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      The maternal drug exposure birth cohort (DEBC) in China

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          Abstract

          Drug exposure during pregnancy lacks global fetal safety data. The maternal drug exposure birth cohort (DEBC) study, a prospective longitudinal investigation, aims to explore the correlation of maternal drug exposure during pregnancy with pregnancy outcomes, and establish a human biospecimen biobank. Here we describe the process of establishing DEBC and show that the drug exposure rate in the first trimester of pregnant women in DEBC (n = 112,986) is 30.70%. Among the drugs used, dydrogesterone and progesterone have the highest exposure rates, which are 11.97% and 10.82%, respectively. The overall incidence of adverse pregnancy outcomes is 13.49%. Dydrogesterone exposure during the first trimester is correlated with higher incidences of stillbirth, preterm birth, low birth weight, and birth defects, along with a lower incidence of miscarriage/abortion. Due to the limitations of this cohort study, causative conclusions cannot be drawn. Further follow-up and in-depth data analysis are planned for future studies.

          Abstract

          Drug exposure during pregnancy lacks sufficient fetal safety information world-widely. Here, the authors report the establishment a multi-center birth cohort to explore the correlation of maternal drug exposure during pregnancy with pregnancy outcomes.

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          Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis

          Saifon Chawanpaiboon, Joshua P. Vogel, Ann-Beth Moller … (2018)
          Summary Background Preterm birth is the leading cause of death in children younger than 5 years worldwide. Although preterm survival rates have increased in high-income countries, preterm newborns still die because of a lack of adequate newborn care in many low-income and middle-income countries. We estimated global, regional, and national rates of preterm birth in 2014, with trends over time for some selected countries. Methods We systematically searched for data on preterm birth for 194 WHO Member States from 1990 to 2014 in databases of national civil registration and vital statistics (CRVS). We also searched for population-representative surveys and research studies for countries with no or limited CRVS data. For 38 countries with high-quality data for preterm births in 2014, data are reported directly. For countries with at least three data points between 1990 and 2014, we used a linear mixed regression model to estimate preterm birth rates. We also calculated regional and global estimates of preterm birth for 2014. Findings We identified 1241 data points across 107 countries. The estimated global preterm birth rate for 2014 was 10·6% (uncertainty interval 9·0–12·0), equating to an estimated 14·84 million (12·65 million–16·73 million) live preterm births in 2014. 12· 0 million (81·1%) of these preterm births occurred in Asia and sub-Saharan Africa. Regional preterm birth rates for 2014 ranged from 13·4% (6·3–30·9) in North Africa to 8·7% (6·3–13·3) in Europe. India, China, Nigeria, Bangladesh, and Indonesia accounted for 57·9 million (41×4%) of 139·9 million livebirths and 6·6 million (44×6%) of preterm births globally in 2014. Of the 38 countries with high-quality data, preterm birth rates have increased since 2000 in 26 countries and decreased in 12 countries. Globally, we estimated that the preterm birth rate was 9×8% (8×3–10×9) in 2000, and 10×6% (9×0–12×0) in 2014. Interpretation Preterm birth remains a crucial issue in child mortality and improving quality of maternal and newborn care. To better understand the epidemiology of preterm birth, the quality and volume of data needs to be improved, including standardisation of definitions, measurement, and reporting. Funding WHO and the March of Dimes.
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            National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis

            Hannah Blencowe, Julia Krasevec, Mercedes de Onis … (2019)
            Summary Background Low birthweight (LBW) of less than 2500 g is an important marker of maternal and fetal health, predicting mortality, stunting, and adult-onset chronic conditions. Global nutrition targets set at the World Health Assembly in 2012 include an ambitious 30% reduction in LBW prevalence between 2012 and 2025. Estimates to track progress towards this target are lacking; with this analysis, we aim to assist in setting a baseline against which to assess progress towards the achievement of the World Health Assembly targets. Methods We sought to identify all available LBW input data for livebirths for the years 2000–16. We considered population-based national or nationally representative datasets for inclusion if they contained information on birthweight or LBW prevalence for livebirths. A new method for survey adjustment was developed and used. For 57 countries with higher quality time-series data, we smoothed country-reported trends in birthweight data by use of B-spline regression. For all other countries, we estimated LBW prevalence and trends by use of a restricted maximum likelihood approach with country-level random effects. Uncertainty ranges were obtained through bootstrapping. Results were summed at the regional and worldwide level. Findings We collated 1447 country-years of birthweight data (281 million births) for 148 countries of 195 UN member states (47 countries had no data meeting inclusion criteria). The estimated worldwide LBW prevalence in 2015 was 14·6% (uncertainty range [UR] 12·4–17·1) compared with 17·5% (14·1–21·3) in 2000 (average annual reduction rate [AARR] 1·23%). In 2015, an estimated 20·5 million (UR 17·4–24·0 million) livebirths were LBW, 91% from low-and-middle income countries, mainly southern Asia (48%) and sub-Saharan Africa (24%). Interpretation Although these estimates suggest some progress in reducing LBW between 2000 and 2015, achieving the 2·74% AARR required between 2012 and 2025 to meet the global nutrition target will require more than doubling progress, involving both improved measurement and programme investments to address the causes of LBW throughout the lifecycle. Funding Bill & Melinda Gates Foundation, The Children's Investment Fund Foundation, United Nations Children's Fund (UNICEF), and WHO.
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              Pre-eclampsia

              Lucy Chappell, Catherine Cluver, John Kingdom … (2021)
              Pre-eclampsia is a multisystem pregnancy disorder characterised by variable degrees of placental malperfusion, with release of soluble factors into the circulation. These factors cause maternal vascular endothelial injury, which leads to hypertension and multi-organ injury. The placental disease can cause fetal growth restriction and stillbirth. Pre-eclampsia is a major cause of maternal and perinatal mortality and morbidity, especially in low-income and middle-income countries. Prophylactic low-dose aspirin can reduce the risk of preterm pre-eclampsia, but once pre-eclampsia has been diagnosed there are no curative treatments except for delivery, and no drugs have been shown to influence disease progression. Timing of delivery is planned to optimise fetal and maternal outcomes. Clinical trials have reported diagnostic and prognostic strategies that could improve fetal and maternal outcomes and have evaluated the optimal timing of birth in women with late preterm pre-eclampsia. Ongoing studies are evaluating the efficacy, dose, and timing of aspirin and calcium to prevent pre-eclampsia and are evaluating other drugs to control hypertension or ameliorate disease progression.
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                Author and article information

                Contributors
                Ping Yu:
                ORCID: http://orcid.org/0000-0001-9239-9044
                yup@scu.edu.cn
                Yanping Wang: wyxyanping@163.com
                Jun Zhu:
                ORCID: http://orcid.org/0000-0001-9666-8010
                zhujun028@163.com
                Hanmin Liu: liuhm@scu.edu.cn
                Journal
                Journal ID (nlm-ta): Nat Commun
                Journal ID (iso-abbrev): Nat Commun
                Title: Nature Communications
                Publisher: Nature Publishing Group UK (London )
                ISSN (Electronic): 2041-1723
                Publication date (Electronic): 21 June 2024
                Publication date PMC-release: 21 June 2024
                Publication date Collection: 2024
                Volume: 15
                Electronic Location Identifier: 5312
                Affiliations
                [1 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, National Center for Birth Defect Monitoring, West China Second University Hospital, , Sichuan University, ; Chengdu, Sichuan China
                [2 ]GRID grid.419897.a, ISNI 0000 0004 0369 313X, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), , Ministry of Education, ; Chengdu, Sichuan China
                [3 ]GRID grid.410649.e, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, ; Nanning, Guangxi China
                [4 ]Fujian Provincial Maternity and Children’s Hospital, Fuzhou, Fujian, China
                [5 ]GRID grid.453135.5, ISNI 0000 0004 1769 3691, National Research Institute for Family Planning, , National Human Genetic Resource Center, ; Beijing, China
                [6 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Department of Pediatrics, West China Second University Hospital, , Sichuan University, ; Chengdu, Sichuan China
                Author information
                http://orcid.org/0000-0001-9239-9044
                http://orcid.org/0000-0001-9666-8010
                Article
                Publisher ID: 49623
                DOI: 10.1038/s41467-024-49623-0
                PMC ID: 11192739
                PubMed ID: 38906856
                SO-VID: cd3481a1-bfde-43ff-8d90-c22d31f6b47f
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 6 March 2023
                Date accepted : 12 June 2024
                Funding
                Funded by: The work was supported by the National Key Research and Development Program of China (NO.2022YFC2704701, 2016YFC1000102), the scientific research project of the Sichuan province (NO.2019YFS0530), and Sichuan Science and Technology Program (No. 2022NSFSC0656, 2022NSFSC0661).
                Categories
                Subject: Article
                Custom metadata
                issue-copyright-statement © Springer Nature Limited 2024

                ScienceOpen disciplines: Uncategorized
                Keywords: epidemiology
                Data availability:
                ScienceOpen disciplines: Uncategorized
                Keywords: epidemiology

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