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      Association of maternal prenatal selenium concentration and preterm birth: a multicountry meta-analysis

      research-article
      1 , 2 , 3 , , 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , INTERBIO-21st Study Consortium, 11 , 12 , 13 , 14 , 15 , 16 , 17 , 4 , 2 , 4 , 4 , 18 , 19 , 19 , 19 , 6 , 6 , 6 , 6 , 6 , 6 , 7 , 7 , 8 , 8 , 8 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 28 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 9 , 43 , 7 , 8 , 10 , 2 , 3 , 4 , , 2 , 3 , 4 , 44
      BMJ Global Health
      BMJ Publishing Group
      child health, environmental health, epidemiology, maternal health, nutrition

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          Abstract

          Background

          Selenium (Se), an essential trace mineral, has been implicated in preterm birth (PTB). We aimed to determine the association of maternal Se concentrations during pregnancy with PTB risk and gestational duration in a large number of samples collected from diverse populations.

          Methods

          Gestational duration data and maternal plasma or serum samples of 9946 singleton live births were obtained from 17 geographically diverse study cohorts. Maternal Se concentrations were determined by inductively coupled plasma mass spectrometry analysis. The associations between maternal Se with PTB and gestational duration were analysed using logistic and linear regressions. The results were then combined using fixed-effect and random-effect meta-analysis.

          Findings

          In all study samples, the Se concentrations followed a normal distribution with a mean of 93.8 ng/mL (SD: 28.5 ng/mL) but varied substantially across different sites. The fixed-effect meta-analysis across the 17 cohorts showed that Se was significantly associated with PTB and gestational duration with effect size estimates of an OR=0.95 (95% CI: 0.9 to 1.00) for PTB and 0.66 days (95% CI: 0.38 to 0.94) longer gestation per 15 ng/mL increase in Se concentration. However, there was a substantial heterogeneity among study cohorts and the random-effect meta-analysis did not achieve statistical significance. The largest effect sizes were observed in UK (Liverpool) cohort, and most significant associations were observed in samples from Malawi.

          Interpretation

          While our study observed statistically significant associations between maternal Se concentration and PTB at some sites, this did not generalise across the entire cohort. Whether population-specific factors explain the heterogeneity of our findings warrants further investigation. Further evidence is needed to understand the biologic pathways, clinical efficacy and safety, before changes to antenatal nutritional recommendations for Se supplementation are considered.

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          Most cited references34

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          Epidemiology and causes of preterm birth

          Summary This paper is the first in a three-part series on preterm birth, which is the leading cause of perinatal morbidity and mortality in developed countries. Infants are born preterm at less than 37 weeks' gestational age after: (1) spontaneous labour with intact membranes, (2) preterm premature rupture of the membranes (PPROM), and (3) labour induction or caesarean delivery for maternal or fetal indications. The frequency of preterm births is about 12–13% in the USA and 5–9% in many other developed countries; however, the rate of preterm birth has increased in many locations, predominantly because of increasing indicated preterm births and preterm delivery of artificially conceived multiple pregnancies. Common reasons for indicated preterm births include pre-eclampsia or eclampsia, and intrauterine growth restriction. Births that follow spontaneous preterm labour and PPROM—together called spontaneous preterm births—are regarded as a syndrome resulting from multiple causes, including infection or inflammation, vascular disease, and uterine overdistension. Risk factors for spontaneous preterm births include a previous preterm birth, black race, periodontal disease, and low maternal body-mass index. A short cervical length and a raised cervical-vaginal fetal fibronectin concentration are the strongest predictors of spontaneous preterm birth.
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            Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals

            Summary Background Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000–15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival. Methods We increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1–59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation. Findings In 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935–1·179]), pneumonia (0·921 million [0·812 −1·117]), and intrapartum-related events (0·691 million [0·598 −0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000–15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR. Interpretation In the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target. Funding Bill & Melinda Gates Foundation, WHO.
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              National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications.

              Preterm birth is the second largest direct cause of child deaths in children younger than 5 years. Yet, data regarding preterm birth (<37 completed weeks of gestation) are not routinely collected by UN agencies, and no systematic country estimates nor time trend analyses have been done. We report worldwide, regional, and national estimates of preterm birth rates for 184 countries in 2010 with time trends for selected countries, and provide a quantitative assessment of the uncertainty surrounding these estimates. We assessed various data sources according to prespecified inclusion criteria. National Registries (563 datapoints, 51 countries), Reproductive Health Surveys (13 datapoints, eight countries), and studies identified through systematic searches and unpublished data (162 datapoints, 40 countries) were included. 55 countries submitted additional data during WHO's country consultation process. For 13 countries with adequate quality and quantity of data, we estimated preterm birth rates using country-level loess regression for 2010. For 171 countries, two regional multilevel statistical models were developed to estimate preterm birth rates for 2010. We estimated time trends from 1990 to 2010 for 65 countries with reliable time trend data and more than 10,000 livebirths per year. We calculated uncertainty ranges for all countries. In 2010, an estimated 14·9 million babies (uncertainty range 12·3-18·1 million) were born preterm, 11·1% of all livebirths worldwide, ranging from about 5% in several European countries to 18% in some African countries. More than 60% of preterm babies were born in south Asia and sub-Saharan Africa, where 52% of the global livebirths occur. Preterm birth also affects rich countries, for example, USA has high rates and is one of the ten countries with the highest numbers of preterm births. Of the 65 countries with estimated time trends, only three (Croatia, Ecuador, and Estonia), had reduced preterm birth rates 1990-2010. The burden of preterm birth is substantial and is increasing in those regions with reliable data. Improved recording of all pregnancy outcomes and standard application of preterm definitions is important. We recommend the addition of a data-quality indicator of the per cent of all live preterm births that are under 28 weeks' gestation. Distinguishing preterm births that are spontaneous from those that are provider-initiated is important to monitor trends associated with increased caesarean sections. Rapid scale up of basic interventions could accelerate progress towards Millennium Development Goal 4 for child survival and beyond. Bill & Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme; March of Dimes; the Partnership for Maternal Newborn and Childe Health; and WHO, Department of Reproductive Health and Research. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2021
                9 September 2021
                : 6
                : 9
                : e005856
                Affiliations
                [1 ]departmentDivision of Neonatology , Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                [2 ]departmentCenter for Prevention of Preterm Birth , Perinatal Institute, Cincinnati Children’s Hospital Medical Center and March of Dimes Prematurity Research Center Ohio Collaborative , Cincinnati, Ohio, USA
                [3 ]departmentDepartment of Pediatrics , University of Cincinnati College of Medicine , Cincinnati, Ohio, USA
                [4 ]departmentDivision of Human Genetics , Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                [5 ]departmentInternational Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland, USA
                [6 ]departmentBiorepository and Omics Research Group, Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College , The Aga Khan University , Karachi, Sindh, Pakistan
                [7 ]Center for Public Health Kinetics , New Delhi, India
                [8 ]departmentResearch Division , Public Health Laboratory, Center for Public Health Kinetics , Chake Chake, Tanzania
                [9 ]departmentMaternal and Child Health Division , International Centre for Diarrhoeal Disease Research Bangladesh , Dhaka, Dhaka District, Bangladesh
                [10 ]departmentObstetrics and Gynecology , University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
                [11 ]departmentINTERBIO-21st Study Consortium, Nuffield Department of Women’s & Reproductive Health , University of Oxford , Oxford, UK
                [12 ]departmentNutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research Bangladesh , Dhaka, Dhaka District, Bangladesh
                [13 ]departmentCenter for Child Health Research, Faculty of Medicine and Health Technology , Tampere University , Tampere, Pirkanmaa, Finland
                [14 ]Benh Vien Tu Du , Ho Chi Minh City, Viet Nam
                [15 ]departmentDepartment of Women's and Children's Health , University of Liverpool , Liverpool, UK
                [16 ]departmentDepartment of Chemistry , University of Cincinnati , Cincinnati, Ohio, USA
                [17 ]departmentJean Mayer USDA Human Nutrition Research Center on Aging , Tufts University , Medford, Massachusetts, USA
                [18 ]departmentGrand Forks Human Nutrition Research Center , USDA ARS , Grand Forks, North Dakota, USA
                [19 ]Projahnmo Research Foundation , Dhaka, Bangladesh
                [20 ]departmentNutritional and Clinical Services Division , International Centre for Diarrhoeal Disease Research Bangladesh , Dhaka, Dhaka District, Bangladesh
                [21 ]departmentSchool of Medicine , University of Zambia , Lusaka, Zambia
                [22 ]departmentSchool of Public Health , University of Zambia , Lusaka, Zambia
                [23 ]departmentCardiology , ICDDR, B , Dhaka, Bangladesh
                [24 ]departmentNutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research Bangladesh , Dhaka, Bangladesh
                [25 ]University of Tampere , Tampere, Pirkanmaa, Finland
                [26 ]departmentSchool of Public Health , University of Malawi College of Medicine , Blantyre, Malawi
                [27 ]departmentMedical Research Centre Oulu, PEDEGO Research Unit , University of Oulu , Oulu, Pohjois-Pohjanmaa, Finland
                [28 ]departmentDepartment of Women's and Children's Health , University of Liverpool , Liverpool, Merseyside, UK
                [29 ]departmentDepartment of Obstetrics and Gynecology , Duke University Medical Center , Durham, North Carolina, USA
                [30 ]departmentDepartment of Obstetrics, Gynecology and Reproductive Sciences , University of California San Francisco , San Francisco, California, USA
                [31 ]departmentDepartment of Epidemiology , University of Iowa , Iowa City, Iowa, USA
                [32 ]departmentDepartment of Pediatrics , University of Iowa , Iowa City, Iowa, USA
                [33 ]departmentDepartment of Medicine , World Health Organization , Geneva, Switzerland
                [34 ]Global Alliance to Prevent Prematurity and Stillbirth , Lynnwood, Washington, USA
                [35 ]departmentDivision of Perinatal Medicine , University of Liverpool , Liverpool, UK
                [36 ]departmentCenter for Child Health Research, Faculty of Medicine and Health Technology , University of Tampere , Tampere, Pirkanmaa, Finland
                [37 ]departmentDepartment of Pediatrics , Tampere University Hospital , Tampere, Finland
                [38 ]departmentInternational Center for Maternal and Newborn Health, Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland, USA
                [39 ]departmentNuffield Department of Women’s and Reproductive Health , University of Oxford , Oxford, UK
                [40 ]departmentDepartment of Biological Sciences and Center for Human Health and the Enivironment , North Carolina State University , Raleigh, North Carolina, USA
                [41 ]departmentDepartment of Pediatrics and Child Health , Aga Khan University , Karachi, Pakistan
                [42 ]departmentDepartment of Epidemiology and Biostatistics , University of California San Francisco , San Francisco, California, USA
                [43 ]departmentDepartment of Paediatrics , The Hospital for Sick Children , Toronto, Ontario, Canada
                [44 ]Burroughs Wellcome Fund , Research Triangle Park, North Carolina, USA
                Author notes
                [Correspondence to ] Nagendra Monangi; nagendra.monangi@ 123456cchmc.org ; Ge Zhang; Ge.Zhang@ 123456cchmc.org

                NM, HX, RK, WK, SD, JP, JTP, AAM, YF, TQL and AC are joint first authors.

                ZA, PA, AB, JH, CH, FJ, LLJ-P, AR, DER, SS, JS, GZ and LM are joint last authors.

                Author information
                http://orcid.org/0000-0003-2498-6452
                http://orcid.org/0000-0001-7995-8163
                http://orcid.org/0000-0002-8780-8760
                http://orcid.org/0000-0002-8292-9846
                http://orcid.org/0000-0003-0570-0308
                http://orcid.org/0000-0003-2311-2593
                http://orcid.org/0000-0003-1033-5034
                http://orcid.org/0000-0002-9590-7216
                Article
                bmjgh-2021-005856
                10.1136/bmjgh-2021-005856
                8438754
                34518202
                cbde9482-2f8b-4ff6-aed7-29d09b7e757f
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 29 March 2021
                : 04 August 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;
                Award ID: OPP1152451
                Award ID: OPP1175128
                Categories
                Original Research
                1506
                Custom metadata
                unlocked

                child health,environmental health,epidemiology,maternal health,nutrition

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