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PubMed2000

The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System.

CONTEXT: The World Health Organization defines preterm birth as birth at less than 37 completed gestational weeks, but most studies have focused on very preterm infants (birth at <32 weeks) because of their high risk of mortality and serious morbidity. However, infants born at 32 through 36 weeks are more common and their public health impact has not been well studied. OBJECTIVE: To assess the quantitative contribution of mild (birth at 34-36 gestational weeks) and moderate (birth at 32-33 gestational weeks) preterm birth to infant mortality. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study using linked singleton live birth-infant death cohort files for US birth cohorts for 1985 and 1995 and Canadian birth cohorts (excluding Ontario) for 1985-1987 and 1992-1994. MAIN OUTCOME MEASURES: Relative risks (RRs) and etiologic fractions (EFs) for overall and cause-specific early neonatal (age 0-6 days), late neonatal (age 7-27 days), postneonatal (age 28-364 days), and total infant death among mild and moderate preterm births vs term births (at >/=37 gestational weeks). RESULTS: Relative risks for infant death from all causes among singletons born at 32 through 33 gestational weeks were 6.6 (95% confidence interval [CI], 6.1-7.0) in the United States in 1995 and 15.2 (95% CI, 13.2-17.5) in Canada in 1992-1994; among singletons born at 34 through 36 gestational weeks, the RRs were 2.9 (95% CI, 2.8-3.0) and 4.5 (95% CI, 4.0-5.0), respectively. Corresponding EFs were 3.2% and 4.8%, respectively, at 32 through 33 gestational weeks and 6.3% and 8.0%, respectively, at 34 through 36 gestational weeks; the sum of the EFs for births at 32 through 33 and 34 through 36 gestational weeks exceeded those for births at 28 through 31 gestational weeks. Substantial RRs were observed overall for the neonatal (eg, for early neonatal deaths, 14.6 and 33.0 for US and Canadian infants, respectively, born at 32-33 gestational weeks; EFs, 3.6% and and 6. 2% for US and Canadian infants, respectively) and postneonatal (RRs, 2.1-3.8 and 3.0-7.0 for US and Canadian infants, respectively, born at 32-36 gestational weeks; EFs, 2.7%-5.8% and 3.0%-7.0% for the same groups, respectively) periods and for death due to asphyxia, infection, sudden infant death syndrome, and external causes. Except for a reduction in the RR and EF for neonatal mortality due to infection, the patterns have changed little since 1985 in either country. CONCLUSIONS: Mild- and moderate-preterm birth infants are at high RR for death during infancy and are responsible for an important fraction of infant deaths. JAMA. 2000;284:843-849

Canada↗
PubMed2005

Haematological effect of iron supplementation in breast fed term low birth weight infants.

AIMS: To determine the haematological effects of iron supplementation in predominantly breast fed term low birth weight (LBW) infants. METHODS: Seventy three healthy term LBW (<2500 g), predominantly breast fed infants aged 50-80 days were randomised into two groups to receive either iron (3 mg/kg/day) (iron supplemented (IS) group; n = 37) or placebo drops (placebo (P) group; n = 36). Haematological parameters and anthropometry were measured at baseline and repeated after four and eight weeks. RESULTS: A total of 62 subjects (32 in the IS group and 30 in the P group) came for the first follow up and 26 (13 in the IS group and 13 in the P group) reported for the second visit. There were no significant differences in serum ferritin and anthropometry. However, covariates (infant age, haemoglobin, and ferritin, and maternal haemoglobin) adjusted haemoglobin change was significantly higher in the IS group after four weeks (4.6 g/l; 95% CI 0.5 to 8.8) and eight weeks (8.6 g/l; 95% CI 1.8 to 15.4). CONCLUSIONS: Iron supplementation in a therapeutic dose in term breast fed LBW infants results in a marginal increase in haemoglobin. The functional benefit of this haemoglobin rise requires further evaluation.

Adult↗
PubMed2004

Employment, working conditions, and preterm birth: results from the Europop case-control survey.

STUDY OBJECTIVE: To analyse the relation between preterm birth and working conditions in Europe using common measures of exposure and to test whether employment related risks varied by country of residence. DESIGN: A case-control study in which cases included all consecutive singleton preterm births and controls included one of every ten singleton term births in each participating maternity unit. Data about working conditions were obtained by interview from women after delivery. SETTING: Sixteen European countries. PARTICIPANTS: The analysis included 5145 preterm and 7911 term births of which 2369 preterm and 4098 term births were to women employed during pregnancy. Analyses of working conditions were carried out for women working through at least the third month of pregnancy. MAIN RESULTS: Employed women did not have an excess risk of preterm birth. Among working women, a moderate excess risk was observed for women working more than 42 hours a week (OR = 1.33, CI = 1.1 to 1.6), standing more than six hours a day (OR = 1.26, CI = 1.1 to 1.5), and for women with low job satisfaction (OR = 1.27, CI = 1.1 to 1.5). There were stronger links in countries with a lower overall level of perinatal health and a common practice of long prenatal leaves. CONCLUSION: These findings show that specific working conditions affect the risk of preterm birth. They also suggest employment related risks could be mediated by the social and legislative context.

Case-Control Studies↗
PubMed2003

Fetal growth and body proportion in preeclampsia.

OBJECTIVE: To evaluate the effects of early- and late-onset preeclampsia on fetal growth and body proportion. METHODS: This was a population-based study based on records of 672,130 pregnancies from the Medical Birth Registry of Norway during 1967-1998. Women with a prior birth, multiple births, those without valid data on the last menstrual period or newborn's crown-heel length, and chronic maternal disease were excluded. RESULTS: In newborns of women with preeclampsia, mean birth weight, crown-heel length, and ponderal index were 4.4%, 0.8%, and 2.6% lower than in births without preeclampsia, respectively. In preterm births, mean differences in birth weight ranged from -11% to -23% against near-equal birth weights in term births. Mean differences in crown-heel length and ponderal index ranged from -1% to -5% and from -5% to -10% before term, respectively. In late preeclampsia, rates of birth weight and crown-heel length above the 90th and 97.5th percentiles and ponderal index above the 97.5th percentile were slightly but significantly higher than in term births without preeclampsia (odds ratios = 1.1-1.5). However, infants born to mothers with preterm preeclampsia were less likely to be heavy, long, or with high ponderal index for gestational age (odds ratios = 0.4-0.6). CONCLUSION: Our results support the hypothesis that preeclampsia is an etiologically heterogeneous disorder that occurs in at least two subsets, one with normal or enhanced placental function, and another involving placental dysfunction and fetal growth restriction, often with asymmetric fetal body proportion, reduced fetal length, and preterm delivery. In future studies, distinguishing between the two subtypes may be important.

Adult↗
PubMed2005

Neurodevelopmental, functional and growth status of term low birth weight infants at eighteen months.

This study was done to evaluate the neurodevelopmental, functional and growth status of term infants weighing 2000 g or less at 18 months, and to analyze major medical and social factors associated with an adverse neurodevelopmental and/or functional outcome. All infants were assessed for growth, audio-visual, neurological impairment, and motor and mental development using Indian modification of Bayley Scales of infant development. A detailed history was also taken. Term infants with birth weight of >2500 g without any antenatal or neonatal complications served as controls. Fifty low birth weight (LBW) term infants and 30 controls were evaluated. The mean mental development Quotient for LBW infants [91.51(16.97)] was significantly lower than that of Controls [102.02(8.4)]; the mean motor development Quotient however was comparable. The LBW infants were significantly lagging in terms of weight, length and head circumference at assessment. Neonatal complications were associated with an abnormal motor outcome while lower Socio-economic status and maternal education were related to adverse mental status. We concluded that Term LBW infants are at a significant disadvantage in terms of growth and mental scores at 18 months.

Child Development↗
PubMed1998

Birth asphyxia.

The term Birth asphyxia covers a number of clinical and physiological definitions. Birth asphyxia is a relatively common clinical event. In the majority of cases the outcome in terms of brain damage and future development of the child is excellent. However, a small number of children go on to develop patterns of brain damage which are then associated with disability. The article seeks to provide a basic understanding of the various mechanisms involved in producing injury.

Asphyxia Neonatorum↗
PubMed2004

The temperament of pre-term, low birth weight infants and its potential biological substrates.

Temperament profiles of pre-term, low birth weight (LBW) infants were assessed at 6 months of age using standardized norms from the Revised Infant Temperament Questionnaire (RITQ). The contributions of perinatal risk, ethnicity, and gender to various temperament dimensions were examined. The sample included 152 infants with a mean birth weight of 1687 g and a mean gestational age of 31 weeks. Eighty percent of the infants were classified as having temperaments that were difficult to manage. Irregularity of the infants' biorhythms, slowness in their ability to adapt to changes, and distractibility were the most problematic. Birth weight, gestational age, and gender were not associated with temperament. Perinatal morbidity was related to the temperament dimension of infant persistence, with implications for the infant's attention span and task performance. Euro American infants were rated as more persistent and less intense in emotional expression than were infants of other ethnic groups. Results suggest the need for a more direct assessment of the effects of neurobiological processes on development of temperament phenotypes and for measurement of temperament that is socioculturally appropriate.

Adult↗
PubMed1981

Behavioral and psychiatric assessment of preterm and full-term low birth weight children at 9-11 years of age.

Preterm (N = 33) and full-term (N = 18) low birth weight subjects were compared at age 9 to 11 years to 52 full-term normal birth weight subjects of similar age and socioeconomic levels. All groups were evaluated by a psychiatrist who was not aware of prenatal or perinatal histories at the time of the interview. Mothers completed various standardized questionnaires designed to elicit information about the children's behaviors. There were no significant differences among the groups in the numbers of subjects with diagnoses of psychiatric disorders or in scores on ratings of hyperactivity, general behavioral maladjustment, and specific behavioral factors. These results indicate that low birth weight per se does not portend serious psychiatric sequelae during middle childhood.

Child↗
PubMed1991

Occurrence of other reproductive failures among women with recurrent spontaneous abortion.

We have previously reported an association between recurrent spontaneous abortion and ectopic pregnancy. We now report that not only ectopic pregnancy, but also other reproductive failures including hydatidiform moles, preterm births, and stillbirths are also associated with recurrent spontaneous abortion. The obstetrical histories of 455 women who had experienced two or more consecutive spontaneous abortions were studied for the occurrence of term births, preterm births, stillbirths, spontaneous abortions, ectopic pregnancies, and hydatidiform moles. The observed frequencies of these reproductive outcomes were compared with the expected frequencies of 920 term births, 80 preterm births, five stillbirths, 150 spontaneous abortions, 14.5 ectopic pregnancies and 0.5 molar pregnancies per 1,000 livebirths. The 455 women had experienced 1,968 pregnancies of which 184 were term births, 30 were preterm births, 16 were stillbirths, 1,669 were spontaneous abortions, 63 were ectopic pregnancies, and six were molar pregnancies. The ratio of observed to expected values was term births 0.1, preterm births 1.6, stillbirths 14.0, spontaneous abortion 6.6, ectopic pregnancy 2.6, and molar pregnancy 7.1. The gravid specific proportions of reproductive outcomes were constant suggesting comorbidity or common cause(s). The commonality that links these types of reproductive failure will provide insight into the mechanisms of reproductive wastage.

Abortion, Habitual↗
PubMed1997

Early dating by ultrasound and perinatal outcome. A cohort study.

BACKGROUND: This study aims to evaluate the impact of routine ultrasound in early pregnancy on pregnancy outcome and perinatal mortality. METHODS: Using the Swedish Medical Birth Registry, a two-stage study was designed. First, an ecological study that included data from 45 hospitals, with 1,280,746 children born during the years 1974-1991, was designed by differentiating hospitals on the basis of ultrasound usage. Second, a historical cohort study (n = 60,864) was designed for the years 1982-84, including a treatment group (having had routine ultrasound in early pregnancy) and a reference group (having had no routine ultrasound). RESULTS: In hospitals practicing early dating by ultrasound, post-term births were reduced from 13.3% to 7.4%, while pre-term births were increased from 5.7% to 6.8%. For the treatment group, the cohort study showed: 1) fewer post-term births, RR 0.7 (95% CL 0.7-0.8), 2) lower post-term perinatal mortality, RR 0.3 (95% CL 0.1-1.0), 3) fewer twin births post-term, RR 0.1 (95% CL 0.1-0.7), 4) fewer acute growth retarded among term, RR 0.7 (95% CL 0.6-0.9) and post-term, RR 0.3 (95% CL 0.1-1.1), and 5) a tendency towards less asphyxia among post-term births. CONCLUSION: The study shows that early dating with ultrasound increases the possibilities of clinical judgment at the end of the pregnancy and also indicates that the procedure could contribute to a positive perinatal outcome.

Adult↗
PubMed1998

The development of low birth weight term infants and the effects of the environment in northeast Brazil.

OBJECTIVES: (1) To compare the mental and psychomotor development of low birth weight term (LBW-T) infants with that of appropriate birth weight (ABW) infants at 6 and 12 months of age. (2) To examine the relationship between developmental levels and social background. METHODS: A cohort of 131 LBW-T infants (1500 to 2499 gm) and 131 ABW infants (3000 to 3499 gm) matched for sex and time of birth, recruited from six maternity centers in Northeast Brazil were followed for 1 year. Their development was assessed with the Bayley Scales at 6 and 12 months of age, and at 12 months their behavior during the test was rated on five scales. Details of their families' socioeconomic status were recorded and the degree of stimulation in their homes was assessed. RESULTS: At 6 months of age the LBW-T infants had significantly lower scores than the ABW infants on the mental development index (MDI; 4.2 points lower, p < 0.001) and on the psychomotor development index (PDI; 7.3 points lower, p < 0.001). The difference had increased by 12 months of age (MDI 7.0 points lower, p < 0.001; PDI 9.9 points lower, p < 0.001). Socioeconomic variables were related to development at both ages in both groups. Maternal literacy was significantly related to the PDI in LBW-T infants at 12 months but not in ABW infants. Similarly, stimulation in the home was related to the MDI in LBW-T infants at 6 and 12 months but not in ABW infants. LBW-T infants were less active, cooperative, vocal, and happy, and were more inhibited than ABW infants. CONCLUSIONS: LBW-T infants had poorer development than ABW infants and differed in their behavior. There was an interaction between birth weight and the environment. LBW-T infants, but not ABW infants, were affected by the quality of stimulation in the home and maternal illiteracy.

Birth Weight↗
PubMed1989

[Uterine spiral arteries of the human in gestosis, fetal growth retardation and postmaturity].

The uterine spiral arteries in humans were examined after a normal course of pregnancy and a pathological course with gestosis, fetal growth retardation and post-term birth. We found that the spiral arterioles in normal pregnancy underwent physiological changes, such as invasion of trophoblasts and decomposition of fibromuscular media and elastic tissue. Apart from the post-term birth, we detected in pathological pregnancies a narrowing of the vascular lumen by proliferation of the intima and often little or no physiological changes of the spiral arterioles in the myometrial segment. Compared to normal pregnancies, thrombogenic formation, swelling of the intima and infiltration of erythrocytes were more frequently observed in post-term births. The flow resistance of maternal blood is greater in cases of gestosis and fetal growth retardation than in normal pregnancies, since the uterine spiral arterioles exhibited a narrowing of the vascular lumen and little or no physiological changes of the vascular wall, and in post-term births also increased thrombogenic formation and swelling of the intima. The resulting decrease in uteroplacental blood flow could lead to a functional insufficiency of the placenta.

Arteries↗
PubMed2003

Factors associated with size and proportionality at birth in term Jamaican infants.

The objective of this study was to identify the factors associated with size and proportionality at birth in a cohort of term infants established to investigate their growth and development. One hundred and forty term low-birth-weight (birth-weight < 2,500 g) infants and 94 normal birth-weight infants (2,500- < 4,000 g) were recruited within 48 hours of birth at the main maternity hospital, Kingston, Jamaica. Birth anthropometry and gestational age were measured, and maternal information was obtained by interview and from hospital records. Controlling for gestational age, variables independently associated with birth-weight were rate of weight gain in the second half of pregnancy, maternal height, haemoglobin level < 9.5 microg/dL, time of first attendance in antenatal clinic, birth order, pre-eclampsia, and consumption of alcohol, with 33% of the variance in birth-weight explained. Birth length was associated only with maternal height and age, while measures of proportionality (ponderal index and head/length ratio) were associated with characteristics of the environment in late pregnancy, including rate of weight gain, weight in late pregnancy, and pre-eclampsia. The variation in maternal characteristics associated with size or proportionality at birth may reflect the times during gestation when different aspects of growth are most affected.

Adult↗
PubMed2004

[Growth velocity and survival of full-term low birth weight infants in an African rural area (Burkina Faso)].

UNLABELLED: The objective of the study was to compare weight gain and mortality between full-term low birth weight (LBW) and normal birth weight (NBW) children. METHODS: One hundred and fifty-five full-term children born with LBW (<2500 g) and 280 NBW were recruited retrospectively in a rural health district of Burkina. Growth velocity, maternal characteristics and socio-economic status of families were investigated. RESULTS: Difference in weight means between the two groups decreased gradually from 3 months of age and did no more significantly differ from 8 months (P = 0.213). LBW, higher mother's BMI and number of antenatal care visits were associated with higher weight gain at 7 months. Lower weight gain was observed in children whose mothers had no education or high parity. Mortality risk was higher for LBW children (RR = 4.53; P = 0.005). LBW children's weight gain at 3 months was better than that of NBW infants. Nevertheless LBW children had a high mortality risk in the first year of life. CONCLUSION: Our results suggest that it could be interesting to focus early attention on LBW children without spontaneous catch up growth, to improve maternal nutritional status and girl's education.

Adolescent↗
PubMed1998

Cranial trauma following birth in term infants.

The purpose of this pictorial review is to demonstrate the imaging features of a range of cranial injuries associated with birth at term. Scalp and skull injuries include simple cephalhaematoma, osteomyelitis of the skull vault from infected cephalhaematoma, subgaleal haemorrhage and skull fracture. Intracranial injuries include extradural, subdural and subarachnoid haemorrhage, leptomeningeal cyst and brain infarct. Radiologists need to be aware of the range of cranial injuries following birth and their differentiating features.

Birth Injuries↗
PubMed2004

Association between maternal exposure to elevated ambient sulfur dioxide during pregnancy and term low birth weight.

This retrospective cohort study investigated whether the risk of delivering full term (37-44 completed weeks of gestation) low birth weight (LBW) infants is associated with differences in exposure to air pollutants in different trimesters. Full-term infants (37 completed weeks of gestation) with a birth weight below 2500 g were classified as term LBW infants. The study infants comprised 92,288 full-term live singletons identified from the Taiwan birth registry and born in the city of Taipei or Kaoshiung in Taiwan between 1995 and 1997. Maternal exposures to various air pollutants including CO, SO2, O3, NO2, and PM10 in each trimester of pregnancy was estimated as the arithmetic means of all daily measurements taken by the air quality monitoring station nearest to the district of residence of the mother at birth. The multivariable logistic regression model with adjustment for potential confounders was used to assess the independent effect of specific air pollutants on the risk of term LBW. This study suggested a 26% increase in term LBW risk given maternal ambient exposure to SO2 concentration exceeding 11.4 ppb during pregnancy compared to low exposure (<7.1 ppb) (OR=1.26, 95% CI=1.04-1.53). Since the relative risk of term LBW was reassessed according to exposure level in each trimester, mothers exposed to >12.4 ppb of SO2 in the last trimester showed 20% higher risk (OR=1.20, 95% CI=1.01-1.41) of term LBW delivery than mothers with lower exposure (<6.8 ppb). No significant elevation ORs was observed for other air pollutants.

Adult↗
PubMed2005

Periodontal disease -- the emergence of a risk for systemic conditions: pre-term low birth weight.

This paper addresses the problem of adverse pregnancy outcome in relation to periodontal disease. There is compelling evidence that a link exists between pre-term low birth weight (PLBW) and periodontitis. Although 25% to 50% of PLBW deliveries occur without any known aetiology, there is increasing evidence that infection may play a significant role in pre-term delivery. A model explaining the plausible relationship is proposed based upon the concept of infection leading to a cascade of inflammatory reactions associated with pre-term labour and periodontal disease. Current evidence has pointed to an interest in dental intervention studies to control periodontal disease as one of the potential strategies to reduce pre-term labour. This paper reviews the potential association between periodontal infection and adverse pregnancy outcomes.

Animals↗
PubMed1985

The outcome of pregnancy after threatened abortion.

A prospectively collected group of 93 pregnancies complicated by threatened abortion was carefully monitored throughout pregnancy, during birth and in the perinatal period, and any deviation from a completely uneventful course was registered. Comparison was made with a selected group of 282 non-risk pregnant women. A significant association was found between threatened abortion and the overall number of complications in the second half of pregnancy requiring medical intervention and/or admission to hospital, impending pre-term birth requiring betamimetics, pre-term birth, retention of the placenta, birth weight below 2000 g, light-for-dates infants in case of pre-term birth or birth weight below 2000 g, and hyperbilirubinemia in infants with birth weight below 2000 g. The incidences of perinatal mortality and congenital malformations did not differ significantly from those of the control group. Pregnancies complicated by threatened abortion constitute a risk group requiring careful obstetric and perinatal supervision and follow-up.

Abortion, Threatened↗