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Biomedical subjects

I Emanuel

Publications and source records attributed to I Emanuel.

At least 19 recordsLinked to original sources
PubMed2001

Perinatal mortality and neonatal morbidity rates among twin pairs at different gestational ages: optimal delivery timing at 37 to 38 weeks' gestation.

OBJECTIVE: The aim of this study was to determine the gestational age at delivery associated with the lowest rates of perinatal mortality, respiratory distress syndrome, and long hospital stays among twins, with pair rates used to account for both infants in each twin pregnancy. STUDY DESIGN: We conducted a population-based retrospective study that analyzed linked birth certificates, fetal and infant death certificates, and hospital discharge data for 8150 twin pairs born in Washington State during 1987 through 1997. The chi2 or Fisher exact test was used to assess the statistical significance. RESULTS: The nadirs of perinatal mortality rate, respiratory distress syndrome incidence, and long hospital stay rate were seen at delivery dates of 39, 40, and 38 weeks' gestation, respectively. Restriction to pairs delivered vaginally without the induction of labor revealed that the perinatal mortality rate was lowest for delivery at 37 weeks' gestation, the gestational age at which the highest numbers of such spontaneously timed pairs were born. CONCLUSION: Induction of labor should be routinely considered for twins at 37 to 38 weeks' gestation.

Adolescent↗
PubMed2000

Early-life risk factors and the development of Alzheimer's disease.

OBJECTIVE: To investigate the association of early-life factors with AD. BACKGROUND: The early-life environment and its effect on growth and maturation of children and adolescents are linked to many adult chronic diseases (heart disease, stroke, hypertension, and diabetes mellitus), and these effects are also linked to maternal reproduction. AD may have an early-life link. The areas of the brain that show the earliest signs of AD are the same areas of the brain that take the longest to mature during childhood and adolescence. A poor-quality childhood or adolescent environment could prevent the brain from reaching complete levels of maturation. Lower levels of brain maturation may put people at higher risk for AD. METHODS: In a community-based case-control study (393 cases, 377 controls), we investigated the association of early-life factors and AD. Early-life variables include mother's age at patient's birth, birth order, number of siblings, and area of residence before age 18 years. Patient education level and apolipoprotein E (APOE) genotypes were also included in the analysis. RESULTS: Area of residence before age 18 years and number of siblings are associated with subsequent development of AD. For each additional child in the family the risk of AD increases by 8% (OR = 1.08, 95% CI = 1.01 to 1.15). More controls compared with cases grew up in the suburbs (OR = 0.45, 95% CI = 0.25 to 0.82). APOE epsilon 4 and the patient's education level did not confound or modify the associations. CONCLUSIONS: The early-life childhood and adolescent environment is associated with the risk of AD.

Adolescent↗
PubMed2000

Respiratory distress syndrome and maternal birth weight effects.

OBJECTIVE: To study traditional risk factors and the intergenerational risk factor maternal low birth weight (LBW) for respiratory distress syndrome (RDS) in infants in multiple ethnic groups. METHODS: The population-based database consists of hospital records linked to Washington state maternal and infant vital records. Four racial-ethnic groups were studied, whites, blacks, Native Americans, and Hispanics. Poisson regression models were used to estimate relative risks of various factors for RDS. RESULTS: Rates for RDS were whites 1.2%, blacks 1.9%, Native Americans 1.3%, and Hispanics 1.0%. Maternal LBW was associated with increased relative risk (RR) for RDS in whites (2.6, 95% confidence interval [CI] 1.6, 4.2) and blacks (3.3, 95% CI 1.9, 5.6) for infants born vaginally. Compared with mothers of normal infants, birth weights of mothers of infants with RDS and delivered vaginally were significantly lower in whites, blacks, and Native Americans. The association of maternal LBW with RDS persisted in blacks even when multiple risk factors were added to the model (RR 2.4; 95% CI 1.1, 5.1). CONCLUSION: The association of maternal LBW with RDS is probably due in part to the association of maternal LBW with infant LBW and preterm birth. The strong persistent association of maternal LBW with RDS in blacks suggests that improvement of perinatal outcomes in that group will require improvement of long-term birth weight distribution.

Adult↗
PubMed2000

Maternal birth weight and cesarean delivery in four race-ethnic groups.

OBJECTIVE: We hypothesized that maternal birth weight was associated with the risk of cesarean delivery for nulliparous women. STUDY DESIGN: In a population-based cohort study, maternal birth data were linked to a Washington State database, including the birth certificates of 18,905 first-born singleton infants (1987-1995). RESULTS: Among non-Hispanic white subjects, maternal birth weight of 2500 to 3999 g was associated with a 20.9% risk of cesarean delivery, which was the lowest risk, compared with 24.5% for a maternal birth weight <2500 g (P <.05) and 24.0% for a maternal birth weight > or =4000 g (P <.05). Similar patterns of risk were noted among Hispanic and Native American subjects, although the associations did not reach statistical significance. Risk of cesarean delivery was not associated with maternal birth weight among African American subjects. Among non-Hispanic white subjects, the risk of cesarean delivery was 3.23 times greater with a maternal birth weight <2500 g and an infant birth weight > or =4000 g compared with pregnancies with both maternal and infant birth weights between 2500 and 3999 g (P <. 001). Adjustment for socioeconomic factors did not alter these results. CONCLUSION: Low and high maternal birth weights exert an intergenerational risk of cesarean delivery in nulliparous non-Hispanic white women.

Adult↗
PubMed1999

The Washington State Intergenerational Study of Birth Outcomes: methodology and some comparisons of maternal birthweight and infant birthweight and gestation in four ethnic groups.

A statewide database of vital records and hospital discharge summaries of obstetric and neonatal admissions for Washington State in 1987-95 was linked to the birth certificates of mothers born in the state. A total of 46,000 births to mothers of four racial/ethnic groups were studied: Whites, African-Americans, Native Americans and Hispanics. For all four groups inverse associations were found between maternal birthweight and infant low birthweight and preterm birth. The birthweight distribution of African-American mothers was displaced markedly downwards compared with the Whites; this difference in maternal birthweight is offered as a partial explanation of the greater prevalence of suboptimal pregnancy outcomes in the former. In contrast, the maternal birthweight distributions of Whites, Native Americans and Hispanics are similar; differences in pregnancy outcomes are probably more related to maternal preconceptional and postnatal factors in these groups as well as differences in pregnancy-related factors. Mothers' birthweight may have clinical value in identifying high-risk pregnancies.

Adult↗
PubMed1999

A population-based cohort study of the relation between maternal birthweight and risk of gestational diabetes mellitus in four racial/ethnic groups.

Intrauterine growth retardation and low birthweight have been associated with an increased risk of insulin resistance and type II diabetes later in life. We hypothesised that maternal low birthweight is associated with an increased risk of gestational diabetes mellitus (GDM). Study subjects comprised women giving birth in Washington State between 1987 and 1995. Information for 21,528 births to non-Hispanic white women, 6359 to African-American women, 7456 to Native American women and 6496 to Hispanic women was available for analysis. All information was derived from statewide computerised vital records and hospital discharge summaries of obstetric and neonatal admissions with linkage to birth certificates of mothers. Maternal birthweight was collected from subjects' birth certificates. Information from both the birth certificates and the obstetric and neonatal admissions database was used to determine whether subjects developed GDM. Poisson regression models were estimated to calculate unadjusted and adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for GDM by categories of maternal birthweight. The cumulative incidence of GDM among non-Hispanic white, African-American, Native American and Hispanic women was 2.8, 2.6, 2.7 and 3.0% respectively. After adjusting for maternal age, parity, cigarette smoking, history of chronic hypertension and participation in the Medicaid programme, non-Hispanic white women with a birthweight < 2000 g were 1.7 times more likely to have had their pregnancy complicated by GDM (RR = 1.7; 95% CI 0.8, 3.3) than those with a birthweight 3000-3999 g. The corresponding adjusted RRs for African-American, Native American, and Hispanic women were 2.8 [95% CI 1.2, 6.1], 3.1 [95% CI 1.2, 8.2] and 2.4 [95% CI 0.9, 6.0] respectively. Among African-American women, those with a birthweight > or = 4000 g also experienced a twofold increased risk of GDM (RR = 2.1; 95% CI 1.0, 4.1). This association of high birthweight and increased GDM risk was not found among women in the other three racial/ethnic groups. These findings suggest that individuals with low birthweight constitute a group at increased risk for GDM.

Adolescent↗
PubMed1998

Birthweight and blood pressure among children in Harare, Zimbabwe.

AIM: To determine whether poor uterine growth may be associated with increased blood pressure and subsequent hypertension in adulthood. METHODS: A retrospective cohort study of 756 schoolchildren (mean age 6.5 years) was carried out in six low income areas in Harare city, Zimbabwe. Indices of intrauterine growth and blood pressure were assessed. RESULTS: Adjusted for current weight, the children's systolic blood pressure was inversely related to their birthweight; for each decreasing kg of birthweight, systolic blood pressure rose by 1.73 mm Hg (95% CI; 0.181 to 3.28). After adjustment for current weight, systolic blood pressure was also inversely associated with occipito-frontal circumference, but not with birth length or gestational age. Diastolic blood pressure was not associated with any of the intrauterine indices. CONCLUSION: Fetal size may be inversely related to systolic blood pressure in childhood in an African population.

Africa↗
PubMed1997

Juvenile delinquency and adolescent trauma: how strong is the connection?

OBJECTIVES: To determine whether youth convicted of juvenile offenses have a greater risk of injury resulting in hospitalization compared with nonoffending adolescents. DESIGN: A statewide hospital discharge database was linked to juvenile justice records to identify all hospitalizations occurring at ages 13 to 17 years for juvenile offenders and nonoffenders. SUBJECTS: Juvenile offenders and nonoffenders in Washington State during 1989 through 1992. MAIN OUTCOME MEASURES: Incidence of hospitalizations attributable to injury, analyzed by cause of injury and intent. RESULTS: The prevalence of delinquency was 19.1% of male and 9.5% of female adolescents. Hospitalization for injury was 2.7-fold greater for male and 1.6-fold greater for female offenders compared with nonoffenders. The greatest risk of hospitalization was for intentional injury, especially that attributable to firearms, and for drug overdoses. CONCLUSIONS: Juvenile offenders are much more likely to be hospitalized for an injury than nonoffenders. Admission to the hospital for trauma may serve as an opportunity for health providers to intervene with youth exhibiting high-risk behavior.

Adolescent↗
PubMed1997

Maternal and perinatal risk factors for later delinquency.

BACKGROUND: The early identification of risk factors for juvenile offending is one important step in preventing youth violence and offending. This cohort study examined whether perinatal circumstances predicted offending during adolescence. METHODS: Washington State birth certificates from 1974 to 1975 were linked to juvenile justice data to identify all individuals adjudicated between 10 and 17 years of age. Thirteen thousand five hundred seventy-three offenders were compared with a sample of 38 387 nonoffenders matched on gender and birth order. RESULTS: Both male and female children of mothers who were teenagers at the child's birth or at her first birth, or who were born to unmarried mothers, had significantly increased risk for any juvenile offending, and for being adjudicated for five or more crimes (chronic offending). Males born to unmarried mothers under 18 years old had an 11-fold increased risk of chronic offending compared with males born to married mothers >/=20 years old. Low birth weight and preterm gestational age carried no increased risk for juvenile offending. CONCLUSIONS: Birth to teenage or unmarried mothers are strongly associated with later risk of juvenile delinquency. Although there are multiple, interrelated risk factors for juvenile delinquency, prevention of births to teenage and/or unmarried mothers may help to prevent subsequent juvenile delinquency.

Adolescent↗
PubMed1996

Perinatal factors and risk of breast cancer.

A high level of endogenous estrogen in utero has been hypothesized to be a possible risk factor for breast cancer. We used information from two population-based case-control studies to investigate the relation between perinatal factors and risk of invasive breast cancer among women age 21-45 years (746 cases, 960 controls) and women age 50-64 years (401 cases, 439 controls). Breast cancer cases were ascertained through a population-based cancer registry, and controls were selected by random digit dialing. After adjustment for age, menopausal status, and maternal smoking, the birthweight-breast cancer association in women age 21-45 years followed a J-shaped curve, with women whose birthweight was less than 2,500 gm [odds ratio (OR) = 1.3; 95% confidence interval (CI) = 0.9-2.0] and 4,000 gm or more (OR = 1.7; 95% CI = 1.1-2.5) at increased risk. Women age 50-64 years who were 4,000 gm or more at birth appeared to be at slightly reduced risk of breast cancer (OR = 0.6; 95% CI = 0.3-1.1). With the exception of maternal smoking, there was little effect of other perinatal factors on breast cancer risk in either group. These results support the hypothesized association between intrauterine estrogen exposure and subsequent risk of breast cancer.

Adult↗
PubMed1995

The intergenerational relationship between mother's birthweight, infant birthweight and infant mortality in black and white mothers.

The relationship between the birthweight of white and black mothers and the outcomes of their infants were examined using the 1988 National Maternal and Infant Health Survey. White and black women who were low birthweight themselves were at increased risk of delivering very low birthweight (VLBW), moderately low birthweight (MLBW), extremely preterm and small size for gestational age (SGA) infants. Adjustment for the confounding effects of prepregnant weight and height reduced the risks of all these outcomes slightly, and more substantially reduced the maternal birthweight associated risk of moderately low birthweight among white mothers. There was little effect of maternal birthweight on infant birthweight-specific infant mortality in white mothers; however, black mothers who weighed less than 4 lbs at birth were at significantly increased risk of delivering a normal birthweight infant who subsequently died. Although the risks for the various outcomes associated with low maternal birthweight were not consistently higher in black mothers compared with white mothers, adjustment for prepregnant weight and height had a greater effect in white mothers than in black mothers. We suggest that interventions to reduce the risks for adverse pregnancy outcomes associated with low maternal birthweight should attempt to optimise prepregnant weight and foster child health and growth.

Adult↗