r = 0.39, p < 0.001), increasing age (r = 0.26, p < 0.05) and to the level of global satisfaction with life (rho = 0.23, p < 0.05). The number of steps was also positively and significantly associated with level of global satisfaction with life (rho = 0.37, p < 0.001).ConclusionDespite a progressive physical disability, people with late effects of polio are physically active, but much of the activities are performed as part of their household activities and not as traditional exercise. The relationship between PA, life satisfaction and age further supports the general contention that an active lifestyle is an important factor for perceived well-being among older people.     

Adolescent E-Cigarette Onset and Escalation: Associations With Internalizing and Externalizing Symptoms

PurposeWe sought to evaluate if internalizing symptoms (i.e., anxiety and depression) and/or externalizing symptoms (i.e., impulsivity, sensation seeking, and substance use) were risk factors for the onset of 30-day e-cigarette use and escalation in the number of days used across the following 30 months among adolescents.MethodsAdolescents (N = 1,808) from public high schools outside Philadelphia, PA, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 30 months (spring 2019, end of 11th grade).ResultsA two-part latent growth curve model of e-cigarette use revealed significant positive associations between externalizing factors, past 30-day e-cigarette use, and the number of days of e-cigarette use only at wave 1 (p values <.05). Cigarette smoking was associated with a slowing in the rate of onset of 30-day e-cigarette use across the 30-month follow-up (β = ?.24, z = ?2.41, p = .02). Depression was associated with an increased rate of escalation in the number of days of e-cigarette use across the following 30 months (β = .01, z = 2.52, p = .01), whereas anxiety was associated with a decreased rate (β = ?.72, z = ?2.36, p = .02).ConclusionsThe findings highlight two groups of adolescents at risk for e-cigarette use: adolescents whose e-cigarette use reflects a higher-risk profile with early e-cigarette onset, and adolescents who have a lower-risk profile, at least initially, with later e-cigarette use onset. The timing and content of prevention efforts should be tailored to each group.     

Prevalence of physical activity in European adults — Compliance with the World Health Organization's physical activity guidelines

BackgroundAdults are recommended to engage in at least 150 min/week of moderate-to-vigorous physical activity (PA).PurposeThis study aimed to examine the level of compliance with PA recommendations among European adults.MethodsUsing data from European Social Survey round 6, PA self-report data was collected from 52,936 European adults from 29 countries in 2012. Meeting PA guidelines was assessed using World Health Organization criteria.Results61.47% (60.77% male, 62.05% female) of European adults reported to be engaged in moderate to vigorous PA at least 30 min on 5 or more days per week. The likelihood of achieving the PA recommended levels was higher among respondents older than 18–24. For those aged 45–64 years the likelihood increased 65% (OR = 1.65, 95% CI: 1.51–1.82, p < 0.001) and 112% (OR = 2.12, 95% CI: 1.94–2.32, p < 0.001) for males and females, respectively. Those who were high school graduates were more likely to report achieving the recommended PA levels than those with less than high school education (males: OR = 1.19, 95% CI: 1.12–1.27, p < 0.001; females: OR = 1.13, 95% CI: 1.06–1.20, p < 0.001).ConclusionAlthough about 60% of European adults reported achieving the recommended levels of PA, there is much room for improvement among European adults, particularly among relatively inactive subgroups.     

The Association Between Major Birth Defects and Preterm Birth

Objective To evaluate the association between preterm birth and major birth defects by maternal and infant characteristics and specific types of birth defects. Study Design We pooled data for 1995–2000 from 13 states with population-based birth defects surveillance systems, representing about 30% of all U.S. births. Analyses were limited to singleton, live births from 24–44 weeks gestational age. Results Overall, birth defects were more than twice as common among preterm births (24–36 weeks) compared with term births (37–41 weeks gestation) (prevalence ratio [PR] = 2.65, 95% confidence interval [CI] 2.62–2.68), and approximately 8% of preterm births had a birth defect. Birth defects were over five times more likely among very preterm births (24–31 weeks gestation) compared with term births (PR = 5.25, 95% CI 5.15–5.35), with about 16% of very preterm births having a birth defect. Defects most strongly associated with very preterm birth included central nervous system defects (PR = 16.23, 95% CI 15.49–17.00) and cardiovascular defects (PR = 9.29, 95% CI 9.03–9.56). Conclusions Birth defects contribute to the occurrence of preterm birth. Research to identify shared causal pathways and risk factors could suggest appropriate interventions to reduce both preterm birth and birth defects.