Survival of infants with spina bifida and the role of maternal prepregnancy body mass index

Abstract

Objective: To investigate first-year survival of infants born with spina bifida, and examine the association of maternal prepregnancy body mass index (BMI) with infant mortality. Methods: This is a retrospective cohort study of 1,533 liveborn infants with nonsyndromic spina bifida with estimated dates of delivery from 1998 to 2011 whose mothers were eligible for the National Birth Defects Prevention Study (NBDPS). NBDPS data were linked to death records to conduct survival analyses. Kaplan-Meier survival functions estimated mortality risk over the firstyear of life. Cox proportional hazards models estimated hazard ratios (HRs) for maternal prepregnancy BMI categorized as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), and obese (≥30). Results: Infant mortality risk among infants with spina bifida was (4.4% [3.52, 5.60%]). Infants with multiple co-occurring defects, very preterm delivery, multiple gestation, high-level spina bifida lesions, or non-Hispanic Black mothers had an elevated risk of infant mortality. Maternal prepregnancy underweight and obesity were associated with higher infant mortality (15.7% [7.20, 32.30%] and 5.82% [3.60, 9.35%], respectively). Adjusted HR estimates showed underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 [1.08, 16.72] and 2.6 [1.36, 8.02], respectively). Conclusion: The overall risk of infant mortality for infants born with spina bifida was lower than most previously reported estimates. Infants born with spina bifida to mothers who were underweight or obese prepregnancy were at higher risk of

Factors Associated with Early Neonatal and First-Year Mortality in Infants with Myelomeningocele in California from 2006 to 2011

“…We were also not able to examine mortality by level of lesion, which is a known predictor with ascending lesions significantly associated with mortality among infants with spina bifida. 10,15,23 In conclusion, our study had the lowest rate of infant mortality compared with prior studies, which were conducted during the postfortification years in the United States. We also examined early neonatal mortality among infants with myelomeningocele and factors associated with this outcome for the first time.…”

“…Another study examining postfortification period in the United States for mothers, who were eligible for the National Birth Defects Prevention Study and with estimated dates of delivery from 1998 to 2011, found a significantly increased risk of infant mortality among spina bifida cases with multiple co-occurring birth defects, very preterm gestation, multiple gestation, high-level spina bifida lesions, and non-Hispanic Black mothers. 15 We found a protective association for infant mortality if the infant also had a diagnosis of congenital hydrocephalus. This contradicted a previous study where congenital hydrocephalus increased the risk of death in infancy among those with spina bifida.…”

“…12 Few studies have examined individual-level factors associated with infant mortality in children with spina bifida in the United States; they have reported associations with birth weight, gestational age, having multiple birth defects, level of spina bifida lesion, and maternal race/ethnicity, education, and prepregnancy body mass index. 8,10,[13][14][15] Associations with factors indicative of social disadvantage (e.g., poverty and insurance payer status), receipt of prenatal care, and delivery or repair hospital characteristics have not been examined. A more contemporary understanding of such factors is needed.…”

Epidemiology and (Patho)Physiology of Folic Acid Supplement Use in Obese Women before and during Pregnancy

“…Meta-analyses showed a dose-response association between maternal Body Mass Index (BMI) and NTDs, and the risk rapidly increased in women with a BMI ≥ 30 kg/m 2 ( Table 1 ) [ 4 , 5 , 6 ]. In addition, a BMI ≥ 30 kg/m 2 , defined as maternal obesity, is also associated with the severity of the NTD in the offspring [ 7 , 8 ].…”

Maternal Undernutrition and Breast Milk Macronutrient Content Are Not Associated with Weight in Breastfed Infants at 1 and 3 Months after Delivery

“…National campaign to promote maternal and child health in 21st-century Japan (Healthy Parents and Children 21) [2] has raised concerns regarding the nutritional status of women of reproductive age in Japan because the proportion of underweight in both junior high and high school girls in Japan has increased to 20% [3]. Previous publications suggested that children born to such underweight women had an increased risk of infant mortality [4,5]. A recent database study [6] with more than 90,000 pregnant women compiled by the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System demonstrated that underweight women are more likely to bear small babies.…”