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PubMed2004

Lactation among adolescent mothers and subsequent bone mineral density.

OBJECTIVE: To investigate the association of breastfeeding during adolescence with bone mineral density (BMD) during young adulthood. METHODS: Secondary analysis of data from the National Health and Nutrition Examination Survey III, a nationally representative cross-sectional survey conducted from 1988 through 1994, was performed. The BMDs for 5 regions of the proximal femur as measured by dual energy x-ray absorptiometry were compared for 5 groups of women aged 20 to 25 years (n = 819); the groups included those who had been: (1) adolescent mothers and had breastfed (n = 94), (2) adolescent mothers and had not breastfed (n = 151), (3) mothers who first gave birth as adults and breastfed (n = 67), (4) mothers who first gave birth as adults and had not breastfed (n = 89), and (5) nulliparous (n = 418). SUDAAN software was used to account for the complex sampling design of the National Health and Nutrition Examination Survey. Adjusted mean differences in BMD were estimated using least-squares linear regression. RESULTS: During young adulthood, women who breastfed during adolescence had higher adjusted BMDs, which was statistically significant in 4 of the 5 regions, than those who had not breastfed (total proximal femur area difference, 0.049 gm/cm(2) [95% confidence interval, 0.002-0.095]) and BMDs equivalent to nulliparous women (total proximal femur area difference, 0.024 gm/cm(2) [95% confidence interval, -0.023 to 0.071]). Adjusting also for obstetric variables, women who breastfed during adolescence had higher BMDs in all 5 regions compared with their peers who had not breastfed (total proximal femur area difference, 0.053 gm/cm(2) [95% confidence interval, 0.029-0.077]). CONCLUSIONS: In this nationally representative sample, breastfeeding by adolescent mothers was associated with greater BMD in the proximal femur during young adulthood. Lactation was not found to be detrimental and may be protective to the bone health of adolescent mothers.

Absorptiometry, Photon↗
PubMed1989

Histologic types of breast carcinoma in relation to international variation and breast cancer risk factors. WHO Collaborative Study of Neoplasia and Steroid Contraceptives.

Associations between breast cancer risk factors and histologic types of invasive breast carcinoma were studied in 2,728 patients. Lobular and tubular carcinomas occurred with increased relative frequency in most high-risk groups. The proportion of these types increased with age to a maximum at 45-49 years and decreased in the following decade. Significantly increased proportions of lobular and tubular carcinomas were also associated with high-risk countries, prior benign breast biopsy, bilateral breast cancer, concurrent mammary dysplasia, high age at first live birth, never-pregnant patients compared to those with a first live birth before age 20, private pay status, and length of education. Nonsignificant increases were associated with family history of breast cancer, less than 5 live births, less than 25 months total of breast feeding, use of oral contraceptives or IUD, and high occupational class. As a general trend, the higher the overall relative risk, the higher the proportion of lobular and tubular carcinomas. The occurrence of other histologic types also increased with increased breast cancer risk, but to a smaller degree than for lobular/tubular carcinomas. It is suggested that all hormonally related, socio-economic and geographic risk factors exert their effect by selectively increasing number of lobular cells at risk. Family history of breast carcinoma and age over 49 years did not follow the general trend parallel increases in the proportion of lobular/tubular carcinomas and breast cancer risk, and may operate through other mechanisms.

Adult↗
PubMed1999

Effects of antenatal corticosteroids on blood pressure in very low birth weight infants during the first 24 hours of life.

OBJECTIVE: We tested the hypothesis that prenatal glucocorticoids significantly increase mean arterial blood pressure in very low birth weight preterm infants during the first 24 hours after birth. STUDY DESIGN: Prospectively collected data from 178 inborn infants with birth weights between 500 and 1499 gm were examined. A total of 80 infants were born to mothers treated with corticosteroids (birth weight: 1057 +/- 271 gm, gestational age: 28.0 +/- 2.6 weeks), and 98 infants were untreated controls (birth weight: 1030 +/- 280 gm, gestational age: 28.0 +/- 2.8 weeks). The study setting was a university-based tertiary care center for newborn intensive care. RESULTS: Mean blood pressures on admission and at 3, 6, 12, 18, and 24 hours were significantly higher in steroid-treated infants. Steroid-treated infants received significantly less volume expansion (3.8 +/- 8.5 ml/kg versus 14.4 +/- 20.7 ml/kg; p < 0.001) than controls. Vasopressor support was also reduced in the steroid group (2.5% versus 11.5%; p < 0.05). CONCLUSION: Antenatal steroids are associated with both a higher mean systemic blood pressure and a decreased use of vasopressors and plasma expanders in very low birth weight infants during the first 24 hours after birth. This effect is not limited to infants of < 1000 gm; it is also significant in infants with a birth weight between 1000 and 1499 gm, and is already detectable in the first hours of life. We speculate that this finding may contribute to the mechanism of steroid protection against conditions such as intraventricular hemorrhage.

Adrenal Cortex Hormones↗
PubMed1982

Metabolic events in infants of diabetic mothers during first 24 hours after birth. III. Changes in plasma amino acids.

Plasma amino acid concentration (AAC) were studied in 31 diabetic mothers (10 of White class A, 10 of B-C and 11 of D-F) and their 32 infants during the first 24 hours after birth. Only minor differences between the 3 groups were found at birth and 2 hours, and none at 12 and 24 hours after birth. The individual AAC in umbilical vein plasma did not correlate with birthweight. All AAC except aspartic acid, asparagine, cystine and glutamic acid were higher in umbilical venous plasma than in maternal plasma. Umbilical venous-arterial differences of amino acids did not correlate with maternal or umbilical vein insulin concentrations except for threonine and valine. In general essential amino acids decreased after birth. In 8 infants with hypoglycemia and hyperinsulinism at 2 hours of age several plasma amino acids were lower than in the normoglycemic infants.

Adult↗
PubMed2002

Can the sex of the second child be predicted by the birth-weight of the first child?

The reproduction costs to a human mother are different if she has a son as opposed to a daughter. According to the Trivers-Willard hypothesis, evolution should promote those females who, having the ability to invest in the more expensive sex, are also able to adjust the sex of their offspring accordingly. It is therefore possible that a mother's biological condition (which is also connected with her reproductive potential), as measured by the neonatal weight of her first child, can be a good predictor of the second child's sex. From data for 227 healthy mothers from Wroclaw (Poland) we show that the probability of giving birth to a boy in the second pregnancy is higher after a relatively heavier first-born child (ANOVA, F(1,225)=3.79, P<0.053). This relationship, however, is only significant after a first-born daughter (F(1,117)=9.66, P<0.002) and not after a first-born boy. Some possible explanations of the fact that only the birth-weight of a first-born daughter--and not a son--can be a good predictor of the secondary sex ratio are also discussed.

Birth Order↗
PubMed2004

Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial.

OBJECTIVE: To test a multifaceted collaborative quality improvement intervention designed to promote evidence based surfactant treatment for preterm infants of 23-29 weeks' gestation. DESIGN: Cluster randomised controlled trial. SETTING AND PARTICIPANTS: 114 neonatal intensive care units (which treated 6039 infants of 23-29 weeks gestation born in 2001). MAIN OUTCOME MEASURES: Process of care measures: proportion of infants receiving first surfactant in the delivery room, proportion receiving first surfactant more than two hours after birth, and median time from birth to first dose of surfactant. Clinical outcomes: death before discharge home, and pneumothorax. INTERVENTION: Multifaceted collaborative quality improvement advice including audit and feedback, evidence reviews, an interactive training workshop, and ongoing faculty support via conference calls and email. RESULTS: Compared with those in control hospitals, infants in intervention hospitals were more likely to receive surfactant in the delivery room (adjusted odds ratio 5.38 (95% confidence interval 2.84 to 10.20)), were less likely to receive the first dose more than two hours after birth (adjusted odds ratio 0.35 (0.24 to 0.53)), and received the first dose of surfactant sooner after birth (median of 21 minutes v 78 minutes, P < 0.001). The intervention effect on timing of surfactant was larger for infants born in the participating hospitals than for infants transferred to a participating hospital after birth. There were no significant differences in mortality or pneumothorax. CONCLUSION: A multifaceted intervention including audit and feedback, evidence reviews, quality improvement training, and follow up support changed the behaviour of health professionals and promoted evidence based practice.

Cluster Analysis↗
PubMed1975

Chymotryptic activity in stool of low birth weight infants in the first week of life.

Pancreatic enzyme activity in low birth weight (LBW) infants during the first postnatal week has been evaluated by analysing the chymotrypsin content of 198 stool specimens from 42 LBW infants with birth weights ranging between 750 and 2570 g. A wide variation in chymotryptic activity yet with a tendency to initially low values with a peak on the third day after birth was found. Small-for-gestational age (SGA) infants had significantly lower values than appropriate-for-gestational age (AGA) infants. This is considered due to intra-uterine malnutrition with secondary pancreatic dysfunction in SGA infants. In screening program for cystic fibrosis or other defects of exocrine pancreatic activity, low stool chymotrypsin values cannot be considered pathological until after the fourth day of life.

Age Factors↗
PubMed1998

Reproductive factors and fatal hip fractures. A Norwegian prospective study of 63,000 women.

STUDY OBJECTIVE: The aim of the study was to investigate the impact of reproductive variables (age at menarche, menopause, first and last birth as well as parity, lactation, and abortions) on hip fracture mortality. DESIGN AND SETTING: A prospective study in Norway with more than 60,000 women followed up for 29 years. A total of 465 deaths as a result of hip fracture were recorded. MAIN RESULTS: Statistically significant linear relations (p < or = 0.02) were found between both age at menarche and length of reproductive period (defined as age at menopause to age at menarche) and the mortality of hip fractures in women aged less than 80. The death rate for women with a late menarche (> or = 17 years) was twice that of the women with relatively early menarche (< or = 13 years). Compared with women with less than 30 years between menopause and menarche, the mortality rate ratio in women with more than 38 reproductive years was 0.5. We also found an inverse relation with age at first birth. CONCLUSIONS: This study supports by hypothesis that an early menarche and a long reproductive period protect against hip fracture mortality. High age at first birth may also be protective.

Abortion, Spontaneous↗
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↗
PubMedDate not supplied

Lessons for prevention and intervention in adolescent pregnancy: a five-year comparison of outcomes of two programs for school-aged pregnant adolescents.

Adolescent fertility control has been linked with educational completion and long-term economic success. This study evaluated the effect of short-term prenatal intervention on selected maternal and child indexes with first-time pregnant adolescents. Birth patterns were examined over a 5-year period for three groups (N = 216) of adolescents who received varying amounts of prenatal intervention for the index birth. No significant differences between groups were found on number of subsequent births within 5 years, mean time between births, graduation from high school, gestational age, or mean birth weight of infants. Age at first birth was a predictor of the number of subsequent births and subsequent graduation from high school. Grade in school at first pregnancy and total number of births in 5-years were related to high school graduation. Findings support the need for continued intensive community-based collaborative intervention for adolescent mothers during the 5 years after the index birth, the peak childbearing years for these women.

Adolescent↗
PubMed1980

Glycogen content in subcutaneous adipose tissue of newborns of different birth weights in the first week of life.

The glycogen content of the subcutaneous adipose tissue was examined in 164 newborns of different birth weights. It amounted to 0.48 +/- 0.05 mg glycogen/g wet weight on average and did not depend on the weight of the newborn, week of gestation in the 38th to 41st week of pregnancy and duration of labor. In small-for-date newborns the glycogen content per gram wet weight was equal to the eutrophic and large-for-date newborns. The amount of fat tissue and also the total glycogen content in small-for-date newborns, however, is substantially lower. The glycogen content decreases in the first hours of life. It reaches the lowest values at 24-48 h of life. This bears witness to the quick depletion of glycogen reserves of the subcutaneous adipose tissue. The different amounts of carbohydrate and fat reserves stress the importance of early nutrition in some groups of newborns, especially of low-birth-weight newborns.

Adipose Tissue↗
PubMed2005

Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth.

This study reports the temporal pattern of milk output in 2 groups of lactating mothers during the first 6 weeks postpartum. A study aim was to examine if the average milk output for postpartum days 6 and 7 (baseline) predicts milk adequacy at week 6 postpartum. Mothers of preterm (< or = 31 weeks) infants (n = 95) used mechanical expression to initiate and maintain their milk supply; mothers of a singleton healthy term infant (n = 98) fed their infant at the breast. Baseline milk output was predictive of milk adequacy, defined as > or = 500 mL/d at week 6 (P = .000). Preterm mothers were 2.81 times more at risk of not producing adequately than term mothers were. Study findings suggest that interventions that promote the initiation and maintenance of an adequate milk supply during the first week postbirth are critical.

Adult↗
PubMedDate not supplied

Fat elimination in parenterally fed low birth weight infants during the first two weeks of life.

Eighteen low birth weight infants (27-34 wk gestation) were given supplementary parenteral nutrition via peripheral veins of a maximal dose of 8.5 g glucose, 2.5 g amino acids (Aminovenös päd 10%) and 2 g soybean oil egg lecithin emulsion (Intralipid 10%) kg body weight/24 hr. The fat emulsion was infused continuously at a rate of 0.084 g/kg body weight/hr. The elimination of Intralipid from the blood stream was controlled by enzymatic determination of serum triglyceride concentrations, and the fatty acid pattern of the serum lipids was determined by gas chromatography. The serum triglyceride concentrations were 0.60 +/- 0.16 mmol/liter on the 1st day, increased to 0.96 +/- 0.29 mmol/liter up to the 5th day, and approached a level around 0.90 mmol/liter in the further course. No hypertriglyceridemia was noted. The fatty acid pattern of the serum lipids showed a linoleic acid fraction of 8.1 +/- 4.0% in the beginning, which was followed by a continuous increase up to 27.8 +/- 4.8% on the 7th day. No significant changes were noticed thereafter. The levels were within the normal limits as found in 2-wk-old enterally fed preterm infants of comparative maturity (25.6 +/- 3.4%). We conclude that the preterm infants can eliminate Intralipid from the blood stream if maximal dosage and infusion rate, as described above, are applied.

Fat Emulsions, Intravenous↗
PubMed1976

Changes in the organs of pigs in response to feeding for the first 24 h after birth. III. Fluorescence histochemistry of the carbohydrates of the intestine.

The duodenum, jejunum, ileum and large intestine of newborn, and 24-hour-old fed and unfed piglets, and of 10-day-old piglets have been studied by new histochemical methods. At birth Meissner's plexus was most developed in the duodenum. There was little change during the first 24 h, but by 10 days it had become elaborated. Goblet cells were present at birth in all parts of the intestine. After 24 h a large proportion of those in the duodenum had discharged and were being replaced with a new generation. Similar changes took place more slowly in the jejunum and ileum and very much more slowly in the large intestine. Feeding increased the rate of turnover.

Animal Nutritional Physiological Phenomena↗
PubMed1995

Birth weights of infants of first generation Asian women in Britain compared with second generation Asian women.

OBJECTIVES: To compare birth weights of infants of first generation Asian women (women born in the Indian subcontinent) with those of infants of second generation Asian women (born in the United Kingdom). DESIGN: Retrospective case note study. SETTING: Bolton District General Hospital. SUBJECTS: 331 Asian women who gave birth between January 1989 and December 1989: 220 of these women were first generation Asians and 111 were second generation Asians. MAIN OUTCOME MEASURE: Birth weights of babies born to first and second generation Asian women. RESULTS: At all gestational ages at delivery, babies born to second generation Asian women were heavier than those born to first generation women. The mean birth weight for babies of second generation women was 3196 g, 249 g more than the mean birth weight of 2946 g of babies of first generation women (P < 0.001). After a stepwise multiple regression analysis was carried out the adjusted difference in birth weights was 280 g, greater than the crude difference. CONCLUSION: Birth weights are important in relation to perinatal mortality, which is notoriously high among Asians. The results of this study indicate that there is hope for lowering of perinatal mortality and improving postnatal growth in babies of second generation Asians.

Adult↗