ABSTRACT Background Although mental capital is increasingly recognised as a foundation for children's later well‐being, its perinatal determinants remain unclear because traditional classifications such as preterm birth and small for gestational age (SGA) capture only partial and overlapping aspects of vulnerability. Objectives Using the integrated small vulnerable newborn (SVN) framework with mutually exclusive categories, we aimed to assess associations between SVN categories and mental capital at ages 6–7 years by sex. Methods We analysed data from six waves of the Adachi Child Health Impact of Living Difficulty (A‐CHILD) study, a population‐based repeated cross‐sectional survey of first‐grade students in Adachi City, Tokyo, conducted between 2015 and 2024 ( n = 20,928). Caregivers provided gestational week and birthweight from the Maternal and Child Health Handbook, and children were classified into SVN categories (term non‐SGA, term SGA, preterm non‐SGA, preterm SGA). Mental capital, including behavioural problems, prosocial behaviour, and resilience, was assessed using the parent‐reported Strengths and Difficulties Questionnaire and Children's Resilience and Coping Scale. Multivariable regression models were fitted, stratified by biological sex. Results Among the 20,928 children, 3402 (16.3%) were term SGA, 1093 (5.2%) were preterm non‐SGA, and 227 (1.1%) were preterm SGA. Compared with term non‐SGA, term SGA was associated with higher total difficulties scores among girls (standardised β 0.11, 95% confidence interval [CI] 0.05, 0.17) but not among boys ( β 0.03, 95% CI –0.03, 0.09). Term SGA girls also showed lower resilience ( β −0.07, 95% CI –0.12, −0.01). In contrast, preterm non‐SGA boys had higher total difficulties scores ( β 0.13, 95% CI 0.04, 0.21). There was no evidence that any SVN category was associated with prosocial behaviour in either sex. Conclusions Term SGA tended to be associated with behavioural problems and lower resilience among girls, whereas preterm non‐SGA tended to be associated with behavioural problems among boys.
ABSTRACT Background Systemic inflammation may affect female reproductive function, but there is relatively little epidemiological evidence regarding the association between pre‐pregnancy inflammatory status and fertility. We explore the association between the pre‐pregnancy Systemic Inflammation Response Index (SIRI) and the time to pregnancy (TTP) in couples trying to conceive. Method This study included 1739 couples from the National Free Preconception Check‐up Project (NFPCP) in Guangzhou. SIRI was calculated as neutrophil count × monocyte count/lymphocyte count from routine complete blood count (CBC) at baseline. Quartile and continuous variable analysis of SIRI was performed, and restricted cubic spline functions were used to evaluate the dose–response relationship. The associations were adjusted for demographic, behavioural, and lifestyle factors. Results In the NFPCP preconception couple cohort, 1182 pregnancy events were observed. In categorical analyses, women in the highest quartile of SIRI (Q4: 0.99, 5.58) had lower fecundability than those in Q2 (FR, 0.79; 95% CI 0.63, 0.98), indicating a longer TTP. The inverse association became more apparent at SIRI levels above approximately 0.89 in spline‐based analyses. Sensitivity analyses yielded comparable effect estimates after restricting the analysis to live birth outcomes and excluding women with chronic inflammatory conditions, fertility‐related disorders, or antibiotic use, supporting the robustness of the observed association. Conclusions Higher preconception SIRI was associated with longer TTP, and the association remained generally consistent across adjusted and sensitivity analyses. SIRI may have potential value in preconception risk stratification, but further studies are required to confirm its clinical relevance.
ABSTRACT Background Cardiometabolic complications in pregnancy may alter the intrauterine environment, influence offspring biological ageing and potentially increase the risk of chronic diseases later in life. Objectives This systematic review and meta‐analysis aimed to examine associations between diabetes in pregnancy, hypertensive disorders of pregnancy, maternal BMI and metabolic syndrome, and offspring biological ageing markers, including telomere length and DNA methylation. Data Sources Studies were retrieved from PubMed, EMBASE, Scopus and Web of Science. Study Selection and Data Extraction Study characteristics, exposures and outcomes were independently extracted and summarised. Synthesis Standardised mean differences in telomere length were calculated using Hedges' g, and random effects meta‐analysis was applied to pool effect estimates. Results Of the 123 studies, 90 assessed DNA methylation, 28 reported telomere length and 5 reported both outcomes. No differences in telomere length were observed in offspring exposed to gestational diabetes (7 studies) or hypertensive disorders (14 studies). Each unit increase in maternal BMI was associated with a 0.27% decrease in offspring telomere length (3 studies). Exposure to cardiometabolic complications was associated with aberrant DNA methylation patterns in genes related to cardiometabolic pathways. Higher mean methylation level was reported in cord blood (2 studies) and placenta (7 studies) following exposure to diabetes and hypertensive disorders. Conclusions Higher maternal BMI was associated with slightly shorter offspring telomeres, while no differences were observed following exposure to gestational diabetes or hypertensive disorders. Altered DNA methylation in cardiometabolic genes suggests epigenetic effects of in utero exposure, although heterogeneity in biospecimens and measurement methods limits definitive conclusions.
ABSTRACT Background Understanding the costs to the healthcare system of caesarean delivery with a low‐risk indication (‘maternal request’) is important for informing policies on its use. Numerous studies have examined hospital length of stay (LOS)—a key driver of hospital costs—by actual mode of delivery (vaginal vs. caesarean). This comparison, however, is misaligned with the information available at the time of antenatal decision‐making, as a planned vaginal delivery could result in either an actual vaginal delivery or an emergency intrapartum caesarean. Objectives To compare maternal LOS in hospital and hospital costs for pre‐labour caesarean delivery for a low‐risk indication with planned vaginal delivery. Methods We conducted a population‐based cohort study of all singleton births ≥ 37 weeks from nulliparous pregnancies in British Columbia, Canada, 2013–2023, using the British Columbia Perinatal Data Registry. We identified pre‐labour caesarean deliveries for breech presentation (proxies for caesarean deliveries with no medical indication) as well as planned vaginal deliveries. We examined maternal total LOS in hospital, in days, and hospital costs. Differences were estimated using generalized linear models with a gamma distribution and a log link. Results The planned caesarean group comprised 5545 women, and the planned vaginal group comprised 146,270 women (29% emergency caesarean). The total length of hospital stay for the planned caesarean group was 2.9 days and 2.7 days for planned vaginal delivery (absolute difference 0.22 days; relative difference 8.3%, 95% considence interval [CI] −1.75, 19.4). Hospital delivery admission costs were CDN$981 higher (95% CI 886, 1076) for low‐risk, pre‐labour caesarean delivery than planned vaginal delivery. Conclusion Maternal hospital length of stay for pre‐labour caesareans for a low‐risk indication was similar to planned vaginal delivery, while hospital costs were 21% higher. These findings provide contemporary evidence to help inform policy development on the use of ‘maternal request’ caesareans, alongside other clinical, patient, and health system considerations.
ABSTRACT Background Adolescent pregnancy is linked to adverse perinatal outcomes, yet distinctions between early (10–14 years) and late (15–19 years) adolescence and the impact of prenatal care adequacy remain unclear. We compared perinatal outcomes across maternal‐age groups and explored the contribution of prenatal‐care inadequacy to the association between maternal age and preterm birth. Methods We conducted a hospital‐based cross‐sectional study using SINASC data from a tertiary referral centre in Brazil. Live births to mothers aged 10–24 years from 2015 to 2020 were classified as early adolescence (10–14 years), late adolescence (15–19 years), or 20–24 years (reference). Preterm birth (< 37 weeks), preterm‐birth severity, a birth‐weight‐percentile proxy, and prenatal‐care adequacy were assessed. Adjusted risk ratios (RRs) were estimated using modified Poisson regression with robust variance and multiple imputation (20 datasets). An exploratory g‐computation analysis evaluated the contribution of inadequate prenatal care (< 7 visits) to the maternal‐age–preterm‐birth association. Results Early and late adolescents had higher risks of preterm birth (RR 1.33 and 1.19) and inadequate prenatal care (RR 1.13 for both) compared to the reference group. Early adolescents also had increased risk of low birth‐weight percentile (RR 1.47). Inadequate prenatal care accounted for approximately 10% of the association between adolescent age and preterm birth. Conclusions Adolescent pregnancy, especially early adolescence, is associated with increased preterm birth and prenatal care inadequacy. While prenatal care partially explains this risk, substantial direct associations persist, highlighting the need for comprehensive interventions beyond prenatal visit frequency.
