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PubMed1990

Effects of maternal birth season on birth seasonality in the Canadian population during the seventeenth and eighteenth centuries.

Birth records of the French-Canadian population for the period 1621-1765 were analyzed retrospectively to examine the effect of maternal birth season on the seasonal distribution of births. Preliminary examination indicated that there was a bimodal pattern in birth seasonality: a major peak in early spring, a trough in early summer, a minor peak in autumn, and a trough around December. Because this seasonality was strongly biased at the level of the first birth by the month of marriage, which was concentrated in November, the seasonality of nonfirst births (n = 32,926) was examined in relation to the four seasons of maternal birth. Mothers born in May-July showed a flatter monthly distribution of nonfirst births at a maternal age of 28 years or more. Analysis of marriage-first birth intervals indicated that mothers who married in August-October showed a lower percentage of immediate conception (intervals of 8-10 months), whereas those mothers born in May-July had a higher percentage of immediate conception. This difference in birth seasonality shown by mothers born in May-July is similar to results from early twentieth-century Japan. Some seasonal infertility factors could have affected the embryos at the earliest stage of pregnancy, modifying a part of the seasonal variation in birth rate.

Birth Intervals↗
PubMed1986

Monitoring for congenital malformations.

Many countries instituted birth defects monitoring systems in the wake of the thalidomide tragedy. Having these systems in place will shorten the time before an alarm is signaled, should a teratogen of the potency of thalidomide be introduced. However, with stronger laws and regulations for testing drugs for adverse reproductive outcomes, a tragedy on the scale of thalidomide from ingestion of prescribed drugs by pregnant women is unlikely. Prospective parents could be exposed at the critical times to new physical, infectious, or nondrug chemical agents teratogenically as potent as thalidomide. (Teratogenic agents whose widespread use antedates monitoring will not cause rate changes or clusters detectable by monitoring.) What seems more likely is that the introduction of "weakly" teratogenic agents, or the inadvertent use of new drugs that are teratogenic, like isotretinoin, will be responsible for increases in birth defects. In neither of these situations are large numbers of cases likely to accumulate in short periods of time, particularly in the relatively small catchment areas (fewer than 50 to 100,000 births per year) of many monitoring programs. In addition to having to cope with this problem of rare outcomes, many monitoring systems have not been able to obtain complete ascertainment of CMs, at least not from single, rapidly reporting sources. Two remedies to these inadequacies are possible: Expand the catchment area. All births in the US, for instance, could be monitored if information on specific CMs was included on birth certificates, which were then transmitted to a central agency that could analyse the data rapidly. Alternatively, if different monitoring systems had comparable methods of ascertainment and diagnostic classifications, their data could be pooled with greater reliability than is currently possible. CMs in newborns are only one indicator of teratogenicity. At least 20% of all conceptions end in spontaneous abortions. A much higher proportion of abortuses have chromosome abnormalities, congenital malformations, or both, than newborns. The time necessary for such outcomes to manifest after the introduction of a new teratogen could be considerably shorter than the time before significant increases of CMs occurred in liveborns and stillborns. Monitoring the spontaneous abortion rate or chromosomal and other abnormalities in abortuses would be an important adjunct to monitoring newborns. However, since some teratogens may only cause CMs in newborns, the current approach to monitoring should not be abandoned. Moreover, the problems of ascertainment encountered in monitoring newborns are greater still in monitoring abortuses.(ABSTRACT TRUNCATED AT 400 WORDS)

Abnormalities, Drug-Induced↗
PubMed1993

Contraceptive delivery in the developing world.

A strong demand for family planning exists in most developing countries and family size is falling rapidly in many of them. Effective family planning programmes offer a world-wide range of choices (including voluntary sterilisation and abortion) through a variety of distribution channels. Universal access to voluntary family planning can be achieved easily and cheaply by the turn of the century, but only if conservative medical policies are overcome and funding is greatly expanded. The international community faces a genuine choice: if it responds to current opportunities the global population will stabilize at approximately 10 billion or fewer; if it fails, population may grow to 14 billion or more. The difference between these two projections (approximately equal to the present world population of 5.4 billion) may well determine the future of the planet.

Contraception↗
PubMed1991

Fertility rates in 238 HIV-1-seropositive women in Zaire followed for 3 years post-partum.

Birth-control use and fertility rates were prospectively determined in 238 HIV-1-seropositive and 315 HIV-1-seronegative women in Kinshasa, Zaire, during the 36-month period following the delivery of their last live-born child. No women delivered children during the first follow-up year. Birth-control utilization rates (percentage use during total observation time) and fertility rates (annual number of live births per 1000 women of child-bearing age) in the second year of follow-up were 19% (107.4 per 1000) for HIV-1-seropositive women and 16% (144.7 per 1000) for HIV-1-seronegative women. In the third year of follow-up these rates were 26 (271.0 per 1000) and 16% (38.6 per 1000) for HIV-1-seropositive and HIV-1-seronegative women, respectively (P less than 0.05 for the difference in birth-control utilization and fertility rates between seropositive and seronegative women in the third year of follow-up). Seven (2.9%) of the 238 HIV-1-seropositive women initially included in the study brought their sex partners in for HIV-1 testing; three (43%) of these men were found to be HIV-1-seropositive. New HIV-1 infection did not have a dramatic effect on the fertility of seropositive women. The nearly uniform unwillingness of HIV-1-seropositive women to inform husbands or sexual partners of their HIV-1 serostatus accounted in large part for the disappointingly high fertility rates in seropositive women who had been provided with a comprehensive program of HIV counseling and birth control. Counseling services for seropositive women of child-bearing age which do not also include these women's sexual partners are unlikely to have an important impact on their high fertility rates.

AIDS-Related Complex↗
PubMed1985

Changes in obstetric practice in our time.

In the years since 1939 there has been a marked change in the nature and results of obstetric practice at the Royal Women's Hospital, Melbourne. The noteworthy changes have been a reduction in the number of maternal deaths (from 12.2 per 1,000 in the 1940's to 0.2 per 1,000 in the 1980's), especially those due to septic abortion, and an increase in the Caesarean section rate (from 2% to 14%). The increase in the operative delivery rate has been matched by a decrease in mortality in patients thus delivered, the maternal and perinatal mortality rates changing from 5.5 and 88.9 per 1,000 to 0 and 7.6 per 1,000 respectively in the case of forceps delivery and from 24.7 and 162.5 per 1,000 to 0.15 and 10.6 per 1,000 respectively in the case of Caesarean delivery.

Adult↗
PubMed1996

Outcome of isolated congenital complete heart block diagnosed in utero.

OBJECTIVE: To establish identifiable prenatal factors in fetal heart block which might predict death in utero, the need for intervention, or the probability of pacemaker requirement. SETTING: Tertiary referral unit for fetal echocardiography. SUBJECTS: 36 fetuses with congenital complete heart block and structurally normal hearts identified between 1980 and 1993. METHODS: Maternal anti-Ro antibody status was documented. Prenatal variables examined included absolute heart (ventricular) rate, change in rate, and development of hydrops fetalis. Postnatally, heart rate, need for pacing, and the indications for pacing were detailed. RESULTS: Of the total of 36 patients, there are 24 survivors; 11 are paced. Of those fetuses which died, two were electively aborted for severe hydrops, seven died in utero, two were immediate postnatal deaths, and one was an unrelated infant death. The trend was for the heart rate to decrease during fetal life and postnatally. Fetuses with deteriorating cardiac function did not always show the lowest heart rates. Bradycardia of less than 55 beats/min in early pregnancy or rapid decrease in heart rate prenatally were poor prognostic signs. Hydrops was also associated with bad outcome, 10 out of the 12 hydropic fetuses dying (83%). Of 10 fetuses presenting with a heart rate above 60/min, nine survived of whom three required pacing. Of seven presenting with heart rates of 50/min or less, only three survived and two of these required pacing. Of the two fetuses with negative maternal anti-Ro antibody status one died in utero and one required heart transplantation after pacemaker insertion. CONCLUSIONS: Isolated complete heart block identified in fetal life does not always have a good prognosis. An individual heart rate does not accurately predict the outcome in utero or the need for postnatal pacing. Regular, careful monitoring during pregnancy is required in order to optimise care and timing of any interventions.

Cardiac Pacing, Artificial↗
PubMed1975

Family planning services in the United States.

In recent years the United States has made considerable progress in providing family planning services for those in need. This does not mean, however, that the problems posed by unwanted pregnancies and unwanted births have been completely overcome. Estimates of the number of low-income women needing and receiving family planning services indicate that roughly 3.6 million women at risk of an unwanted pregnancy were receiving family planning services in 1973. This represented almost two-thirds of those in need at the time. Many programs are also seeking to meet the teenage need demonstrated by very high rates of out-of-wedlock births, premarital conceptions, obstetric problems, and legal abortion demands of women 15 to 19 years of age. As of 1973, it appeared that between 1.3 and 2.2 million never-married teenagers were in need of organized family planning services, and that of these, services were being received by between 25 and 42 per cent.

Abortion, Legal↗
PubMedDate not supplied

Contraceptive paths toward the reduction of unintended pregnancy and abortion.

Based on data from the 1982 National Survey of Family Growth, exposure to the risk of unintended pregnancy is classified by use of specific contraceptive methods and by nonuse, and average rates of unintended pregnancy are estimated for each type of exposure. Three hypothetical models of improved contraceptive practice are then applied to the data for all women and for age, race and marital-status subgroups. The first two models assume increases in the use of some existing contraceptive methods, but only the second model additionally assumes the introduction of new methods. The third model assumes the complete elimination of nonuse of contraception. These models yield different estimates of the reduction in unintended pregnancy rates which are illustrated for various age-groups, for whites and blacks and for married and unmarried women. Among all women aged 15-44, the changes assumed by Model I imply a 32 percent reduction in unintended pregnancy; Model II implies a 56 percent reduction; and Model III implies a 57 percent reduction. The implied reductions in abortion are in a similar range.

Abortion, Induced↗
PubMed1978

Fertility and family planning in rural northern Thailand.

From the mid-1960s to the mid-1970s, when fertility was declining in Thailand as a whole, especially rapid declines occurred in Northern Thailand, but they did not occur uniformly in all the region's provinces. The Northern Thailand Fertility Study, initiated in 1975 to study the reported fertility changes, gathered data in two provinces: Chiang Mai, where fertility decline has been quite rapid, and Chiang Rai, which experienced relatively little decline until 1974. This preliminary report discusses fertility levels and trends in the two provinces, fertility experience and expectations of respondents, attitudes toward and knowledge of family planning, and contraceptive practice. The results suggest that most of the difference in fertility decline is related to the different level of family planning program activity in the two provinces.

Abortion, Spontaneous↗
PubMed1995

Fertility of the over forties.

This article focuses on women aged forty and over in England and Wales. It identifies changes in fertility patterns in the late childbearing ages, including trends in multiple maternities, conceptions terminated by an abortion, and the effects of delayed childbearing on births outside marriage and on the birth order distribution of births within marriage.

Adult↗
PubMed1977

A component analysis of recent fertility decline in singapore.

To aid in achieving demographic goals, since 1968 the government of Singapore has passed a series of laws designed to limit family size. Policies were instituted in 1968 to discourage couples from having more than three children; policies introduced in 1973 discouraged having more than two. Trends in fertility rates and in the numbers of abortions and sterilizations in recent years are consistent with the intent of these social policies. Decline in third and subsequent births was the most important factor in fertility decline after 1972, and the numbers of abortions and sterilizations undergone by higher parity women have increased substantially sin"e 1970. Although other factors have affected fertility in Singapore, the data suggest that the disincentives have played a role in continued fertility decline in recent years.

Abortion, Legal↗