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Fat supplementation and reproduction in beef females.

Inadequate dietary energy intake and poor body condition can negatively affect reproductive function. Supplemental lipids have been used to increase energy density of the diet and may also have direct positive effects on reproduction in beef cattle. Several fatty acid sources have been studied as they relate to reproductive function. Common sources include sunflower, safflower, cottonseed, rice bran, soybeans, fishmeal, animal tallow, and calcium salts of fatty acids. Fats have been fed before and after calving, during the breeding season, and during heifer development. Response to fat has been investigated through measuring body weight and body condition score, age at puberty, postpartum interval, first-service conception rates, pregnancy rates, calving interval, calving difficulty, and calf birth and weaning weight. Animal response seems to depend on body condition score, age (parity), nutrients available in the diet, and type of fat supplemented. To elucidate potential mechanisms of action, scientists have investigated changes in follicular and uterine development, hormonal profiles, brain function, and embryonic development. Feeding supplemental fat has resulted in varied and inconsistent effects on reproductive function. Elucidating how supplemental fat can influence reproductive function has been a difficult process. The complexity of the reproductive system and makeup of fat supplements are often confounded by management conditions and forage quality both in research and commercial feeding situations.

Animals↗

[Quantitative changes in fibro-architectonics of the human cerebral cortex from birth to 12 years of age].

The peculiarities of fibroarchitectonics in topographically and functionally distinct cortical zones (including temporo-parieto-occipital subarea, occipital, pre-, postcentral, and frontal areas) were studied in the brain specimens of 74 children of different ages (from birth to 12 years) taken with yearly intervals, while those in the first year of life--with monthly intervals. Frontal sections stained with Nissl, Peters and Golgi methods were studied using computer analysis of optical images. The data were obtained on the increment rates of radial fiber fascicles' thickness, distances between fascicles and age dynamics of ratios of volume densities of neurons and fibers in areas 3, 4p, 6op, 17, 19, 37ac, 44 and 32/10. It was shown that age-related transformations of fibroarchitectonics in the areas of sensomotor, somatosensory, occipital, temporo-parieto-occipital and frontal cortex were heterochronic and took place with different intensity; most pronounced changes were found to occur during the first 2-3 years, while less intensive ones were observed up to the age of 9-12 years.

Aging↗

Factors associated with repetition of low birthweight: Missouri longitudinal study.

The tendency to repeat low birthweight (LBW < 2500 g) was studied in 182,285 linked first and second birth Missouri livebirths for 1978-90, of which 10,701 had first birth LBW. We examined the likelihood of LBW repetition by first birth birthweight, preterm delivery, and small-for-gestational-age (SGA) status by race, and the odd ratios (ORs) of repeat LBW for risk factors such as smoking, in comparison with ORs of second birth LBW among women with normal-weight first births. We found a strong tendency to repeat LBW (21%), especially following more extreme LBW first births. Adjusted ORs for repeat LBW were 10.1 for births that were preterm and SGA; 7.9 for preterm non-SGA; and 6.3 for SGA term births. Significant ORs of LBW repetition were found for smoking (1.52 and 1.85 for smoking in second pregnancy only and both pregnancies, respectively), short interpregnancy interval (1.33), and advanced maternal age (1.17), but the ORs were generally lower than those for women with normal-weight first births. Low pre-pregnancy weight was a significant risk factor for LBW repetition.

Birth Order↗

Projecting individualized probabilities of developing breast cancer for white females who are being examined annually.

To assist in medical counseling, we present a method to estimate the chance that a woman with given age and risk factors will develop breast cancer over a specified interval. The risk factors used were age at menarche, age at first live birth, number of previous biopsies, and number of first-degree relatives with breast cancer. A model of relative risks for various combinations of these factors was developed from case-control data from the Breast Cancer Detection Demonstration Project (BCDDP). The model allowed for the fact that relative risks associated with previous breast biopsies were smaller for women aged 50 or more than for younger women. Thus, the proportional hazards models for those under age 50 and for those of age 50 or more. The baseline age-specific hazard rate, which is the rate for a patient without identified risk factors, is computed as the product of the observed age-specific composite hazard rate times the quantity 1 minus the attributable risk. We calculated individualized breast cancer probabilities from information on relative risks and the baseline hazard rate. These calculations take competing risks and the interval of risk into account. Our data were derived from women who participated in the BCDDP and who tended to return for periodic examinations. For this reason, the risk projections given are probably most reliable for counseling women who plan to be examined about once a year.

Adult↗

Malignant melanoma: reduced risk associated with early childbearing and multiparity.

Pigmentary changes during pregnancy and sex-specific differences in incidence patterns of cutaneous malignant melanoma (CMM) suggest that sex hormones may be involved in the development of CMM. We explored possible associations between childbearing and the risk of CMM in a case-control study "nested' in a nation-wide cohort. A total of 4,779 incident cases of CMM in women aged 24-65 were compared with 23,888 individually age-matched controls. Delayed childbearing was associated with an increased risk of CMM, corresponding to approximately 16% per 5 years. Parous women had a significantly lower risk of CMM compared with nulliparous women; in univariate analysis there was an 8% reduction in risk for each additional birth (odds ratio = 0.92; 95% confidence interval = 0.89-0.95). In multivariate analyses the risk of CMM was best explained by a model including both age at first birth and parity. Age at first birth was the most important variable. Time since most recent birth was unrelated to risk of CMM. These findings indicate that early childbearing and multiparity reduce the risk of CMM. Conceivable explanations are hormonal changes induced by childbearing, enhanced immunologic activity via exposure to fetal antigens during pregnancy, or long-lasting effects of pregnancy-associated hyperpigmentation. Our results need confirmation in studies with proper adjustment for confounding; less sun exposure in young mothers and high parity women may represent an alternative explanation but is unlikely to explain entirely the twofold difference in risk found between extreme categories of age at first birth and parity.

Adult↗

Demography and life history of Thomas langurs (Presbytis thomasi).

Life history data from wild primate populations are necessary to explain variation in primate social systems and explain differences between primates and other mammals. Here we report life history data from a 12.5-year study on wild Thomas langurs. Mean age at first reproduction was 5.4 years and the sex ratio at birth was even. The mean interbirth interval (IBI) after a surviving infant was 26.8 mo, after nonsurviving infants 17.7 mo, and combined 22.0 mo. Mean annual birth rate of adult females was 0.44, while reaching a peak at 6 years of age and showing no decrease with age. Mortality was highest during the first year of life (48.0% for males and 43.0% for females) and consistently higher for males than females. The oldest female observed during the study was estimated to be 20 years of age, whereas the oldest male disappeared at age 13 years, indicating that males die at a much earlier age than females. A Leslie matrix based on these estimates yielded a growth rate of 1.01, which is comparable to the nonsignificant increase in density indicated by our long-term field data. A comparison with life history data for sympatric frugivorous primates suggests that folivory might be associated with faster life history.

Age Factors↗

The recurrence risk of adverse outcome in the second pregnancy in women with rheumatic disease1.

OBJECTIVE: To study recurrence risks of adverse pregnancy outcome in the second pregnancy in women with rheumatic disease. METHODS: In a national population-based cohort study, women with rheumatic disease recorded from 1967 to 1995 in the Medical Birth Registry of Norway were compared with mothers without such diagnoses with regard to recurrence risks of adverse pregnancy outcomes in the second pregnancy. The odds ratios (ORs) of all outcomes were adjusted for maternal age, those of cesarean delivery for time period, and those of preeclampsia for interpregnancy interval. RESULTS: Women with rheumatic disease an dadverse pregnancy outcome in the first pregnancy had a statistically significant higher recurrence risk of the same event in the second pregnancy than women without rheumatic disease (preeclampsia: OR 2.22; 95% confidence interval [CI] 1.18, 4.19) (cesarean delivery: OR 1.52; 95% CI 1.05, 2.21) (preterm birth: OR 1.86; 95% CI 1.12, 3.11). In women with rheumatic disease diagnosed between the first and second births, a significantly increased recurrence risk of low birth weight occurred. Women with rheumatic disease also had a higher occurrence of markers for placental dysfunction (preeclampsia, preterm birth, or small for gestational age) in the second birth after any of these outcomes in the first birth (OR 1.35; 95% CI 1.02, 1.78) (35.1% versus 29.2%). CONCLUSION: The recurrence risk of an adverse outcome in the second pregnancy is increased in any woman, but was even higher in women with a rheumatic disease. These patients should be counseled accordingly, be closely monitored during pregnancy, and have access to appropriate subspecialists.

Adult↗

Impact of palivizumab prophylaxis on respiratory syncytial virus hospitalizations in high risk Alaska Native infants.

BACKGROUND: Alaska Native children experience extremely high rates of hospitalization for respiratory syncytial virus (RSV) infection. We evaluated the effect of palivizumab prophylaxis on the incidence of RSV hospitalizations in high risk Alaska Native children. METHODS: We analyzed two retrospective cohorts. The first analysis, of southwest Alaska Native children hospitalized with acute respiratory infections during 1993 to 1996 and 1998 to 2001, compared RSV hospitalization rates among premature and nonpremature infants born before (1993 to 1996) and after (1998 to 2001) palivizumab use. The second analysis, of Alaska Native infants with a history of prematurity or lung disease during 1998 through 2001, compared RSV hospitalization among children receiving palivizumab during protected periods (within 32 days after a dose of palivizumab) and unprotected periods. RESULTS: First RSV hospitalizations in premature infants from southwest Alaska meeting criteria for palivizumab prophylaxis decreased from 439 per 1000 births before to 150 per 1000 births after palivizumab (relative rate, 0.34; 95% confidence interval, 0.17 to 0.68), whereas the rate in nonpremature infants remained stable (148 per 1000 births compared with 142 per 1000). Among high risk Alaska Native children during 1998 through 2001, the rate of first RSV hospitalization was 0.55 per 1000 protected days and 1.07 per 1000 unprotected days (relative rate, 0.52; 95% confidence interval, 0.28 to 0.93). CONCLUSIONS: Palivizumab reduced RSV hospitalizations in high risk infants in a region with high rates of RSV hospitalization.

Alaska↗

Rates of and factors associated with recurrence of preterm delivery.

CONTEXT: Information about risk of recurrent preterm delivery is useful to clinicians, researchers, and policy makers for counseling, generating etiologic leads, and measuring the related public health burden. OBJECTIVES: To identify the rate of recurrence of preterm delivery in second pregnancies, factors associated with recurrence, and the percentage of preterm deliveries in women with a history of preterm delivery. DESIGN AND SETTING: Population-based cohort study of data from birth and fetal death certificates from the state of Georgia between 1980 and 1995. SUBJECTS: A total of 122 722 white and 56174 black women with first and second singleton deliveries at 20 to 44 weeks' gestation. MAIN OUTCOME MEASURE: Length of gestation (categorized as 20-31, 32-36, or > or =37 weeks) at second delivery compared with length of gestation at first delivery, by age and race. RESULTS: Most women whose first delivery was preterm subsequently had term deliveries. Of 1023 white women whose first delivery occurred at 20 to 31 weeks, 8.2% (95% confidence interval [CI], 6.6%-10.1%) delivered their second birth at 20 to 31 weeks and 20.1% (95% CI, 17.7%-22.8%) at 32 to 36 weeks. Of 1084 comparable black women, 13.4% (95 % CI, 11.4%-15.6%) delivered at 20 to 31 weeks and 23.4% (95% CI, 20.9%-26.1%) delivered at 32 to 36 weeks. Among women whose first delivery occurred at 32 to 36 weeks, all corresponding rates were lower than those whose first birth was at 20 to 31 weeks; the rates of second birth at 20 to 31 weeks were substantially lower (for white women, 1.9% [95% CI, 1.7%-2.2%]; for black women, 3.8% [95% CI, 3.4%-4.2%]). Compared with women aged 20 to 49 years at their second delivery, women younger than 18 years had twice the risk of recurrence of delivery at 20 to 31 weeks. Of all second deliveries at 20 to 31 weeks, 29.4% for white women and 37.8% for black women were preceded by a preterm delivery. CONCLUSIONS: Our data suggest that recurrence of preterm delivery contributes a notable portion of all preterm deliveries, especially at the shortest gestations.

Adolescent↗

Outdoor air pollution, low birth weight, and prematurity.

This study tested the hypothesis, suggested by several recent reports, that air pollution may increase the risk of adverse birth outcomes. This study analyzed all singleton live births registered by the Czech national birth register in 1991 in 67 districts where at least one pollutant was monitored in 1990-1991 (n = 108,173). Maternal exposures to sulfur dioxide (SO(2)), total suspended particles (TSP), and nitrous oxides (NO(x)) in each trimester of pregnancy were estimated as the arithmetic means of all daily measurements taken by all monitors in the district of birth of each infant. Odds ratios of low birth weight (< 2,500 g), prematurity (< 37 weeks of gestation), and intrauterine growth retardation (IUGR; < 10th percentile of birth weight for gestational age and sex) were estimated by robust logistic regression. The median (and 25th and 75th percentile) trimester exposures were 32 (18, 56) microg/m(3) for SO(2); 72 (55, 87) microg/m(3) for TSP; and 38 (23, 59) microg/m(3) for NO(x). Low birth weight (prevalence 5.2%) and prematurity (prevalence 4.8%) were associated with SO(2) and somewhat less strongly with TSP. IUGR was not associated with any pollutant. The effects on low birth weight and prematurity were marginally stronger for exposures in the first trimester, and were not attenuated at all by adjustment for socioeconomic factors or the month of birth. Adjusted odds ratios of low birth weight were 1.20 [95% confidence interval (CI), 1.11-1.30] and 1.15 (CI, 1.07-1.24) for a 50 microg/m(3) increase in SO(2) and TSP, respectively, in the first trimester; adjusted odds ratios of prematurity were 1.27 (CI, 1.16-1.39) and 1.18 (CI, 1.05-1.31) for a 50 microg/m(3) increase in SO(2) and TSP, respectively, in the first trimester. Low gestational age accounted for the association between SO(2) and low birth weight. These findings provide further support for the hypothesis that air pollution can affect the outcome of pregnancy.

Air Pollutants↗

Delayed interval delivery in multiple pregnancies. Is optimism justified?

OBJECTIVE: Evaluation of the success of delayed interval delivery in multiple pregnancies. METHOD: Retrospective analyses of all multiple pregnancies with the birth of one child at a gestational age of 16-31 weeks (n=80). Three groups were defined: group I, unsuccessful attempt to temporize delivery, group II, interval between the first child and the other child or children 3 hours or more, with delivery of the remaining children before 28 weeks and group III, prolongation of pregnancy beyond 28 weeks. RESULTS: In 15 multiple pregnancies (ten sets of twins, five sets of triplets), the aim was to postpone the delivery of the second (and third) child. The mean gestational age at admittance was 25 weeks. Delay of the delivery of the second child was achieved in ten cases, five in group II and five in group III. In groups II and III, the mean interval of delivery was 12 days; the gestational age at the delivery of the remaining children in these ten patients was 27 5/7 weeks. No relation could be found between the reason for admittance and the interval in delivery between the first and the other children. The only severe maternal complication was blood loss exceeding 2 liters. In the neonatal outcome of first and second children (with a gestational age of 28 weeks or more) no striking differences were observed. CONCLUSION: Delayed delivery in multiple pregnancies after the birth of the first child is only successful in a minority of patients and should be considered prior to the birth of the first child.

Birth Intervals↗

[Serum concentration of gentamicin in newborn infants].

Serum levels of gentamicin were determined in 15 premature infants (birth weight 1,120-2,250 g, gestational age 27-36 weeks) by agar immunoassay. The intramuscular applied doses was 6 mg/kg/day, the doses interval 12 hours. We found an increase of the gentamicin serum level during the first 72 hours after the beginning of therapy. At the second day of treatment the serum levels in 46.5% of all patients were determined below the therapeutic concentration, but a toxic level was found in more than 60% of all cases during the period of steady state. The serum levels were higher in preterm newborns of less than 1,500 g birth weight, then in more mature infants. We recommend: 1. To double the first doses of gentamicin 2. To modify the gentamicin level by expanded intervals of therapy and/or reduced doses under monitoring, especially during the first week of life.

Bacterial Infections↗

Grand multiparity and incidence of endometrial cancer: a population-based study in Finland.

The hormonal background of endometrial cancer is insufficiently characterised. We investigated the significance of parity, age at first birth, intensity between births, length of time from the first to the last birth and length of delivery-free premenopausal period in a cohort of grand multiparous (GM) women, i.e., women with at least 5 births. Data of the Population Register of Finland (86,978 GM-women) and the population-based Finnish Cancer Registry were combined. Standardised incidence ratios (SIRs) were calculated by dividing the number of observed cancer cases by the expected number based on the national incidence rates. Multivariate relative risks (RRs) were estimated by Poisson regression analysis. The SIR for endometrial cancer among GM-women was low [419 cases; SIR=0.57, 95% confidence interval (CI) 0.52-0.63]. The RR of endometrial cancer was 0.58 (95% CI 0.34-0.97) among women giving their first birth at an age of more than 30 years compared to women with first birth before the age of 20. In ages 50+ (94% of endometrial cancer cases), the RR for women with at least 8 births was 0.63 (95% CI 0.44-0.92) compared to those with 5 births, and those with a birth period of 20+ years had RR=0.57 (95% CI 0.34-0.96) compared to those with a period of <10 years, while prolonged average intensity between births showed only a small protective effect. The RR of endometrial cancer also correlated with the length of premenopausal delivery-free period (RR = 0.61, 95% CI 0.44-0.86) for women with a short (<10 years) period compared to women with a long (>15 years) period. Our findings, that a large number of births, old age at first birth, a long birth period and a short premenopausal delivery-free period reduced the risk of postmenopausal endometrial cancer of GM-women, emphasise the protective role of progesterone and the stimulatory role of estradiol in the hormonal background of this disease.

Adenocarcinoma↗

Gestational bleeding, bacterial vaginosis, and common reproductive tract infections: risk for preterm birth and benefit of treatment.

OBJECTIVE: To examine associations between bacterial vaginosis and other prevalent lower genital tract infections and clinically recognized first-trimester bleeding; possible independent and joint effects of gestational bleeding and bacterial vaginosis or other prevalent infections on preterm birth and premature rupture of membranes; and effects of antimicrobial treatment on reducing risks of preterm birth among these women. METHODS: A secondary analysis was conducted of 1100 pregnant women enrolled in a prospective observational study that examined the effects of standardized diagnosis and treatment of lower genital tract infections to prevent preterm birth. RESULTS: Sixty percent of women with first-trimester bleeding had one or more study infections detected at the initial examination. First-trimester bleeding was associated independently with the presence of bacterial vaginosis (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0, 2.3), Trichomonas vaginalis (OR 2.3, 95% CI 1.3, 4.2), and Chlamydia trachomatis (OR 2.7, 95% CI 1.4, 5.1). Preterm birth was increased among women with first-trimester bleeding and bacterial vaginosis (relative risk [RR] 4.4, 95% CI 2.0, 9.5) and bacterial vaginosis and T vaginalis (RR 3.0, 95% CI 1.0, 8.8). Systemic antimicrobial treatment reduced the rate of preterm birth among women with bacterial vaginosis without first-trimester bleeding (RR 0.37, 95% CI 0.16, 0.88). Treatment of women with both first-trimester bleeding and bacterial vaginosis reduced preterm birth (RR 0.52, 95% CI 0.18, 1.55), but not significantly. CONCLUSION: First-trimester bleeding was increased among women with bacterial vaginosis, T vaginalis, C trachomatis, and combinations of these infections. Women with bacterial vaginosis who also experienced first-trimester bleeding were at heightened risk for preterm birth. Treatment of studied infections reduced significantly the risks of preterm birth among women without first-trimester bleeding.

Adolescent↗

Reduced circulating placental protein concentrations during the first trimester are associated with preterm labour and low birth weight.

Serum concentrations of human chorionic gonadotrophin (HCG), Schwangerschaftsprotein 1 (SP-1), pregnancy-associated plasma protein A (PAPP-A), progesterone and oestradiol were measured at weekly intervals between the fifth (embryo transfer plus 3 weeks) and 13th week of gestation during the first trimester of pregnancies achieved following in-vitro fertilization (IVF) and embryo transfer in a group of women who delivered before (n = 8) or at term (n = 52). Those women who had a preterm delivery had significantly lower concentrations of PAPP-A (weeks 7-13; P = 0.0001-0.028) and SP-1 (weeks 6-8 and 10-12; P = 0.004-0.04). After correction of birth weight for sex and gestational age at delivery, preterm delivery was found not to be associated with growth retardation. However, comparison of the circulating concentrations of the substances analysed in mothers who delivered babies of < 85% of the 50th centile of the normal range of birth weight for a given gestational age and sex, with those who delivered babies of > 85% revealed that the concentrations of HCG (P = 0.012-0.04 on weeks 6-9) and SP-1 (P = 0.003-0.03 on weeks 7, 9-13) were significantly lower in the former group. Weak, inconsistent associations were found between the circulating concentrations of HCG, SP-1 and PAPP-A and both corrected birth weight and gestational age at delivery. Thus, both the gestational age at delivery and low birth weight may be related to impaired placental development/function during the first trimester.

Chorionic Gonadotropin↗

Outcomes among term infants when two-hour postnatal pH is compared with pH at delivery.

OBJECTIVE: This study was undertaken to measure infant outcomes when pH at birth was compared with neonatal pH determined within 2 hours of age. STUDY DESIGN: We retrospectively studied term infants born between January 1, 1988, and August 31, 1998, who had umbilical artery blood pH measured at birth and again from the radial artery or umbilical artery within 2 hours after birth. Statistical significance was determined with the chi2 test. Odds ratios and 95% confidence intervals were calculated by means of the Mantel-Haenszel method. RESULTS: Data from a total of 1691 infants were analyzed: 178 (11%) had acidemia at birth (pH of <7.20) that persisted through the first 2 hours after birth; 110 (6%) had development of acidemia after birth; and 594 (35%) were born with a cord pH of <7.20 that improved after delivery. The remaining 809 infants (48%) did not have acidemia either at birth or during the neonatal period, and these served as the reference group. Seizures during the first 24 hours after birth were more likely among those infants with persistent acidemia (odds ratio, 13.0; 95% confidence interval, 6.3-26.7). The odds ratio for seizures among infants in whom acidemia developed after birth was 5.7 (95% confidence interval, 2.2-14.5). Other than the reference group, the infants who were born with acidemia that was corrected by 2 hours after birth had the lowest risk of seizures (odds ratio, 2.5; 95% confidence interval, 1.2-5.3). Significant differences in neonatal outcomes persisted after correction for anomalies. CONCLUSION: The direction of pH change from birth to the immediate neonatal period was significantly related to morbidity and mortality among term infants who were ill at birth or became ill shortly thereafter.

Acidosis↗

Risk factors for epithelial ovarian tumours of borderline malignancy.

A case-control study was conducted on 91 cases with histologically-confirmed borderline ovarian tumours and 237 control subjects in hospital for acute non-gynaecological, hormonal or neoplastic disease. Women reporting three or more births, compared to nulliparae, had a relative risk (RR) estimate of 0.6, but this finding was not statistically significant (95% confidence interval (CI): 0.2-1.4). The risk of borderline tumours increased, although not significantly, with later age at first birth: compared to women reporting first birth at age 24 or before, the RRs were 1.3 and 1.7 in those reporting respectively their first birth at age 25-29 and 30 years or more. No significant relationship emerged between borderline ovarian cancer and age at menarche, menopausal status and lifelong menstrual pattern. Cases tended to report a later age at menopause than controls, but the trend in risk was not statistically significant. Nine cases (9.9%) and 68 controls (24.9%) reported oral contraceptive use: compared with never users the multivariate RR for ever users was 0.3, and the risk dropped with duration of use to 0.2 in users for two years or more (chi 2 (1) trend = 12.70, p less than 0.001). This study provides epidemiological evidence of a pathogenetic continuum between borderline and invasive ovarian tumours.

Adult↗

Short birth intervals and the risk of school unreadiness among a Medicaid population in South Carolina.

BACKGROUND: Communities across the United States have become more involved in enhancing school readiness. Many of the predictors of school readiness relate to conditions prior to and following the birth of the child, including a child's birthweight. Shortened birth intervals are related to a variety of health and social consequences that affect child development, yet no formal research has examined the association between birth intervals and school readiness. METHODS: This study was a secondary data analysis of de-identified pregnancy-related vital record information, matched to selected items from the Department of Health and Human Services Medicaid records on mothers and children and to the Cognitive Skills Assessment Battery score in South Carolina for the year 2000 for the child of interest (N = 6915). Analysis of covariance and logistic regression were used to determine if there was a statistically significant relationship between birth interval and school readiness. RESULTS: Results showed that birth interval is a significant predictor of school readiness with a P-value <0.001 even after controlling for various socio-demographic factors. Children born with inadequate birth intervals (less than 24 months) are more likely to fail the Cognitive Skills Assessment Battery compared with those with adequate birth intervals. Potential implications of this research include promoting optimal birth spacing to improve the likelihood that future first graders will come to school ready to learn.

Adult↗