The purpose of this study was to evaluate the obstetrical outcomes in pregnant women with twin pregnancies who underwent an emergency cerclage placement. The pregnancy outcomes of the patients carrying twin gestations who underwent emergency cerclage from January 2010 to January 2016 in twin clinic of maternal-fetal medicine division in Cheil general hospital were evaluated. We defined an emergency cerclage as any cerclage placed in a patient with painless cervical dilation and exposed fetal membrane on speculum examination (Group 1) or short cervical length measured by transvaginal sonography (Group 2). Short CL was defined as a CL of less than 15mm or presenting cervical internal os dilatation (funnelling) greater than 50%. During the study period, total 64 twin pregnant women underwent emergency cerclage procedure. The median gestational week at cerclage was 24.1 and the median gestational week at delivery was 34.4. The average time between cerclage placement and delivery was 68.3 days overall. And the rate of delivery at or above 32+0 weeks of gestation is 67.2% (43 out of 64). In 16 women the cervix was dilated with bulging of membranes (Group 1), and in 48 women corresponded to Group 2 at the time of emergency cerclage. The mean interval between the cerclage to the delivery was significantly longer in group 2 (50.4 days vs 74.3 days, respectively P= .006). The mean gestational age at delivery was significantly higher in group 2 compared to group 1 (29.3±5.1 vs 34.0±3.7 weeks, P= .003). The rate of delivery at or above 32+0 weeks of gestation was significantly higher in group 2 compared to in group 1 (37.5% vs 77.1%, P= .006). Emergency cerclage could be considered an option for patients with twin pregnancies and dilated cervix. However, the pregnancy outcome was not favourable in twin pregnant women with membrane bulging at the time of the cerclage in our result. Our result might be helpful in counselling the patients with twin pregnancy about the consideration of emergency cerclage.
Abstract Previous studies have examined the prevalence of allergic diseases in adolescents 1–2 years after the emergence of the COVID-19 pandemic. However, more data is needed to understand the long-term impact of COVID-19 on allergic diseases. Thus, we aimed to examine the trend of the atopic dermatitis prevalence in Korean adolescents before and during the COVID-19 pandemic across 14 years. Additionally, we analyze the risk factors of atopic dermatitis (AD) based on the results. The Korean Disease Control and Prevention Agency conducted the Korea Youth Risk Behavior Web-based Survey from 2009 to 2022, from which the data for this study were obtained. Prevalence trends were compared across subgroups, and the β difference (β diff ) was calculated. We computed odds ratios to examine changes in the disease prevalence before and during the pandemic. This study included a total of 917,461 participants from 2009 to 2022. The prevalence of atopic dermatitis increased from 6.79% (95% CI 6.66–6.91) in 2009–2011 to 6.89% (95% CI 6.72–7.05) in 2018–2019, then decreased slightly to 5.82% (95% CI 5.60–6.04) in 2022. Across the 14 years, middle school student status, low parent’s highest education level, low household income, non-alcohol consumption, non-smoker smoking status, no suicidal thoughts, and no suicide attempts were associated with increased risk of atopic dermatitis, while female sex, rural residence, high BMI, low school performance, low household income, and no feelings of sadness and despair was associated with a small increase. This study examined the prevalence of atopic dermatitis across an 18-year, and found that the prevalence increased in the pre-pandemic then decreased during the start of the pandemic and remained constant throughout the pandemic. This trend could be explained mainly by the large scale social and political changes that occurred during the COVID-19 pandemic.
BACKGROUND Understanding the association between hypertension prevalence and socioeconomic and behavioral variables during a pandemic is essential, and this analysis should extend beyond short-term trends. OBJECTIVE This study aims to examine long-term trends in the prevalence of participants diagnosed with and receiving treatment for hypertension, using data collected by a nationally representative survey from 2009 to 2022, which includes the COVID-19 pandemic era. METHODS A nationwide, population-based, cross-sectional study used data collected from the South Korea Community Health Survey between 2009 and 2022. The study sample comprised 3,208,710 Korean adults over a period of 14 years. We aimed to assess trends in the prevalence of participants diagnosed with and receiving treatment for hypertension in the national population from 2009 to 2022, with a specific focus on the COVID-19 pandemic, using weighted linear regression models. RESULTS Among the included 3,072,546 Korean adults, 794,239 (25.85%) were aged 19-39 years, 1,179,388 (38.38%) were aged 40-59 years; 948,097 (30.86%) were aged 60-79 years, and 150,822 (4.91%) were aged 80 years or older. A total of 1,426,379 (46.42%) were men; 761,896 (24.80%) and 712,264 (23.18%) were diagnosed with and received treatment for hypertension, respectively. Although the overall prevalence over the 14-year period increased, the upward trends of patients diagnosed with and receiving treatment for hypertension decreased during the COVID-19 pandemic era compared with the prepandemic era (β difference for trend during vs before the pandemic –.101, 95% CI –0.107 to –0.094 vs –.133, 95% CI –0.140 to –0.127). Notably, the trends in prevalence during the pandemic were less pronounced in subgroups of older adults (≥60 years old) and individuals with higher alcohol consumption (≥5 days/month). CONCLUSIONS This nationwide representative study found that the national prevalence of participants diagnosed with and receiving treatment for hypertension increased during the prepandemic era. However, there was a marked decrease in these trends during the prepandemic era, compared with the pandemic era, particularly among specific subgroups at increased risk of negative outcomes. Future studies are needed to evaluate the factors associated with changes in the prevalence of hypertension during the COVID-19 pandemic.
The aim of this study was to evaluate the effect of cervical cerclage on the recurrence risk of preterm birth in singleton pregnant women after a preceding twin spontaneous preterm birth. This multicentre retrospective cohort study included singleton pregnant women after a preceding twin spontaneous preterm birth, from January 2009 to December 2018 in 10 referral hospitals. We compared cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage during pregnancy. We evaluated the independent risk factors on the spontaneous preterm birth (<37 weeks of gestation) in a subsequent singleton pregnancy. In the index singleton pregnancy, preterm birth occurred in 7 (11.1%) of 63 women. There was no significant difference in cervical lengths during pregnancy in women with or without cerclage. The independent risk factor of subsequent singleton preterm birth was the placement of emergency cerclage (odds ratio 37.3; 95% CI 1.5-911.3, p = 0.027), but not the placement of prophylactic cerclage (odds ratio 11.8; 95% CI 0.8-181.0, p = 0.077), in stepwise multivariate logistic regression analysis. There was no case who delivered before 35 weeks' gestation in the index singleton pregnancy, in women who received prophylactic cerclage, although there was significant difference in the mean gestational weeks at delivery, between no cerclage and prophylactic cerclage group (38.13±1.08 vs 37.25±0.97, p = 0.013). Cerclage did not improve the risk of preterm births in a subsequent singleton pregnancy after a preceding twin spontaneous preterm birth. Emergency cerclage was an independent risk factor of preterm birth. Prophylactic cerclage might be considered in women who experienced spontaneous preterm birth, at extreme gestation, to prevent recurrent preterm birth at extreme gestation, in a preceding twin pregnancy.
Fetal growth assessment via ultrasound has recently shifted to using personalised growth charts rather than the more common growth curves. Fetal growth can vary by race. In addition, the differences in growth curves between singleton and twins are already known and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) twin chart has been developed and used. However, there is no growth chart in Korean twins. The purpose of this study is to analyse fetal growth patterns suitable for Korean twins. This is a multicentre retrospective cohort study, which was conducted on 1,714 women were delivered, from January 2009 to June 2021, in 33 referral and local hospitals in Korea. Linear mixed models with a cubic spline mean structure analysis was used to constructed reference growth chart in twin. We compared the Korean twin standard chart to Korean single chart, and NICHD twin chart. It was found that the 50 percentile EFW of the Korean singleton growth chart (KSGC) and the 90 percentile EFW of the Korean twin growth chart (KTGH) have similar values. Comparing the MC twin and the DC twin growth chart, both are significantly smaller than the KSGC, but among them, the MC twin slightly smaller than the DC twin growth chart. The 50 percentile values of the Korean DC twin growth chart and are similar to NICHD but the KTGH has a smaller 90 percent value and a larger 10 percent value than NICHD chart. The KTGH has different patterns from the KSGC, and it has a very similar value to the 50 percentile of NICHD. However, the width of the distribution is narrow compared to the NICHD chart. Korean twins will need to apply a new chart that fits Korean standards clinically. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Although previous studies have investigated trends in unmet health care and dental care needs, most have focused on specific groups, such as patients with chronic conditions and older adults, and have been limited by smaller data sets.
Abstract As mounting evidence suggests a higher incidence of adverse consequences, such as disruption of the immune system, among patients with a history of COVID-19, we aimed to investigate post-COVID-19 conditions on a comprehensive set of allergic diseases including asthma, allergic rhinitis, atopic dermatitis, and food allergy. We used nationwide claims-based cohorts in South Korea (K-CoV-N; n = 836,164; main cohort) and Japan (JMDC; n = 2,541,021; replication cohort A) and the UK Biobank cohort (UKB; n = 325,843; replication cohort B) after 1:5 propensity score matching. Among the 836,164 individuals in the main cohort (mean age, 50.25 years [SD, 13.86]; 372,914 [44.6%] women), 147,824 were infected with SARS-CoV-2 during the follow-up period (2020−2021). The risk of developing allergic diseases, beyond the first 30 days of diagnosis of COVID-19, significantly increased (HR, 1.20; 95% CI, 1.13−1.27), notably in asthma (HR, 2.25; 95% CI, 1.80−2.83) and allergic rhinitis (HR, 1.23; 95% CI, 1.15−1.32). This risk gradually decreased over time, but it persisted throughout the follow-up period (≥6 months). In addition, the risk increased with increasing severity of COVID-19. Notably, COVID-19 vaccination of at least two doses had a protective effect against subsequent allergic diseases (HR, 0.81; 95% CI, 0.68−0.96). Similar findings were reported in the replication cohorts A and B. Although the potential for misclassification of pre-existing allergic conditions as incident diseases remains a limitation, ethnic diversity for evidence of incident allergic diseases in post-COVID-19 condition has been validated by utilizing multinational and independent population-based cohorts.
Summary Objective To investigate the potential association between prenatal opioid exposure and the risk of neuropsychiatric disorders in children. Design Nationwide birth cohort study. Setting From 1 January 2009 to 31 December 2020, birth cohort data of pregnant women in South Korea linked to their liveborn infants from the National Health Insurance Service of South Korea were collected. Participants All 3 251 594 infants (paired mothers, n=2 369 322; age 32.1 years (standard deviation 4.2)) in South Korea from the start of 2010 to the end of 2017, with follow-up from the date of birth until the date of death or 31 December 2020, were included. Main outcome measures Diagnosis of neuropsychiatric disorders in liveborn infants with mental and behaviour disorders (International Classification of Diseases 10th edition codes F00-99). Follow-up continued until the first diagnosis of neuropsychiatric disorder, 31 December 2020 (end of the study period), or the date of death, whichever occurred first. Eight cohorts were created: three cohorts (full unmatched, propensity score matched, and child screening cohorts) were formed, all of which were paired with sibling comparison cohorts, in addition to two more propensity score groups. Multiple subgroup analyses were performed. Results Of the 3 128 571 infants included (from 2 299 664 mothers), we identified 2 912 559 (51.3% male, 48.7% female) infants with no prenatal opioid exposure and 216 012 (51.2% male, 48.8% female) infants with prenatal opioid exposure. The risk of neuropsychiatric disorders in the child with prenatal opioid exposure was 1.07 (95% confidence interval 1.05 to 1.10) for fully adjusted hazard ratio in the matched cohort, but no significant association was noted in the sibling comparison cohort (hazard ratio 1.00 (0.93 to 1.07)). Prenatal opioid exposure during the first trimester (1.11 (1.07 to 1.15)), higher opioid doses (1.15 (1.09 to 1.21)), and long term opioid use of 60 days or more (1.95 (1.24 to 3.06)) were associated with an increased risk of neuropsychiatric disorders in the child. Prenatal opioid exposure modestly increased the risk of severe neuropsychiatric disorders (1.30 (1.15 to 1.46)), mood disorders, attention deficit hyperactivity disorder, and intellectual disability in the child. Conclusions Opioid use during pregnancy was not associated with a substantial increase in the risk of neuropsychiatric disorders in the offspring. A slightly increased risk of neuropsychiatric disorders was observed, but this should not be considered clinically meaningful given the observational nature of the study, and limited to high opioid dose, more than one opioid used, longer duration of exposure, opioid exposure during early pregnancy, and only to some neuropsychiatric disorders.
BACKGROUND Although previous studies have investigated trends in unmet health care and dental care needs, most have focused on specific groups, such as patients with chronic conditions and older adults, and have been limited by smaller data sets. OBJECTIVE This study aims to investigate the trends and relative risk factors for unmet health care and dental care needs, as well as the impact of the COVID-19 pandemic on these needs. METHODS We assessed unmet health care and dental care needs from 2009 to 2022 using data from the Korea Community Health Survey (KCHS). Our analysis included responses from 2,750,212 individuals. Unmet health care or dental care needs were defined as instances of not receiving medical or dental services deemed necessary by experts or desired by patients. RESULTS From 2009 to 2022, the study included 2,700,705 individuals (1,229,671 men, 45.53%; 673,780, 24.95%, aged 19-39 years). Unmet health care needs decreased before the COVID-19 pandemic; however, during the pandemic, there was a noticeable increase (β<sub>diff</sub> 0.10, 95% CI 0.09-0.11). Unmet dental care needs declined before the pandemic and continued to decrease during the pandemic (β<sub>diff</sub> 0.23, 95% CI 0.22-0.24). Overall, the prevalence of unmet dental care needs was significantly higher than that for unmet health care needs. While the prevalence of unmet health care needs generally decreased over time, the β difference during the pandemic increased compared with prepandemic values. CONCLUSIONS Our study is the first to analyze national unmet health care and dental care needs in South Korea using nationally representative, long-term, and large-scale data from the KCHS. We found that while unmet health care needs decreased during COVID-19, the decline was slower compared with previous periods. This suggests a need for more targeted interventions to prevent unmet health care and dental care needs.
Although previous studies suggest an association between SARS-CoV-2 infection and atopic dermatitis (AD) in adults, insufficient attention has been given to the impact of SARS-CoV-2 infection on pregnant woman and their offspring. Evidence on prenatal SARS-CoV-2 infection and subsequent risk of AD is lacking; therefore, we aimed to investigate the risk of AD in infants born to women who were infected with SARS-CoV-2 during pregnancy.
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