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PubMed1993

Small-for-gestational-age term birth: the contribution of socio-economic, behavioural and biological factors to recurrence.

This paper follows a previous study comparing women who had repeatedly given birth to small-for-gestational-age (SGA) term infants ('repeater' mothers) with multiparous women who had had only one such infant ('non-repeater' mothers). The present investigation involves the individual matching of each woman in the above groups with a control mother whose offspring were all term non-SGA infants. The study was based on all Western Australian Caucasian women giving birth to singletons and the study population comprised 594 repeater cases with 594 matched controls and 935 non-repeater cases with 935 matched controls. Conditional logistic regression analyses indicated that demographic and paternal factors were significant predictors for recurrent SGA term birth whereas obstetric conditions, particularly preeclampsia, were important for the prediction of isolated SGA term birth. Maternal smoking, low maternal birthweight and lack of higher educational qualifications were associated with both types of SGA birth. After multivariable analyses, a strong and significant association remained between having a first infant as a teenager and recurrent SGA term birth. The tendency to repeat SGA term birth appears to be associated with social, economic and behavioural disadvantage and is unlikely to be ameliorated without fundamental changes in society.

Adolescent↗
PubMed2006

Brain and cognitive-behavioural development after asphyxia at term birth.

Perinatal asphyxia occurs in approximately 1-6 per 1000 live full-term births. Different patterns of brain damage can result, though the relation of these patterns to long-term cognitive-behavioural outcome remains under investigation. The hippocampus is one brain region that can be damaged (typically not in isolation), and this site of damage has been implicated in two different long-term outcomes, cognitive memory impairment and the psychiatric disorder schizophrenia. Factors in addition to the acute episode of asphyxia likely contribute to these specific outcomes, making prediction difficult. Future studies that better document long-term cognitive-behavioural outcome, quantitatively identify patterns of brain injury over development and consider additional variables that may modulate the impact of asphyxia on cognitive and behavioural function will forward the goals of predicting long-term outcome and understanding the mechanisms by which it unfolds.

Asphyxia Neonatorum↗
PubMed2004

History of abortion, preterm and term birth, and risk of gestational hypertension: a population-based study.

OBJECTIVE: To examine the consequence of prior abortion and preterm and term birth on the occurrence of gestational hypertension in the subsequent pregnancy. STUDY DESIGN: A population-based, retrospective, cohort study was conducted based on 140,773 pregnancies delivered between 1993 and 1999 in 49 hospitals in northern and central Alberta, Canada. Multivariate logistic regression was applied to estimate ORs with 95% CIs, adjustedfor confounding variables. RESULTS: The incidence of gestational hypertension was markedly lower in women who previously delivered at term than in primigravid women (2.4% vs. 5.6%) (adjusted OR [aOR]: .41 [.38-.44], p < 0.001). The incidence of gestational hypertension in women with previous preterm birth but without prior abortion or term pregnancy was also lower than in primiparous women (3.9% vs. 5.6%) (aOR: .72 [.54-.95], p<0.05). Moreover, there was a trend toward a decreased incidence of gestational hypertension among women with a longer duration of previous preterm gestation. Although there was a statistically significant decreased incidence of gestational hypertension in pregnancies in women with a previous history of abortion (4.9%) as compared to women without such a history (5.6%) (aOR:.85[95% CI: .77-.93], p < 0.05), 2, 3 or more abortions were not associated with a decreased risk of gestational hypertension, calling into question the clinical significance of the effect of abortion. CONCLUSION: There was a trend toward a decreased incidence of gestational hypertension among women with a longer duration of previous gestation. However, a history of term pregnancy (> or =37 weeks) conveyed the most substantial protection against gestational hypertension in the subsequent pregnancy.

Abortion, Induced↗
PubMed2003

Ultrasonic prediction of term birth weight in Hispanic women. Accuracy in an outpatient clinic.

OBJECTIVE: To investigate the accuracy of ultrasonic fetal biometric algorithms for estimating term fetal weight. STUDY DESIGN: Ultrasonographic fetal biometric assessments were made in 74 Hispanic women who delivered at 37-42 weeks of gestation. Measurements were taken of the fetal biparietal diameter, head circumference, abdominal circumference and femur length. Twenty-seven standard fetal biometric algorithms were assessed for their accuracy in predicting fetal weight. Results were compared to those obtained by merely guessing the mean term birth weight in each case. RESULTS: The correlation between ultrasonically predicted and actual birth weights ranged from 0.52 to 0.79. The different ultrasonic algorithms estimated fetal weight to within +/- 8.6-15.0% (+/- 295-520 g) of actual birth weight as compared with +/- 13.6% (+/- 449 g) for guessing the mean birth weight in each case (mean +/- SD). The mean absolute prediction errors for 17 of the ultrasonic equations (63%) were superior to those obtained by guessing the mean birth weight by 3.2-5.0% (96-154 g) (P < .05). Fourteen algorithms (52%) were more accurate for predicting fetal weight to within +/- 15%, and 20 algorithms (74%) were more accurate for predicting fetal weight to within +/- 10% of actual birth weight than simply guessing the mean birth weight (P < .05). Ten ultrasonic equations (37%) showed significant utility for predicting fetal weight > 4,000 g (likelihood ratio > 5.0). CONCLUSION: Term fetal weight predictions using the majority of sonographic fetal biometric equations are more accurate, by up to 154 g and 5%, than simply guessing the population-specific mean birth weight.

Adult↗
PubMed1997

Full-term birth weight and placental morphology at high and low altitude.

OBJECTIVE: To study the association between placental morphology and full-term birth weight at high and low altitude. SUBJECTS: Twenty normal pregnant women living permanently at high altitude (3100 m) and 20 normal pregnant women living permanently at low altitude (500 m) in Southern Saudi Arabia. METHOD: For each subject in the two groups the mean hemoglobin concentration and hematocrit values throughout pregnancy were estimated and these were used as indices for maternal hypoxia. After delivery, the birth weight of each fetus was determined together with the placental weight. Placentas were then examined histologically using sections stained by periodic acid-Schiff and hematoxylin-eosin. The mean percentages of villi with syncytial knots, cytotrophoblastic cells and fetal capillaries were determined. RESULTS: The mean hemoglobin concentration and hematocrit values were significantly greater at high altitude than at low altitude (P < 0.001 for both). The mean birth weight and placental weight were significantly greater at low altitude compared to high altitude (P < 0.025 and 0.001, respectively). The placentas from high altitude showed histological changes suggestive of placental hypoxia i.e. significant increase in the incidence of syncytial knots, cytotrophoblastic cells and fetal capillaries at high altitude compared to low altitude (P < 0.005, 0.001 and < 0.05, respectively). At both high and low altitude the incidences of syncytial knots and cytotrophoblastic cells showed positive and significant correlations with mean maternal hemoglobin (r = 0.5 and 0.6, P < 0.01 and < 0.001, respectively) and hematocrit (r = 0.5 and 0.6, P < 0.01 and 0.001, respectively) during pregnancy and negative and significant correlations with fetal birth weight (r = -0.4 and -0.6, P < 0.01 and P < 0.001, respectively). CONCLUSION: The low birth weight observed at high altitude compared to low altitude appeared to be mainly secondary to placental hypoxia resulting from maternal hypoxia which in turn was caused by high altitude hypoxia.

Altitude↗
PubMed2004

Prediction of term birth weight in Hispanic women using an equation based on maternal characteristics.

OBJECTIVE: To test the accuracy of a birth weight prediction equation based on maternal characteristics in Hispanic women. STUDY DESIGN: A previously published birth weight prediction equation based on maternal and pregnancy-specific characteristics was used to predict birth weights for 283 normal Caucasian women of Hispanic ethnicity. The accuracy of these birth weight estimates was compared to a similarly selected group of 233 non-Hispanic Caucasian gravidas who were located 2500 miles away. RESULTS: Birth weight predictions for Hispanic women were accurate to within +/- 8.4% (+/- 287 g). The percentages of birth weights predicted to within +/- 15 and +/- 10% of actual values were 84 and 68%, respectively. These results were no different than those that were obtained for non-Hispanic Caucasian gravidas. CONCLUSIONS: A previously derived birth weight prediction equation based on maternal and pregnancy-specific characteristics alone successfully predicts term birth weight in normal Hispanic gravidas to within +/- 8.4% (+/- 287 g).

Adult↗
PubMed2002

Familial aggregation of fetal growth restriction in a French cohort of 7,822 term births between 1971 and 1985.

An association between fetal growth restriction and increased rates of metabolic and cardiovascular diseases in adulthood has been reported. This study evaluated familial aggregation of fetal growth restriction in term births. The population consisted of 3,505 sibships comprised of 7,822 full-term singleton infants born between 1971 and 1985 in Haguenau, France, and selected from a regional register of births. Sib-sib odds ratios were estimated for being born small for gestational age (SGA), defined as having a birth weight below the 10th percentile of the sex-specific curve of birth weight by week of gestation. SGA births were further stratified according to ponderal index (birth weight/length(3)). After adjustment for maternal factors, the sib-sib odds ratios were 4.8 (95% confidence interval (CI): 3.7, 6.3) for all SGA births, 7.7 (95% CI: 4.1, 14.7) for SGA births with a low ponderal index (<10th percentile), and 4.4 (95% CI: 2.3, 8.2) for SGA births with a normal ponderal index (25th-75th percentile). None of the maternal factors investigated significantly influenced the magnitude of these odds ratios. This strong residual sib-sib aggregation suggests a role for genetic and/or shared environmental factors in the etiology of fetal growth restriction, especially when associated with a low ponderal index.

Cohort Studies↗
PubMed2002

History of abortion, preterm, term birth, and risk of preeclampsia: a population-based study.

OBJECTIVE: The objective of this study was to examine the effect of previous abortion and preterm and term birth on the incidence of preeclampsia in subsequent pregnancies. STUDY DESIGN: A population-based retrospective cohort study was conducted that was based on 140,773 pregnancies that had delivered between 1993 and 1999 in 49 hospitals in Northern and Central Alberta, Canada. Multivariate logistic regression was applied to estimate odds ratios, with 95% confidence intervals, and to control for confounding variables. RESULTS: No significant difference was found in the incidence of preeclampsia in nulliparous women with previous abortion (2.6%) as compared to nulliparous women without previous abortion (2.9%; adjusted odds ratio, 0.89; 95% confidence interval, 0.78-1.01; P >.05). A single previous abortion was associated with a slightly decreased risk of preeclampsia (adjusted odds ratio, 0.84; 95% confidence interval, 0.72-0.97; P <.05). However, 2 and > or =3 abortions were not associated with a decreased risk of preeclampsia. In women with no history of previous abortion and term pregnancy, there was no significant difference in incidence of preeclampsia between women who had previous preterm birth (2.7%) and primigravid women (2.8%; adjusted odds ratio, 0.71; 95% confidence ratio, 0.48-1.03; P >.05). However, > or =2 previous preterm births were associated with a decreased risk of preeclampsia (adjusted odds ratio, 0.28; 95% confidence interval, 0.09-0.84; P <.01). The incidence of preeclampsia was markedly lower in multiparous women who previously delivered at term (0.9%) as compared to the incidence in primigravida women (2.9%; adjusted odds ratio, 0.29; 95% confidence interval, 0.26-0.33; P <.001). The adjusted odds ratios of preeclampsia for women with 1, 2, 3, and > or =4 previous term pregnancies were 0.32 (95% confidence interval, 0.28-0.36), 0.27 (95% confidence interval, 0.22-0.34), 0.22 (95% confidence interval, 0.15-0.33), and 0.21 (95% confidence interval, 0.12-0.35), respectively. CONCLUSION: A history of term pregnancy (> or =37 weeks) conveys a substantial "protection" against preeclampsia in the subsequent pregnancy.

Abortion, Induced↗
PubMed2000

Cervical length as a predictor of pre-term birth in twin gestations.

The aim of this study was to determine the predictive value of cervical length as a risk factor for spontaneous pre-term birth in twin gestations. A retrospective chart review was carried out on patients with twin pregnancies referred to our multiples' clinic. Cervical length was measured by transvaginal ultrasonography. Patients with an indicated pre-term delivery or intervention were excluded from the analysis. Outcomes included preterm delivery < 28 and < 35 weeks gestation. After extracting the data, 2 x 4 tables were constructed. Likelihood ratios were then generated for cervical lengths < or = 2.0 cm, < or = 2.5 cm, < or = 3.0 cm, and > 3.0 cm. Because of the limited number of measurements taken < 25 weeks gestation, we elected to collapse the tables, thereby achieving more meaningful results. For measurements taken before 30 weeks gestation, a shorter cervix did predict delivery < 28 weeks gestation (likelihood ratios for cervical lengths < or = 2.0 cm, < or = 2.5 cm, < or = 3.0 cm, and > 3.0 cm were 4.43, 1.94, 0.97, and 1.02, respectively). The probability of preterm delivery < 35 weeks gestation increased with decreasing cervical length (likelihood ratios for cervical length < or = 2.0 cm, < or = 2.5 cm, < or = 3.0 cm, and > 3.0 cm were 2.58, 1.66, 1.38, and 0.81, respectively). A shorter cervix measured before 30 weeks gestation was a stronger predictor of preterm delivery < 28 weeks compared to < 35 weeks gestation. Cervical length was not predictive of preterm delivery if measured after 30 weeks. Cervical length is predictive of preterm delivery < 28 weeks and < 35 weeks gestation when measured before 30 weeks gestation. No trend was seen when measured after 30 weeks gestation. A prospective study is currently underway to confirm these results.

Anthropometry↗
PubMed1999

Outcomes of post-term births: the role of fetal growth restriction and malformations.

OBJECTIVE: To evaluate the risks of adverse pregnancy outcomes among term and post-term small for gestational age (SGA) and appropriate for gestational age (AGA) births, before and after excluding infants with congenital malformations. METHODS: We did a population-based study of 510,029 singleton term (37-41 completed weeks) and post-term (at or after 42 weeks) births recorded in the Swedish Birth Register. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the risks of stillbirth, infant death, convulsions, meconium aspiration, and Apgar score less than 4 at 5 minutes. RESULTS: Among term births, 2.2% were SGA; among post-term births, 3.8% were SGA. Compared with term AGA births, term SGA births were at increased risk of stillbirth (OR 8.02; 95% CI 6.57, 9.80) and infant death (OR 7.57; 95% CI 6.39, 8.96). Among post-term SGA births, the ORs were 10.56 (95% CI 6.95, 16.05) for stillbirth and 5.00 (95% CI 3.04, 8.22) for infant death. When births with congenital malformations were excluded, the risk of infant death decreased considerably. Risks of convulsions and Apgar score less than 4 were higher in SGA than AGA infants. Post-term AGA infants had no significant increase in the risks of stillbirth or infant death but did have increased risks of convulsions, meconium aspiration, and Apgar score less than 4. CONCLUSION: The increased risk of stillbirth in post-term pregnancies is partly explained by an increased rate of SGA infants. The increased risk of death among SGA infants is caused to a large extent by congenital malformations.

Adolescent↗
PubMed1979

Comparison of two successive policies of cervical cerclage for the prevention of pre-term birth.

The percentage of women receiving cervical cerclage increased from 5% to 18% between two periods at Haguenau maternity hospital, according to a new policy for the prevention of pre-term birth. A parallel reduction of premature deliveries by about a half was observed in the relevant group of women. This suggests that cerclage might be employed on another basis than is currently the case, and that a randomized trial is urgently needed to define its indications more precisely.

Cervix Uteri↗
PubMed2002

Biochemical markers for the prediction of spontaneous pre-term birth.

OBJECTIVES: The aim of this study was to identify predictive biochemical markers for preterm labor. METHODS: In this prospective study we included 225 asymptomatic Caucasian women consecutively enrolled at 24 weeks of gestation. The following data were collected only once at 24 weeks of gestation: vaginal pH, vaginal fFN, cervical and serum concentration of IL-6, IL-8 and TNFalpha, maternal blood serum, ferritin. Student's t-test, the chi(2)-test and multiple linear regression were used as statistical methods. RESULTS: There were no differences between the age of patients, parity and gestational age at sampling between women who delivered at term and those who delivered pre-term (<37 weeks' gestation). There was a significant increase of cervical IL-6 (pre-term 608+/-1595 pg/l vs. at term 58.9+/-112 pg/l) and serum ferritin (pre-term microg/l 74.4+/-1.1 vs. at term 26.3+/-56.5 microg/l) in pregnant women who delivered pre-term (P<0.05). No differences in cervical IL-8 and cervical TNFalpha between pre-term and term deliveries were found. Multiple linear regression confirmed that the vaginal pH value and cervical fFN test were the best predictive biochemical markers of pre-term birth (standardized coefficient Beta=0.33 and 0.22, respectively). CONCLUSIONS: In order to evaluate pregnancies for pre-term labor, the presence of pH>4.5 and a positive fFN test seems to be predictive of subsequent pre-term delivery.

Adult↗
PubMed1992

Serum levels of immunoreactive inhibin, FSH, and LH in human infants at preterm and term birth.

Serum levels of immunoreactive inhibin, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were determined in 112 fetal cord blood samples obtained at birth between 26 and 40 weeks of gestation. High levels of inhibin immunoreactivity were detected in all samples. Between the gestational age of 26 and 28 weeks, the levels (mean +/- SE) were higher (p less than 0.05) in male (21.6 +/- 1.0 U/ml; n = 12) than in female (12.8 +/- 0.2 U/ml; n = 12) fetuses. With ongoing gestation, the serum inhibin immunoreactivity decreased and was found to be similar in male (12.1 +/- 0.3 U/ml; n = 13) and female (9.1 +/- 0.7 U/ml; n = 8) fetuses at term. Serum FSH and LH levels were elevated at the beginning of the 3rd trimester of pregnancy and decreased with ongoing gestation to undetectable values at term birth. Between 26 and 32 weeks of gestation, the FSH levels were higher in females (p less than 0.02), whereas the LH levels were higher in males (p less than 0.01). These observations suggest that in the human fetus the pituitary-gonadal axis is active and presents sexual dimorphism; both characteristics are pronounced early during the 3rd trimester of gestation and decrease towards term.

Female↗
PubMed2006

Risk factors for pre-term birth in Iraq: a case-control study.

BACKGROUND: Preterm birth (PTB)is a major clinical problem associated with perinatal mortality and morbidity. The aim of the present study is to identify risk factors associated with PTB in Mosul, Iraq. METHODS: A case-control study was conducted in Mosul, Iraq, from 1st September, 2003 to 28th February, 2004. RESULTS: A total of 200 cases of PTB and 200 controls of full-term births were screened and enrolled in the study. Forward logistic regression analysis was used in the analysis. Several significant risk associations between PTB and the following risk factors were identified: poor diet (OR = 4.33), heavy manual work (OR = 1.70), caring for domestic animals (OR = 5.06), urinary tract infection (OR = 2.85), anxiety (OR = 2.16), cervical incompetence (OR = 4.74), multiple pregnancies (OR = 7.51), direct trauma to abdomen (OR = 3.76) and abortion (OR = 6.36). CONCLUSION: The main determinants of PTB in Iraq were low socio-economic status and factors associated with it, such as heavy manual work and caring for domestic animals, in addition to urinary tract infections and poor obstetric history.

Journal Article↗
PubMed1998

Seasonality of low birthweight in indigenous Australians: an increase in pre-term birth or intrauterine growth retardation?

We have analysed birthweights of 4,508 Aboriginal and Torres Strait Islander livebirths in the Kimberley region of Western Australia from 1981-93. Mean birthweight varied significantly according to month of birth (F(11) = 2.57, p = 0.003) and low birthweight babies were more common during the wet season. A significant increase in the proportion of very low birthweight (VLBW) babies was observed during the wet season compared with the dry season (OR 2.73; 95% CI 2.3-3.67; p < 0.001); whereas babies weighing 1,500-2,499 g were not significantly more common during the wet season (OR 1.06; 95% CI 0.96-1.17; p = ns). The results indicate that adverse environmental conditions may be associated with increased risk of VLBW. Since newborns weighing less than 1500 g are very likely to be pre-term (< 37 weeks' gestation), the findings also suggest that seasonality of birthweight may be due to an increase in pre-term births rather than an increase in intrauterine growth retardation. Further research is required to identify the underlying causes of an increase in VLBW babies during the wet season.

Birth Rate↗
PubMed2002

Physical and social predictors for pre-term births and low birth weight infants in Taiwan.

The purpose of this study was to examine the risk factors associated with pre-term labor (PTL) (< 37 gestational weeks) and low birth weight (LBW) (< 2500 gm) infants in a healthy Taiwanese population. From December 1998 through June 1999, a total of 633 healthy pregnant women were recruited at three teaching hospitals in Taipei. Using a prospective study design, the pregnancy outcome information was followed up by telephone or from medical records during the first month postpartum. Data were statistically analyzed by multiple logistic regression. The prevalence of premature births was 5.4%, and the prevalence of LBW infants was 5.1%. Pre-term births were significantly associated with high self-reported fatigue scores (OR = 3.45); extreme maternal age (< 20 and >/= 35 years, OR = 2.38); history of abortion (>/= 2, OR = 3.11); maternal height (</= 158 cm, OR = 1.73); low income (OR = 1.88), and multiple pregnancies (OR = 18.78). The risk for low birth weight infants was significantly increased when the woman had an extreme maternal age (OR = 2.65), nulliparity (OR = 1.64); multiple pregnancies (OR = 9.3) and no domestic helper (OR = 1.65). The study provides a reference basis for prenatal care.

Abortion, Spontaneous↗
PubMedDate not supplied

Epidemiology of spontaneous premature rupture of membranes: factors in pre-term births.

The frequency of spontaneous premature rupture of membranes (PROM) was determined in the pregnancies of 1,848 white mothers and their singleton infants, born at the University of Kansas Medical Center between April 1975 and April 1978. The frequency of PROM increased significantly from a low of 34/707 (4.8 percent) among low-risk mothers, to 40/444 (9.0 percent) among mothers smoking one to 60 cigarettes a day, to 21/204 (10.3 percent) among mothers with multiple adverse maternal practices, and to 12/46 (26 percent) among mothers with selected complications of their pregnancies. The proportion of low birth weight (LBW) (less than 2,500 g) pre-term infants born to PROM mothers increased among the risk factor groups in a similar manner, from a low of 2/34 (6 percent) in low-risk pregnancies to 8/40 (20 percent) among mothers smoking one to 60 cigarettes a day, to 7/21 (33 percent) among mothers with multiple adverse practices, and to 7/12 (58 percent) among mothers with selected complications of pregnancy. The increased incidence of low birth weight pre-term infants born to mothers with PROM was associated with evidence of growth retardation among full-term infants in the high-risk groups. This finding was manifested by reductions in mean birth weights of full-term infants born to high-risk mothers but not observed in full-term infants born to low-risk mothers. The attained growth at birth of low birth weight pre-term infants could not be determined, because appropriate birth weight standards for pre-term infants born to mothers with low-risk pregnancies are not available. These results suggest that growth retardation in fetuses increased the probability of the mothers having PROM prior to the onset of labor, and, if PROM did occur, of having a premature delivery. We hypothesize that the tensile strength of the amnion and chorion is diminished by the same conditions that retard fetal growth, and that this reduction in strength of the fetal membranes contributes to premature rupture of membranes and pre-term delivery.

Female↗