一项关于巴西儿童和青少年孕期暴露于传染病对慢性病发病影响的全国性纵向调查。
A nationwide longitudinal investigation on the role of prenatal exposure to infectious diseases on the onset of chronic conditions in children and adolescents in Brazil.
作者信息
Paixao Enny S, Cerqueira-Silva Thiago, Florentino Pilar T V, Carroll Orlagh, Sanchez Clemente Nuria, Lawlor Deborah A, Ribeiro Silva Rita de Cássia, Rodrigues Laura Cunha, Smeeth Liam, Barreto Mauricio L
机构信息
Faculty of Epidemiology and Population Health, London School of hygiene and Tropical Medicine, London, UK.
Centre for Data and Knowledge Integration for Health, Salvador, Brazil.
出版信息
Wellcome Open Res. 2024 Oct 17;9:320. doi: 10.12688/wellcomeopenres.22430.2. eCollection 2024.
BACKGROUND
In utero exposure to infections might set the stage for a chain of events leading to a wide spectrum of long-term health outcomes observed in children and adolescents. This proposal aims to investigate whether syphilis, zika, dengue and chikungunya during pregnancy can increase the risk of the offspring developing a non-infectious chronic condition during childhood and adolescence.
OBJECTIVES
- Estimate the risk of non-infectious chronic conditions associated to syphilis, zika, dengue and chikungunya during pregnancy and when appropriate, explore if the risk varies by timing during pregnancy when the infection is acquired (first, second or third trimester) and severity (such as severe or mild dengue); 2) Investigate whether in uterus exposure to maternal infection affects the growth pattern of children and adolescents; 3) Examine the extent to which the relationship between maternal infection and non-infectious chronic outcomes are mediated by intrauterine growth restriction and preterm birth.
METHODS
We will compare health outcomes and growth trajectories of children and adolescents born to mothers with and without specific infections during pregnancy using conventional multivariable regression in the whole study population, in a within sibship design, using the subgroup of offspring with at least one sibling who is not exposed to the infection, and negative control outcome. Then we will decompose the direct and mediated effects (by preterm birth and small for gestational age) of maternal infection on chronic disorders.
RESULTS AND CONCLUSIONS
The results from this study will advance our understanding of the relationship between infections during pregnancy and chronic disorders, with widespread implications enabling targeting of critical points along the path from in utero exposure to outcomes to avoid or mitigate illness and disability over the life course.
背景
子宫内感染可能引发一系列事件，导致儿童和青少年出现多种长期健康问题。本研究旨在调查孕期梅毒、寨卡病毒、登革热和基孔肯雅热感染是否会增加子代在儿童期和青少年期患非传染性慢性病的风险。
目的
1）评估孕期梅毒、寨卡病毒、登革热和基孔肯雅热感染与非传染性慢性病的关联风险，并在适当情况下，探讨风险是否因孕期感染时间（孕早期、孕中期或孕晚期）及严重程度（如重症或轻症登革热）而异；2）调查子宫内暴露于母体感染是否会影响儿童和青少年的生长模式；3）研究母体感染与非传染性慢性结局之间的关系在多大程度上由子宫内生长受限和早产介导。
方法
我们将在整个研究人群中使用传统多变量回归，通过同胞设计，利用至少有一个未感染同胞的子代亚组和阴性对照结局，比较孕期有特定感染和无特定感染母亲所生孩子的健康结局和生长轨迹。然后，我们将分解母体感染对慢性疾病的直接和介导效应（通过早产和小于胎龄）。
结果与结论
本研究结果将增进我们对孕期感染与慢性疾病之间关系的理解，具有广泛影响，有助于确定从子宫内暴露到结局过程中的关键点，以避免或减轻一生中的疾病和残疾。
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