ingest
cdrApp
2017-07-05T14:20:50.723Z
50c63b7d-d0f6-4ed5-9538-cbd87f801826
modifyDatastreamByValue
RELS-EXT
fedoraAdmin
2017-07-05T15:20:40.158Z
Setting exclusive relation
modifyDatastreamByValue
RELS-EXT
fedoraAdmin
2017-07-05T15:20:48.372Z
Setting exclusive relation
addDatastream
MD_TECHNICAL
fedoraAdmin
2017-07-05T15:20:56.442Z
Adding technical metadata derived by FITS
modifyDatastreamByValue
RELS-EXT
fedoraAdmin
2017-07-05T15:21:12.508Z
Setting exclusive relation
addDatastream
MD_FULL_TEXT
fedoraAdmin
2017-07-05T15:21:21.277Z
Adding full text metadata extracted by Apache Tika
modifyDatastreamByValue
RELS-EXT
fedoraAdmin
2017-07-05T15:21:38.361Z
Setting exclusive relation
modifyDatastreamByValue
RELS-EXT
cdrApp
2017-07-05T17:45:00.390Z
Setting exclusive relation
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2018-01-25T13:26:05.844Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2018-01-27T13:25:23.732Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2018-03-14T10:40:05.746Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2018-05-18T13:26:27.048Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2018-07-11T09:11:17.873Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2018-07-18T05:16:17.413Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2018-08-16T18:24:08.418Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2018-09-27T14:12:30.240Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2018-10-12T05:22:21.835Z
modifyDatastreamByValue
MD_DESCRIPTIVE
cdrApp
2019-03-21T15:08:26.802Z
Nelson
Pace
Author
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births.
Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)).
Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise.
Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
Winter 2017
2017
Epidemiology
Public health
Medicine
birth defects, body mass index, infant mortality, maternal diet, spina bifida, survival analysis
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF
LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting
for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is
characterized by the protrusion of the spinal cord through a boney defect in the vertebral
column. First-year mortality occurs among approximately 8% of infants with spina bifida,
thirteen times higher than the national average risk of infant mortality for all U.S.
births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of
pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore,
in the U.S., the average childbearing woman has a diet that is considered poor quality.
Rates of childhood obesity have increased over the last few decades. We conducted a
retrospective cohort study using data from the National Birth Defects Prevention Study
linked to state death records to examine the role of pre-pregnancy body mass index and
maternal dietary patterns on survival among infants born with spina bifida during the
first-year of life. Overall first-year mortality risk among infants with spina bifida was
4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very
preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic
Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight
and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20,
32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers
(2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential
confounding by maternal age, education, race/ethnicity, and folic acid supplementation
showed that underweight and obese mothers had greater hazard of infant mortality compared
to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02),
respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating
Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality
compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4
(0.93, 5.78), respectively) though the estimates were imprecise. Our results support
maternal pre-pregnancy body mass index as a modifiable factor that may be useful in
efforts to improve infant survival. This study provides suggestive evidence that maternal
pre-pregnancy diet is associated with infant survival among babies born with spina bifida.
Nonetheless, adherence to dietary guidelines and healthy eating patterns have been
associated with reduced risks of adverse pregnancy outcomes such as birth defects and
improved maternal health.
Winter 2017
2017
Epidemiology
Public health
Medicine
birth defects, body mass index, infant mortality,
maternal diet, spina bifida, survival analysis
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting
institution
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise. Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
Winter 2017
2017
Epidemiology
Public health
Medicine
birth defects, body mass index, infant mortality, maternal diet, spina bifida, survival analysis
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise. Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
2017-12
2017
Epidemiology
Public health
Medicine
birth defects, body mass index, infant mortality, maternal diet, spina bifida, survival analysis
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise. Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
2017
Epidemiology
Public health
Medicine
birth defects, body mass index, infant mortality, maternal diet, spina bifida, survival analysis
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
2017-12
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise. Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
2017
Epidemiology
Public health
Medicine
birth defects, body mass index, infant mortality, maternal diet, spina bifida, survival analysis
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
2017-12
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise. Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
2017
Epidemiology
Public health
Medicine
birth defects, body mass index, infant mortality, maternal diet, spina bifida, survival analysis
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
2017-12
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise. Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
2017
Epidemiology
Public health
Medicine
birth defects, body mass index, infant mortality, maternal diet, spina bifida, survival analysis
eng
Doctor of Philosophy
Dissertation
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
2017-12
University of North Carolina at Chapel Hill
Degree granting institution
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise. Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
2017
Epidemiology
Public health
Medicine
birth defects; body mass index; infant mortality; maternal diet; spina bifida; survival analysis
eng
Doctor of Philosophy
Dissertation
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
2017-12
University of North Carolina at Chapel Hill
Degree granting institution
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise. Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
2017
Epidemiology
Public health
Medicine
birth defects, body mass index, infant mortality, maternal diet, spina bifida, survival analysis
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
2017-12
Nelson
Pace
Creator
Department of Epidemiology
Gillings School of Global Public Health
SURVIVAL OF INFANTS WITH SPINA BIFIDA DURING THE FIRST YEAR OF LIFE
Birth defects are a leading cause of infant mortality in the U.S. accounting for 1 in every 5 infant deaths. Spina bifida, a serious though rare defect, is characterized by the protrusion of the spinal cord through a boney defect in the vertebral column. First-year mortality occurs among approximately 8% of infants with spina bifida, thirteen times higher than the national average risk of infant mortality for all U.S. births. Pre-pregnancy obesity (body mass index greater than or equal to 30 at the start of pregnancy) is common occurring in more than 1 in 5 pregnant women in the U.S. Furthermore, in the U.S., the average childbearing woman has a diet that is considered poor quality. Rates of childhood obesity have increased over the last few decades. We conducted a retrospective cohort study using data from the National Birth Defects Prevention Study linked to state death records to examine the role of pre-pregnancy body mass index and maternal dietary patterns on survival among infants born with spina bifida during the first-year of life. Overall first-year mortality risk among infants with spina bifida was 4.4% (95% CI: 3.52, 5.60%). Infants who had multiple co-occurring defects, were born very preterm, were one of multiples, had high-level spina bifida lesions, or had non-Hispanic Black mothers were at highest risk of infant mortality. Maternal pre-pregnancy underweight and obesity were associated with higher infant mortality risk (15.7% (95% CI: 7.20, 32.30%) and 5.8% (95% CI: 3.60, 9.35%), respectively) compared to normal weight mothers (2.2% (95% CI: 1.19, 4.18%)). Cox proportional hazards model adjusted for potential confounding by maternal age, education, race/ethnicity, and folic acid supplementation showed that underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 (95% CI: 1.08, 16.72) and 2.6 (1.36, 8.02), respectively). Mothers that scored low (poorer diet quality) in both the Healthy Eating Index and the Diet Quality Index for Pregnancy had higher hazard of infant mortality compared to mothers with high (better diet quality) scores (HR: 1.4 (0.54, 4.33) and 2.4 (0.93, 5.78), respectively) though the estimates were imprecise. Our results support maternal pre-pregnancy body mass index as a modifiable factor that may be useful in efforts to improve infant survival. This study provides suggestive evidence that maternal pre-pregnancy diet is associated with infant survival among babies born with spina bifida. Nonetheless, adherence to dietary guidelines and healthy eating patterns have been associated with reduced risks of adverse pregnancy outcomes such as birth defects and improved maternal health.
2017
Epidemiology
Public health
Medicine
birth defects; body mass index; infant mortality; maternal diet; spina bifida; survival analysis
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Anna Maria
Siega-Riz
Thesis advisor
Robert
Meyer
Thesis advisor
Andrew
Olshan
Thesis advisor
Stephen
Cole
Thesis advisor
Nancy
Chescheir
Thesis advisor
text
2017-12
Pace_unc_0153D_16694.pdf
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2017-01-20T03:16:04Z
2019-07-05T00:00:00
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