Special Issue "Population-Based Birth Cohort Studies in Epidemiology"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 March 2020).

Special Issue Editors

Prof. Dr. Cristina Canova
Website
Guest Editor
Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
Interests: population-based birth cohort study; longitudinal studies; environmental epidemiology; pharmacoepidemiology; real-world data
Dr. Anna Cantarutti
Website
Guest Editor
1. National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy;
2. Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
Interests: biostatistics; epidemiology; pharmacoepidemiology; healthcare research; real-world data; real-world evidence; population-based birth cohort study; longitudinal studies; utilization, comparative safety and effectiveness of prescription medications in pregnant women and their offspring
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Special Issue Information

Dear colleagues,

Progressive technological and organizational improvements in recording, storing and integrating healthcare data have increased interest in the use of real-world data to enhance the efficiency of research and to bridge evidentiary gaps between clinical research and practice. Real-world data derives from a variety of sources, including health administrative databases (HADs) and electronic health records. HADs are designed to collect information related to healthcare services such as drug prescriptions, hospital discharge records, birth and mortality records, exemptions from health-care copayments and so on for administrative purposes. However, they are increasingly being used to examine features of healthcare delivery such as practice patterns, quality of care, safety and effectiveness of drugs, and other parameters that can be evaluated by means of epidemiological studies, as well as to support healthcare/policy decision-making. In countries with a universal healthcare system, these data sources reliably reflect health-related conditions at a population level, by gathering widespread information at the individual level.

Despite the difficulty of disentangling risk factors, the period of in utero development is one of the most critical windows during which adverse conditions and exposures may influence the growth and development of the fetus, as well as its future postnatal developmental and behavioral outcomes. Therefore, the prenatal and early postnatal periods are important for identifying critical windows of susceptibility.

Birth cohort studies are the most appropriate design to determine the causal relation between potential risk factors during the prenatal period and the health of the newborn and child. Since individuals are followed longitudinally across their life span from birth, or even from the intrauterine period, birth cohorts allow us to delineate associations between early exposures and subsequent outcomes. Birth cohorts based on the recruitment and active follow-up of mothers and children allow the collection of biological material, and specific clinical and genetic information. However, they require a considerable amount of time and resources and, besides being usually of limited size, they are exposed to the risk of loss of subjects to follow-up, with decrease statistical power and possible selection bias. For these reasons, linking the medical birth register with administrative health records for mothers and babies—first carried out in the Scandinavian countries—is increasingly being used in other countries, including Italy, Scotland, Canada, Australia, the US and the Netherlands, amongst others.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) focuses on the current state of knowledge on perinetal and postnatal exposures and adverse pregnancy, maternal, fetal and neonatal outcomes through record-linkage, population-based birth cohort study designs. Papers of a high academic standard addressing these topics are invited for submission to this Special Issue.

Possible topics for this Special Issue include:

  1. Pharmacoepidemiology in pregnancy and childhood and the epidemiology of pregnancy and related neonatal complications;
  2. Maternal social disadvantage and birth outcomes;
  3. Exposure to prenatal environmental risk factors (i.e. air pollution, chemicals, etc.) on perinatal and childhood outcomes;
  4. Safety and effectiveness of prescription medications in pregnant women and their offspring.

Prof. Dr. Cristina Canova
Dr. Anna Cantarutti
Guest Editors

Manuscript Submission Information

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Keywords

  • Birth cohort study
  • Epidemiology
  • Real-world data
  • Record linkage
  • Perinatal and postnatal exposure
  • Environmental exposure
  • Pharmacoepidemiology

Published Papers (13 papers)

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Editorial

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Open AccessEditorial
Population-Based Birth Cohort Studies in Epidemiology
Int. J. Environ. Res. Public Health 2020, 17(15), 5276; https://doi.org/10.3390/ijerph17155276 - 23 Jul 2020
Abstract
Birth cohort studies are the most appropriate type of design to determine the causal relationship between potential risk factors during the prenatal or postnatal period and the health status of the newborn up to childhood and potentially adulthood. To date, there has been [...] Read more.
Birth cohort studies are the most appropriate type of design to determine the causal relationship between potential risk factors during the prenatal or postnatal period and the health status of the newborn up to childhood and potentially adulthood. To date, there has been a growth in interest regarding observational population-based studies which are performed to provide answers to specific research questions for defined populations, for instance, assessing the exposure to environmental pollutants or drugs on the risk of developing a disease. Birth cohorts based on the recruitment and active follow-up of mothers and children allow the collection of biological material, and specific clinical and genetic information. However, they require a considerable amount of time and resources and, besides being usually of limited size, they are exposed to the risk of the loss of subjects to follow-up, with decreased statistical power and possible selection bias. For these reasons, linking the medical birth register with administrative health records for mothers and babies is increasingly being used in countries with a universal healthcare system, allowing researchers to identify large and unselected populations from birth, and to reconstruct relevant traits and care pathways of mothers and newborns. This Special Issue of the International Journal of Environmental Research and Public Health focuses on the current state of knowledge on perinatal and postnatal exposures and adverse pregnancy, maternal, fetal and neonatal outcomes through population-based birth cohort studies, with a specific focus on real-word data. The 12 accepted articles covered a wide range of themes that can be addressed specifically through birth cohort study design; however, only three were based on real word data with record-linkage to health administrative databases. In particular, two papers have addressed the topic of socioeconomic status considering several indicators both at the individual and contextual level. Two papers focused on inflammatory bowel diseases, both as an outcome of perinatal and antibiotic exposure in early life and as a condition associated with asthma, among children identified in a birth cohort based on a Regional Medical Birth Register. Three articles focused on medication use during pregnancy and its impact on maternal and fetal health. The effect of exposure to prenatal environmental risk factors on perinatal and childhood outcomes has been considered in two papers. Two papers analyzed ad hoc nationwide prospective birth cohorts set in Japan and UK. Finally, we included a systematic review with meta-analysis to evaluate the relation between growth restriction at birth and congenital heart defects. We think that this Special Issue may contribute to enriching the discussion of future challenges, opportunities, strengths and limitations for all research topics that can be investigated using a population-based birth cohort study design. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)

Research

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Open AccessArticle
Risk of Prevalent Asthma among Children Affected by Inflammatory Bowel Disease: A Population-Based Birth Cohort Study
Int. J. Environ. Res. Public Health 2020, 17(12), 4255; https://doi.org/10.3390/ijerph17124255 - 15 Jun 2020
Cited by 1
Abstract
Literature on the risk of asthma among children with inflammatory bowel disease (IBD) is limited and has reported discording results. To the best of our knowledge, no previous study has evaluated the association between asthma and childhood onset IBD, focusing on pediatric IBD [...] Read more.
Literature on the risk of asthma among children with inflammatory bowel disease (IBD) is limited and has reported discording results. To the best of our knowledge, no previous study has evaluated the association between asthma and childhood onset IBD, focusing on pediatric IBD with onset between 10 and 17 years, early-onset IBD (EO-IBD) between 0 and 9 years, and very early-onset IBD (VEO-IBD) between 0 and 5 years, all conditions characterized by different clinical progressions. A nested matched case-control design on a longitudinal cohort of 213,515 newborns was adopted. Conditional binomial regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) of asthma among children with IBD compared with controls. We found 162 children with IBD and 1620 controls. Overall, childhood onset IBD was associated with increased risks of being affected by asthma (OR: 1.49 95% CI 1.05–2.12), although a significant risk was only present among males (OR: 1.60 95% CI 1.02–2.51). Children with Crohn’s disease and ulcerative colitis had similarly increased risks, although they failed to attain statistical significance. Risks of asthma based on age at IBD onset were inversely related to age, with the lowest non-significant risks for pediatric IBD and EO-IBD, while children affected by VEO-IBD had the highest risk of asthma (OR: 2.75 95% CI 1.26–6.02). Our study suggests the presence of a higher prevalence of asthma among both male children with IBD and children with VEO-IBD. It could be advisable to pay greater attention to possible respiratory symptoms among these categories at higher risk. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
Open AccessFeature PaperArticle
Use and Intentional Avoidance of Prescribed Medications in Pregnancy: A Cross-Sectional, Web-Based Study among 926 Women in Italy
Int. J. Environ. Res. Public Health 2020, 17(11), 3830; https://doi.org/10.3390/ijerph17113830 - 28 May 2020
Cited by 1
Abstract
Nation-wide information about medication use in pregnancy is lacking for Italy, and no study has so far investigated the prescribed medications which pregnant women deliberately avoid. In this study, we map medication use patterns in pregnancy, as well as the extent and type [...] Read more.
Nation-wide information about medication use in pregnancy is lacking for Italy, and no study has so far investigated the prescribed medications which pregnant women deliberately avoid. In this study, we map medication use patterns in pregnancy, as well as the extent and type of prescribed medications which are purposely avoided by pregnant women in Italy. This is a sub-study within the “Multinational Medication Use in Pregnancy Study”—a cross-sectional, web-based study conducted in Italy from 7 November 2011 to 7 January 2012. Using an anonymous electronic questionnaire, we collected data from pregnant women and new mothers on medication use and deliberate avoidance during pregnancy and maternal characteristics. The sample included 926 women residing in Italy. The point prevalence of total medication use was 71.2%. Whereas 61.4% and 12.4% of women reported medication use for the treatment of short and longer-term illnesses, respectively, only 8.8% reported medication use for the treatment of both a short and a longer-term illness in pregnancy. We found no substantial differences in estimates across various geographical areas of Italy. Overall, 26.6% of women reported to have deliberately avoided a prescribed medication in pregnancy—most often nimesulide or ketoprofen, but also antibiotics. We conclude that prenatal exposure to medication is common among women in Italy, but estimates are lower than in other Western countries. Intentional avoidance of important medications by pregnant women raises concerns about the safeguarding of maternal–child health. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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Open AccessFeature PaperArticle
An Italian Network of Population-Based Birth Cohorts to Evaluate Social and Environmental Risk Factors on Pregnancy Outcomes: The LEAP Study
Int. J. Environ. Res. Public Health 2020, 17(10), 3614; https://doi.org/10.3390/ijerph17103614 - 21 May 2020
Cited by 1
Abstract
In Italy, few multicentre population-based studies on pregnancy outcomes are available. Therefore, we established a network of population-based birth cohorts in the cities of Turin, Reggio Emilia, Modena, Bologna, and Rome (northern and central Italy), to study the role of socioeconomic factors and [...] Read more.
In Italy, few multicentre population-based studies on pregnancy outcomes are available. Therefore, we established a network of population-based birth cohorts in the cities of Turin, Reggio Emilia, Modena, Bologna, and Rome (northern and central Italy), to study the role of socioeconomic factors and air pollution exposure on term low birthweight, preterm births and the prevalence of small for gestational age. In this article, we will report the full methodology of the study and the first descriptive results. We linked 2007–2013 delivery certificates with municipal registry data and hospital records, and selected singleton livebirths from women who lived in the cities for the entire pregnancy, resulting in 211,853 births (63% from Rome, 21% from Turin and the remaining 16% from the three cities in Emilia-Romagna Region). We have observed that the association between socioeconomic characteristics and air pollution exposure varies by city and pollutant, suggesting a possible effect modification of both the city and the socioeconomic position on the impact of air pollution on pregnancy outcomes. This is the largest Italian population-based birth cohort, not distorted by selection mechanisms, which has also the advantage of being sustainable over time and easily transferable to other areas. Results from the ongoing multivariable analyses will provide more insight on the relative impact of different strands of risk factors and on their interaction, as well as on the modifying effect of the contextual characteristics. Useful recommendations for strategies to prevent adverse pregnancy outcomes may eventually derive from this study. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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Open AccessArticle
Mother–Infant Co-Sleeping and Maternally Reported Infant Breathing Distress in the UK Millennium Cohort
Int. J. Environ. Res. Public Health 2020, 17(9), 2985; https://doi.org/10.3390/ijerph17092985 - 25 Apr 2020
Cited by 2
Abstract
Mother–infant co-sleeping or bed sharing is discouraged by health organisations due to evidence that it is associated with unexplained sudden infant death. On the other hand, there is evidence that it should theoretically be beneficial for infants. One line of this evidence concerns [...] Read more.
Mother–infant co-sleeping or bed sharing is discouraged by health organisations due to evidence that it is associated with unexplained sudden infant death. On the other hand, there is evidence that it should theoretically be beneficial for infants. One line of this evidence concerns breathing regulation, which at night is influenced by the rocking movement of the mother’s chest as she breathes. Here, the hypothesis that mother–infant co-sleeping will be associated with a lower probability of infant breathing distress is tested in the UK Millennium Cohort Study (n = 18,552 infants). Maternal, infant, family, and socio-economic covariates were included in logistic regression analysis, and in a machine learning algorithm (Random Forest) to make full use of the number of variables available in the birth cohort study data. Results from logistic regression analysis showed that co-sleeping was associated with a reduced risk of breathing difficulties (OR = 0.69, p = 0.027). The Random Forest algorithm placed high importance on socio-economic aspects of infant environment, and indicated that a number of maternal, child, and environmental variables predicted breathing distress. Co-sleeping by itself was not high in the Random Forest variable importance ranking. Together, the results suggest that co-sleeping may be associated with a modest reduction in risk of infant breathing difficulties. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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Open AccessArticle
Long Term Risks to Neonatal Health from Exposure to War—9 Years Long Survey of Reproductive Health and Contamination by Weapon-Delivered Heavy Metals in Gaza, Palestine
Int. J. Environ. Res. Public Health 2020, 17(7), 2538; https://doi.org/10.3390/ijerph17072538 - 08 Apr 2020
Cited by 5
Abstract
Introduction: High levels of environmental contaminants with long term effects and teratogenic and carcinogenic potential, such as heavy metals, were introduced by weaponry in war areas in the last decades. Poorer reproductive health and increases in non-communicable diseases were reported after wars [...] Read more.
Introduction: High levels of environmental contaminants with long term effects and teratogenic and carcinogenic potential, such as heavy metals, were introduced by weaponry in war areas in the last decades. Poorer reproductive health and increases in non-communicable diseases were reported after wars and are the suspected long term effects of contamination by stable war remnants. Although potentially affecting millions of people, this is still an understudied issue of public health. Background: Gaza, Palestine since 2006 has been an object of repeated severe military attacks that left heavy metals remnants in the environment, in wound tissues and that were assumed by the population. Retrospective studies showed a progressive increase in birth defects since the 2006 attacks. In 2011 we started surveillance at birth alongside analysis of the heavy metals load carried by pregnant women and their babies. Methods: We used protocols for birth registration which also document the extent of exposures to attacks, war remnants and to other environmental risks that allow comparison of 3 data sets—2011, 2016 and 2018–2019 (4000–6000 women in each set). By ICP/MS analysis we determined the content of 23 metals in mothers’ hair. Appropriate statistical analysis was performed. Results: Comparison of data in birth registers showed a major increase in the prevalence in birth defects and preterm babies between 2011 and 2016, respectively from 1.1 to 1.8% and from 1.1 to 7.9%, values remaining stable in 2019. Negative outcomes at birth in 2016 up to 2019 were associated with exposure of the mothers to the attacks in 2014 and/or to hot spots of heavy metals contamination. Metal loads since the attacks in 2014 were consistently high until 2018–2019 for barium, arsenic, cobalt, cadmium, chrome, vanadium and uranium, pointing to these metals as potential inducers for the increased prevalence of negative health outcomes at birth since 2016. Conclusions: Bodily accumulation of metals following exposure whilst residing in attacked buildings predispose women to negative birth outcomes. We do not know if the metals act in synergy. Trial for mitigation of the documented negative effects of high metal load on reproductive health, and ensuing perinatal deaths, could now be done in Gaza, based on this documentary record. High load of heavy metals may explain recent increases in non-communicable diseases and cancers at all ages in Gaza. Modern war’s legacy of diseases and deaths extends in time to populations and demands monitoring. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
Open AccessFeature PaperArticle
Perinatal and Antibiotic Exposures and the Risk of Developing Childhood-Onset Inflammatory Bowel Disease: A Nested Case-Control Study Based on a Population-Based Birth Cohort
Int. J. Environ. Res. Public Health 2020, 17(7), 2409; https://doi.org/10.3390/ijerph17072409 - 02 Apr 2020
Cited by 3
Abstract
The role of early-life environmental exposures on Inflammatory Bowel Disease (IBD) onset remains unclear. We aimed to quantify the impact of perinatal conditions and antibiotic use in the first 6 and 12 months of life, on the risk of childhood-onset IBD, in a [...] Read more.
The role of early-life environmental exposures on Inflammatory Bowel Disease (IBD) onset remains unclear. We aimed to quantify the impact of perinatal conditions and antibiotic use in the first 6 and 12 months of life, on the risk of childhood-onset IBD, in a birth cohort of the region Friuli-Venezia Giulia (Italy). A nested case-control design on a longitudinal cohort of 213,515 newborns was adopted. Conditional binomial regression models were used to estimate Odds Ratios (OR) with 95% confidence intervals (CI) for all analyzed risk factors. We identified 164 individuals with IBD onset before the age of 18 years and 1640 controls. None of the considered perinatal conditions were associated with IBD. Analyses on antibiotic exposure were based on 70 cases and 700 controls. Risks were significantly higher for children with ≥4 antibiotic prescriptions in the first 6 and 12 months of life (OR = 6.34; 95%CI 1.68–24.02 and OR = 2.91; 95%CI 1.31–6.45, respectively). This association was present only among patients with Crohn’s disease and those with earlier IBD onset. We found that perinatal characteristics were not associated to IBD, while the frequent use of antibiotics during the first year of life was associated to an increased risk of developing subsequent childhood-onset IBD. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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Open AccessArticle
Measuring Child Socio-Economic Position in Birth Cohort Research: The Development of a Novel Standardized Household Income Indicator
Int. J. Environ. Res. Public Health 2020, 17(5), 1700; https://doi.org/10.3390/ijerph17051700 - 05 Mar 2020
Cited by 4
Abstract
The assessment of early life socioeconomic position (SEP) is essential to the tackling of social inequalities in health. Although different indicators capture different SEP dimensions, maternal education is often used as the only indicator in birth cohort research, especially in multi-cohort analyses. Household [...] Read more.
The assessment of early life socioeconomic position (SEP) is essential to the tackling of social inequalities in health. Although different indicators capture different SEP dimensions, maternal education is often used as the only indicator in birth cohort research, especially in multi-cohort analyses. Household income, as a direct measure of material resources, is one of the most important indicators, but one that is underused because it is difficult to measure through questionnaires. We propose a method to construct a standardized, cross-cohort comparable income indicator, the “Equivalized Household Income Indicator (EHII)”, which measures the equivalized disposable household income, using external data from the pan-European Union Statistics on Income and Living Conditions (EUSILC) surveys, and data from the cohorts. We apply this method to four studies, Piccolipiù and NINFEA from Italy and ELFE and EDEN from France, comparing the distribution of EHII with other SEP-related variables available in the cohorts, and estimating the association between EHII and child body mass index (BMI). We found that basic parental and household characteristics may be used, with a fairly good performance, to predict the household income. We observed a strong correlation between EHII and both the self-reported income, whenever available, and other individual socioeconomic-related variables, and an inverse association with child BMI. EHII could contribute to improving research on social inequalities in health, in particular in the context of European birth cohort collaborative studies. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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Open AccessArticle
Medication Use among Pregnant Women from the 2015 Pelotas (Brazil) Birth Cohort Study
Int. J. Environ. Res. Public Health 2020, 17(3), 989; https://doi.org/10.3390/ijerph17030989 - 05 Feb 2020
Cited by 4
Abstract
Background: Medication use during pregnancy is a common practice that has been increasing in recent years. The aim of this study is to describe medication use among pregnant women from the 2015 Pelotas (Brazil) Birth Cohort Study. Methods: This paper relies on a [...] Read more.
Background: Medication use during pregnancy is a common practice that has been increasing in recent years. The aim of this study is to describe medication use among pregnant women from the 2015 Pelotas (Brazil) Birth Cohort Study. Methods: This paper relies on a population-based cohort study including 4270 women. Participants completed a questionnaire about the antenatal period, including information about medication use. We performed descriptive analyses of the sample and the medications used and adjusted analyses for the use of medications and self-medication. Results: The prevalence of medication use was 92.5% (95% CI 91.7–93.3), excluding iron salts, folic acid, vitamins, and other minerals. The prevalence of self-medication was 27.7% (95% CI 26.3–29.1). In the adjusted analysis, women who had three or more health problems during pregnancy demonstrated higher use of medicines. Self-medication was higher in lower income groups and among smokers and multiparous women (three pregnancies or more). Acetaminophen, scopolamine, and dimenhydrinate were the medications most commonly used. Conclusions: This study describes the pattern of drug use among pregnant women in a population-based cohort study, with a high prevalence of self-medication. Greater awareness of the risks of self-medication during pregnancy is required, focusing on groups more prone to this practice, as well as ensuring qualified multidisciplinary prenatal care. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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Open AccessArticle
Use of Medications by Breastfeeding Women in the 2015 Pelotas (Brazil) Birth Cohort Study
Int. J. Environ. Res. Public Health 2020, 17(2), 568; https://doi.org/10.3390/ijerph17020568 - 16 Jan 2020
Cited by 1
Abstract
Background: This study describes medication use by women up to 3 months postpartum and evaluates the association between medication use by women who were still breastfeeding at 3 months postpartum and weaning at 6 and 12 months. Methods: Population-based cohort, including women who [...] Read more.
Background: This study describes medication use by women up to 3 months postpartum and evaluates the association between medication use by women who were still breastfeeding at 3 months postpartum and weaning at 6 and 12 months. Methods: Population-based cohort, including women who breastfed (n = 3988). Medications were classified according to Hale’s lactation risk categories and Brazilian Ministry of Health criteria. Duration of breastfeeding was analysed using Cox regression models and Kaplan-Meier curves, including only women who were still breastfeeding at three months postpartum. Results: Medication use with some risk for lactation was frequent (79.6% regarding Hale’s risk categories and 12.3% regarding Brazilian Ministry of Health criteria). We did not find statistically significant differences for weaning at 6 or 12 months between the group who did not use medication or used only compatible medications and the group who used medications with some risk for lactation, according to both criteria. Conclusions: Our study found no association between weaning rates across the different breastfeeding safety categories of medications in women who were still breastfeeding at three months postpartum. Therefore, women who took medications and stopped breastfeeding in the first three months postpartum because of adverse side-effects associated with medications could not be addressed in this analysis. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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Open AccessArticle
Cat and Dog Ownership in Early Life and Infant Development: A Prospective Birth Cohort Study of Japan Environment and Children’s Study
Int. J. Environ. Res. Public Health 2020, 17(1), 205; https://doi.org/10.3390/ijerph17010205 - 27 Dec 2019
Cited by 1
Abstract
Contact with companion animals has been suggested to have important roles in enhancing child development. However, studies focused on child development and pet ownership at a very early age are limited. The purpose of the current study was to investigate child development in [...] Read more.
Contact with companion animals has been suggested to have important roles in enhancing child development. However, studies focused on child development and pet ownership at a very early age are limited. The purpose of the current study was to investigate child development in relation to pet ownership at an early age in a nationwide prospective birth cohort study: the Japan Environment and Children’s Study. Associations between cat and dog ownership at six months and infant development at 12 months of age were examined in this study. Infant development was assessed using the Ages & Stages QuestionnairesTM (ASQ-3) at 12 months. Among participants of (Japan Environment and Children’s Study) JECS, those with available data of cat and dog ownership at six months and data for the ASQ-3 at 12 months were included (n = 78,868). Having dogs showed higher percentages of pass in all five domains measured by ASQ-3 (communication, gross motor, fine motor, problem-solving, and personal-social) compared to those who did not have dogs. Significantly decreased odds ratios (ORs) of developmental delays were observed in association with having dogs in all fix domains (communication: OR = 0.73, gross motor: OR = 0.86, fine motor: OR = 0.84, problem-solving: OR = 0.90, personal-social: OR = 0.83). This study suggested that early life dog ownership may reduce the risks of child developmental delays. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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Open AccessArticle
Causal Effects of Prenatal Exposure to PM2.5 on Child Development and the Role of Unobserved Confounding
Int. J. Environ. Res. Public Health 2019, 16(22), 4381; https://doi.org/10.3390/ijerph16224381 - 09 Nov 2019
Cited by 1
Abstract
Prenatal exposure to airborne particles is a potential risk factor for infant neuropsychological development. This issue is usually explored by regression analysis under the implicit assumption that all relevant confounders are accounted for. Our aim is to estimate the causal effect of prenatal [...] Read more.
Prenatal exposure to airborne particles is a potential risk factor for infant neuropsychological development. This issue is usually explored by regression analysis under the implicit assumption that all relevant confounders are accounted for. Our aim is to estimate the causal effect of prenatal exposure to high concentrations of airborne particles with a diameter < 2.5 µm (PM2.5) on children’s psychomotor and mental scores in a birth cohort from Gipuzkoa (Spain), and investigate the robustness of the results to possible unobserved confounding. We adopted the propensity score matching approach and performed sensitivity analyses comparing the actual effect estimates with those obtained after adjusting for unobserved confounders simulated to have different strengths. On average, mental and psychomotor scores decreased of −2.47 (90% CI: −7.22; 2.28) and −3.18 (90% CI: −7.61; 1.25) points when the prenatal exposure was ≥17 μg/m3 (median). These estimates were robust to the presence of unmeasured confounders having strength similar to that of the observed ones. The plausibility of having omitted a confounder strong enough to drive the estimates to zero was poor. The sensitivity analyses conferred solidity to our findings, despite the large sampling variability. This kind of sensitivity analysis should be routinely implemented in observational studies, especially in exploring new relationships. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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Review

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Open AccessReview
Children Born with Congenital Heart Defects and Growth Restriction at Birth: A Systematic Review and Meta-Analysis
Int. J. Environ. Res. Public Health 2020, 17(9), 3056; https://doi.org/10.3390/ijerph17093056 - 28 Apr 2020
Cited by 2
Abstract
Newborns with congenital heart defects tend to have a higher risk of growth restriction, which can be an independent risk factor for adverse outcomes. To date, a systematic review of the relation between congenital heart defects (CHD) and growth restriction at birth, most [...] Read more.
Newborns with congenital heart defects tend to have a higher risk of growth restriction, which can be an independent risk factor for adverse outcomes. To date, a systematic review of the relation between congenital heart defects (CHD) and growth restriction at birth, most commonly estimated by its imperfect proxy small for gestational age (SGA), has not been conducted. Objective: To conduct a systematic review and meta-analysis to estimate the proportion of children born with CHD that are small for gestational age (SGA). Methods: The search was carried out from inception until 31 March 2019 on Pubmed and Embase databases. Studies were screened and selected by two independent reviewers who used a predetermined data extraction form to obtain data from studies. Bias was assessed using the Critical Appraisal Skills Programme (CASP) checklist. The database search identified 1783 potentially relevant publications, of which 38 studies were found to be relevant to the study question. A total of 18 studies contained sufficient data for a meta-analysis, which was done using a random effects model. Results: The pooled proportion of SGA in all CHD was 20% (95% CI 16%–24%) and 14% (95% CI 13%–16%) for isolated CHD. Proportion of SGA varied across different CHD ranging from 30% (95% CI 24%–37%) for Tetralogy of Fallot to 12% (95% CI 7%–18%) for isolated atrial septal defect. The majority of studies included in the meta-analysis were population-based studies published after 2010. Conclusion: The overall proportion of SGA in all CHD was 2-fold higher whereas for isolated CHD, 1.4-fold higher than the expected proportion in the general population. Although few studies have looked at SGA for different subtypes of CHD, the observed variability of SGA by subtypes suggests that growth restriction at birth in CHD may be due to different pathophysiological mechanisms. Full article
(This article belongs to the Special Issue Population-Based Birth Cohort Studies in Epidemiology)
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