PDF(Pubmed)
Abstract：
UNASSIGNED: The 1980 and 1986 Swedish so-called speed premium policies aimed at protecting parents\' income-based parental leave benefits for birth intervals shorter than 24 and 30 months, respectively, but indirectly encouraged shorter birth spacing and childbearing at older ages, both risk factors for several perinatal health outcomes. Whether those policy changes are associated with perinatal health remains unknown.
UNASSIGNED: To evaluate the association between the 1980 and 1986 speed premium policies and perinatal health outcomes.
UNASSIGNED: This cross-sectional study investigated data from 1 762 784 singleton births in the Swedish Medical Birth Register from January 1, 1974, through December 31, 1991. Data were analyzed from October 11, 2022, to December 12, 2023.
UNASSIGNED: Speed premium policy introduction (January 1, 1980) and extension (January 1, 1986).
UNASSIGNED: Total population register data were used in an interrupted time series analysis with segmented logistic regression to calculate the odds of preterm birth, low birth weight, small for gestational age (SGA) at preterm, and stillbirth measured before and after the speed premium policy reforms. Subgroup analyses by maternal origin were conducted to evaluate changes by different policy responses.
UNASSIGNED: Among 1 762 784 births analyzed, 4.8% were preterm (of which 12.0% were SGA), 3.2% had low birth weight, and 0.3% were stillbirths. The 1980 speed premium policy was associated with a 0.3% monthly increase in the odds of preterm birth compared with the period before the reform (odds ratio [OR], 1.0029 [95% CI, 1.002-1.004]), equivalent to a 26.4% increase from January 1, 1980, to December 31, 1985. After the 1986 relaxation of the policy, preterm birth odds decreased 0.5% per month (OR, 0.9951 [95% CI, 0.994-0.996]), equivalent to an 11.1% decrease across the next 6 years. Low birth weight displayed a similar pattern for both reform periods, that is, increased 0.2% (OR, 1.0021; 95% CI, 1.001-1.003) per month in 1980 through 1985 compared with baseline, and decreased 0.3% (OR, 0.9975; 95% CI, 0.996-0.998) per month in the following period, but was attenuated when considering low birth weight at term. Odds of SGA at preterm were decreased after 1980 (OR, 0.9965; 95% CI, 0.994-0.999) but not in 1986 (OR, 1.0009; 95% CI, 0.998-1.003), whereas stillbirths did not change following either reform (1980: OR, 1.0020 [95% CI, 0.999-1.005]; 1986: OR, 1.0002 [95% CI, 0.997-1.003]). Subgroup analyses suggested that perinatal health changes were restricted to births to Swedish- and Nordic-born mothers, the primary groups to adjust their fertility behaviors to the reforms.
UNASSIGNED: Despite its economic advantages for couples, especially for mothers, the introduction of the speed premium policy was associated with adverse perinatal health consequences, particularly for preterm births. Family policies should be carefully designed with a \"Health in All Policies\" lens to avoid possible unintended repercussions for fertility behaviors and, in turn, perinatal health.
UNASSIGNED: To evaluate the association between the 1980 and 1986 speed premium policies and perinatal health outcomes.
UNASSIGNED: This cross-sectional study investigated data from 1 762 784 singleton births in the Swedish Medical Birth Register from January 1, 1974, through December 31, 1991. Data were analyzed from October 11, 2022, to December 12, 2023.
UNASSIGNED: Speed premium policy introduction (January 1, 1980) and extension (January 1, 1986).
UNASSIGNED: Total population register data were used in an interrupted time series analysis with segmented logistic regression to calculate the odds of preterm birth, low birth weight, small for gestational age (SGA) at preterm, and stillbirth measured before and after the speed premium policy reforms. Subgroup analyses by maternal origin were conducted to evaluate changes by different policy responses.
UNASSIGNED: Among 1 762 784 births analyzed, 4.8% were preterm (of which 12.0% were SGA), 3.2% had low birth weight, and 0.3% were stillbirths. The 1980 speed premium policy was associated with a 0.3% monthly increase in the odds of preterm birth compared with the period before the reform (odds ratio [OR], 1.0029 [95% CI, 1.002-1.004]), equivalent to a 26.4% increase from January 1, 1980, to December 31, 1985. After the 1986 relaxation of the policy, preterm birth odds decreased 0.5% per month (OR, 0.9951 [95% CI, 0.994-0.996]), equivalent to an 11.1% decrease across the next 6 years. Low birth weight displayed a similar pattern for both reform periods, that is, increased 0.2% (OR, 1.0021; 95% CI, 1.001-1.003) per month in 1980 through 1985 compared with baseline, and decreased 0.3% (OR, 0.9975; 95% CI, 0.996-0.998) per month in the following period, but was attenuated when considering low birth weight at term. Odds of SGA at preterm were decreased after 1980 (OR, 0.9965; 95% CI, 0.994-0.999) but not in 1986 (OR, 1.0009; 95% CI, 0.998-1.003), whereas stillbirths did not change following either reform (1980: OR, 1.0020 [95% CI, 0.999-1.005]; 1986: OR, 1.0002 [95% CI, 0.997-1.003]). Subgroup analyses suggested that perinatal health changes were restricted to births to Swedish- and Nordic-born mothers, the primary groups to adjust their fertility behaviors to the reforms.
UNASSIGNED: Despite its economic advantages for couples, especially for mothers, the introduction of the speed premium policy was associated with adverse perinatal health consequences, particularly for preterm births. Family policies should be carefully designed with a \"Health in All Policies\" lens to avoid possible unintended repercussions for fertility behaviors and, in turn, perinatal health.
摘要：
■1980年和1986年瑞典所谓的速度保费政策，旨在保护父母基于收入的育儿假福利，其出生间隔短于24个月和30个月，分别,但间接地鼓励了较短的生育间隔和年龄较大的生育，这两个风险因素对几个围产期健康结局。这些政策的变化是否与围产期健康有关仍然未知。
■评估1980年至1986年的速度保费政策与围产期健康结果之间的关联。
■这项横断面研究调查了从1974年1月1日至1991年12月31日在瑞典医学出生登记册中的1762784例单胎出生的数据。数据从2022年10月11日至2023年12月12日进行了分析。
■速度保费保单介绍（1980年1月1日）和延期（1986年1月1日）。
■总人口登记数据用于分段逻辑回归的中断时间序列分析，以计算早产的几率，低出生体重,小于胎龄（SGA）在早产，以及在速度保费政策改革前后测量的死胎。进行了按母亲来源的亚组分析，以评估不同政策反应的变化。
■在分析的1762784名新生儿中，4.8%为早产（其中12.0%为SGA），3.2%的人出生体重低，0.3%为死产。1980年的速度保费政策与改革前相比，早产的几率每月增加0.3％（优势比[OR]，1.0029[95%CI，1.002-1.004])，相当于从1980年1月1日到1985年12月31日增加了26.4%。1986年政策放松后，早产几率每月下降0.5%(或，0.9951[95%CI，0.994-0.996])，相当于未来6年下降11.1%。低出生体重在两个改革时期都表现出相似的模式，也就是说,增加0.2%(或，1.0021；95%CI，1.001-1.003）1980年至1985年每月与基线相比，并下降0.3%(或，0.9975；95%CI，0.996-0.998)下一时期每月，但在考虑足月低出生体重时减弱。1980年后早产时SGA的几率降低(或，0.9965；95%CI，0.994-0.999)，但1986年没有(OR，1.0009；95%CI，0.998-1.003），而死胎在两次改革后都没有改变(1980：或，1.0020[95%CI，0.999-1.005]；1986年：或，1.0002[95%CI，0.997-1.003]）。亚组分析表明，围产期健康变化仅限于瑞典和北欧出生的母亲的出生，主要群体根据改革调整生育行为。
■尽管它对夫妻有经济优势，尤其是对母亲来说，速度保费政策的推出与不良围产期健康后果有关，特别是早产。家庭政策应精心设计，并带有“所有政策中的健康”镜头，以避免对生育行为产生可能的意外影响，反过来,围产期健康。
■评估1980年至1986年的速度保费政策与围产期健康结果之间的关联。
■这项横断面研究调查了从1974年1月1日至1991年12月31日在瑞典医学出生登记册中的1762784例单胎出生的数据。数据从2022年10月11日至2023年12月12日进行了分析。
■速度保费保单介绍（1980年1月1日）和延期（1986年1月1日）。
■总人口登记数据用于分段逻辑回归的中断时间序列分析，以计算早产的几率，低出生体重,小于胎龄（SGA）在早产，以及在速度保费政策改革前后测量的死胎。进行了按母亲来源的亚组分析，以评估不同政策反应的变化。
■在分析的1762784名新生儿中，4.8%为早产（其中12.0%为SGA），3.2%的人出生体重低，0.3%为死产。1980年的速度保费政策与改革前相比，早产的几率每月增加0.3％（优势比[OR]，1.0029[95%CI，1.002-1.004])，相当于从1980年1月1日到1985年12月31日增加了26.4%。1986年政策放松后，早产几率每月下降0.5%(或，0.9951[95%CI，0.994-0.996])，相当于未来6年下降11.1%。低出生体重在两个改革时期都表现出相似的模式，也就是说,增加0.2%(或，1.0021；95%CI，1.001-1.003）1980年至1985年每月与基线相比，并下降0.3%(或，0.9975；95%CI，0.996-0.998)下一时期每月，但在考虑足月低出生体重时减弱。1980年后早产时SGA的几率降低(或，0.9965；95%CI，0.994-0.999)，但1986年没有(OR，1.0009；95%CI，0.998-1.003），而死胎在两次改革后都没有改变(1980：或，1.0020[95%CI，0.999-1.005]；1986年：或，1.0002[95%CI，0.997-1.003]）。亚组分析表明，围产期健康变化仅限于瑞典和北欧出生的母亲的出生，主要群体根据改革调整生育行为。
■尽管它对夫妻有经济优势，尤其是对母亲来说，速度保费政策的推出与不良围产期健康后果有关，特别是早产。家庭政策应精心设计，并带有“所有政策中的健康”镜头，以避免对生育行为产生可能的意外影响，反过来,围产期健康。
