Identifying determinants of birth outcomes in South America

描述（由申请人提供）：出生体重、胎龄和宫内生长（IUG）是重要的出生结局，对未来的健康有重要贡献。不良结局包括低出生体重、早产和宫内发育迟缓（IUGR），大大增加了死亡和残疾的风险。全世界每年发生的400万新生儿死亡中约有28%与早产有关，约80%发生在LBW婴儿中。LBW和早产是常见的结果，在过去的二十年中一直在上升-全世界16%的婴儿出生在LBW。这些结果的病因在很大程度上仍然未知，但一些环境，行为和遗传风险被认为是通过独立和互动的作用。在南美洲，关于出生结局的可靠研究相对较少，以前的大多数研究都依赖于有限的病例对照样本以及相当简单的统计技术，这些技术非常容易受到偏见的影响。本研究旨在获得不良出生结局发生率的可靠估计值，并通过来自8个南美国家的非畸形婴儿的独特和大型出生样本中的独立或交互作用，确定导致这些结局的健康、人口统计学、行为和社会经济风险因素（超过100，000名新生儿）通过拉丁美洲先天性异常合作研究（ECLAMC）招募。这些样本是在大约90家医院中使用相同的采样和数据收集策略招募的，这些医院每年约有180，000例分娩，并且很好地代表了大型和未充分研究的南美人群。现有关于孕产妇健康、生育和行为风险以及可能在这些结果中发挥重要作用的社会经济和人口因素的数据。将使用卫生生产的卫生经济学模型和先进的多元技术来研究所有潜在相关投入和特征的贡献。这项研究具有重要意义，因为它对几个南美人群的不良出生结果负担提供了可靠的评估，确定卫生政策和干预措施可以针对的风险因素，以改善出生结果，并允许对各种风险因素的影响和作用进行国际比较，这不仅有助于确定研究国家的预防战略，也有助于确定其他国家的预防战略，美方一个例子是将这些高度混合的人群中的婴儿和母亲血统的影响与美国的那些人进行比较，在美国，发现LBW和早产率因种族而异。该研究还为相关风险因素和遗传变异之间的相互作用效应的更大研究提供了关键的初步步骤，这些研究也可能参与这些结果，并为研究选定干预措施改善出生结果的有效性的临床试验提供了关键的初步步骤。 公共卫生相关性：该项目的目的是确定不利的出生结果的决定因素，包括低出生体重，早产和子宫内生长限制在几个研究不足的南美人口。研究结果不仅对所包括的国家，而且对包括美国在内的其他国家，都与确定预防战略高度相关。

DESCRIPTION (provided by applicant): Birth weight, gestational age and intrauterine growth (IUG) are important birth outcomes that significantly contribute to future health. Adverse outcomes including low birth weight (LBW), preterm birth and IUG restriction (IUGR) increase substantially the risks of mortality and disability. About 28% of the 4 million neonatal deaths that occur each year worldwide are related to preterm birth, and about 80% occur among LBW infants. LBW and preterm birth are common outcomes and have been on the rise in the past two decades- 16% of babies worldwide are born at LBW. The etiology of these outcomes remains largely unknown but several environmental, behavioral and genetic risks are thought to be involved through both independent and interactive roles. Reliable studies of birth outcomes in South America have been relatively scarce and most previous studies have relied on limited case-control samples as well as fairly simple statistical techniques that are highly vulnerable to bias. This study aims at obtaining reliable estimates of the rates of adverse birth outcomes and identifying health, demographic, behavioral and socioeconomic risk factors that contribute to these outcomes through independent or interactive effects in unique and large birth samples of non-malformed infants from 8 South American countries (more than 100,000 births) recruited through the Latin American Collaborative Study of Congenital Anomalies (ECLAMC). These samples were recruited using the same sampling and data collection strategy in about 90 hospitals that attend about 180,000 births annually and are well representative of large and understudied South American populations. Data is available on maternal health, fertility and behavioral risks as well as on socioeconomic and demographic factors that may play an important role in these outcomes. A health economics model for health production and advanced multivariate techniques will be used to study the contribution of all potentially relevant inputs and characteristics. The study has important implications by providing a reliable assessment of the burden of adverse birth outcomes in several South America populations, identifying risk factors that can be targeted by health policies and interventions to improve birth outcomes and allowing international comparisons of the effects and roles of various risk factors which further help to identify prevention strategies not only in the studied countries but also in other countries including the US. An example would be comparing the effects of infant and maternal ancestry in these highly admixed populations to those in the US where LBW and preterm rates are found to vary significantly by race. The study also provides a key preliminary step to larger studies of interactive effects between relevant risk factors and genetic variants that may also be involved in these outcomes and to clinical trials that study the effectiveness of selected interventions to improve birth outcomes. PUBLIC HEALTH RELEVANCE: This project aims at identifying determinants of adverse birth outcomes including low birth weight, preterm birth and intrauterine growth restriction in several understudied South American populations. Study results are highly relevant for identifying prevention strategies not only for the included countries but also for others including the United States.