Background About 3 million stillbirths occur each year, 98% of which are in low-income and middle-income countries (LMICs). Interpregnancy interval is a key risk factor of interest, because it is modifiable. We aimed to investigate whether there is a causal relationship between the length of interpregnancy interval and risk of subsequent stillbirth.
MethodsWe used Demographic and Health Surveys (2002-18) from 58 LMICs to study reproductive histories of women and to identify livebirths and stillbirths in the preceding 5 years. Countries were selected on the basis of the availability of interpregnancy interval data and other covariates of interest (age, education, urban or rural residence, and wealth) in surveys done since 2002. Exclusion criteria were being nulliparous, having missing parity data, and not having had at least two births (livebirth or stillbirth) in the 5 years before the survey. We combined two analytic approaches: one that analyses intervals between all births and another that analyses intervals within mothers. We report stratified estimates for the first, second, and third intervals, controlling for all past birth outcomes and intervals in a 5-year period, and other socioeconomic covariates. We also explored effect heterogeneity across key cohort subgroups.Findings Between July, 1997, and April, 2018, we identified 716 478 births from 338 223 women in 123 Demographic and Health Surveys from 58 LMICs, of which 9647 were stillbirths. Intervals of less than 6 months were associated with an increased risk of stillbirth in the between-mother models when considering the first interval (risk difference [RD] 0·0096, 95% CI 0·008-0·011). This association was slightly attenuated when considering only the second interval (RD 0·0054, 95% CI 0·0010 to 0·0099) and substantially attenuated when considering only the third interval (0·0007, -0·037 to 0·039). Within-mother modelling showed a null association with intervals of 24-59 months when considering the first and second (RD 0·007, 95% CI -0·001 to 0·016) and first and third (0·040, -0·422 to 0·501) intervals.Interpretation Although interpregnancy intervals of less than 12 months were associated with increased risk of stillbirth, these effects were attenuated when considering second and third intervals, suggesting the association in the first interval might not be causal. Future studies should use generalisable cohorts with longitudinal data, and report estimates stratified by birth order.
Because meat is more resource intensive than vegetal protein sources, replacing it with efficient plant alternatives is potentially desirable, provided these alternatives prove nutritionally sound. We show that protein conserving plant alternatives to meat that rigorously satisfy key nutritional constraints while minimizing cropland, nitrogen fertilizer (Nr) and water use and greenhouse gas (GHG) emissions exist, and could improve public health. We develop a new methodology for identifying nutritional constraints whose satisfaction by plant eaters is challenging, disproportionately shaping the optimal diets, singling out energy, mass, monounsaturated fatty acids, vitamins B
3,6,12
and D, choline, zinc, and selenium. By replacing meat with the devised plant alternatives—dominated by tofu, soybeans, peanuts, and lentils—Americans can collectively eliminate pastureland use while saving 35–50% of their diet related needs for cropland, Nr, and GHG emission, but increase their diet related irrigation needs by 15%. While widely replacing meat with plants is logistically and culturally challenging, few competing options offer comparable multidimensional resource use reduction.
IMPORTANCEGestational diabetes is common in pregnancy and is associated with adverse pregnancy and fetal outcomes. Currently, population-based data on the prevalence of gestational diabetes are limited in India.OBJECTIVE To provide a comprehensive national assessment of gestational diabetes in India and its socioeconomic, demographic, and geographic associations, using elevated random blood glucose data as a proxy for a gestational diabetes diagnosis.
Aim: To assess concordance between HER2 status measured by traditional methods and ERBB2 amplification measured by next-generation sequencing and its association with first-line trastuzumab clinical benefit in patients with advanced esophagogastric cancer. Methods: Retrospective analysis of HER2/ ERBB2 concordance using a deidentified USA-based clinicogenomic database. Clinical outcomes were assessed for patients with HER2+ advanced esophagogastric cancer who received first-line trastuzumab. Results: Overall HER2/ ERBB2 concordance was 87.5%. Among patients who received first-line trastuzumab, concordant HER2/ ERBB2 was associated with longer time to treatment discontinuation (adjusted hazard ratio [aHR]: 0.63; 95% CI: 0.43–0.90) and overall survival (aHR: 0.51; 95% CI: 0.33–0.79). ERBB2 copy number ≥25 (median) was associated with longer time to treatment discontinuation (aHR: 0.56; 95% CI: 0.35–0.88) and overall survival (aHR: 0.52; 95% CI: 0.30–0.91). Conclusion: HER2/ ERBB2 concordance and higher ERBB2 copy number predicted clinical benefit from trastuzumab.
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