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Epidemiology > Perinatal epidemiology > Flashcards

Perinatal epidemiology Flashcards

1
Q

what is meant by perinatal

A

around the time or birth
ICD10 definition = 22 completed weeks of gestation to 7 completed days after birth

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2
Q

when does WHO say the perinatal period ends

A

28 weeks of gestation or when the fetus weighs 1000g to the end of the 7th completed day

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3
Q

how does the NHS define perinatal

A

the time between conceiving a baby until the end of the first postnatal year

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4
Q

what is the importance of perinatal epidemiology

A

identifying effects of events during pregnancy, outcome, maternal fetal and neonatal health outcomes
can identify harmful exposures during pregnancy, diet, genetic constitution, the effects of illness and medications
increased evidence that adverse experiences during pregnancy can impact childhood and adult health

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5
Q

what is the fetal origins hypothesis

A

Barkers 1995
says undernutrition in the womb during middle-late pregnancy causes improper fetal growth and so predisposition to diseases in adulthood

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6
Q

what is meant by fetal programming

A

events occurring during critical points of pregnancy may cause permanent effects on fetus and infant long after birth

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7
Q

what are methodological challenges to consider when using randomised control trial in perinatal research

A

randomising women
recruitment
factors like age, ethnicity, genetic constitution
inclusion of multiple births and subsequent births from the same mother

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8
Q

how do calculate perinatal prevalence rates

A

total birth prevalence = no. cases / no. births (live and still

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9
Q

how to find number of births for calculating prevalence

A

LB + FD + IA
live born
fetal deaths from 20 weeks gestation
IA - induced abortion or termination of pregnancy

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10
Q

what is perinatal mortality

A

number of stillbirths and deaths in the first week of life per 1000 live births

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11
Q

what is a stillbirth

A

a baby born dead after 24 completed weeks of pregnancy
before this is a miscarriage
5 in 1000 births in the Uk are still
stillbirth rates in most industralised countries have declined over the past 20 years

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12
Q

outline neonatal death

A

deaths among live born infants prior to first 28 days of life, per 1000 live births

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13
Q

what is ENMR

A

early neonatal mortality = deaths 0-6 days

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14
Q

what is LNMR

A

late neonatal mortality
= deaths 7-28 days

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15
Q

what is post neonatal mortality

A

deaths among live born infants between 29 days of life to the end of the first year of life per 1000 live births

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16
Q

what did Shenyang show for neonatal death between 1997 and 2014

A

urban neonatal mortality rate was lowest compared to rural neonatal mortality rate which was highest
per 1000 live births

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17
Q

what can perinatal mortality be used as

A

a public health indicator to assess the populations health status
effective way to compare public health between populations and over time
compare perinatal and antenatal health care between countries

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18
Q

what are factors undepinning perinatal death burden

A

genetics
environment
diagnostic services
methods of data collection
termination of pregnancy

19
Q

what are some health and survival challenges to the fetus

A

abnormal placentation
poor nutrition
multiple births
congenital abnormalities
infection
these can lead to stillbirth

20
Q

why is the rate of twins increasing

A

due to increasing maternal age and assisted reproductive technologies

21
Q

outline the global burden of congenital abnormalities

A

2-3% of babies born with significant congenital anomaly
major cause of stillbirth, infant mortality, childhood morbidity and long term disability

22
Q

outline genetics as a cause of congenital anomaly

A

abnormalities of large portion or entire chromosome
inheritance of abnormal genes
sporadic mutations in one of the germ cells contributing to fetus

23
Q

outline teratogenic exposure as a cause of congenital anomaly

A

in intrauterine environment of fetus
- dietary deficiency e.g maternal folic acid associated with increased risk of spina bifida
- toxic effects - exposure to harmful substance during pregnancy e.g thalidomide, mercury
- maternal infection e.g rubella and syphilis

24
Q

what can the zika virus cause

A

microcephaly
below average head size of baby, often caused by failure of brain to grow at normal rate
affects 25,000 babies in US each year

25
Q

what was the rate of stillbirths in 2020

A

3.8 stillbirths per 1000 births - unchanged since 2019

26
Q

what is the reason for lack of decline in stillbirth rates

A

unknown but may be related to changes in the distribution of risk factors
e.g greater numbers of births to very young and older women, increase in obesity and diabetes

27
Q

how many neonatal deaths are there worldwide

A

4 million

28
Q

what are the main causes of neonatal death

A

preterm birth - 28%
infections - 26%
asphyxia - 23%
tetanus - 7%

29
Q

what are some consequences of challenges to the fetus

A

premature delivery
low birth weight
cerebral palsy
gastroschisis
neonatal death

30
Q

what are common infectious diseases associated with fetus

A

respiratory tract infection
adenovirus
pneumonia

31
Q

what is the rate of preterm birth

A

5-7%
large ethnic variation
interventions have limited success
genetic suscpetibility factors believed to be important

32
Q

what are the consequences of preterm birth

A

patent ductus arteriosus (PDA) - delay of closure to blood vessel diverting blood from lungs
developmental delay
respiratory distress
neonatal mortality
importance of nutrition to catch up growth

33
Q

what is the leading cause of illness and death in mothers and new born babies

A

late pregnancy
19% of all first pregnancies affected

34
Q

what are 3 diseases of late pregnancy

A
  • pre-eclampsia - severe high BP, risk of stroke and seizure - 5% of first time mothers
  • fetal growth restriction - due to placenta problems leading to inadequate nutrition - 1 in 10 pregnancies
  • pre-term labour - long term disability, high morbidity and mortality
35
Q

what are causes of low birth weight

A

alcohol consumption
increased chorioaminonitis
cocaine use
increased multiple births
preterm induction of labour

36
Q

what is cerebral palsy

A

group of non-progressive neurological disabilities in development of human movement and posture
arises from disturbance in fetal brain development
no decline over past 60 years

37
Q

what are the 2 types of cerebral palsy

A

congenital - during pregnany - 75%
acquired - after birth - 25%

38
Q

what is the incidence of cerebral palsy

A

2.5 per 1000 live births

39
Q

what are some known causes of cerebral palsy

A

80% of cases have unknown aetiology
infections, malnutrition, head injury in early childhood

40
Q

what is gastroschisis

A

opening in abdominal wall causes bowel to develop outside of babys stomach
occurs during 4th week of development due to lack of meeting between lateral body and walls of embryo
associated with young maternal age

41
Q

what is the prevalence of gastroschisis

A

4 in 1000 new borns

42
Q

what are risk factors associated with gastroschisis

A

low social class
smoking
alcohol consumption
medications
use of recreational drugs like cocaine
opioid use

43
Q

in summary what are the causes of neonatal death

A

birth outcomes
obsteric and neonatal complications (injury, asphyxia, hypothermia)
maternal health preceding and during pregnancy
bacterial and viral infections

Epidemiology (23 decks)

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