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PubMed1997

Recent trend of the decrease in mean birthweights of infants in the western provinces of Gifu Prefecture, Japan.

The mean birthweight has decreased recently in Japan. The author assessed the etiology of this trend by comparing the birthweight during the years 1983-1984 and 1993-1994 in Central Japan. All birth certificates of 3767 and 3423 infants were available for 1983-1984 and 1993-1994, respectively. The mean birthweight decreased from 3165 g to 3128 g. The proportion of first infants whose mean birthweight decreased more than that of the other infants increased from 41.0% to 47.1%. Comparison and multivariate analysis revealed the main cause of decreased birthweight as a decrease of the mean birthweight of first infants and changes of the proportion of birth order. Influences of the increases in the proportion of multiple births and that of low birthweight infants to the decrease of mean birthweight were small. The mean birthweight of infants who were born in public hospitals was lower than that of infants born in clinics, private hospitals, and others. The proportion of low birthweight infants was also highest among the infants born in public hospitals. These results indicate that pregnant women with high risk factors are more likely to be referred to the care of public hospitals.

Adult↗
PubMed2002

Temporal trends of risk factors associated with low birth weight--national and state of Connecticut: 1992-1998.

OBJECTIVES: To describe the magnitude of the problem of low birth weight in the U.S. and the State of Connecticut. To describe the temporal trends of selected risk factors associated with low birth weight (LBW) from 1992-1998. METHODS: Retrospective, descriptive study utilizing reports from birth certificate data from National Center for Health Statistics and Annual Registration Reports for the State of Connecticut. RESULTS: Over the seven-year period (1992-1998), the birth rate decreased from 15.9% to 14.6% at the national level and from 14.5% to 13.4% in Connecticut. However, percent of low birth weight increased from 7.1% to 7.6% at the national level and from 6.9% to 7.8% in Connecticut. There was an increase in the percent of premature infants nationally. Significant changes in the LBW risk factors at both the national level and in Connecticut were increased births to mothers > or = 35 years (P < 0.0001) and increased multiple births (P = 0.0001).

Birth Weight↗
PubMed2003

[Delivery and anal incontinence: definition, classification, prevalence and pathophysiology].

OBJECTIVE: Summary of the mutual relationship between vaginal delivery and anal incontinence. DESIGN: Review. SETTING: Department of Gynecology and Obstetric, Charles University and Faculty Hospital Pilsen. SUMMARY: Review of the current international literature covering the given problem. Anal incontinence is defined as an unvoluntary leakage of flatus, liquid or solid stool. Fecal incontinence means the leakage of liquid and solid stool only. Women are at eighttimes higher risk of developing anal incontinence (the leakage of flatus, fluid or hard stool). The main reason considered to be the cause of this difference is a birth. Postnatal anal incontinence is a disabling problem for as much as 13-20% of women. Review describes classification, prevalence, incidence and cause of AI in women considering maternal position at birth, second stage of labor, breastfeeding, anal sexual intercourse and multiple births. Two main pathogenetic mechanisms are presented. 1) Perineal neurological injury is described in earlier studies. This looks to be the major reason for 3rd and following vaginal births. 2) An apparent or occult anal sphincter tear seems to be the main factor particularly for the 1st vaginal birth. 2.3% of primigravidae have an apparent tear and 35% sonographically detected occult anal sphincter tear. Anal incontinence develops nearly exclusively in these groups. 42% of afflicted women complain of impaired quality of life. Anal incontinence appears to be improved within the time (in 36-76%). Longterm outcome is not known yet. The postnatal check-up should also include the question of de novo developed anal and urine incontinence or impaired sexual health.

Delivery, Obstetric↗
PubMedDate not supplied

Preventing preterm birth: are we making any progress?

Most industrialized countries have reported recent decreases in the size of infants born at term but no reduction, or even a rise in the incidence of preterm birth. This paper reviews recent secular trends in preterm birth and the evidence about possible reasons for those trends. The hypothesized reasons include ignorance about the causal determinants of preterm birth, failure to reduce exposure to recognized determinants, increases in multiple births, the use of early ultrasound (rather than menstrual dates) to estimate gestational age, early induction or cesarean section for pregnancy complications, and registration of extremely immature births of borderline viability.

Developed Countries↗
PubMed1975

A study of some biological and socio-economic factors in low birth weight.

Of 3841 children born alive in Malmö in Sweden in 1966, 188, 4.9% had a birth weight of larger than 2500 g. We studied these children with their families and a control in order to form an opinion on the role played by certain social and biological factors in the aetiology of LBW in a country with a relatively high average standard of living. Biological factors were analysed, such as the mother's age, parity, stature, and weight, as well as purely socio-economic factors such as the mother's civil staatus, the social group of the mother and father, income, mother's allowance in case of illness, social help or investigations regarding one or more members of the family, as well as the frequency of immigrants. The combined effect of various socio-economic factors was judged by help of a "social score". The results were analysed for 3 different groups of low birth weight, appropriate for gestational age, small for gestational age and multiple births. Judging from our investigation, biological factors probably play the greatest role in the question of LBW but these factors are difficult to distinguish from socio-economic factors which probably still play a certain role in the group preterm children, appropriate for gestational age.

Adult↗
PubMed1997

Fertility therapy and the risk of very low birth weight.

OBJECTIVE: To test the hypothesis of an association between maternal infertility therapy and the risk of very low birth weight (VLBW), defined as birth weight less than 1500 g, independent of the risk of multiple births, and to estimate the contribution of infertility therapy to the national incidence of VLBW. METHODS: The National Maternal and Infant Health Survey conducted in 1988 was used to develop statistics describing outcomes among this birth cohort and to construct logistic regression models evaluating fertility therapy as an independent risk factor for VLBW. RESULTS: An estimated 10.1% of live births and 18.2% of VLBW births nationally were associated with either maternal subfertility or infertility therapy (6.8% and 11.4%, respectively). The risk of VLBW among women concerned with subfertility (i.e., receiving diagnostic testing or advice on timing intercourse) was 1.4 (95% confidence interval [CI] 1.1, 1.9), whereas that for women undergoing therapeutic interventions (ie, ovarian stimulation, surgery, in vitro fertilization, or artificial insemination) was 2.6 (95% CI 2.1, 3.2). Accounting for effects of multiple gestation, maternal age, and a history of miscarriage, the odds ratios for the concerned and therapy groups were 1.5 (95% CI 1.1, 1.9) and 2.0 (95% CI 1.5, 2.5), respectively. Black women were less likely to use fertility therapy but more likely to experience a therapy-related VLBW. CONCLUSION: Fertility therapy is associated with an important portion of all VLBW and with an elevated risk of VLBW, related only in part to an increased risk of multiple gestations. Women expressing concern about subfertility but not receiving therapy are also at increased risk of VLBW, suggesting that a history of infertility may mediate part of the risk associated with fertility therapy.

Adult↗
PubMed1996

Associations between siblings for esotropia and exotropia.

OBJECTIVE: To quantify familial aggregation of esotropia and exotropia in children examined in a large multicenter study. METHODS: Pregnant women and their children were examined in the Collaborative Perinatal Project of the National Institute of Neurological Disorders and Stroke, Bethesda, Md. Strabismus was evaluated in the children during follow-up examinations up to the age of 7 years. The second-order generalized estimating equations approach to logistic regression was used to estimate familial aggregation of esotropia and exotropia. RESULTS: For any pair of siblings, the odds for one sibling having esotropia more than doubled when the other sibling had esotropia. For exotropia, there were differences in sibling associations based on birth relationships. In particular, there was no statistically significant association between siblings from separate single births. On the other hand, for the pairs of siblings from multiple births (ie, twins, triplets, and quadruplets), the odds for exotropia in one sibling were increased by at least a factor of 17 when the other sibling from that birth also had exotropia. For both esotropia and exotropia, adjustment for previously identified risk factors only somewhat reduced the magnitudes of the observed associations. Limited data on zygosity showed a stronger association between monozygotic twins than between dizygotic twins. CONCLUSIONS: There is a significant familial component in the cause of strabismus. Furthermore, there are important contributions to this familial aggregation beyond those associated with known risk factors for strabismus.

Child↗
PubMed2003

Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide.

BACKGROUND: Inhaled corticosteroids are recommended as first-line therapy for pregnant women with moderate to severe asthma, although the effects on pregnancy outcome are uncertain. A low compliance with the recommendations might lead to inadequate control of asthma, which has been associated with adverse outcomes both for the mother and the infant. OBJECTIVE: To investigate whether the reported use of inhaled budesonide (Pulmicort) during pregnancy influences birth outcome. METHODS: Data were derived from the Swedish Medical Birth Register, which includes 99% of births in Sweden. During 1995 to 1998, 293,948 newborn infants were identified. Pregnancy outcomes were compared for mothers in Sweden reporting asthma medication usage with those reporting no asthma medication usage. RESULTS: The 2,968 mothers who reported use of inhaled budesonide during early pregnancy gave birth to infants of normal gestational age, birth weight, and length, with no increased rate of stillbirths or multiple births. The rate of caesarean births was higher among mothers who used asthma medication during their pregnancy than among the control group. CONCLUSIONS: The use of inhaled budesonide in Sweden is not linked with any clinically relevant effects associated with pregnancy outcome.

Administration, Inhalation↗
PubMed2002

On the twin risk in autism.

Autism is considered by many to be the most strongly genetically influenced multifactorial childhood psychiatric disorder. In the absence of any known gene or genes, the main support for this is derived from family and twin studies. Two recent studies (Greenberg et al. 2001; Betancur et al. 2002) suggested that the twinning process itself is an important risk factor in the development of autism. If true, this would have major consequences for the interpretation of twin studies. Both studies compared the number of affected twin pairs among affected sib pairs to expected values in two separate samples of multiplex families and reported a substantial and significant excess of twin pairs. Using data from our epidemiological study in Western Australia, we investigated the possibility of an increased rate of autism in twins. All children born between 1980 and 1995 with autism, Asperger syndrome, or pervasive developmental disorder not otherwise specified (PDD-NOS) were ascertained. Of the 465 children with a diagnosis, 14 were twin births (rate 30.0/1,000) compared to 9,640 children of multiple births out of a total of 386,637 births in Western Australia between 1980 and 1995 (twin rate weighted to number of children with autism or PDD per year 26.3/1,000). These data clearly do not support twinning as a substantial risk factor in the etiology of autism. We demonstrate that the high proportion of twins found in affected-sib-pair studies can be adequately explained by the high ratio of concordance rates in monozygotic (MZ) twins versus siblings and the distribution of family size in the population studied. Our results are in agreement with those of two similar studies by Croen et al. (2002) in California and Hultman et al. (2002) in Sweden.

Australia↗
PubMed1989

Breastfeeding multiples.

Although breastfeeding two or more infants requires greater organization and presents a challenge to the family, it may in the long run save time. Fatigue, the greatest deterrent to breastfeeding multiples, is common among all new mothers. It is essential for the nurse to demonstrate all of the potential positions for feeding, to stress adequate nutrition, and to encourage getting help from others so that the mother has time to rest each day. Nurses are in an optimal position for influencing successful breastfeeding for multiple birth parents. The dearth of knowledge about breastfeeding twins or other multiples indicates the need for research in this area.

Breast Feeding↗
PubMedDate not supplied

Maternity care monitoring in Ibadan, Nigeria.

During this hospital stay, 993 women delivered 1008 infants at University College Hospital in Ibadan, Nigeria from January through June 1977. The stillbirth rate was 45.4 per 1000 deliveries; the neonatal mortality rate was 20.2 per 1000 deliveries. Significant differences occurred in patient characteristics, antenatal care, and complications of labour/delivery between those patients with favourable and unfavourable birth outcomes. As expected from all previous reports, the rate of multiple births was very high: 37 sets of twins and 3 sets of triplets. Contraceptive acceptance rose after delivery from 17.1% to 63.5% accepting some method. Orals were the most popular choice both antepartum and postpartum.

Adolescent↗
PubMed2003

Expression of a truncated Sall1 transcriptional repressor is responsible for Townes-Brocks syndrome birth defects.

Townes-Brocks syndrome (TBS, OMIM #107480) is an autosomal dominant disorder that causes multiple birth defects including renal, ear, anal and limb malformations. Mutations in SALL1 have been postulated to cause TBS by haploinsufficiency; however, a mouse model carrying a sall1-null allele does not mimic the human syndrome. Since the mutations that cause TBS could express a truncated SALL1 protein containing the domain necessary for transcriptional repression but lacking the complete DNA binding domain, we hypothesized that TBS is due to dominant-negative or gain-of-function activity of a mutant protein. To test this hypothesis, we have created a mutant allele, sall1-DeltaZn2-10, that produces a truncated protein and recapitulates the abnormalities found in human TBS. Heterozygous mice mimic TBS patients by displaying high-frequency sensorineural hearing loss, renal cystic hypoplasia and wrist bone abnormalities. Homozygous sall1-DeltaZn2-10 mutant mice exhibit more severe defects than sall1-null mice including complete renal agenesis, exencephaly, limb and anal deformities. We demonstrate that truncated Sall1 mediates interaction with all Sall family members and could interfere with the normal function of all Sall proteins. These data support a model for the pathogenesis of TBS in which expression of a truncated SALL1 protein causes abnormal development of multiple organs.

Abnormalities, Multiple↗
PubMed2005

Temporal changes in the distribution of population risk factors attenuate the reduction in perinatal mortality.

BACKGROUND AND OBJECTIVE: To examine and quantify the changing contribution of some risk factors to the perinatal mortality rate. METHODS: A population-based retrospective cohort study in Northern England compared stillbirth, neonatal, and perinatal mortality rates by birthweight, maternal age, plurality, and gender between 1982-1990 and 1991-2000. RESULTS: Atlhough the perinatal mortality rate fell by 20% between 1982-1990 and 1991-2000, the proportion of births in high risk groups (low and high birthweight, older mothers, and multiple births) increased. Standardizing the rates for 2000 to the risk factor distribution in 1982 resulted in lower rates. Changes in the birthweight distribution had the largest impact, particularly on neonatal mortality. Nearly a quarter of neonatal deaths in Northern England in 2000 can be attributed to the shift in the birthweight distribution since 1982, especially to the increase in low birthweight births. CONCLUSION: Changes in the distribution of birthweight, maternal age, and plurality over the study period attenuated the observed reduction in perinatal mortality. It is important to consider differences in the population prevalence of such risk factors to make valid geographic or temporal comparisons. Reasons for the secular shift in birthweight and the implications of any contributing change in obstetric practice require further investigation.

Birth Weight↗
PubMed2000

Is season of birth associated with multiple sclerosis?

OBJECTIVE: To compare the monthly distribution of multiple sclerosis (MS) patients' births with that of the Sicilian population. BACKGROUND: Studies on the association between season of birth and risk of MS are scanty and controversial. DESIGN AND METHODS: Archives of the Institute of Neuropsychiatry of the Universities of Palermo and Catania were searched up to 1995 for definite MS patients (McDonald & Halliday criteria). The monthly distribution of MS patients' births (N= 965) was compared with that of the Sicilian population (N= 5,608,307). RESULTS: The distribution of births among MS patients compared with the general population was not different when tested by the chi2 statistic (P> 0.25). The Hewitt's non-parametric test for seasonality showed an excess of births between June and November among MS patients (P=0.004). CONCLUSION: A different pattern of MS patients' births is observed in Sicily and in Northern countries.

Age Factors↗
PubMed2004

Antepartum management and neonatal outcome of triplet pregnancies.

MATERIALS AND METHODS: The maternal and neonatal outcome of 27 triplet and 1 quadruplet gestations was studied at the University Hospital of Verona. RESULTS: Mean maternal age was 31.7+/-3.7 years; 24 women (85.7%) were nulliparous. Six (21.4%) patients had conceived spontaneously. Common maternal complications were: preterm labor (78.6%), anemia (57.1%), preeclampsia (25.0%). Thirteen patients (46.4%) had cervical cerclage, 21(75%) received tocolysis, 20 (71.4%) corticosteroid prophylaxis, 4 (14.3%) unfractionated heparin. All patients underwent Caesarean section with mean gestational age of 32+/-2.5 weeks and mean postoperative stay was 9 days. Three patients were treated in ICU after delivery, 1 was hysterectomized and 6 received blood transfusions. The live newborns were 80, the stillborns 5. Mean birth weight was 1,520+/-516 g (range 650-2,665), 95.0% being LBW. The following neonatal complications were observed: RDS (28.7%), cerebral hemorrhage (26.2% of II degrees and 1.2% of III degrees ), anemia (20%), PDA (12.5%), ROP (6.5%), polyglobulia (3.75%), NEC (2.5%). Mean hospitalization time was 30.6 days (range 2-132). DISCUSSION: Iatrogenic multiple births are increasing as the use of assisted conception techniques expands. Gynecologists should be aware of maternal complications and neonatal outcome of triplet pregnancies and infertility management strategies should try to avoid iatrogenic multiple gestations.

Adult↗
PubMed2002

The correspondence between interracial births and multiple-race reporting.

OBJECTIVES: Race-specific health statistics are routinely reported in scientific publications; most describe health disparities across groups. Census 2000 showed that 2.4% of the US population identifies with more than 1 race group. We examined the hypothesis that multiple-race reporting is associated with interracial births by comparing parental race reported on birth certificates with reported race in a national health survey. METHODS: US natality data from 1968 through 1998 and National Health Interview Survey data from 1990 through 1998 were compared, by year of birth. RESULTS: Overall multiple-race survey responses correspond to expectations from interracial births. However, there are discrepancies for specific multiple-race combinations. CONCLUSIONS: Projected estimates of the multiple-race population can be only partially informed by vital records.

Birth Certificates↗
PubMed1996

Risk factors for preterm birth in an upper middle class Chinese population.

OBJECTIVE: To examine the risk factors associated with preterm birth in an upper middle class Chinese population. STUDY DESIGN: From March 1994 to February 1995, a total of 301 cases (gestational age between 20 and 37 weeks) and 656 controls (gestational age at or greater than 37 weeks) were recruited at Mackay Memorial Hospital, Taipei, Taiwan. Using a case-control study design, logistic regression was used to examine the relative significance of various risk factors associated with preterm birth. RESULTS: Age and educational level were identified as significant risk factors for preterm birth. Multiple pregnancies, fetal congenital anomalies, placenta previa or abruptio placentae, and preeclampsia were found to be strongly associated with preterm birth (crude odds ratios between 6.37 and 25.89); vaginal bleeding during or after the first trimester, prior history of preterm delivery, and two or more previous first trimester abortions were associated with preterm birth to a lesser extent (crude odds ratios between 1.67 and 2.9). The magnitude of the increased risk associated with these variables in preterm birth did not show change to any great extent after age and educational level were adjusted for. Further stratification of these cases into groups with and without premature rupture of the membranes (PROM), showed that a multiple pregnancy was still the leading risk factor of preterm birth in both groups. Carrying an abnormal fetus was the next important risk factor for preterm birth in cases with PROM, but was less important in the group without PROM. However, placenta previa or abruptio placentae and preeclampsia were the next most important factors in the group without PROM. CONCLUSIONS: Unfavorable current obstetric conditions and a history of more than two prior abortions and preterm delivery were positively associated with preterm birth.

Abruptio Placentae↗
PubMed2005

In vitro fertilization (IVF) in Sweden: infant outcome after different IVF fertilization methods.

OBJECTIVE: To compare infant outcome after different IVF techniques. DESIGN: A register study in Sweden of IVF infants compared with all infants born. SETTING: National health registers. PATIENT(S): We studied 16,280 IVF infants, 30% of whom were conceived by intracytoplasmic sperm injection (ICSI). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Multiple births, infant sex, preterm birth, low birth weight, and small for gestational age among singletons, mortality, low Apgar score, neonatal diagnoses. RESULT(S): Twinning was less frequent after frozen standard IVF (18.1%) and after ICSI (21.8%) than after fresh standard IVF (24.4%). The male/female ratio was significantly increased in infants conceived after standard IVF. No significant differences were seen between singleton infants conceived after different IVF methods with respect to preterm birth, low birth weight, or infant mortality, with the possible exception of frozen standard IVF, for which some of these rates were lower than after fresh standard IVF. Infants born after ICSI had an indicated lower risk of respiratory problems than infants born after standard IVF. CONCLUSION(S): Little difference in outcome was seen after different IVF methods. The differences observed might be due to dissimilar characteristics of the treated women (e.g., because ICSI was mainly used in connection with male infertility).

Confidence Intervals↗