Browsing by Author "Roseline Ochieng"

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    Association between Preterm-Birth Phenotypes and Differential Morbidity, Growth, and Neurodevelopment at Age 2 Years: Results from the INTERBIO-21st Newborn Study
    (2021-05-01) Jose Villar; María C. Restrepo-Méndez; Rose McGready; Fernando C. Barros; Cesar G. Victora; Shama Munim; Aris T. Papageorghiou; Roseline Ochieng; Rachel Craik; Hellen C. Barsosio; James A. Berkley; Maria Carvalho; Michelle Fernandes; Leila Cheikh Ismail; Ann Lambert; Shane A. Norris; Eric O. Ohuma; Alan Stein; Chrystelle O.O. Tshivuila-Matala; Krina T. Zondervan; Adele Winsey; Francois Nosten; Ricardo Uauy; Zulfiqar A. Bhutta; Stephen H. Kennedy; Faculty of Tropical Medicine, Mahidol University; The Wellcome Centre for Human Genetics; University of Sharjah; Wellcome Trust Research Laboratories Nairobi; Aga Khan Hospital Nairobi; The Aga Khan University; London School of Hygiene & Tropical Medicine; Hospital for Sick Children University of Toronto; Green Templeton College; University of Oxford; University of Southampton, Faculty of Medicine; Universidade Catolica de Pelotas; Liverpool School of Tropical Medicine; The World Bank Group; University of the Witwatersrand, Johannesburg; Universidade Federal de Pelotas; Wits School of Public Health; Nuffield Department of Medicine; University of Oxford Medical Sciences Division
    Importance: The etiologic complexities of preterm birth remain inadequately understood, which may impede the development of better preventative and treatment measures. Objective: To examine the association between specific preterm-birth phenotypes and clinical, growth, and neurodevelopmental differences among preterm newborns compared with term newborns up to age 2 years. Design, Setting, and Participants: The INTERBIO-21st study included a cohort of preterm and term newborn singletons enrolled between March 2012 and June 2018 from maternity hospitals in 6 countries worldwide who were followed up from birth to age 2 years. All pregnancies were dated by ultrasonography. Data were analyzed from November 2019 to October 2020. Exposures/Interventions: Preterm-birth phenotypes. Main Outcomes and Measures: Infant size, health, nutrition, and World Health Organization motor development milestones assessed at ages 1 and 2 years; neurodevelopment evaluated at age 2 years using the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) tool. Results: A total of 6529 infants (3312 boys [50.7%]) were included in the analysis. Of those, 1381 were preterm births (mean [SD] gestational age at birth, 34.4 [0.1] weeks; 5148 were term births (mean [SD] gestational age at birth, 39.4 [0] weeks). Among 1381 preterm newborns, 8 phenotypes were identified: no main maternal, fetal, or placental condition detected (485 infants [35.1%]); infections (289 infants [20.9%]); preeclampsia (162 infants [11.7%]); fetal distress (131 infants [9.5%]); intrauterine growth restriction (110 infants [8.0%]); severe maternal disease (85 infants [6.2%]); bleeding (71 infants [5.1%]); and congenital anomaly (48 infants [3.5%]). For all phenotypes, a previous preterm birth was a risk factor for recurrence. Each phenotype displayed differences in neonatal morbidity and infant outcomes. For example, infants with the no main condition detected phenotype had low neonatal morbidity but increased morbidity and hospitalization incidence at age 1 year (odds ratio [OR], 2.2; 95% CI, 1.8-2.7). Compared with term newborns, the highest risk of scoring lower than the 10th centile of INTER-NDA normative values was observed in the fine motor development domain among newborns with the fetal distress (OR, 10.6; 95% CI, 5.1-22.2) phenotype. Conclusions and Relevance: Results of this study suggest that phenotypic classification may provide a better understanding of the etiologic factors and mechanisms associated with preterm birth than continuing to consider it an exclusively time-based entity..
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    Fetal cranial growth trajectories are associated with growth and neurodevelopment at 2 years of age: INTERBIO-21st Fetal Study
    (2021-04-01) José Villar; Robert B. Gunier; Chrystelle O.O. Tshivuila-Matala; Stephen A. Rauch; Francois Nosten; Roseline Ochieng; María C. Restrepo-Méndez; Rose McGready; Fernando C. Barros; Michelle Fernandes; Verena I. Carrara; Cesar G. Victora; Shama Munim; Rachel Craik; Hellen C. Barsosio; Maria Carvalho; James A. Berkley; Leila Cheikh Ismail; Shane A. Norris; Eric O. Ohuma; Alan Stein; Ann Lambert; Adele Winsey; Ricardo Uauy; Brenda Eskenazi; Zulfiqar A. Bhutta; Aris T. Papageorghiou; Stephen H. Kennedy; Faculty of Tropical Medicine, Mahidol University; Center for Environmental Research and Children's Health; University of Sharjah; Wellcome Trust Research Laboratories Nairobi; Aga Khan Hospital Nairobi; The Aga Khan University; London School of Hygiene & Tropical Medicine; Hospital for Sick Children University of Toronto; Green Templeton College; University of Oxford; University of Southampton, Faculty of Medicine; Universidade Catolica de Pelotas; The World Bank Group; University of the Witwatersrand, Johannesburg; Universidade Federal de Pelotas; Wits School of Public Health; Nuffield Department of Medicine; University of Oxford Medical Sciences Division
    Many observational studies and some randomized trials demonstrate how fetal growth can be influenced by environmental insults (for example, maternal infections)1 and preventive interventions (for example, multiple-micronutrient supplementation)2 that can have a long-lasting effect on health, growth, neurodevelopment and even educational attainment and income in adulthood3. In a cohort of pregnant women (n = 3,598), followed-up between 2012 and 2019 at six sites worldwide4, we studied the associations between ultrasound-derived fetal cranial growth trajectories, measured longitudinally from <14 weeks’ gestation, against international standards5,6, and growth and neurodevelopment up to 2 years of age7,8. We identified five trajectories associated with specific neurodevelopmental, behavioral, visual and growth outcomes, independent of fetal abdominal growth, postnatal morbidity and anthropometric measures at birth and age 2. The trajectories, which changed within a 20–25-week gestational age window, were associated with brain development at 2 years of age according to a mirror (positive/negative) pattern, mostly focused on maturation of cognitive, language and visual skills. Further research should explore the potential for preventive interventions in pregnancy to improve infant neurodevelopmental outcomes before the critical window of opportunity that precedes the divergence of growth at 20–25 weeks’ gestation.