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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2008.10.017 Byline: Nina Ayen (a)(b)(c), Gry Poulsen (a), Heather A. Boyd (a), Jan Wohlfahrt (a), Peter K.A. Jensen (d), Mads Melbye (a) Abstract: Time trends in congenital heart defects (CHD) by specific phenotype and with long follow-up time are rarely available for an entire population. We present trends in national CHD prevalences over the past 3 decades. Author Affiliation: (a) Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (b) Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (c) Department of Public Health and Primary Healthcare, University of Bergen, Bergen, Norway (d) Department of Clinical Genetics, Arhus University Hospital, Arhus, Denmark Article History: Received 22 September 2008; Accepted 23 October 2008

Early Crohn's disease (CD) treatment involves anti-tumor necrosis factor (TNF) agents, whereas ileocecal resection (ICR) is reserved for complicated CD or treatment failure. We compared long-term outcomes of primary ICR and anti-TNF therapy for ileocecal CD. Using cross-linked nationwide registers, we identified all individuals diagnosed with ileal or ileocecal CD between 2003 and 2018 and treated with ICR or anti-TNF agents within 1 year of diagnosis. The primary outcome was a composite of ≥1 of the following: CD-related hospitalization, systemic corticosteroid exposure, CD-related surgery, and perianal CD. We conducted adjusted Cox's proportional hazards regression analyses and determined the cumulative risk of different treatments after primary ICR or anti-TNF therapy. Of 16,443 individuals diagnosed with CD, 1279 individuals fulfilled the inclusion criteria. Of these, 45.4% underwent ICR and 54.6% received anti-TNF. The composite outcome occurred in 273 individuals (incidence rate, 110/1000 person-years) in the ICR group and in 318 individuals (incidence rate, 202/1000 person-years) in the anti-TNF group. The risk of the composite outcome was 33% lower with ICR compared with anti-TNF (adjusted hazard ratio, 0.67; 95% confidence interval, 0.54–0.83). ICR was associated with reduced risk of systemic corticosteroid exposure and CD-related surgery, but not other secondary outcomes. The proportion of individuals on immunomodulator, anti-TNF, who underwent subsequent resection, or were on no therapy 5 years post-ICR was 46.3%, 16.8%, 1.8%, and 49.7%, respectively. These data suggest that ICR may have a role as first-line therapy in CD management and challenge the current paradigm of reserving surgery for complicated CD refractory or intolerant to medications. Yet, given inherent biases associated with observational data, our findings should be interpreted and applied cautiously in clinical decision making. [Display omitted] Using nationwide data with long-term follow up of an unselected population-based cohort from Denmark, we report improved long-term outcomes with ileocecal resection compared with anti-tumor necrosis factor as primary treatment for early ileal and ileocecal Crohn's disease and that a substantial subset of patients was on no medication 5 years after ileocecal resection. [ABSTRACT FROM AUTHOR]

Objective: To measure agreement between gestational age based on maternal report of expected date of delivery (EDD) 9 months after birth and gestational age at birth in routine hospital data. Furthermore, to examine whether sociodemographic and perinatal factors influenced agreement and whether disagreement affected classification of infants in preterm groups.Study Design and Setting: The study used data on 8,058 singleton infants from the UK Millennium Cohort Study. Women were interviewed 9 months after birth and interviews were linked to routine hospital data. The infant's date of birth and EDD were used to calculate gestational age in completed weeks.Results: Agreement between maternal report and hospital data was 72% for exact number of weeks' gestation and 94% for agreement within 1 week. Disagreement was associated with the infant not being firstborn, unplanned pregnancy, late or no antenatal care, and low socioeconomic status. Maternal report of gestational age resulted in slightly more children being classified as preterm (6.4%) than gestational age based on hospital data (6.1%). Agreement was found to be poor for postterm births.Conclusion: Gestational age based on retrospective maternal reporting of EDD is reliable within 1 week or when used to assign infants to broad gestational groups. [ABSTRACT FROM AUTHOR]

Abstract: Immune maladaption between mother and infant has been suggested to induce preeclampsia/eclampsia. When fetuses share more human leukocyte antigen (HLA) types with their mother, immune differences would be limited and thereby could affect this risk. Data from Danish women (1996–2002) with single live-birth pregnancies complicated by severe preeclampsia/eclampsia were compared to women with term pregnancies uncomplicated by hypertension. HLA A, B, and DR types were resolved at the intermediate-level typing (antigen). A total of 201 cases and 195 control mother–infant pairs had complete HLA types. The odds ratios of preeclampsia/eclampsia in mothers sharing both HLA antigens with their infants were 1.19 (95% confidence interval: 0.81–1.76) for HLA A, 0.91 (0.59–1.42) for HLA B, and 1.05 (0.5–1.59) for HLA DR antigens. No specific HLA antigens in either mother or infant appeared important after Bonferroni correction, except possibly DR01 in mothers (protective). Thus, maladaption mediated by adaptive immunity between mother and infant is not the basis for the mother developing preeclampsia/eclampsia. [Copyright &y& Elsevier]

Background: Time trends in congenital heart defects (CHD) by specific phenotype and with long follow-up time are rarely available for an entire population. We present trends in national CHD prevalences over the past 3 decades. Methods: We linked information from the National Patient Register, the Causes of Death Register, and the Danish Cytogenetic Central Register for all persons born in Denmark, 1977 to 2005, and registered in the Civil Registration System, yielding a cohort of 1,763,591 persons—18,207 with CHD. Individuals with CHDs were classified by phenotype (heterotaxia, conotruncal defect, atrioventricular septal defect, anomalous pulmonary venous return, left and right ventricular outflow tract obstructions, septal defects, complex defects, associations, patent ductus arteriosus, unspecified, and other specified) by combining International Classification of Diseases codes using a hierarchical approach. Results: From 1977 to 2005, the overall CHD birth prevalence increased from 73 to 113 per 10,000 live births. Generally, prevalence increased for defects diagnosed in infancy, until 1996–1997, and then stabilized. For each 5-year interval, isolated septal defects and severe defects increased by 22% (95% CI, 20%-25%) and 5% (95% CI, 4%-7%), respectively. Among the severe defects, conotruncal defects and atrioventricular septal defect showed the largest prevalence increases. Women had a lower prevalence of severe defects during the 1980s. The CHD prevalence increase was unchanged when persons with extracardiac defects or chromosomal aberrations were excluded. Conclusions: CHD birth prevalence increased from the beginning of the 1980s but stabilized in the late 1990s. [Copyright &y& Elsevier]