Suchergebnisse

Dette temanummer handler om ulighed i sundhed, og gennem syv meget for- skellige artikler sætter nummerets forfattere fokus på, hvordan ulighed i sund- hed kan opleves og forstås i dagens Danmark. Med temanummeret ønsker vi at anskueliggøre, at der er behov for at tænke og handle anderledes, hvis vi som sundhedssystem og samfund virkelig vil gøre noget ved udfordringer i forhold til ulighed i sundhed og ulighed i adgang hertil.

Severe prenatal stress exposure has been found to increase the risk of neuropsychiatric conditions like schizophrenia. We examined the risk of attention-deficit/hyperactivity disorder (ADHD) in the offspring following prenatal maternal bereavement, as a potential source of stress exposure. We conducted a nationwide population-based cohort study including all 1,015,912 singletons born in Denmark from 1987 to 2001. A total of 29,094 children were born to women who lost a close relative during pregnancy or up to 1 year before pregnancy. These children were included in the exposed cohort and other children were in the unexposed cohort. We used Cox regression to estimate hazard ratios for ADHD, defined as the first-time ADHD hospitalization or first-time ADHD medication after 3 years of age. Boys born to mothers who were bereaved by unexpected death of a child or a spouse, had a 72% increased risk of ADHD [hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.09–2.73]. Boys born to mothers who lost a child or a spouse during 0–6 months before pregnancy and during pregnancy had a HR of 1.47 (95% CI 1.00–2.16) and 2.10 (95% CI 1.16–3.80), respectively. Our findings suggest that prenatal maternal exposure to severe stress may increase the risk of ADHD in the offspring.

Publisher's version (útgefin grein) ; Objectives: Breast feeding is associated with health benefits for both mother and child, but many studies focusing on neurodevelopment have lacked information on important confounders and few randomised trials exist. Our objective was to examine the influence of breast feeding on child IQ at 5 years of age while taking maternal IQ and other relevant factors into account. Design: Prospective observational study. Setting: Population-based birth cohort in Denmark. Participants: We used data from The Lifestyle During Pregnancy Study 1782 mother-child pairs sampled from the Danish National Birth Cohort (n=101 042). Outcome measures: Child IQ was assessed at age 5 years by the Wechsler Primary and Preschool Scales of Intelligence-Revised. On the same occasion maternal intelligence was assessed by Wechsler Adult Intelligence Scale and Raven's Standard Progressive Matrices. Exposure data on duration of breast feeding (n=1385) were extracted from telephone interviews conducted when the child was 6 and 18 months, and analyses were weighted by relevant sampling fractions. Results: In multivariable linear regression analyses adjusted for potential confounders breast feeding was associated with child IQ at 5 years (categorical χ2 test for overall association p=0.03). Compared with children who were breast fed ≤1 month, children breast fed for 2-3, 4-6, 7-9 and 10 or more months had 3.06 (95% CI 0.39 to 5.72), 2.03 (95% CI -0.38 to 4.44), 3.53 (95% CI 1.18 to 5.87) and 3.28 (95% CI 0.88 to 5.67) points higher IQ after adjustment for core confounders, respectively. There was no dose-response relation and further analyses indicated that the main difference in IQ was between breast feeding ≤1 month versus >1 month. Conclusions: Breastfeeding duration of 1 month or shorter compared with longer periods was associated with approximately three points lower IQ, but there was no evidence of a dose-response relation in this prospective birth cohort, where we were able to adjust for some of the most critical confounders, including maternal intelligence. ; The Lifestyle During Pregnancy Study was supported primarily by Centers for Disease Control and Prevention, Atlanta, Georgia, USA, and also from the National Board of Health, the Lundbeck Foundation, Ludvig & Sara Elsass' Foundation, the Augustinus Foundation, and Aase & Ejnar Danielsens Foundation. Furthermore, the study was supported by the European Union (EU) Integrated Research Project EARNEST (FOOD-CT-2005-007036). The Danish National Birth Cohort has been financed by the March of Dimes Birth Defects Foundation, the Danish Heart Association, the Danish Medical Research Council, and the Sygekassernes Helsefond, Danish National Research Foundation, Danish Pharmaceutical Association, Ministry of Health, National Board of Health, Statens Serum Institut. The study is part of the research programme of the Centre for Fetal Programming (the Danish Council for Strategic Research grant no. 09-067124). ; Peer Reviewed

ABSTRACT
ObjectivesHigher rates of infant mortality in the UK than in the Nordic countries are partly explained by wider socio-economic disparities in the UK. We examined the extent to which low birth weight mediates the association between socioeconomic status (SES) and infant mortality using causal mediation analysis. We used cohorts of live births identified in administrative hospital data for the whole of Scotland and Denmark to explore the contribution of prenatal factors, represented by low birth weight, to differences in infant mortality between the two countries.
ApproachWe included live-born children born in Denmark (n=1,432,205) and Scotland (n=1,427,163) from 1981-2004. Follow up was to 12 months of age. Information on deaths in first year of life was obtained through linkage with cause of death registers. We determined the effect of socioeconomic status on all cause infant mortality by comparing the highest and lowest quintiles of area-based deprivation (based on Carstairs score in Scotland) or level of maternal education in Denmark. Causal mediation analysis was used for survival outcomes with adjustment for maternal age at birth, sex, birth year of the child, and records indicating congenital malformation.
ResultsDuring the follow-up, there were 8,158(0.57%) deaths in Denmark and 8,271(0.58%) deaths in Scotland. Comparing with the very high SES group, the overall hazard ratios of death for each SES quintile (starting with the lowest) compared with the highest SES quintile were 1.58(95% Confidence interval: 1.47-1.71), 1.40(1.32-1.49),1.25(1.20-1.30), 1.11(1.09-1.14) in Denmark, and 1.50(1.36-1.65),1.35(1.25-1.45),1.22(1.16-1.28),1.10(1.08-1.13) in Scotland. The proportions of excess infant deaths mediated through low birth weight (starting with the lowest) compared with the highest SES quintile were 54.7%, 52.1%, 49.5%, 46.9% in Denmark, and 26.0%, 23.9%, 22.0%, 20.1% in Scotland.
ConclusionOur result suggests that SES has similar effects on infant mortality in Denmark and Scotland but more of the effect of SES on infant mortality is mediated through low birth weight in Denmark. Public health preventive strategies for infant mortality in both countries need to address prenatal risk factors for low birth weight. The substantial direct effects of SES on infant mortality seen in Scotland, which were not mediated through low birth weight, may be explained by other birth characteristics or could reflect persisting SES disparities in the care of infants after birth.

BACKGROUND: High levels of nitrate ( NO 3 - ) in drinking water cause methemoglobinemia in infants; however, few studies have examined the potential effects of low-level exposure on fetal growth, and the results have been inconsistent. OBJECTIVES: We sought to assess the association between maternal exposure to nitrate in drinking water during pregnancy and offspring size at birth in a nationwide study of full-term ( ≥ 37 wk gestation) live-born singletons. METHODS: We estimated maternal nitrate exposure for 898,206 births in Denmark during 1991-2011 by linkage of individual home address(es) with nitrate data from the national monitoring database. Maternal address during pregnancy, infant size at birth [i.e., birth weight, low birth weight (LBW), body length, and birth head circumference] and covariates were compiled from the Danish Civil Registration System, the Danish Medical Birth Register, and The Integrated Database for Longitudinal Labor Market Research. Linear and logistic models with generalized estimating equations were used to account for multiple births to an individual. Nitrate exposure was modeled using five categories and as a log-transformed continuous variable. RESULTS: There was evidence of a decreasing trend in models for term birth weight using categorical or continuous measures of exposure. Modeling exposure continuously, a difference of - 9.71 g (95% confidence interval: - 14.60 , - 4.81 ) was predicted at 25 mg / L (half the value of the European Union drinking water standard) compared with 0 mg / L NO 3 - . Body length also decreased as nitrate concentrations increased in categorical and continuous models. There was little evidence of an association between NO 3 - and head circumference or LBW. DISCUSSION: Although the estimated effects were small, our findings for live singleton births to Danish-born parents suggest that maternal intake of nitrate from drinking water may reduce term birth weight and length, which are markers of intrauterine growth. However, there was little evidence for an association between nitrate and head circumference or LBW. Future studies in other populations and with data on dietary sources of nitrate are encouraged to confirm or refute these findings. https://doi.org/10.1289/EHP7331.

BACKGROUND: High levels of nitrate ( NO 3 - ) in drinking water cause methemoglobinemia in infants; however, few studies have examined the potential effects of low-level exposure on fetal growth, and the results have been inconsistent. OBJECTIVES: We sought to assess the association between maternal exposure to nitrate in drinking water during pregnancy and offspring size at birth in a nationwide study of full-term ( ≥ 37 wk gestation) live-born singletons. METHODS: We estimated maternal nitrate exposure for 898,206 births in Denmark during 1991-2011 by linkage of individual home address(es) with nitrate data from the national monitoring database. Maternal address during pregnancy, infant size at birth [i.e., birth weight, low birth weight (LBW), body length, and birth head circumference] and covariates were compiled from the Danish Civil Registration System, the Danish Medical Birth Register, and The Integrated Database for Longitudinal Labor Market Research. Linear and logistic models with generalized estimating equations were used to account for multiple births to an individual. Nitrate exposure was modeled using five categories and as a log-transformed continuous variable. RESULTS: There was evidence of a decreasing trend in models for term birth weight using categorical or continuous measures of exposure. Modeling exposure continuously, a difference of - 9.71 g (95% confidence interval: - 14.60 , - 4.81 ) was predicted at 25 mg / L (half the value of the European Union drinking water standard) compared with 0 mg / L NO 3 - . Body length also decreased as nitrate concentrations increased in categorical and continuous models. There was little evidence of an association between NO 3 - and head circumference or LBW. DISCUSSION: Although the estimated effects were small, our findings for live singleton births to Danish-born parents suggest that maternal intake of nitrate from drinking water may reduce term birth weight and length, which are markers of intrauterine growth. However, there was little evidence for an association between nitrate and head circumference or LBW. Future studies in other populations and with data on dietary sources of nitrate are encouraged to confirm or refute these findings. https://doi.org/10.1289/EHP7331.

Paracetamol (N-acetyl-p-aminophenol (APAP), otherwise known as acetaminophen) is the active ingredient in more than 600 medications used to relieve mild to moderate pain and reduce fever. APAP is widely used by pregnant women as governmental agencies, including the FDA and EMA, have long considered APAP appropriate for use during pregnancy when used as directed. However, increasing experimental and epidemiological research suggests that prenatal exposure to APAP might alter fetal development, which could increase the risks of some neurodevelopmental, reproductive and urogenital disorders. Here we summarize this evidence and call for precautionary action through a focused research effort and by increasing awareness among health professionals and pregnant women. APAP is an important medication and alternatives for treatment of high fever and severe pain are limited. We recommend that pregnant women should be cautioned at the beginning of pregnancy to: forego APAP unless its use is medically indicated; consult with a physician or pharmacist if they are uncertain whether use is indicated and before using on a long-term basis; and minimize exposure by using the lowest effective dose for the shortest possible time. We suggest specific actions to implement these recommendations. This Consensus Statement reflects our concerns and is currently supported by 91 scientists, clinicians and public health professionals from across the globe.

Paracetamol (N-acetyl-p-aminophenol (APAP), otherwise known as acetaminophen) is the active ingredient in more than 600 medications used to relieve mild to moderate pain and reduce fever. APAP is widely used by pregnant women as governmental agencies, including the FDA and EMA, have long considered APAP appropriate for use during pregnancy when used as directed. However, increasing experimental and epidemiological research suggests that prenatal exposure to APAP might alter fetal development, which could increase the risks of some neurodevelopmental, reproductive and urogenital disorders. Here we summarize this evidence and call for precautionary action through a focused research effort and by increasing awareness among health professionals and pregnant women. APAP is an important medication and alternatives for treatment of high fever and severe pain are limited. We recommend that pregnant women should be cautioned at the beginning of pregnancy to: forego APAP unless its use is medically indicated; consult with a physician or pharmacist if they are uncertain whether use is indicated and before using on a long-term basis; and minimize exposure by using the lowest effective dose for the shortest possible time. We suggest specific actions to implement these recommendations. This Consensus Statement reflects our concerns and is currently supported by 91 scientists, clinicians and public health professionals from across the globe.

Paracetamol (N-acetyl-p-aminophenol (APAP), otherwise known as acetaminophen) is the active ingredient in more than 600 medications used to relieve mild to moderate pain and reduce fever. APAP is widely used by pregnant women as governmental agencies, including the FDA and EMA, have long considered APAP appropriate for use during pregnancy when used as directed. However, increasing experimental and epidemiological research suggests that prenatal exposure to APAP might alter fetal development, which could increase the risks of some neurodevelopmental, reproductive and urogenital disorders. Here we summarize this evidence and call for precautionary action through a focused research effort and by increasing awareness among health professionals and pregnant women. APAP is an important medication and alternatives for treatment of high fever and severe pain are limited. We recommend that pregnant women should be cautioned at the beginning of pregnancy to: forego APAP unless its use is medically indicated; consult with a physician or pharmacist if they are uncertain whether use is indicated and before using on a long-term basis; and minimize exposure by using the lowest effective dose for the shortest possible time. We suggest specific actions to implement these recommendations. This Consensus Statement reflects our concerns and is currently supported by 91 scientists, clinicians and public health professionals from across the globe.

Results from studies evaluating potential effects of prenatal exposure to radio-frequency electromagnetic fields from cell phones on birth outcomes have been inconsistent. Using data on 55,507 pregnant women and their children from Denmark (1996-2002), the Netherlands (2003-2004), Spain (2003-2008), and South Korea (2006-2011), we explored whether maternal cell-phone use was associated with pregnancy duration and fetal growth. On the basis of self-reported number of cell-phone calls per day, exposure was grouped as none, low (referent), intermediate, or high. We examined pregnancy duration (gestational age at birth, preterm/postterm birth), fetal growth (birth weight ratio, small/large size for gestational age), and birth weight variables (birth weight, low/high birth weight) and meta-analyzed cohort-specific estimates. The intermediate exposure group had a higher risk of giving birth at a lower gestational age (hazard ratio = 1.04, 95% confidence interval: 1.01, 1.07), and exposure-response relationships were found for shorter pregnancy duration (P < 0.001) and preterm birth (P = 0.003). We observed no association with fetal growth or birth weight. Maternal cell-phone use during pregnancy may be associated with shorter pregnancy duration and increased risk of preterm birth, but these results should be interpreted with caution, since they may reflect stress during pregnancy or other residual confounding rather than a direct effect of cell-phone exposure. ; The Generalized EMF Research Using Novel Methods (GERoNiMO) Project was supported by the European Union (grant 603794). The Amsterdam Born Children and Their Development Study (ABCD) was supported by the Netherlands Organization for Health Research and Development (grant 2100.0076) and the Electromagnetic Fields and Health Research program (grants 85600004 and 85800001). The Danish National Birth Cohort Study (DNBC) was supported by the Danish Epidemiology Science Centre, the Lundbeck Foundation (grant 195/04), the Egmont Foundation, the March of Dimes Birth Defect Foundation, the Augustinus Foundation, and the Medical Research Council (grant SSVF 0646). The Spanish Environment and Childhood Project (INMA) was supported by the European Union (grants FP7-ENV-2011, 282957, and HEALTH.2010.2.4.5-1); Instituto de Salud Carlos III (grants G03/176, CB06/02/0041, FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/01007, 11/02591, CP11/00178, FIS-PI06/0867, FIS-PS09/00090, FIS-PI041436, FIS-PI081151, FIS-PI042018, FIS-PI09/02311, FISPI13/1944, FIS-PI13/2429, FIS-PI14/0981, FIS-PI13/141687, CP13/00054 (including FEDER funds), and MS13/00054); the Conselleria de Sanitat Generalitat Valenciana; the Generalitat de Catalunya (grants CIRIT1999SGR and 00241); Obra Social Cajastur; the Universidad de Oviedo; the Department of Health of the Basque Government (grants 2005111093 and 2009111069); and the Provincial Government of Gipuzkoa (grants DFG06/004 and DFG08/001). The Korean Mothers and Children's Environment Health Study (MOCEH) was supported by the National Institute of Environmental Research, the Ministry of the Environment, and the Information and Communication Technology (ICT) research and development program of the Ministry of Science and ICT (grants 2017-0-00961 and 2019-0-00102), South Korea.