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PubMed2004

Risk factors and obstetric complications associated with macrosomia.

OBJECTIVE: Macrosomia is associated with adverse maternal outcomes. The objective of this study was to characterize the epidemiology of macrosomia and related maternal complications. METHOD: Live births (146,526) were identified between 1995 and 1999 in the Kaiser Permanente Medical Care Program's Northern California Region (KPMCP NCR) database. Bivariate and multivariate analyses were performed for risk factors and complications associated with macrosomia (birth weight >4500 g). RESULT: Male infant sex, multiparity, maternal age 30-40, white race, diabetes, and gestational age >41 weeks were associated with macrosomia (p<0.001). In bivariate and multivariate analyses, macrosomia was associated with higher rates of cesarean birth, chorioamnionitis, shoulder dystocia, fourth-degree perineal lacerations, postpartum hemorrhage, and prolonged hospital stay (p<0.01). CONCLUSION: Macrosomia was associated with adverse maternal outcomes in this cohort. More research is needed to determine how to prevent complications related to excessive birth weight.

Adult↗
PubMed2004

Normal human pregnancy is associated with an elevation in the immune suppressive CD25+ CD4+ regulatory T-cell subset.

Summary CD4+ CD25+ T regulatory cells (TReg), suppress antigen-specific immune responses and are important for allograft tolerance. During pregnancy the mother tolerates an allograft expressing paternal antigens (the fetus) requiring substantial changes in immune regulation over a programmed period of time. We analysed whether immune-suppressive TReg cells were altered during pregnancy and therefore might play a part in this tolerant state. The presence of TReg cells was assessed in the blood of 25 non-pregnant, 63 pregnant and seven postnatal healthy women by flow cytometry. We observed an increase in circulating TReg cells during early pregnancy, peaking during the second trimester and then a decline postpartum. Isolated CD25+ CD4+ cells expressed FoxP3 messenger RNA, a marker of TReg cells, and suppressed proliferative responses of autologous CD4+ CD25- T cells to allogeneic dendritic cells. These data support the concept that normal pregnancy is associated with an elevation in the number of TReg cells which may be important in maintaining materno-fetal tolerance.

Adult↗
PubMed1993

Combined mother and baby care: does it meet the needs of families?

Combined mother/baby care is thought to be an effective way to prepare a family for the changing roles and added responsibilities that the arrival of a new baby entails, but few studies have evaluated this care delivery system. Therefore, the postpartum staff at Sudbury General Hospital conducted a post-test control group study design with a self-selected sample of postpartum mothers when the unit was changing from traditional to combined mother/baby care. One hundred and three mothers who received traditional care and 102 who had combined mother/baby care completed a questionnaire to assess perceptions of their own competence and satisfaction with the type of care administered. There were no significant differences between the two study groups. Factors that may have confounded the results include: insufficient time between institution of the program and its evaluation, and the quality of prenatal education received. Multiparous mothers scored higher on self care, infant care, and maternal competence than did primiparous mothers regardless of the care delivery system. Maternal concerns related to immediate needs. Future research should take the differences between primiparas and multiparas into account, and focus on the less immediate needs of mothers.

Adolescent↗
PubMed1993

Evaluation of routine diabetes and lipid screening after age 35 in candidates for or current users of oral contraceptives.

OBJECTIVE: To evaluate the efficacy of a diabetes and lipid screening program in women aged 35 or older who either were currently using a low-estrogen-dose oral contraceptive (OC) (0.03-0.04 ethinyl estradiol) or who desired to initiate low-dose OC therapy after using a non-OC method or following a recent pregnancy. METHODS: Healthy women with no history of abnormal glucose tolerance, hypertension, or hyperlipidemia aged 35 years and older were routinely screened for diabetes (fasting and 2-hour values after 75 g glucose) and dyslipidemia (fasting total cholesterol, high-density lipoprotein [HDL] and low-density lipoprotein [LDL] cholesterol, and triglycerides). Three groups of women were studied: women currently using low-dose OCs (OC group), women desiring to change to OC therapy (non-OC group), and women within 3 months post-pregnancy (postpartum group). RESULTS: The three groups were similar in age, parity, body mass index (BMI), and mean arterial pressure. The mean months of contraceptive use were not different between the OC group (30.2 months; 95% confidence interval [CI] 26.6-33.8) and the non-OC group (38.4 months; 95% CI 32.0-44.8). The mean fasting serum glucose, after adjusting for age and BMI, was significantly lower in the OC group (82.4 +/- 9.4 mg/dL) than in the non-OC and postpartum groups (87.2 +/- 12.5 and 86.8 +/- 13.0 mg/dL, respectively; P = .01). After adjustments, no differences between the groups were found in the 2-hour post-glucose levels, triglycerides, or HDL or LDL cholesterol levels. The non-OC group was found to have a significantly lower total cholesterol level (188.7 +/- 32.4 mg/dL) than the OC and postpartum groups (202.7 +/- 38.1 and 204.4 +/- 41.0 mg/dL; P = .02) after adjusting for age and BMI. This association lost its significance after applying multiple range tests, maintaining an alpha error of 0.05. CONCLUSION: The absence of significant adverse metabolic markers in longer-term OC users over the age of 35, in comparison to similar-age control groups, does not support the routine use of lipid and diabetes screening before initiating or during the use of low-dose OCs.

Adult↗
PubMed1986

Mortality associated with sterilization: preliminary results of an international collaborative observational study.

Sterilization is the contraceptive method most widely used worldwide, yet the case-fatality rate of deaths attributable to sterilization is not known. We used data collected from 1971-1979 from 28 countries by Family Health International to estimate case-fatality rates. We adjusted these rates for individuals lost to follow-up. Of 41,834 sterilizations, 23 resulted in deaths temporally associated with the procedure used. The adjusted attributable case-fatality rates were 13.4 per 100,000 for interval procedures, 53.3 per 100,000 for postabortion procedures, and 43.4 per 100,000 sterilizations after vaginal delivery. Multiple factors contributed to the deaths, including pre-existing health problems, infection and anesthesia. Prevention of deaths resulting from sterilization depends on complete ascertainment of deaths associated with sterilization and careful investigation to determine preventable risk factors. We conclude that, overall, sterilization in these programs was conducted with very low attributable mortality.

Female↗
PubMed1987

Benefits associated with WIC supplemental feeding during the interpregnancy interval.

Interpregnancy WIC supplementation was evaluated by comparing maternal nutritional status indicators and subsequent birth outcomes of 703 WIC participants divided into two groups. Study group women received postpartum benefits for 5-7 mo while control group women received postpartum benefits for only 0-2 mo. Both groups received prenatal benefits during each of two study pregnancies. Infants born to study group women had a higher mean birthweight (131 g) and birthlength (0.3 cm) and a lower risk of being less than or equal to 2500 g. Additionally, at the onset of the second pregnancy study group women had higher mean hemoglobin levels and lower risk of maternal obesity. These results suggest that postpartum WIC supplementation has positive benefits for both the mother and her subsequent infants.

Birth Weight↗
PubMed2005

Measuring preferences for delivery services in rural Vietnam.

BACKGROUND: The relatively low use of maternity services at the primary health care level in Vietnam has highlighted the need for economic evaluations of the current maternal health delivery network. This study measured willingness-to-pay for obstetric delivery preferences in rural Vietnam. METHODS: An interviewer-administered survey was conducted among 200 postpartum and 196 pregnant women, and 196 men in Quang Xuong district, Thanh Hoa province of Vietnam, using the payment card technique. RESULTS: A kappa score of 0.98 showed very good agreement between the two interviewers administering the survey. An association was found between willingness-to-pay and satisfaction with the quality of maternity services. No significant differences were found in willingness-to-pay values between prenatal and postpartum groups, and between male and female participants. CONCLUSIONS: The study demonstrates that the willingness-to-pay instrument is a feasible tool, and is relatively reliable to measure the benefit of different alternatives of delivery services in rural Vietnam. For wider application of the instrument, its validity should be investigated further. Meanwhile, health care managers and decision makers should be encouraged to apply the instrument in the evaluation of maternal health programs.

Adult↗
PubMed2000

[Postpartum risk factors in the development of children born to opiate-addicted mothers; comparison between mothers with and without methadone substitution].

In a retrospective case control study at the University of Frankfurt, Germany, 101 babies born to opiate-addicted mothers were identified from birth charts from 1988 to 1995. After birth, they developed a withdrawal syndrome (neonatal abstinence syndrome). Fifty control infants and their mothers were selected from neonatal wards. The group of opiate-exposed babies was subdivided into a group born to mothers without methadone treatment (n = 48) and a group born to mothers who were enrolled in a methadone program (n = 51). The methadone infants had a significantly higher mean birth weight (2822 g) than children in the group without methadone (2471 g). The abstinence syndrome was much more intense in the methadone group (convulsions 47.1%) than in heroin-exposed babies without methadone treatment (convulsions 27.1%). Women in methadone maintenance programs lived in more stable socioeconomic conditions than opiate-addicted women without methadone substitution. Moreover, they cared significantly better for their babies: 81.3% of the methadone mothers visited their children on a regular basis and 90.9% cared adequately. The data emphasize the need in future research to look more closely at the role of methadone treatment programs in the development of opiate-exposed babies.

Adult↗
PubMed2003

Breastfeeding patterns of primiparous mothers in Hong Kong.

BACKGROUND: An understanding of patterns of breastfeeding is necessary for the effective implementation of breastfeeding promotion and intervention programs. In Hong Kong, little current data have been gathered on women's breastfeeding rates. The objective of this study was to determine how patterns of breastfeeding, maternal demographics, and maternal employment affect continuation of breastfeeding in primiparous women in Hong Kong. METHOD: A longitudinal self-report survey was used to collect data when first-time mothers (n=218) were in the hospital, at 1, 3, 6, 9, and 12 months postpartum, or until they weaned their infant. All data (self-report survey, demographic data, and follow-up telephone surveys) were collected in Cantonese and then translated into English. Data were analyzed by determining, first, the influence of individual variables on the length of breastfeeding using a simple Cox regression analysis, and second, by grouping variables according to time sequence and entering them into a Cox regression model in 4 sequential phases. RESULTS: Factors that were significantly associated with continuation of breastfeeding were maternal age (HR=0.97; p=0.048); attendance at a prenatal breastfeeding class (HR=0.69; p=0.020); intended weeks of breastfeeding (HR=0.97; p<0.001); breastfeeding score in hospital (HR=0.99; p=0.009); and length of exclusive breastfeeding (HR=0.93; p<0.001). Similar results were obtained in the multiphase Cox regression analysis; only the breastfeeding score in hospital became marginally insignificant (p=0.053) after adjusting for demographics, prenatal, and other immediate postpartum factors. CONCLUSIONS: Short periods of exclusive breastfeeding and early supplementation were common in this sample. Unlike previous research, maternal employment was not a statistically significant factor in length of continued breastfeeding. Study findings show that multiple factors influence continued breastfeeding in Hong Kong, suggesting further areas for investigation. Changes in practice may improve continued and exclusive breastfeeding rates.

Breast Feeding↗
PubMed1998

Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women.

This study sought to quantify influenza-related serious morbidity in pregnant women, as measured by hospitalizations for or death from selected acute cardiopulmonary conditions during predefined influenza seasons. The study population included women aged 15-44 years who were enrolled in the Tennessee Medicaid program for at least 180 days between 1974 and 1993. In a nested case-control study, 4,369 women with a first study event during influenza season were compared with 21,845 population controls. The odds ratios associated with study events increased from 1.44 (95% confidence interval (CI) 0.97-2.15) for women at 14-20 weeks' gestation to 4.67 (95% CI 3.42-6.39) for those at 37-42 weeks in comparison with postpartum women. A retrospective cohort analysis, which controlled for risk factors identified in the case-control study, identified 22,824 study events during 1,393,166 women-years of follow-up. Women in their third trimester without other identified risk factors for influenza morbidity had an event rate of 21.7 per 10,000 women-months during influenza season. Approximately half of this morbidity, 10.5 (95% CI 6.7-14.3) events per 10,000 women-months, was attributable to influenza. Influenza-attributable risks in comparable nonpregnant and postpartum women were 1.91 (95% CI 1.51-2.31) and 1.16 (95% CI -0.09 to 2.42) per 10,000 women-months, respectively. The data suggest that, out of every 10,000 women in their third trimester without other identified risk factors who experience an average influenza season of 2.5 months, 25 will be hospitalized with influenza-related morbidity.

Adolescent↗
PubMed2003

The role of early newborn discharge legislation in influencing policy development: understanding the Kansas experience.

Early newborn discharge legislation began a movement in health policy towards incremental changes in how medical consumers receive services. While well intentioned, these initiatives may undermine national efforts to address problems through more comprehensive reform, while stifling smaller efforts to address the problems locally. This paper discusses early newborn discharge legislation in Kansas: its origins, apparent impact, and implications. Findings from a hospital survey and two-year follow-up suggest a minimal effect of the legislation on health services in the state. Though acute hospital care appeared to replace home-based programs in many hospitals we spoke with, the more longstanding impact of the legislation seems to have been its precedent in how health policy is now made.

Female↗
PubMed2000

[Perinatal mental health in hospital care of labor and puerperium].

The biomedical model has successfully reduced mother and child mortality and diseases during the labor and puerperal period. In the perinatal period, the mother and her offspring can also have psychosocial problems, that have been insufficiently studied and that we propose considering. Based on neurobiological information, on bonding theory and on a focus change in the everyday work of human behavior experts in maternity hospitals, we propose that perinatal mental health should have an important place and can be harmoniously articulated with the biomedical model. This mental health work should aim at generating safe mother-child bonds. It should be maintained Thereafter through social networks to prevent child abuse, to promote healthy development and to prevent psychopathology. We review some of the programs carried out in the ten year period in which we have worked as a mental health team in the maternity ward of a public hospital in Santiago, Chile.

Adult↗
PubMed2005

[A study of the effects of behavior contact in early mother-infant attachment].

PURPOSE: The main purpose of this study was to establish a nursing intervention data base to improve maternal attachment. METHOD: The first group of mothers(control group), experienced their first physical contact with their infants after being discharged from the hospital. The second group(experimental group) practiced early initial mother-infant postpartum contact known as the most sensitive period for founding maternal-infancy attachment. The subjects of this study gave birth to normal infants at M hospital from Aug.25 to Sept.30, 2004. During the same time, data was collected through direct observation, with instruments designed by Cropley et al., to assess the behaviors of normal attachment. The statistical methods for data analysis were percentage, mean, standard deviation and t-test with an SPSS program. RESULT: The group practicing initial mother-infant contact, showed a higher degree of physical and functional bonding than the group experiencing the first contact after discharge from the hospital (control group)(p<.01). The group practicing initial mother-infant contact, showed higher degrees of bonding attachment assessments than the group experiencing their first initial contact after their discharge from the hospital(p<.01). CONCLUSION: The group practicing early mother-infant contact, showed more maternal-infant interaction than the group experiencing their initial contact after their discharge from the hospital. These results show that maternal attachment behavior increases according with an early initial mother-infant contact.

Adult↗
PubMed2005

The effect of a single oxytocin or carbetocin treatment on uterine contractility in early postpartum dairy cows.

The uterotonic characteristics and effectiveness of a single treatment with either oxytocin or carbetocin were quantified in early postpartum dairy cows after normal, uncomplicated calvings. Both the short-term (within 4 h), and the long-term effects (between 12 and 36 h) of the two treatments were compared. Between 14 and 16 h after parturition, 27 multiparous Holstein-Friesian dairy cows, without fetal membrane retention, were selected and divided into three groups. The first group (n = 9) was administered 50 IU oxytocin intramuscularly, the second group (n = 10) received 0.35 mg carbetocin, while animals of the third group (n = 8), serving as a control, were administered 5 mL saline solution. A transcervically introduced open tip catheter system was used for the non-invasive acquisition of the intrauterine pressure (IUP) recording. After digitalization, the signals were analyzed, using a specially adapted graphical software program. A significant short-term effect was found both in the oxytocin and carbetocin treated groups from the analysis of the contraction frequencies (FREQ) and of the total area under the curve (TAUC). After significant peaking during the first post-treatment hour, the values of the parameters for these two groups remained higher during the second hour, returning to the initial levels again during the third hour and reaching the level of the control group by the 12th hour. Mean amplitude (AMP), duration (DUR) and area under the curve (AUC) of pressure cycles were not significantly affected by any of the treatments. Although mean FREQ and TAUC significantly declined from the initial values to 12, 24 and 36 h in all groups, mean AMP and AUC in the oxytocin and carbetocin treated groups, and mean DUR only in the carbetocin treated group to 12 and 36 h, the long-term analysis revealed no significant treatment differences for any IUP parameters. Because treatment with either oxytocin, or carbetocin elicited similar uterotonic effects in healthy, early postpartum cows, it cannot be expected, that using carbetocin in preference to oxytocin, will result in a more beneficial clinical effect on uterine involution during this period.

Animals↗
PubMed2005

Biomedical research on health and performance of military women: accomplishments of the Defense Women's Health Research Program (DWHRP).

In 1994, Congress provided dollar 40 M for biomedical research on issues of importance for military women. This supported 104 intramural and 30 extramural studies and launched an era of research to narrow the knowledge gap on protection and enhancement of health and performance of military women. Projects addressed issues specific to female physiology (e.g., gynecological health in the field, maternal malaria), problems with higher prevalence for women (e.g., marginal iron deficiency, stress fracture), and issues of drug and materiel safety that had only been extrapolated from studies of men (e.g., chemical agent prophylaxis, fatigue countermeasures). Several important assumptions about female physiology and occupational risks were found to be astoundingly wrong. Hormonal changes through the menstrual cycle were less important to acute health risks and performance than predicted, exercise did not increase risk for amenorrhea and consequent bone mineral loss, and women tolerated G-forces and could be as safe as men in the cockpit if their equipment was designed for normal size and strength ranges. Data on personal readiness issues, such as body fat, physical fitness, nutrition, and postpartum return to duty, allowed reconsideration of standards that were gender appropriate and not simply disconnected adjustments to existing male standards. Other discoveries directly benefited men as well as women, including development of medical surveillance databases, identification of task strength demands jeopardizing safety and performance, and greater understanding of the effects of psychosocial stress on health and performance. This surge of research has translated into advances for the welfare of service women and the readiness of the entire force; relevant gender issues are now routine considerations for researchers and equipment developers, and some key remaining research gaps of special importance to military women continue to be investigated.

Attitude to Health↗