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PubMed2000

Vaginal births after Caesarean (VBAC): a population study.

This paper describes delivery outcomes for women from Victoria, Australia, who gave birth in 1995 and whose immediately previous (penultimate) delivery, within a 5-year search period, was a Caesarean section. Because of the large numbers of records involved, dedicated computer software for record linkage was used to identify the previous delivery and link it with the woman's current birth in 1995. Overall, 79% of the records from multiparous women were linked successfully. Approximately 15% were not linked because the previous birth was before the search period or was an abortion that would not have been reported to the Perinatal Data Collection Unit. Reasons for not being able to link the last 6% of the records include the previous pregnancy being overseas or interstate. Women who had a vaginal birth as the penultimate birth or a multiple birth at either event were excluded, resulting in a study population of 4663 linked records. More women (68%) had a repeat Caesarean than went into labour and, of the remaining women who laboured, 56% delivered vaginally. Overall, 18% of the women delivered vaginally. For the women who went into labour, the reported number experiencing a uterine rupture was two per 1000 births. Uterine rupture was not reported in the two-thirds who did not labour but had a repeat Caesarean. A review of the perinatal deaths identified only two deaths, one baby being born by elective Caesarean and one by a vaginal birth after a previous Caesarean (VBAC) where the choice of delivery methods may have contributed to the death. This large study is one of the few in the literature to provide population-based information on vaginal births after a previous Caesarean and related outcomes.

Adolescent↗
PubMed2003

Prevalence of adverse pregnancy outcomes around hazardous industrial sites in Cumbria, north-west England, 1950-93.

The objective of this study was to investigate the risk of stillbirth, neonatal death and lethal congenital anomaly in relation to proximity to hazardous industrial facilities at the time of birth in Cumbria, 1950-93. A retrospective cohort study was carried out using all 4325 stillbirths, 3430 neonatal deaths and 1569 deaths from congenital anomaly among the 287 993 births to mothers living in Cumbria between 1950 and 1993. Logistic regression was used to investigate the risk of each outcome in relation to proximity at birth to hazardous industrial sites, stratifying the analysis by time period and adjusting for social class, year of birth, birth order and multiple births. Continuous odds ratios for trend with proximity to sites were estimated. No significantly increased risk was found for stillbirth, lethal congenital anomaly or neonatal deaths in relation to proximity to hazardous industrial facilities, except for deaths from congenital heart defects in 1983-93. Overall, there was no evidence to suggest an increased risk of adverse lethal pregnancy outcome among babies whose mothers lived closer to hazardous industrial sites. The significantly increased risk of lethal congenital heart defects with proximity to these sites was likely to be a chance finding, given the large number of outcome groups and time periods analysed. However, effective environmental monitoring of industrial processes is required to enable studies to investigate the potential health risks of industrial pollution.

England↗
PubMed1985

Birth stress and self-reported sleep difficulty.

Difficulty in falling asleep and frequency of night wakenings were assessed in 1,272 college-aged individuals for whom birth histories (based on retrospective maternal reports) were available. A history of birth complications was associated with reports of sleep difficulties as an infant. Birth stressors, such as breech birth, prolonged labor, low birth weight, and multiple births, were predictive of disrupted sleep patterns in the young adult.

Adolescent↗
PubMed1991

Infants with single umbilical artery studied in a national registry. General epidemiological characteristics.

In this paper, registry data on infants born in Sweden between 1983 and 1986 are reviewed to describe the epidemiological characteristics of infants with single umbilical artery (SUA). During this period 372,066 births were registered with information on the number of umbilical vessels. Our data set contains 1782 SUA infants. The incidence at birth was: in multiple births 0.8%, in infants with chromosome anomalies 6.1% and in singletons without a known chromosome anomaly 0.46%. Incidence was higher in girls than in boys. There were no consistent seasonal variations in the date of presumed conception. Low birthweight (less than 2500 g) and preterm birth (less than 37 weeks) were seen more frequently in SUA singleton infants than in infants with three vessels. At any given gestation, SUA infants had a lower mean birthweight than infants with three vessels. The risk of having a SUA infant was increased in women over 40 years, and slightly increased at or above parity of three.

Birth Weight↗
PubMed1995

The changing pattern of cerebral palsy in Avon.

The overall rate of cerebral palsy excluding post-neonatal cases, has remained relatively constant, varying between 1.93 and 2.27 per 1000 births over the 20-year period between 1969 and 1988 in Avon. The rate of the subgroup of spastic cerebral palsy varied from 1.40 to 1.78 per 1000 births over the same time period. In singletons the corresponding figures were 1.80-2.17 per 1000 births and 1.28-1.67 per 1000 births, and in multiple births the figures were 7.12-8.80 per 1000 births and 7.12-8.44 per 1000 births. Although the overall rates have remained fairly constant there was an increase in incidence in the later years among children with low birthweight and short gestation.

Birth Weight↗
PubMed2006

Thyroid function and perchlorate in drinking water: an evaluation among California newborns, 1998.

Perchlorate (ClO4-) has been detected in groundwater sources in numerous communities in California and other parts of the United States, raising concerns about potential impacts on health. For California communities where ClO4- was tested in 1997 and 1998, we evaluated the prevalence of primary congenital hypothyroidism (PCH) and high thyroid-stimulating hormone (TSH) levels among the 342,257 California newborns screened in 1998. We compared thyroid function results among newborns from 24 communities with average ClO4- concentrations in drinking water>5 microg/L (n=50,326) to newborns from 287 communities with average concentrations 5 microg/L were observed, with 20.4 expected [adjusted prevalence odds ratio (POR)=0.71; 95% confidence interval (CI), 0.40-1.19]. Although only 36% of all California newborns were screened before 24 hr of age in 1998, nearly 80% of newborns with high TSH were screened before 24 hr of age. Because of the physiologic postnatal surge of TSH, the results for newborns screened before 24 hr were uninformative for assessing an environmental impact. For newborns screened>or=24 hr, the adjusted POR for high TSH was 0.73 (95% CI, 0.40-1.23). All adjusted odds ratios (ORs) were controlled for sex, ethnicity, birth weight, and multiple birth status. Using an assessment of ClO4- in drinking water based on available data, we did not observe an association between estimated average ClO4- concentrations>5 microg/L in drinking water supplies and the prevalence of clinically diagnosed PCH or high TSH concentrations.

California↗
PubMed2006

Factors associated with exclusive breast-feeding in Japan: for activities to support child-rearing with breast-feeding.

BACKGROUND: Benefits of breast-feeding are not only limited to nutrition and sanitation in developing countries but also extend to cost-saving health care and alleviation of anxiety related to childrearing in developed countries. This study aims to elucidate factors associated with exclusive breast-feeding in Japan and use this information to achieve child-rearing support worldwide by promoting breast-feeding. METHODS: This cross-sectional study used data from a survey conducted by Ministry of Health, Labour and Welfare of the Japanese government, the First Longitudinal Survey of Babies in 21st Century. All subjects were infants (n=53,575) born in Japan in 2001 between January 10 and 17 and between July 10 and 17. According to the data, the exclusive breast-feeding rate in Japan during the first 6 months of life was 21.0%. We examined the factors associated with exclusive breast-feeding using univariate and multivariate logistic regression analyses. RESULTS: Among the factors examined, the adjusted odds ratio (OR) for exclusive breast-feeding was low for late childbearing, low birth weight infants, multiple births, smoking parents, living with grandparents, and feeling burdened by childrearing. The adjusted OR was high for factors that included sufficient childcare leave and consultation about childrearing with the spouse, a birth attendant and/or nurse, and a peer in a child-rearing circle. CONCLUSIONS: Exclusive breast-feeding is associated not only with medical factors but also with social factors. This study clarifies the necessity of social support to reduce the child rearing burden and a political system to promote paternal participation in childrearing and to improve the childcare leave system.

Adult↗
PubMed2002

Sampling survey on low-birth weight in China in 1998.

OBJECTIVE: To study the weight of live births and incidence of low-birth weight (LBW) in China. METHODS: A national survey on the weight of live births with gestational ages of 28 weeks or over in 16 cities and 28 counties of 11 provinces in China was carried with stratified sampling during July to October, 1998. RESULTS: Totally 22 350 live newborns, 11 584 males and 10 766 females, with gestational ages of 28 weeks or more in sampling sites were measured at their birth. Rates of multiple births and preterm birth (< 37 weeks of gestation) were 1.8% and 3.5%, respectively. LBW rates were 4.20% and 6.26% for urban and rural areas, respectively, with a national weighted-average of 5.87%. Full term births (>/= 37 weeks of gestation) accounted for 61.2% and 71.6% of the babies with LBW in national and rural areas, respectively. Their average birth weight was 3 301 g and 3 225 g in urban and rural areas, respectively, with statistically significant difference, and 3 280 g and 3 173 g for boys and girls, respectively, approaching to the values recommended by the World Health Organization (WHO). Live birth weight in the coastal, inland, and remote areas appeared a trend of gradual decrease. Early neonatal mortality of babies with LBW was 50.0 per thousand and 179.4 per thousand in urban and rural areas, respectively, with a national average of 151.5 per thousand, significant higher than those with normal birth weight. CONCLUSIONS: The average birth weight and LBW rate in live births of China were close to those in the developed countries, and there was significant difference in them between varied regions. The majority of LBW in China was attributed to intrauterine growth retardation (IUGR). Early neonatal mortality in babies with LBW was significantly higher than that with normal birth weight. Further intervention measures should be implemented.

China↗
PubMedDate not supplied

The safety of newborn early discharge. The Washington State experience.

CONTEXT: While early discharge of newborns following routine vaginal delivery has become common practice, its safety has not been firmly established. OBJECTIVE: To assess the risk for rehospitalization following newborn early discharge. DESIGN: Population-based, case-control study. SETTING: Washington State linked birth certificate and hospital discharge abstracts covering 310578 live births from 1991 through 1994. PATIENTS: Case patients were 2029 newborns rehospitalized in the first month of life. Control subjects were 8657 randomly selected newborns not rehospitalized and frequency matched to case patients on year of birth. Cesarean deliveries, multiple births, and births at less than 36 weeks' gestation were not included. MAIN OUTCOME MEASURE: Stratified analyses and logistic regression were performed to assess the risk for rehospitalization within a month of birth after early discharge (<30 hours after birth) compared with later discharge (30-78 hours after birth). RESULTS: Seventeen percent of newborns were discharged early. Newborns discharged early were more likely to be rehospitalized within 7 days (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.11-1.47), 14 days (OR, 1.16; 95% CI, 1.03-1.32), and 28 days (OR, 1.12; 95% CI, 1.00-1.25) of discharge than newborns sent home later. Subgroups at increased risk for rehospitalization following early discharge included newborns born to primigravidas (OR,1.25; 95% CI, 1.07-1.45), mothers younger than 18 years (OR, 1.22; 95% CI, 0.79-1.91), and mothers with premature rupture of membranes (OR, 1.41; 95% CI, 0.85-2.36). Early discharge was also associated with an increased risk of readmission for jaundice, dehydration, and sepsis. CONCLUSION: Newborns discharged home early (<30 hours after birth) are at increased risk for rehospitalization during the first month of life.

Case-Control Studies↗
PubMed2004

Mortality in children aged under 8.

This article presents analyses of deaths in England and Wales of children under the age of eight by year of birth and age at death, focusing on children born between 1993 and 2001 and dying between 1993 and 2003. The analysis looks at risk factors available at birth registration including sex, birthweight, multiple birth status, mother's age, father's social class, mother's country of birth and marital status. It is the first time that ONS has been able to analyse deaths occurring up to age seven by these risk factors. The results show that many of the well established risk factors for death in infancy persist into older ages.

Adult↗
PubMed1992

[Triplets and quadruplets in Switzerland, 1985-1988].

To determine the incidence of multiple births and associated morbidity and mortality, we collected in a retrospective study all the multiple births (twins excluded) in Switzerland from 1985 to 1988. In all we followed 77 sets of triplets and 9 sets of quadruplets, representing an annual incidence of 1/3968 births for the triplets and 1/33,947 births for the quadruplets. The incidence of induced pregnancies increased in the period 1985 to 1988. The principal complications were premature contractions and preeclampsia. Only 56% of the children were born in a hospital with a neonatal intensive care unit. The mean gestational age was 33 0/7 weeks (ranging from 25 0/7 to 38 5/7) for the triplets, and 30 5/7 weeks (ranging from 27 5/7 to 36 3/7) for the quadruplets. The mean birthweight was 1787 g (ranging from 560 to 3000 g) for the triplets and 1189 g (ranging from 590 to 1980 g) for the quadruplets. RDS was found to be the principal neonatal pathology (65.5% of triplets and 85.2% of quadruplets) with 18.8% of triplets and 61.8% of quadruplets requiring ventilation. The mortality rate in our study was 8.9% for triplets and 14.7% for quadruplets.

Birth Weight↗
PubMed1996

Twin births to mothers who are twins: a registry based study.

OBJECTIVES: To estimate the risk of having twin infants for mothers who are twins; to investigate the genetic influence on twinning. DESIGN: Retrospective study of multiple births in two nationwide registries. SETTING: Sweden. SUBJECTS: Multiple births among 31,586 deliveries between 1973 and 1991 to women who were twins. MAIN OUTCOME MEASURES: Numbers of monozygotic and dizygotic twin births expected and estimated. RESULTS: Women who are dizygotic twins have a moderately increased risk of having twins (relative risk 1.30, 95% confidence interval 1.14 to 1.49) which seems to be completely the result of dizygotic twinning. When a mother is a monozygotic twin, her risk of having twins of the same sex is significantly increased (1.47; 1.10 to 1.97). This is the result of an excess of monozygotic twins (39 pairs estimated, 18 expected). CONCLUSIONS: Women who are twins have an increased risk of giving birth to twins. Genetic components of monozygotic and dizygotic twinning seem to be independent.

Female↗
PubMed2005

Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis.

BACKGROUND: Transfer of several embryos after IVF results in a high multiple birth rate associated with increased morbidity and high costs for the neonatal care. In a previous randomized trial we demonstrated that a single embryo transfer (SET) strategy, including one fresh single embryo transfer and, if no live birth, one additional frozen-thawed SET, resulted in a live-birth rate that was not substantially lower than after double embryo transfer (DET) but markedly reduced the multiple birth rate. METHODS: We compared costs for maternal health care and productivity losses and paediatric costs for the SET and DET strategies. In addition, maternal and paediatric outcomes between the two groups were compared. RESULTS: The SET strategy resulted in lower average total costs from treatment until 6 months after delivery. There were a few more deliveries with at least one live-born child in the DET group. The incremental cost per extra delivery in the DET alternative was high, 71 940. The rates of prematurely born and low birthweight children were significantly lower with the SET strategy. There were also markedly fewer maternal and paediatric complications in the SET group. CONCLUSIONS: The SET strategy is superior to the DET strategy, when number of deliveries with at least one live-born child, incremental cost-effectiveness ratio and maternal and paediatric complications are taken into consideration. The findings do not support continuing transfers of two embryos in this group of patients.

Adult↗
PubMed2002

Successful assisted reproductive technology: the beauty of one.

In 1999, the approximately 90,000 in vitro fertilization procedures accounted for 98% of all types of assisted reproductive technologies in the United States. Since 1992, when Congress recognized a public health interest in reporting accurate and timely information about pregnancy success rates for infertility treatments, success has been defined as a live birth after an assisted reproductive technology cycle, regardless of the number of live-born infants per delivery. Because of pressures to achieve success, often more than one pre-embryo is transferred per cycle, frequently resulting in multifetal pregnancy reduction or multiple births. Twin and higher order births associated with assisted reproductive technology have increased significantly since 1980. Although births resulting from assisted reproductive technology amount to less than 1% of all live births, they now account for about a third of all twin births and more than 40% of triplets and higher number births in the United States. Although multiple births fit the current definition of success, they create much higher risks for maternal and infant morbidity and mortality, contributing to more than $640 million in excess initial hospital costs during the year 2000 alone. With recent improvements in assisted reproductive technology procedures that increase the likelihood of delivery after the transfer of just one pre-embryo per cycle, it is time to re-examine how success is measured. Assisted reproductive technology success should be redefined to be the proportion of cycles resulting in a singleton, live birth.

Female↗
PubMed2005

Births: final data for 2003.

OBJECTIVES: This report presents 2003 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, and tobacco and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.09 million births that occurred in 2003 are presented. Denominators for population-based rates are derived from the U.S. 2000 census. RESULTS: In 2003 there were 4,089,950 live births reported in the United States, 2 percent more than the number in 2002. The crude birth rate (CBR) and general fertility rate (GFR) rose slightly. Childbearing among teenagers declined for the 12th straight year to another historic low. Birth rates for women aged 20-24 years also declined, whereas rates for women aged 25-44 years increased 2-6 percent, reaching highs not reported since the mid- to late 1960s. All measures of unmarried childbearing increased considerably in 2003, but smoking during pregnancy continued to decline. Timely initiation of prenatal care improved slightly. The cesarean delivery rate jumped another 5 percent to another all-time high, and the rate of vaginal birth after previous cesarean dropped 16 percent, an all-time low. Key measures of birth outcome-the percentages of preterm and low birthweight (LBW) births-rose. The twinning rate increased, but the rate of triplet and higher order multiple births was essentially stable.

Adolescent↗
PubMed2004

Timing of initial surfactant treatment for infants 23 to 29 weeks' gestation: is routine practice evidence based?

OBJECTIVE: To describe the timing of initial surfactant treatment for high-risk preterm infants in routine practice and compare these findings with evidence from randomized trials and published guidelines. METHODS: Data from the Vermont Oxford Network Database for infants who were born from 1998 to 2000 and had birth weights 401 to 1500 g and gestational ages of 23 to 29 weeks were analyzed to determine the time after birth at which the initial dose of surfactant was administered. Multivariate models adjusting for clustering of cases within hospitals identified factors associated with surfactant administration and its timing. Evidence on surfactant timing from systematic reviews of randomized trials and from published guidelines was reviewed. RESULTS: A total of 47 608 eligible infants were cared for at 341 hospitals in North America that participated in the Vermont Oxford Network Database from 1998 to 2000. Seventy-nine percent of infants received surfactant treatment (77.6% in 1998, 79.4% in 1999, and 79.6% in 2000). Factors that increased the likelihood of surfactant treatment were outborn birth, lower gestational age, lower 1-minute Apgar score, male gender, white race, cesarean delivery, multiple birth, or birth later in the study period. The first dose of surfactant was administered at a median time after birth of 50 minutes (60 minutes in 1998, 51 minutes in 1999, and 42 minutes in 2000). Over the 3-year study period, inborn infants received their initial dose of surfactant earlier than outborn infants (median time: 43 minutes vs 79 minutes). Other factors associated with earlier administration of the initial surfactant dose were gestational age, lower 1-minute Apgar score, cesarean delivery, antenatal steroid treatment, multiple birth, and small size for gestational age. In 2000, 27% of infants received surfactant in the delivery room. There was wide variation among hospitals in the proportion of infants who received surfactant treatment in the delivery room (interquartile range: 0%-75%), in the median time of the initial surfactant dose (interquartile range: 20-90 minutes), and in the proportion of infants who received the first dose >2 hours after birth (interquartile range: 7%-34%). Six systematic reviews of randomized trials of surfactant timing were identified. No national guidelines addressing the timing of surfactant therapy were found. CONCLUSION: Although the time after birth at which the first dose of surfactant is administered to infants 23 to 29 weeks' gestation decreased from 1998 to 2000, in 2000 many infants still received delayed treatment, and delivery room surfactant administration was not routinely practiced at most units. We conclude that there is a gap between evidence from randomized controlled trials that supports prophylactic or early surfactant administration and what is actually done in routine practice at many units.

Databases, Factual↗
PubMed1998

Risk factors for preterm birth: a New Zealand study.

AIM: To identify risk factors for preterm birth. METHODS: A cross sectional study. The study population was 1800 infants selected randomly from all babies born over a three-year period. Of these, 85 (4.8%) were classified preterm (less than 37 completed weeks gestation). Data were collected from obstetric records and parental interviews. RESULTS: Risk factors associated with an increased risk of preterm birth after controlling for potential confounders included smoking during pregnancy (adjusted relative risk (RR) = 2.7, 95% confidence interval (CI) = 1.3, 5.4), and multiple birth (adjusted RR = 48.8, 95% CI = 18.1, 131.4). Urinary tract infection was significant at the 7% level (adjusted RR = 2.3, 95% CI = 1.0, 5.6). Alcohol intake in third trimester was associated with a reduced risk of preterm birth (adjusted RR = 0.4, 95% CI = 0.2, 0.7). CONCLUSION: Maternal smoking and multiple births were the most important modifiable risk factors in this study for preterm birth and may contribute to 17% and 11% of preterm births respectively.

Cross-Sectional Studies↗