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PubMed1984

[Plasma zinc and copper in infants with protein-calorie malnutrition].

Forty-five marasmic infants were studied for plasma zinc and copper levels. They were selected from those children admitted to a nutritional recovery center. The mean plasma zinc level was 92.4 +/- 24 micrograms/dl (mean +/- SD); 7% of the infants had low zinc values as defined by zinc less than 70 micrograms/dl. Median copper was 90 micrograms/dl (range 27-172) and 49% of the children had copper levels below 90 micrograms/dl (established as our normal limit). Birth weight, breast feeding and prior hospitalization for acute diarrhea with dehydration were studied as antecedents related to low Cu and Zn. Children with prior diagnosis of acute diarrhea and hospitalization had lower copper levels than those sent from primary care centers. Breast feeding was associated with higher Cu levels. No relationship was found between zinc levels and those antecedents, but differences were found in regard to the degree of malnutrition, season of the year and Zn status. In this investigation no Zn deficiency was found in marasmus cases. Hypocupremia, however, is a very significant problem in marasmic infants, especially when associated with early weaning and the presence of previous hospitalization for acute diarrhea.

Copper↗
PubMedDate not supplied

Comparison of contraceptive implant adopters and pill users in a family planning clinic in Baltimore.

All 133 women who began using the Norplant contraceptive implant between August and December of 1991 at a Planned Parenthood clinic in Baltimore were compared with a sample of 112 women who obtained prescriptions for the pill at the same clinic during the same time period. A multivariate analysis found that women of Medicaid are significantly more likely than those who are self-paying to select the implant rather than the pill. Similarly, compared with women who have had no children, those who have had two or more are also significantly more likely to choose the implant. However, adolescents and women who have had an abortion are no more likely than other women to select the implant.

Adolescent↗
PubMed2004

Managing births at the limit of viability: the Danish experience.

The issue of how to treat extremely premature infants has been debated several times in Denmark, and the option of withholding intensive care has received considerable support. Accordingly, a conservative, minimally invasive approach is used, with selective use of resuscitation in the delivery room, early nasal continuous positive airway pressure, and elective use of mechanical ventilation. Parents are actively involved, and the clinical process is gradual with the risks and benefits considered at each step. The risks include causing pain, suffering and loss of dignity in the short and long term for both the baby and the family. Few babies delivered before 25 completed weeks' gestation are considered to be alive at birth, and only a minority of those admitted for neonatal care do survive. Now, however, parents seem increasingly prepared to accept the suffering and uncertainty of intensive life support for the most immature babies when it becomes necessary.

Attitude of Health Personnel↗
PubMed1985

Birth spacing and fertility limitation: a behavioral analysis of a nineteenth century frontier population.

Our analysis of changing birth interval distributions over the course of a fertility transition from natural to controlled fertility has examined three closely related propositions. First, within both natural fertility populations (identified at the aggregate level) and cohorts following the onset of fertility limitation, we hypothesized that substantial groups of women with long birth intervals across the individually specified childbearing careers could be identified. That is, even during periods when fertility behavior at the aggregate level is consistent with a natural fertility regime, birth intervals at all parities are inversely related to completed family size. Our tabular analysis enables us to conclude that birth spacing patterns are parity dependent; there is stability in CEB-parity specific mean and birth interval variance over the entire transition. Our evidence does not suggest that the early group of women limiting and spacing births was marked by infecundity. Secondly, the transition appears to be associated with an increasingly larger proportion of women shifting to the same spacing schedules associated with smaller families in earlier cohorts. Thirdly, variations in birth spacing by age of marriage indicate that changes in birth intervals over time are at least indirectly associated with age of marriage, indicating an additional compositional effect. The evidence we have presented on spacing behavior does not negate the argument that parity-dependent stopping behavior was a powerful factor in the fertility transition. Our data also provide evidence of attempts to truncate childbearing. Specifically, the smaller the completed family size, the longer the ultimate birth interval; and ultimate birth intervals increase across cohorts controlling CEB and parity. But spacing appears to represent an additional strategy of fertility limitation. Thus, it may be necessary to distinguish spacing and stopping behavior if one wishes to clarify behavioral patterns within a population (Edlefsen, 1981; Friedlander et al., 1980; Rodriguez and Hobcraft, 1980). Because fertility transition theories imply increased attempts to limit family sizes, it is important to examine differential behavior within subgroups achieving different family sizes. It is this level of analysis which we have attempted to achieve in utilizing parity-specific birth intervals controlled by children ever born.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2005

Shoulder dystocia: are historic risk factors reliable predictors?

OBJECTIVE: Our purpose was to determine the rate of associated risk factors for shoulder dystocia from a large cohort of patients delivered within our Southern California perinatal program. STUDY DESIGN: A retrospective analysis was performed of patients delivered from January 1991 to June 2001. Patients with and without shoulder dystocia were identified from our computer-stored perinatal database and compared. Statistical methods used included: chi 2 test, t test, calculation of odds ratios, and Fisher exact test, as indicated. RESULTS: Among the 267,228 vaginal births during the study period, there were 1,686 cases of shoulder dystocia (rate 0.6%). Rates for operative vaginal delivery, diabetes, epidural use, multiparity, and postdatism were similar among cases with and without shoulder dystocia. The clinical triad of oxytocin use, labor induction, and birth weight greater than 4,500 g yielded a cumulative odds ratio of 23.2 (95% CI 17.3-31.0) for shoulder dystocia, but its sensitivity and positive predictive value were only 12.4% and 3.4%, respectively. CONCLUSION: Historic obstetric risk factors for shoulder dystocia are not useful predictors for the event. Furthermore, although shoulder dystocia was observed more frequently with increasing birth weight, current limitations in estimating birth weight antenatally with accuracy preclude its practical use as a reliable predictor.

Adult↗
PubMed2001

A review of studies on maternal occupational exposures and birth defects, and the limitations associated with these studies.

The proportion of pregnant women who work during pregnancy is increasing as more women move into previously male-dominated occupations. With this move, occupational exposure to chemical or physical factors during pregnancy could be further increased. In the last decade, there have been many reports on the causes of birth defects. Unfortunately, most reported associations between occupational exposures and adverse reproductive outcomes in epidemiological studies are equivocal and often controversial. Many reported associations are only suggestive. More information is needed before firm conclusions can be drawn. The major reasons for ambiguous findings are due to limitations of study methodology, e.g. inappropriate endpoints, multiple confounders, low study power and inadequate analysis methods. It must also be noted that maternal work, and therefore exposure, may also differ greatly from country to country.

Bias↗
PubMed2025

Prematurity and Genetic Liability for Autism Spectrum Disorder.

BACKGROUND: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by diverse presentations and a strong genetic component. Environmental factors, such as prematurity, have also been linked to increased liability for ASD, though the interaction between genetic predisposition and prematurity remains unclear. This study aims to investigate the impact of genetic liability and preterm birth on ASD conditions. METHODS: We analyzed phenotype and genetic data from two large ASD cohorts, the Simons Foundation Powering Autism Research for Knowledge (SPARK) and Simons Simplex Collection (SSC), encompassing 78,559 individuals for phenotype analysis, 12,519 individuals with genome sequencing data, and 8,104 individuals with exome sequencing data. Statistical significance of differences in clinical measures was evaluated between individuals with different ASD and preterm status. We assessed the rare variants burden using generalized estimating equations (GEE) models and polygenic load using ASD-associated polygenic risk score (PRS). Furthermore, we developed a machine learning model to predict ASD in preterm children using phenotype and genetic features available at birth. RESULTS: Individuals with both preterm birth and ASD exhibit more severe phenotypic outcomes despite similar levels of genetic liability for ASD across the term and preterm groups. Notably, preterm ASD individuals showed an elevated rate of de novo variants identified in exome sequencing (GEE model, p=0.005) in comparison to the non-ASD preterm group. Additionally, a GEE model showed that a higher ASD PRS, preterm birth, and male sex were positively associated with a higher predicted probability for ASD, reaching a probability close to 90% in SPARK. Lastly, we developed a machine learning model using phenotype and genetic features available at birth with limited predictive power (AUROC = 0.65). CONCLUSIONS: Preterm birth may exacerbate the multimorbidity present in ASD, which was not due to the ASD genetic factors. However, increased genetic factors may elevate the likelihood of a preterm child being diagnosed with ASD. Additionally, a polygenic load of ASD-associated variants had an additive role with preterm birth in the predicted probability for ASD, especially for boys. We propose that incorporating genetic assessment into neonatal care could benefit early ASD identification and intervention for preterm infants.

Autism Spectrum Disorder↗