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PubMed2001

Ultrasound diagnosis and neurodevelopmental outcome of localised and extensive cystic periventricular leucomalacia.

AIMS: To compare the ultrasound (US) evolution and neurodevelopmental outcome of infants with localised (grade II) and extensive (grade III) cystic periventricular leucomalacia (c-PVL). METHODS: Over a nine year period, c-PVL was diagnosed in 96/3451 (2.8%) infants in two hospital cohorts. Eighteen were excluded from the study. Thirty nine infants with grade II PVL were compared with 39 infants with grade III PVL. RESULTS: The two populations were comparable for gestational age and birth weight. In infants with grade II PVL, cysts were noted to develop more often after the first month of life (53%) in contrast with grade III PVL (22%) (odds ratio (OR) 3.81 (95% confidence interval (CI) 1.19 to 12.63)). Cysts were also more often unilateral in grade II (54%) than in grade III PVL (0%) (OR indefinite; RR 3.17 (95% CI 2.16 to 4.64)). At 40 weeks postmenstrual age (PMA), cysts were no longer seen on US in 13/38 infants with grade II PVL, with ventriculomegaly being the only visible sequel in nine cases. In grade III PVL, cysts were still present in 25 of the 27 surviving infants. Nine infants with grade II PVL were free of motor sequelae at follow up compared with one infant with grade III PVL (OR 8.07 (95% CI 0.92 to 181.66)). Twenty two out of 29 children with grade II PVL who developed cerebral palsy achieved independent walking compared with 3/26 with grade III PVL (OR 75 (95% CI 11.4 to 662)). CONCLUSIONS: In the cohort studied, 50% of the infants with c-PVL had a more localised form (grade II). In grade II PVL, the cysts developed beyond the first month of life in more than half of the cases and were often no longer visible, on US, at 40 weeks PMA. In order not to miss this diagnosis, sequential US should also be performed beyond the first month of life. Mild ventriculomegaly noted at term can sometimes be due to grade II c-PVL. Cerebral palsy was slightly less common and tended to be less severe in infants with grade II PVL than in those with grade III PVL.

Age of Onset↗
PubMed2002

Lack of association between antibiotic use in the first year of life and asthma, allergic rhinitis, or eczema at age 5 years.

Five retrospective studies have reported an association between antibiotic use in early life and asthma in childhood. We studied the relationship between the use of oral antibiotics in the first year of life and asthma, allergic rhinitis, and eczema at age 5 years among 448 children with a parental history of atopy monitored from birth. After adjustment for potential confounders, we found no significant association between antibiotic use in the first year of life and asthma (odds ratio [OR] for one versus no courses of antibiotics, 0.5; 95% confidence interval [CI] for OR, 0.2 to 1.5; OR for two or more versus no courses of antibiotics, 1.0; 95% CI for OR, 0.5 to 2.2), recurrent wheezing, allergic rhinitis, or eczema at age 5 years. There was no significant association between antibiotic use in the first year of life and having at least one of three atopic diseases (asthma, allergic rhinitis, or eczema) at age 5 years (OR for one versus no courses of antibiotics, 0.7; 95% CI, 0.4 to 1.4; OR for two or more versus no courses of antibiotics, 0.9; 95% CI, 0.5 to 1.4). Our findings do not support the hypothesis that antibiotic use in early life is associated with the subsequent development of asthma and atopy in childhood.

Administration, Oral↗
PubMed2004

Fracture risk among First Nations people: a retrospective matched cohort study.

BACKGROUND: Canadian First Nations people have unique cultural, socioeconomic and health-related factors that may affect fracture rates. We sought to determine the overall and site-specific fracture rates of First Nations people compared with non-First Nations people. METHODS: We studied fracture rates among First Nations people aged 20 years and older (n = 32 692) using the Manitoba administrative health database (1987-1999). We used federal and provincial sources to identify ethnicity, and we randomly matched each First Nations person with 3 people of the same sex and year of birth who did not meet this definition of First Nations ethnicity (n = 98 076). We used a provincial database of hospital separations and physician billing claims to calculate standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for each fracture type based on a 5-year age strata. RESULTS: First Nations people had significantly higher rates of any fracture (age- and sex-adjusted SIR 2.23, 95% CI 2.18-2.29). Hip fractures (SIR 1.88, 95% CI 1.61-2.14), wrist fractures (SIR 3.01, 95% CI 2.63-3.42) and spine fractures (SIR 1.93, 95% CI 1.79-2.20) occurred predominantly in older people and women. In contrast, craniofacial fractures (SIR 5.07, 95% CI 4.74-5.42) were predominant in men and younger adults. INTERPRETATION: First Nations people are a previously unidentified group at high risk for fracture.

Adult↗
PubMed1998

Relative efficiencies of wither height and body weight increase from birth until first calving in Holstein cattle.

Female Holstein calves from the Purina Research Center herd averaged 74 cm of height at withers and 40 kg of body weight (BW) at birth. At first calving (24 mo of age), calves averaged 138 cm of height at withers, 611 kg at precalving BW, and 547 kg at postcalving BW. Fifty percent of the total height increase occurred from birth to 6 mo of age, 25% occurred during 7 to 12 mo of age, and 25% occurred during 13 to 24 mo of age. Twenty-five percent of the total BW increase occurred from birth to 6 mo of age, 25% occurred from 6 to 12 mo of age, and the remaining 50% occurred from 13 to 24 mo of age. The increase in BW for 2-mo intervals, expressed as a proportion of the BW of the previous 2-mo interval, declined most rapidly during the first 6 mo, intermediately during the second 6 mo, and more slowly and progressively during the final 12 mo. Feed cost per unit of BW gain was lowest during the first 6 mo and then increased at a decreasing rate over the final 18 mo. The proportion of BW to height linearly increased over the 24-mo period. The increase in wither height as a proportion of the wither height during the previous period was greatest during the first 6 mo, intermediate during the second 6 mo, and lowest in the final 12 mo. Feed cost per unit of height increase was lowest in the first 6 mo, intermediate during the second 6 mo, and highest with a rapid increase during the final 12 mo. The increases in relative BW and wither height are the most rapid and cost efficient during the first 6 mo of life.

Aging↗
PubMed1996

Reproductive factors and incidence of epithelial ovarian cancer: a Norwegian prospective study.

To examine relations between the risk of epithelial ovarian cancer and time-related effects of pregnancies, we analyzed data from a prospective study of 1,145,076 women in Norway aged 20 to 56 years. The mean follow-up time per woman was 16.4 years and a total of 1,694 women were diagnosed with epithelial ovarian cancer. Incidence rate ratios (IRR) were estimated by Poisson regression analysis of person-years at risk. The risk of epithelial ovarian cancer decreased with an increasing number of full-term pregnancies (IRR = 0.56, 95 percent confidence interval = 0.48-0.67 for three pregnancies cf one). However, no further reduction in risk was seen after the third pregnancy. The association with parity became weaker with increasing age at last birth. Further, the reduction in risk among parous women compared with nulliparous women was more pronounced shortly after birth. Both higher age at last birth and shorter time since last birth were associated with a reduction in risk, although these relations were seen mainly for the first and second births. Increasing age at first birth was associated with a decrease in risk among uniparous women but not among multiparous women. Our results indicate that the relations between the incidence of epithelial ovarian cancer and reproductive factors are more complex than previously believed.

Adult↗
PubMed1996

Prenatal care and prevention of preterm birth. A case-control study in southern Spain.

The value of prenatal care is controversial and difficult to establish. A national policy for improving perinatal outcomes was proposed and applied throughout Andalusia (Southern Spain) in 1984. Here we report the results of an evaluation of this health care program as regards the prevention of preterm delivery. Effectiveness of prenatal care was assessed on the basis of two case-control studies in a hospital setting: one performed before the program was implemented (1981-1982) and the second one six years after the program began (1990-1993). A total of 229 cases and 395 controls for the period 1981-1982, and 207 cases and 381 controls for 1990-1993 were selected. Prenatal care was assessed based on the number of prenatal care visits, the date of the first visit, and an American composite index adjusting for gestational age. Multiple-factor adjusted odds ratios and their 95% confidence intervals (CI) were estimated using unconditional logistic regression analysis. The use of prenatal care significantly improved across time: the proportion of women receiving no prenatal care decreased from over 30% to less than 5%, and the proportion of women starting prenatal care in the first trimester for 1990-1993 was three times greater than the figure for 1981-1982. In the 1981-1982 case-control study, the date of first visit and the composite index were shown to be unrelated to preterm birth risk; and the number of visits yielded a significant association, although no definite trend could be established. In the 1990-1993 case-control study, a clear and significant relationship was observed between the number of prenatal care visits, the trimester of the first visit, and the adequacy of care according to the composite index. This latter variable, reflecting a more stringent standard of prenatal care, was selected by a stepwise logistic regression analysis as the best predictor for preterm birth risk. The results suggest that the present Andalusian program helps prevent preterm delivery. Nonetheless, its minimum standards should be raised to further decrease preterm birth risk.

Adult↗
PubMed1999

Breast cancer risk in monozygotic and dizygotic female twins: a 20-year population-based cohort study in Finland from 1976 to 1995.

This population-based study investigated the occurrence of breast cancer over a 20-year period in a cohort of monozygotic (MZ) and dizygotic (DZ) twins in Finland. Altogether, 13,176 female twins of known zygosity who were living in Finland at the end of 1975 were identified from the Finnish Twin Cohort Study and followed-up for cancer through the Finnish Cancer Registry for the years 1976-1995. Standardized incidence ratios (SIRs) were calculated, based on national cancer incidence rates. The relative risk of breast cancer for MZ twins compared to DZ twins was decreased [SIR(MZ)/SIR(DZ) ratio = 0.78; 95% confidence interval (CI), 0.58-1.0]; the decreased risk for MZ twins (SIR = 0.76; 95% CI, 0.58-1.0) accounted for this result, whereas the risk for DZ twins did not differ from the general population risk (SIR = 0.98; 95% CI, 0.84-1.1). There was no risk decrease among MZ twins in other cancers related to reproductive behavior; i.e., number of children and age at first birth seem not to explain the decreased risk of breast cancer. Our results, which are in line with earlier studies on the same topic, suggest that prenatal influences or postnatal behavioral factors may protect MZ female twins from breast cancer.

Adolescent↗
PubMed2004

Maternal use of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), and muscular ventricular septal defects.

BACKGROUND: Muscular ventricular septal defects (mVSDs) are the most common congenital heart defects. Previous studies have suggested maternal use of acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), and/or fever as risk factors. We evaluated the association between mVSDs and maternal use of acetaminophen or NSAIDs adjusting for fever. METHODS: Infants with nonsyndromic mVSDs (cases) and without birth defects (controls), with gestational age > or =37 weeks and their mothers were enrolled in the National Birth Defects Prevention Study. Two exposure periods were defined: the first trimester of pregnancy, and one month before pregnancy through delivery. Mothers reporting fever or medication use at least once during either period were considered exposed. Adjusted odds ratios and 95% confidence intervals were estimated independently for each exposure period. RESULTS: The analysis included 168 cases and 692 controls. Two case groups were evaluated: all mVSD infants (n = 168) (including those with associated minor cardiac defects or noncardiac defects), and infants with isolated mVSDs (n = 133). Mothers of cases were less likely to be African-American than Caucasian (OR, 0.36; 95% CI, 0.18, 0.73). Approximately equal numbers of case mothers and control mothers (10.4 versus 9.7%, respectively) reported at least one febrile episode during the first trimester. Neither acetaminophen nor NSAID exposure was significantly associated with mVSDs. This was true for both case groups and both exposure periods. CONCLUSIONS: Significant associations were not detected between the occurrence of mVSDs and maternal use of NSAIDs or acetaminophen adjusting for maternal fever, nor were they detected between maternal fever and mVSDs.

Acetaminophen↗
PubMed1996

Sudden infant death syndrome and local meteorologic temperature in North Carolina.

The association between meteorologic temperature and sudden infant death syndrome was investigated in the 1982-1983 North Carolina birth cohort. Maximum daily temperatures recorded at weather stations in the subject's county of residence for each day of the first year of life were entered into hazards models as time-dependent covariates. Risk ratios for a maximum temperature of < or = 53 degrees F (12 degrees C) 5 days before the event compared with a maximum temperature of > 53 degrees F were 2.3 (95% confidence interval 1.6-3.3) for blacks and 1.5(95% confidence interval 1.0-2.1) for whites. Similar results were found for minimum daily temperature. The analysis controlled for season of birth, sex, maternal age, maternal education, parity, and birth weight.

Adult↗
PubMed2000

Feeding schedules in hospitals for newborn infants.

BACKGROUND: Regular breastfeeding times have been thought to help establish routines and promote infant digestion, while frequent breastfeeding has been recommended to enhance breastfeeding and infant growth. OBJECTIVES: The objective of this review was to assess the effects of frequent breastfeeding compared with less frequent breastfeeding in the early days after birth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing on demand or frequent breastfeeding (two or three hourly) schedules in hospital compared with four hourly restricted feeds. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: Three trials involving 400 women were included. There were significant methodological limitations in some of the studies. Compared to two hourly, three hourly or on demand breastfeeding, restricted (less frequent four hourly breastfeeding) was associated with greater discontinuation of breastfeeding by four to six weeks postpartum (relative risk 1.53, 95% confidence interval 1.08 to 2.15). Restricted breastfeeding was associated with increased incidence of sore nipples (relative risk 2.12, 95% confidence interval 1.22 to 3.68), engorgement (relative risk 2.10, 95% confidence interval 1.25 to 3.21) and the need to give additional (formula) feeds (relative risk 3.14, 95% 1.24 to 8.00). REVIEWER'S CONCLUSIONS: There appear to be a number of disadvantages from restricting breastfeeding to a four hourly schedule in the first few days after birth. More frequent or on demand breastfeeding is associated with fewer complications and longer duration of breastfeeding.

Breast Feeding↗
PubMed1999

Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of perineal massage during pregnancy for the prevention of perineal trauma at birth. STUDY DESIGN: Pregnant women with (n = 493) and without (n = 1034) a previous vaginal birth from 5 hospitals in the province of Québec, Canada, participated in this single-blind, randomized, controlled trial. All participants received oral and written information on the prevention of perineal trauma. Women in the experimental groups were requested to perform a 10-minute perineal massage daily from the 34th or 35th week of pregnancy until delivery. RESULTS: Among participants without a previous vaginal birth, 24.3% (100/411) from the perineal massage group and 15.1% (63/417) from the control group were delivered vaginally with an intact perineum, for a 9.2% absolute difference (95% confidence interval 3.8%-14.6%). The incidence of delivery with an intact perineum increased with compliance with regular practice of perineal massage (chi2 for trend 13.2, P = 0.0003). Among women with a previous vaginal birth, 34.9% (82/235) and 32.4% (78/241) in the massage and control groups, respectively, were delivered with an intact perineum, for an absolute difference of 2.5% (95% confidence interval -6.0% to 11.0%). There were no differences between the groups in the frequency of sutured vulvar and vaginal tears, women's sense of control, and satisfaction with the delivery experience. CONCLUSION: Perineal massage is an effective approach to increasing the chance of delivery with an intact perineum for women with a first vaginal delivery but not for women with a previous vaginal birth.

Adult↗
PubMed1992

Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case-control study.

OBJECTIVE: Our objective was to evaluate the risk for endometrial cancer in relation to reproductive, menstrual, and medical factors. STUDY DESIGN: A case-control study of 405 endometrial cancer cases and 297 population controls in five areas of the United States enabled risk to be evaluated. RESULTS: A major risk factor was the absence of a prior pregnancy (relative risk 2.8, 95% confidence interval 1.7 to 4.6). The protective effect of pregnancy appeared to reflect the influence of term births, because spontaneous and induced abortions were unrelated to risk. Among nulliparous women infertility was a significant risk factor, with women having sought medical advice having nearly eight times the risk of those without difficulty conceiving. After adjustment for other reproductive characteristics, age at first birth and duration of breast-feeding were not related to risk. CONCLUSIONS: Elevated risks were found for subjects reporting early ages at menarche (relative risk 2.4 for ages < 12 vs > or = 15) and longer days of flow (relative risk 1.9 for > or = 7 vs < 4 days), but there was no relationship with late ages at natural menopause. Height was not associated with risk, but there was a significant relation to weight, with the risk for 200 versus < 125 pounds being 7.2 (95% confidence interval 3.9 to 13.3). After adjustment for weight and other factors, histories of hypertension and gallbladder disease were not significantly related to risk, but an effect of diabetes persisted (relative risk 2.0, 95% confidence interval 1.1 to 3.6). Hirsutism developing at older ages was also significantly related (relative risk 2.0, 95% confidence interval 1.2 to 3.4).

Adult↗
PubMed2000

Parent-reported infant health and illness in a whole year birth cohort.

OBJECTIVE: To describe parent-reported infant health and illness experience at 8 weeks. SETTING: Coventry. STUDY DESIGN: Prospective whole year birth cohort. OUTCOME MEASURES: Period prevalences (birth to 8 weeks) and incidences, unadjusted and adjusted for differential cohort attrition, of parent-reported infant health outcomes. METHODS: Of 3891 live births in 1996, 2572 (66%) were recruited into the study. Data were collected by health visitors as part of routine child health surveillance, at 8 weeks using the Warwick Child Health and Morbidity Profile (WCHMP) incorporated into the Parent Held Record. Period prevalences and incidences of parent-reported health outcomes in the first 8 weeks of life were calculated with and without adjustment for the effects of different rates of cohort attrition by sociodemographic group. RESULTS: Data were collected on 2572 infants at recruitment. Health outcome data were available on 2072 (53% of all 1996 live births) infants at 8 weeks. There was differential attrition by social group between enrollment and 8 weeks. Nineteen (95% confidence intervals (CIs) 14,24)/1000 infants were reported as not very healthy/unhealthy, 12 (95% CIs 8,16)/1000 as having impaired health-related quality of life and 11 (95% CIs 7,15)/1000 impaired functional health. Chronic illness had a period prevalence rate of 19 (95% CIs 14,24)/1000. Sixty-six (95% CIs 55,77)/1000 had acute illnesses requiring medical attention and 43 (95% CIs 34,52)/1000 were admitted to hospital at least once. More minor illness than expected was reported in 87 (95% CIs 75,99)/1000. The incidence rate of accidents requiring medical attention was 16 (95% CIs 9,21)/1000. Behavioural problems had a prevalence rate of 78 (95% CIs 66,90)/1000. CONCLUSIONS: Infant health status data have traditionally been based on mortality, hospital admissions and specific diagnoses. This is the first report of health and illness experience during infancy in a whole year birth cohort based on a validated measure of parent-reported health status incorporated into the Parent Held Record and administered by the family health visitor as part of routine child health surveillance. These data give a more comprehensive picture of infant health and illness experience than traditional measures and provide the basis for infant health needs assessment.

Accidents↗
PubMed1992

[Kinetics of gentamycin in premature infants with a low birth weight during the first four days of postnatal life].

The authors investigated in a group of 19 premature neonates with a low birthweight (0.65-2.1 kg) during the first four days of postnatal life the pharmacokinetics of gentamycin after indicated administration of 2 mg/kg of the antibiotic by the i.v. route by a 30-minute infusion in 18-hour intervals. Serum concentrations of gentamycin were assessed by immunoassay 0.5 hours before administration and then 0.5, 5.5, 11.5 and 17.5 hours after the 5th infusion, i.e. in a steady state. The maximum serum concentrations detected 0.5 hours after the completed infusion exceeded 10 mg/l in 21% of the neonates, while the minimal concentrations of the antibiotic before the next administration were above 2 mg/l in 42% of the infants. The calculation of pharmacokinetic parameters according to the one-compartment model revealed considerable interindividual differences of all values. The authors consider particularly important the low clearance value of the antibiotic (30.24 +/- 14.55 ml/kg.hour-1) which may lead to cumulation of gentamycin and its toxic action. Gentamycin administration to premature neonates should be associated with monitoring of serum concentrations of the drug which would make individual adjustment of the dosage possible.

Birth Weight↗
PubMed2004

Antenatal risk factors associated with unfavorable neurologic status in newborns and at 2 years of age.

The aim of this prospective cohort study was to evaluate the influence of different antenatal factors on neurologic signs in the first days of life and neurodevelopmental outcome at 2 years of age. The study group consisted of 390 children drawn from a cohort of 828 consecutive live births. The data about potential antenatal risk factors, birth complications, and neonatal course were abstracted from pregnancy and delivery records and the hospital register. Odds ratio estimates with 95% confidence intervals were used to measure the associations between antenatal factors and neurologic status in newborns and at 2 years of age. Significance level was set at P < .05. At the mean age of 2 years, 49 of 390 children exhibited adverse neurodevelopmental outcome (cerebral palsy and other developmental disorders). The development of 341 children was normal. Comparative analysis of risk factors was conducted. The strongest correlation with development of hypoxic-ischemic encephalopathy during the first days of life was found in trichomoniasis during pregnancy (odds ratio 4.34; 95% confidence interval 1.32-14.23) and acute respiratory disease (temperature > or = 38 degrees C) in the second half of pregnancy (odds ratio 2.86; 95% confidence interval 1.08-7.58). Of various antenatal factors, bacterial vaginosis combined with impending abortion in the first half of pregnancy (odds ratio 4.96; 95% confidence interval 1.35-18.26) had a significant association with adverse outcome at 2 years of age. The presence of at least one complication at delivery placed the child at risk of adverse neurologic outcome (odds ratio 2.44; 95% confidence interval 1.32-4.54). The study provides supportive evidence that antenatal factors associated with maternal infections can influence the development of hypoxic-ischemic encephalopathy and later neurodevelopmental outcome. These children should be assigned to risk groups for early intervention.

Adult↗
PubMed2001

Do protective factors reduce the risk of hospitalization in infants of teenaged mothers?

OBJECTIVE: To determine the risk of hospitalization associated with prenatal care use and indicators of socioeconomic status and social support among infants of teenage mothers. DESIGN: Population-based case-control study. SETTING: Nonfederal hospitals in Washington State. PARTICIPANTS: Infants born from 1987 to 1995 to mothers younger than 20 years were identified using linked birth certificate-state hospital discharge data. Cases consisted of 8052 infants who were hospitalized during the first year of life at least 2 days after birth hospitalization discharge. An equal number of controls, frequency matched on birth year and maternal age group, were randomly sampled from among nonhospitalized infants. MAIN OUTCOME MEASURE: Hospitalization in the first year of life. RESULTS: Infants with a father listed on the birth certificate or whose mothers had commercial health insurance had a decreased risk of hospitalization (adjusted odds ratios, 0.91 and 0.78, respectively; 95% confidence intervals, 0.83-0.99 and 0.71-0.85, respectively). Participation in state-funded pregnancy programs, adequacy of prenatal care, or marital status did not affect the risk of hospitalization, except among infants whose mothers received more than adequate prenatal care (adjusted odds ratio, 1.15; 95% confidence interval, 1.03-1.29). CONCLUSION: Our results suggest that teenaged mothers who list a father on the birth certificate or who have insurance, indicative of higher socioeconomic status, may have a reduced risk of hospitalization for their infants. Teenaged mothers who receive more than adequate prenatal care may have pregnancy complications that place their infants at increased risk of hospitalization. The effect of these protective factors should be clarified in future studies.

Adolescent↗
PubMed2000

An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania.

CONTEXT: Little is known about pregnancy outcomes among the approximately 11 million refugees worldwide, 25% of whom are women of reproductive age. OBJECTIVE: To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp. DESIGN: Cross-sectional review of records and survey, conducted in February and March 1998. SETTING: Mtendeli refugee camp, Tanzania. PARTICIPANTS: For the overall assessment, 664 Burundi women who had a pregnancy outcome during a recent 5-month period (September 1, 1997-January 31, 1998) and their 679 infants; 538 women (81%) completed the survey. MAIN OUTCOME MEASURES: Incidence of fetal death (fetus born > or =500 g or > or =22 weeks' gestation with no signs of life), low birth weight (<2500 g), neonatal death (death <28 days of life), and maternal death (deaths during or within 42 days of pregnancy from any cause related to or aggravated by the pregnancy or its management). RESULTS: The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcome, those with poor pregnancy outcome were more likely to report prior high socioeconomic status (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), having a first or second pregnancy (OR, 2.2; 95% CI, 1.4-3.4), and having 3 or more episodes of malaria during pregnancy (OR, 2.0; 95% CI, 1.4-3.1). Neonatal and maternal deaths accounted for 16% of all deaths during the period studied. CONCLUSIONS: Poor pregnancy outcomes were common in this refugee setting, and neonatal and maternal deaths, 2 important components of reproductive health-related deaths, contributed substantially to overall mortality.

Adult↗
PubMed2003

Cardiovascular and thromboembolic events following hypertensive pregnancy.

BACKGROUND: Hypertension is a common complication of pregnancy. Previous evidence has linked pregnancy-related hypertension to maternal cardiovascular disease. We conducted a population-based cohort study to estimate the risks for cardiovascular and thromboembolic events in women with pregnancy-related hypertension. METHODS: We analyzed data from all singleton births recorded in Washington State from 1987 to 1998. Mothers were classified as having gestational hypertension, preeclampsia, or chronic hypertension based on hospital discharge and birth record information. Birth records were linked to subsequent hospitalizations within Washington State. Proportional hazards models were used to estimate the relationship between each form of pregnancy-related hypertension and subsequent risk for cardiovascular and thromboembolic events. RESULTS: We identified 31,239 eligible hypertensive pregnancies from 807,010 births. During follow-up, there were 118 hospitalizations for a first acute cardiovascular event and 172 hospitalizations for a first thromboembolic event. Gestational hypertension, mild preeclampsia, and severe preeclampsia were associated with 2.8-fold (95% confidence interval [CI], 1.6 to 4.8), 2.2-fold (95% CI, 1.3 to 3.6), and 3.3-fold (95% CI, 1.7 to 6.5) greater risks for cardiovascular events, respectively. Severe preeclampsia was associated with a 2.3-fold (95% CI, 1.3 to 4.2) greater risk for thromboembolic events. CONCLUSION: Preeclampsia and gestational hypertension are associated with increased risk for cardiovascular events. Pregnancy-induced hypertension appears to be an important risk factor for the development of future cardiovascular disease in young women.

Adult↗