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Summary BackgroundAnkylosing spondylitis is a genetically determined and commonly familial disorder. Men and women differ in their susceptibility to ankylosing spondylitis, with about 2.5 men affected for every woman with the disease. We investigated the influence of the sex of the index case on disease penetrance within families.MethodsThe ages at which 50% and 75% of patients were diagnosed with ankylosing spondylitis were ascertained from a database of 4400 cases. Index patients with children or siblings who were old enough to have obtained a diagnosis (50% and 75% rates) were assessed for prevalence of disease among relatives. Confirmation of diagnosis for affected relatives was sought for all offspring and a random 25% selection of siblings.FindingsAnkylosing spondylitis was more prevalent among children (odds ratio 1.9 [95% CI 1.2-3.0], p<0.005) and siblings (1.5 [1.2-1.9], p<0.0001) of female index cases than among those of male cases. Analyses restricted to index cases with a young age at onset ([≤ OR =]21 years) indicated that children of women had an even higher incidence of ankylosing spondylitis (7.2 [1.5-34], p=0.013) than did children of men at similar age at onset. 38% of children of female cases had disease compared with 8% of male cases. There was no difference in sex distribution among affected children or siblings of female patients with ankylosing spondylitis. By contrast, the sons and brothers of male patients had a higher prevalence of the disease (odds ratio 2.6 [1.4-5.2], p=0.003) than did daughters and sisters (1.7 [1.3-2.2], p<0.0001).InterpretationThe influence of female sex is greater than that of male sex in determining increased susceptibility to ankylosing spondylitis in children. The striking maternal effect is greatest for women with young age at onset, which is not seen in men. The sex ratio of affected children depends on the sex of the affected parent.Lancet 1999; 354: 1687-90 [ABSTRACT FROM AUTHOR]

Pregnancy can be a stressful time and the COVID-19 pandemic is thought to have heightened maternal stress. This study aimed to investigate the effect of the COVID-19 pandemic on population birth outcomes, uptake of primary immunisations, and expectant mothers' experiences of pregnancy in Wales. In this mixed methods study we analysed stillbirths, prematurity, birthweight and caesarean section births before (2016–19) and during (2020) the pandemic using national routine anonymised data held in the Secure Anonymised Information Linkage Databank. Uptake of the first three scheduled primary immunisations were compared between 2019 and 2020. Immunisations were extracted from the routinely collected data in the National Community Child Health Database. We compared percentages between years the ran χ2 with Yates correction for the three percentages given. Expectant mothers (aged ≥16 years) in Wales completed an online survey about their experiences of pregnancy during the pandemic. Inclusion criteria was being aged 16 years or older and living in Wales. The qualitative survey data was analysed using codebook thematic analysis. Ethical approval was granted by Swansea University Ethics Committee and each participant provided written consent before answering any survey questions. There was no significant difference between annual outcomes including gestation and birthweight, stillbirths, and caesarean sections for infants born in 2020 compared with 2016–19. Difference in gestation (moderate to late preterm difference –0·26%, 95% CI –0·52% to –0·01%). Difference in low birthweight 0·13% (0·00% to 0·26%). Difference in stillbirths –0·01% (–0·02% to 0·00%). Difference in caesarean sections –0·42% (–1·13% to 0·29%). There was an increase in late-term births (≥42 weeks gestation) during the first lockdown (odds ratio [OR] 1·28, p=0·019) and a decrease in moderate to late preterm births (32–36 weeks gestation) during the second lockdown (OR 0·74, p=0·001). Fewer babies were born in 2020 (n=29 031) compared with 2016–19 (n=32 582; mean [SD 1561]). All babies received their immunisations in 2020, but there were minor delays in the timings of vaccines. Those vaccinations due at 8-weeks were 8% less likely to be on time (within 28 days) and, at 16-weeks, they were 19% less likely to be on time. The pandemic had a negative effect on the mental health of 151 (72%) of 211 survey respondents, who reported feeling anxious, nervous, or depressed; this finding was associated with attending scans without their partner, giving birth alone, and minimal contact with midwives. The COVID-19 pandemic had a negative effect on mothers' experiences of pregnancy; however, population data suggests that this did not translate to adverse birth outcomes for babies born during the pandemic. Health Care Research Wales [ABSTRACT FROM AUTHOR]