Clustering of Socioeconomic, Behavioural, and Neonatal Risk Factors for Infant Health in Pregnant Smokers

Background: Tobacco smoking is a major cause of morbidity and mortality, including during pregnancy. Although effective ways of promoting smoking cessation during pregnancy exist, the impact of these interventions has not been studied at a national level. We estimated the prevalence of smoking throughout pregnancy in the Netherlands and quantified associations of maternal smoking throughout pregnancy with socioeconomic, behavioural, and neonatal risk factors for infant health and development. Methodology/Principal Findings: Data of five national surveys, containing records of 14,553 Dutch mothers and their offspring were analyzed. From 2001 to 2007, the overall rate of smoking throughout pregnancy fell by 42% (from 13. 2% to 7. 6%) mainly as a result of a decrease among highly educated women. In the lowest-educated group, the overall rate of smoking throughout pregnancy was six times as high as in the highest-educated group (18. 7% versus 3. 2%). Prenatal tobacco smoke exposure was associated with increased risk of extremely preterm (≤28 completed weeks) (OR 7. 25; 95% CI 3. 40 to 15. 38) and small-for-gestational age (SGA) infants (OR 3. 08; 95% CI 2. 66 to 3. 57). Smoking-attributable risk percents in the population (based on adjusted risk ratios) were estimated at 29% for extremely preterm births and at 17% for SGA outcomes. Infants of smokers were more likely to experience significant alcohol exposure in utero (OR 2. 08; 95%CI 1. 25 to 3. 45) and formula feeding in early life (OR 1. 91; 95% CI 1. 69 to 2. 16). Conclusions: The rates of maternal smoking throughout pregnancy decreased significantly in the Netherlands from 2001 to 2007. If pregnant women were to cease tobacco use completely, an estimated 29% of extremely preterm births and 17% of SGA infants may be avoided annually. © 2009 Lanting et al

Neonatal screening for congenital hypothyroidism in the Netherlands: Cognitive and motor outcome at 10 years of age

Contains fulltext : 35300.pdf (publisher's version ) (Open Access)CONTEXT: Patients with thyroidal congenital hypothyroidism (CH-T) born in The Netherlands in 1981-1982 showed persistent intellectual and motor deficits during childhood and adulthood, despite initiation of T(4) supplementation at a median age of 28 d after birth. OBJECTIVE: The present study examined whether advancement of treatment initiation to 20 d had resulted in improved cognitive and motor outcome. DESIGN/SETTING/PATIENTS: In 82 Dutch CH-T patients, born in 1992 to 1993 and treated at a median age of 20 d (mean, 22 d; range, 2-73 d), cognitive and motor outcome was assessed (mean age, 10.5 yr; range, 9.6-11.4 yr). Severity of CH-T was classified according to pretreatment free T(4) concentration. MAIN OUTCOME MEASURE: Cognitive and motor outcome of the 1992-1993 cohort in comparison to the 1981 to 1982 cohort was the main outcome measure. RESULTS: Patients with severe CH-T had lower full-scale (93.7), verbal (94.9), and performance (93.9) IQ scores than the normative population (P < 0.05), whereas IQ scores of patients with moderate and mild CH-T were comparable to those of the normative population. In all three severity subgroups, significant motor problems were observed, most pronounced in the severe CH-T group. No correlations were found between starting day of treatment and IQ or motor outcome. CONCLUSIONS: Essentially, findings from the 1992-1993 cohort were similar to those of the 1981-1982 cohort. Apparently, advancing initiation of T(4) supplementation from 28 to 20 d after birth did not result in improved cognitive or motor outcome in CH-T patients

The Preventive Child and Youth Healthcare Service in the Netherlands: The State of the Art and Challenges Ahead

The Netherlands has a unique system for promoting child and youth health, known as the preventive Child and Youth Healthcare service (CYH). The CYH makes an important contribution to the development and health of children and young people by offering (anticipatory) information, immunisation, and screening, identifying care needs and providing preventive support to children and their families from birth up to the age of 18 years. The CYH is offered free of charge and offers basic preventive care to all children and special preventive care to children who grow up in disadvantaged situations, such as children growing up in poverty or in a family where one of the members has a chronic health condition. Basic care is supported by 35 evidence-based guidelines and validated screening tools. Special care is supported by effective interventions. The impact of the CYH is high. It is estimated that every EUR 1 spent on the CYH provides EUR 11 back. Although the Dutch CYH is a solid public health system with a reach of up to 95% among young children, the access to this service could be further improved by paying more attention to health literacy, making special care available to all children in need and improving transmural and integrated care coordination. In addition, the generation of nationwide data could help to demonstrate the impact of the CYH and will direct and prioritise the necessary care. By continuously developing care on the basis of new (scientific) insights and (societal) issues, the CYH will continue to offer all children in the Netherlands the best preventive healthcare

Socio-economic inequality in oral health in childhood to young adulthood, despite full dental coverage

The aim of this cross-sectional study was to assess differences in caries experience according to socio-economic status (SES) in a health-care system with full coverage of dental costs for children up to the age of 18 yr. In 2011 and 2014, by performing hurdle negative binomial models, we obtained data on 3,022 children and young adults aged 5, 8, 11, 14, 17, 20, and 23 yr, living in four cities in the Netherlands. At all ages between 5 and 23 yr, the percentages of children with caries-free dentitions were lower and mean caries experience were higher in low-SES than in high-SES participants. In 5-yr-old children with dmft > 0, mean caries experience was 3.6 in those with low SES and 2.3 in those with high SES. In 23-yr-old participants, these estimates were 6.8 and 4.4, respectively (P <0.05). Low-SES children have a greater risk of more caries experience than high-SES children. Thus, in a system with full free paediatric dental coverage, socio-economic inequality in caries experience still exists. Dental health professionals, well-child care doctors and nurses, general practitioners, and elementary school teachers should collaborate to promote oral health at the community level, with specific targeting of low-SES families. We further need policy measures to curtail, at community level, the increasing availability and consumption of highly processed, carbohydrate-rich foods, with particular attention for low-SES families

Insufficient vitamin D supplement use during pregnancy and early childhood: a risk factor for positional skull deformation

Vitamin D insufficiency during pregnancy is associated with disturbed skeletal homeostasis during infancy. Our aim was to investigate the influence of adherence to recommendations for vitamin D supplement intake of 10 μg per day (400 IU) during pregnancy (mother) and in the first months of life (child) on the occurrence of positional skull deformation of the child at the age of 2 to 4 months. In an observational case–control study, two hundred seventy-five 2- to 4-month-old cases with positional skull deformation were compared with 548 matched controls. A questionnaire was used to gather information on background characteristics and vitamin D intake (food, time spent outdoors and supplements). In a multiple variable logistic regression analysis, insufficient vitamin D supplement intake of women during the last trimester of pregnancy [adjusted odds ratio (aOR) 1.86, 95% (CI) 1.27–2.70] and of children during early infancy (aOR 7.15, 95% CI 3.77–13.54) were independently associated with an increased risk of skull deformation during infancy. These associations were evident after adjustment for the associations with skull deformation that were present with younger maternal age and lower maternal education, shorter pregnancy duration, assisted vaginal delivery, male gender and milk formula consumption after birth. Our findings suggest that non-adherence to recommendations for vitamin D supplement use by pregnant women and infants are associated with a higher risk of positional skull deformation in infants at 2 to 4 months of age. Our study provides an early infant life example of the importance of adequate vitamin D intake during pregnancy and infanc

(Multinomial) logistic regression analysis of maternal smoking status throughout pregnancy on preterm birth and intrauterine growth in the Netherlands 2001–2007.

<p>OR. Odds ratio.</p><p>CI. Confidence interval.</p>*<p>Odds ratios are adjusted for maternal social factors (age, single motherhood, level of formal education country of birth). Results on gestational age are also adjusted for parity and gender of the newborn.</p>$<p>Extremely preterm: ≤28 completed weeks; very preterm: 28–31; moderately preterm: 32–36 weeks; term ≥37.</p

Prevalence of smoking throughout pregnancy in the Netherlands 2001–2007.

<p>Prevalence of smoking throughout pregnancy in the Netherlands 2001–2007.</p

Prevalence of smoking throughout pregnancy by level of formal education (low, intermediate or high) in the Netherlands 2001–2007.

<p>Prevalence of smoking throughout pregnancy by level of formal education (low, intermediate or high) in the Netherlands 2001–2007.</p