National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, West Glamorgan, UK
National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, West Glamorgan, UK.
BMJ Open. 2023 Feb 10;13(2):e063836. doi: 10.1136/bmjopen-2022-063836.
Globally, 20 million children are born with a birth weight below 2500 g every year, which is considered as a low birthweight (LBW) baby. This study investigates the contribution of modifiable risk factors in a nationally representative Welsh e-cohort of children and their mothers to inform opportunities to reduce LBW prevalence.
A longitudinal cohort study based on anonymously linked, routinely collected multiple administrative data sets.
The cohort, (N=693 377) comprising of children born between 1 January 1998 and 31 December 2018 in Wales, was selected from the National Community Child Health Database.
The risk factors associated with a binary LBW (outcome) variable were investigated with multivariable logistic regression (MLR) and decision tree (DT) models.
The MLR model showed that non-singleton children had the highest risk of LBW (adjusted OR 21.74 (95% CI 21.09 to 22.40)), followed by pregnancy interval less than 1 year (2.92 (95% CI 2.70 to 3.15)), maternal physical and mental health conditions including diabetes (2.03 (1.81 to 2.28)), anaemia (1.26 (95% CI 1.16 to 1.36)), depression (1.58 (95% CI 1.43 to 1.75)), serious mental illness (1.46 (95% CI 1.04 to 2.05)), anxiety (1.22 (95% CI 1.08 to 1.38)) and use of antidepressant medication during pregnancy (1.92 (95% CI 1.20 to 3.07)). Additional maternal risk factors include smoking (1.80 (95% CI 1.76 to 1.84)), alcohol-related hospital admission (1.60 (95% CI 1.30 to 1.97)), substance misuse (1.35 (95% CI 1.29 to 1.41)) and evidence of domestic abuse (1.98 (95% CI 1.39 to 2.81)). Living in less deprived area has lower risk of LBW (0.70 (95% CI 0.67 to 0.72)). The most important risk factors from the DT models include maternal factors such as smoking, maternal weight, substance misuse record, maternal age along with deprivation-Welsh Index of Multiple Deprivation score, pregnancy interval and birth order of the child.
Resources to reduce the prevalence of LBW should focus on improving maternal health, reducing preterm births, increasing awareness of what is a sufficient pregnancy interval, and to provide adequate support for mothers' mental health and well-being.
全球每年有 2000 万名婴儿出生体重低于 2500 克，这被认为是低出生体重（LBW）婴儿。本研究旨在通过威尔士全国代表性电子队列中的儿童及其母亲的可改变风险因素，了解降低 LBW 患病率的机会。
基于匿名链接的、常规收集的多个行政数据集的纵向队列研究。
该队列（n=693377）由 1998 年 1 月 1 日至 2018 年 12 月 31 日期间在威尔士出生的儿童组成，从国家社区儿童健康数据库中选取。
使用多变量逻辑回归（MLR）和决策树（DT）模型探讨与二元 LBW（结局）变量相关的风险因素。
MLR 模型显示，非单胎儿童 LBW 的风险最高（调整后的比值比 21.74（95%置信区间 21.09 至 22.40）），其次是妊娠间隔小于 1 年（2.92（95%置信区间 2.70 至 3.15））、包括糖尿病在内的孕产妇身体和心理健康状况（2.03（1.81 至 2.28））、贫血（1.26（95%置信区间 1.16 至 1.36））、抑郁（1.58（95%置信区间 1.43 至 1.75））、严重精神疾病（1.46（95%置信区间 1.04 至 2.05））、焦虑（1.22（95%置信区间 1.08 至 1.38））和怀孕期间使用抗抑郁药物（1.92（95%置信区间 1.20 至 3.07））。其他孕产妇风险因素包括吸烟（1.80（95%置信区间 1.76 至 1.84））、与酒精相关的住院治疗（1.60（95%置信区间 1.30 至 1.97））、药物滥用（1.35（95%置信区间 1.29 至 1.41））和家庭虐待证据（1.98（95%置信区间 1.39 至 2.81））。生活在贫困程度较低的地区，LBW 的风险较低（0.70（95%置信区间 0.67 至 0.72））。DT 模型中最重要的风险因素包括孕产妇因素，如吸烟、孕产妇体重、药物滥用记录、孕产妇年龄以及与剥夺相关的威尔士多重剥夺指数评分、妊娠间隔和儿童出生顺序。
降低 LBW 患病率的资源应集中于改善孕产妇健康、减少早产、提高对足够妊娠间隔的认识，并为母亲的心理健康和福祉提供充分支持。
