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PubMed1986

Prepregnancy weight, weight gain, and birth weight.

The effect of maternal weight gain on birth weight in 2946 live births with delivery after 37 weeks' gestation was studied at Moffitt Hospital, University of California (San Francisco), between September, 1980, and December, 1983. The sample was stratified into four categories according to prepregnancy weight for height with use of a body mass index. To study the effect of maternal weight gain on infant birth weight, multiple regression analysis, controlled for selected covariables, was carried out on the entire sample and on each prepregnancy weight group. For the entire sample, both pregravid body mass and weight gain significantly influenced birth weight. For the underweight, ideal weight, and moderately overweight women, each kilogram of maternal weight gain significantly increased birth weight. This study supports recent evidence for the association between maternal weight gain and birth weight, but only for women whose prepregnancy weights are 135% of ideal or less. These results suggest that recommendations for a minimum weight gain for obese women are unnecessary.

Adolescent↗
PubMed2004

Causes of late fetal death in New Zealand 1980-1999.

BACKGROUND: In recent years there has been an emerging interest in sudden unexplained intrauterine death. AIMS: To determine the major causes of late fetal death (LFD) in New Zealand during 1980-1999 and to document the proportion of deaths considered unexplained. In addition, to quantify the number of LFD undergoing post-mortem during this period. METHODS: Using the Office for National Statistics (UK) hierarchical classification system, all information available on death certificates was used to assign a single cause to LFD for the period 1980-1999. Trends were analysed using logistic regression and risk factor profiles established for each cause of death. Post-mortem rates and the characteristics of those failing to undergo post-mortem were analysed for the period 1989-1999. RESULTS: LFD rates declined from 60.1 per 10 000 in 1980-1981 to 30.5 in 1998-1999. The declines were not uniform across all causes, with intrapartum deaths declining 73%, congenital anomalies 70% and antepartum asphyxia 50%. In contrast, unspecified deaths increased 1%, and with the decline in other causes of death, also increased proportionally, from 10.8% of LFD in 1980-81 to 28.1% in 1998-1999. Post-mortem rates fell by 31% during 1989-1999, with Maori and Pacific babies and those in more deprived New Zealand Deprivation Index areas being significantly less likely to undergo post-mortem. CONCLUSIONS: While total LFD rates declined significantly during 1980-1999, rates of unspecified LFD remained static. Low post-mortem rates, however, suggest that many of these deaths may be uninvestigated rather than truly unexplained. Nevertheless, the persistence of a category of death which, to date, has failed to improve with advances in obstetric technology suggests that further measures are necessary if New Zealand's LFD rates are to continue to decline.

Adult↗
PubMed1989

[Early amnion rupture as a cause of multiple congenital abnormalities in the newborn infant].

We describe two children with congenital deformities due to the early amniotic rupture syndrome. One child who had an amniotic band around the upper arm suffered from a distal nerve lesion. This was relieved following surgery. The second child died shortly after birth of multiple congenital malformations. The most usual findings in this syndrome are constriction of a limb by an amniotic band, scoliosis or syndactyly due to oligohydramnion with compression. We discuss one accepted hypothesis (subscribed by an experimental animal study) of the aetiology of the early amniotic rupture syndrome.

Abnormalities, Multiple↗
PubMed2001

Do infants with major congenital anomalies have an excess of macrosomia?

BACKGROUND: Infants that develop congenital anomalies may also have an excess prevalence of macrosomia (birth weight > or =4,000 g). This may indicate that abnormalities of glycemic control play a role in the etiology of birth defects. This study was undertaken to determine whether all infants with congenital anomalies have an excess of macrosomia and whether it is confined to specific types of anomalies. METHODS: A case-control study was conducted, comparing the birth weights of 8,226 infants with congenital anomalies ascertained by the Texas Birth Defects Monitoring Division with those of 965,965 infants without birth defects. Odds ratios were calculated to determine the association between birth weight and congenital anomalies, for 45 specific defects, and for all these defects combined. RESULTS: For all 45 defects combined, a significant association occurred only in the highest birth weight category. Infants with congenital anomalies were more likely than infants without birth defects to have a birth weight > or =4,500 g (OR = 1.65; 95% CI = 1.39-1.96). Infants born with ventricular septal defects, atrial septal defects, ventricular hypertrophy, or anomalies of the great vessels were 1.5-2.5 times more likely to weigh > or =4,000 g than were infants without birth defects. Based on small numbers, a stronger excess of macrosomia was observed for infants with encephalocele, holoprosencephaly, anomalies of the corpus callosum, preaxial polydactyly, and omphalocele. CONCLUSIONS: Our data suggest that infants with specific congenital anomalies are more likely to be macrosomic than are infants without an anomaly. If these findings are confirmed, associations between macrosomia and specific types of birth defects may help to identify birth defects that are caused by alterations in glycemic control.

Abnormalities, Multiple↗
PubMedDate not supplied

Consanguinity, twinning and secondary sex ratio in the population of Karnataka, south India.

Consanguineous marriages are strongly favoured in the state of Karnataka. Of 65,492 marriages studied 33.07% were consanguineous, equivalent to a coefficient of inbreeding (F) of 0.0298. The twinning rate was low, 6.9 per thousand, whereas the secondary sex ratio, 0.5221, was higher than in comparable major human populations. Consanguinity exerted no significant effect on either parameter. The results also indicate that consanguinity is not associated with excess antenatal losses and suggest the possibility of enhanced selection against mutations at X chromosome loci.

Consanguinity↗
PubMed2000

Infant mortality by gestational age and birth weight in Canadian provinces and territories, 1990-1994 births.

We compared gestational age-specific and birth weight-specific infant mortality in the Canadian provinces (excluding Ontario) and territories using the linked birth and death records for 1990-1994 births. Compared with Quebec, early neonatal mortality rates were higher in Saskatchewan, Alberta and Newfoundland among extremely small and preterm infants and among infants with no information on gestational age and birth weight on their records. Post- neonatal mortality rates were higher in Prince Edward Island, Manitoba, Saskatchewan, Alberta, British Columbia and the Northwest Territories among preterm (and low birth weight) and term (and normal birth weight) infants. We suggest that differences in registration practices probably explain the substantial interprovincial variations in early neonatal mortality rates among extremely small and preterm infants, whereas differences in demographic profile and the quality of obstetric, neonatal and infant care probably explain interprovincial variations in infant mortality rates among less extremely small and preterm infants.

Adolescent↗
PubMed2002

An infant with pulmonary hypertension due to a congenital porto-caval shunt.

A 20-month-old male child died during an episode of acute bronchitis. The autopsy revealed massive hypertrophy and acute dilatation of the right heart which was caused by pulmonary hypertension exhibiting plexogenic arteriopathy and necrotizing arteriitis of small lung vessels. Further examination revealed complete old fibrotic occlusion of the extrahepatic portal vein and a large porto-systemic shunt. Esophageal varices indicating portal hypertension were not present. Histology showed enlarged hepatic arteries within the portal tracts while branches of the portal vein were lacking. The placenta had been examined at the time of birth and multiple chorangiomas reported. Furthermore, multiple old and florid occlusions of fetal vessels had been detected together with focal lymphoplasmocytic inflammation, which may indicate that intrauterine infection and vascular compromise were the cause of the complete closure of the portal vein around birth. The association of pulmonary hypertension with liver disease is well known, and portal hypertension has been considered a key factor in the pathogenesis of pulmonary hypertension. However, this case illustrates that portal hypertension is not a requisite for the development of pulmonary hypertension. It rather suggests that plexogenic arteriopathy of the lungs can be caused by porto-caval shunting independent of liver damage and portal hypertension. Toxic metabolites of nutrients or residual activity of pancreatic enzymes reaching the pulmonary vascular bed may be involved in the pathogenesis.

Fatal Outcome↗
PubMed1984

The role of parental attitudes in the development of temperament in twins at home, school and in test situations.

In the La Trobe Twin Study, data are collected on temperament and social development in 3-15 year old twins and singletons from four different sources: questionnaires to parents covering development from birth to the present plus the Bristol Social Adjustment Guide completed by the teacher, Sattler's Behavior and Attitude Checklist completed by the tester, and the Qualitative Score on the Porteus Maze Test. Particular stresses are identified which the parents perceive as distinguishing a multiple from a singleton birth. Whereas they perceive no differences between the first and second-born in birth complications, the second-born is judged less favourably particularly in MZ pairs. The distinction continues in the later assessments by the teacher and tester, where in addition the male twins are seen as being different from other children both in cognition and in temperament. It is proposed that social and cognitive development of twins are interrelated and have two unique components, one related to the greater problems accompanying a multiple birth and the other to comparisons between cotwins.

Adolescent↗
PubMed1990

Minor morphological aberrations in children with isolated urinary tract malformations.

The prevalence of 54 minor morphological aberrations (MMAs) (mild malformations, dysplasias, deformities and phenogenetic variants) was determined in 138 children with isolated malformations of the urinary tract and in 32 patients with multiple major birth defects including renal malformations. Children with infectious diseases matched to each patient by sex, age and ethnic origin served as controls. The overall prevalence of MMAs--expressed as MMA/subject ratio--proved to be significantly higher in patients with multiple malformations (2.50) than in those with isolated renal abnormalities (0.80) and in controls (0.76). The difference between the latter two groups was not significant. Apart from characteristic patterns of well-defined syndromes, the only specific association found was the higher prevalence of supernumerary nipples in patients with isolated (and hidden) urinary tract abnormalities of various types (9.4% versus 1.8% in controls; P less than 0.005).

Abnormalities, Multiple↗
PubMed1994

Oesophageal atresia: at-risk groups for the 1990s.

The authors analyzed the outcome for 357 infants with oesophageal atresia and 15 with H-type tracheoesophageal fistula treated from 1980 through 1992. Survival according to Waterston risk categories was 99% for group A, 95% for group B, and 71% for group C. Presently, with optimal management, virtually all infants in groups A and B should survive. When examining the risk factors in the infants who died, two criteria were found to be important predictors of outcome: birth weight of less than 1,500 g and the presence of major congenital cardiac disease. A new classification for predicting outcome in oesophageal atresia is proposed: group I: birth weight > or = 1,500 g, without major cardiac disease, survival 97% (283 of 293); group II: birth weight < 1,500 g, or major cardiac disease, survival 59% (41 of 70); and group III: birth weight < 1,500 g, and major cardiac disease, survival 22% (2 of 9).

Abnormalities, Multiple↗
PubMed2006

Prevalence and associations of anisometropia and aniso-astigmatism in a population based sample of 6 year old children.

AIM: To study the distribution of anisometropia and aniso-astigmatism in young Australian children, together with clinical and ocular biometry relations. METHOD: The Sydney Myopia Study examined 1765 predominantly 6 year old children from 34 randomly selected Sydney schools during 2003-4. Keratometry, cycloplegic autorefraction, and questionnaire data were collected. RESULTS: Spherical equivalent (SE) anisometropia (> or =1 dioptre) prevalence was 1.6% (95% confidence interval (CI) 1.1% to 2.4%). Aniso-astigmatism (>or =1D) prevalence was 1.0% (CI: 0.6% to 1.6%). Both conditions were significantly more prevalent among moderately hyperopic (SE > or =2.0D) than mildly hyperopic (SE 0.5-1.9D) children. Myopic children (SE < or =-0.5D) had higher anisometropia prevalence. Neither condition varied by age, sex, or ethnicity. In multivariate analyses, anisometropia was significantly associated with amblyopia, odds ratio (OR) 29, (CI: 8.7 to 99), exotropia (OR 7.7, CI: 1.2 to 50), and neonatal intensive care unit (NICU) admission (OR 3.6, CI: 1.1 to 12.6). Aniso-astigmatism was significantly associated with amblyopia (OR 8.2, CI: 1.4 to 47), maternal age >35 years (OR 4.0, CI: 1.3 to 11.9), and NICU admission (OR 4.6, CI: 1.2 to 17.2). Anisometropia resulted from relatively large interocular differences in axial length (p<0.0001) and anterior chamber depth (p = 0.0009). Aniso-astigmatism resulted from differences in corneal astigmatism (p<0.0001). CONCLUSION: In this predominantly 6 year old population, anisometropia and aniso-astigmatism were uncommon, had important birth and biometry associations, and were strongly related to amblyopia and strabismus.

Amblyopia↗
PubMed2002

Hypospadias and early gestation growth restriction in infants.

OBJECTIVE: There has been a major increase in the incidence of hypospadias in infants in the 1990s, but the risk factors are not known. Although there are scattered reports in the literature regarding the association of low birth weight and hypospadias, this has not been systematically studied. The objective of this study was to determine the association between early gestation intrauterine growth and hypospadias. METHODS: A retrospective review of 13 years of admissions to 2 tertiary care neonatal intensive care units (NICUs) in Connecticut (1987--2000) showed that 112 (1.66%) of 6746 male infants had any degree of hypospadias. Of these, 8 were part of a genetic syndrome and were excluded. A retrospective cohort analysis of these 6738 infants was performed. Infant growth parameters at birth (weight, head circumference, and length) were analyzed along with maternal risk factors known to be associated with changes in fetal growth, including maternal age, race, diagnosis of preeclampsia, gestational diabetes, and maternal use of alcohol or tobacco or substance abuse during pregnancy. RESULTS: The incidence of hypospadias in the NICU population increased 10-fold from 0.4% in 1987 to 4% in the first quarter of 2000. Hypospadias was significantly more common in infants who had uniformly poor intrauterine growth (<10th percentiles) in the various parameters measured: birth weight, length, or head circumference. There were no significant differences in maternal age or race, nor were there differences in the use of alcohol, tobacco, or street drugs by the mother. There were no differences between singletons and multiple-gestation births. However, the frequency of occurrence was significantly higher among first-born infants (1.9%) compared with all other infants (0.9%). CONCLUSIONS: The incidence of hypospadias in our NICU population has increased 10-fold during the 13-year period of study. There was a significant association of hypospadias with poor intrauterine growth. The growth restriction was probably of early gestational cause as there was proportionate involvement of somatic (weight and length) and brain growth (head circumference). The increasing frequency of hypospadias and its association with poor intrauterine growth originating in early gestation suggests that common environmental factor(s) that have an impact on both conditions may be involved.

Birth Order↗
PubMed1992

Pregnancy-induced hypertension in North Carolina, 1988 and 1989.

INTRODUCTION: Pregnancy-induced hypertension (PIH) is a highly prevalent pregnancy complication with adverse effects on maternal and infant health. Epidemiologic research concerning its etiology is limited. METHODS: Birth records from North Carolina for the period 1988 through 1989 included an indication of the presence of PIH. The risk of PIH was examined in relation to several maternal characteristics and exposures, including reproductive history, demographic characteristics, and tobacco use during pregnancy. Risk ratio estimates, adjusted for confounders, were calculated contrasting PIH among exposed vs unexposed women. RESULTS: The overall risk of PIH was 43.1 per 1000 births, with multiple pregnancies, nulliparity, and advanced maternal age associated with markedly increased risks. Tobacco use was inversely associated with PIH, and Blacks and Whites were at virtually equal risk. CONCLUSIONS: Problems in diagnosis and classification impede research in this area, with birth certificates limited in quality and breadth of information. Nonetheless, several patterns emerged that are worthy of further epidemiologic evaluation using more sophisticated designs.

Adult↗
PubMed2005

Improving case ascertainment of a population-based birth defects registry in New York State using hospital discharge data.

BACKGROUND: The assessment of the data quality of population-based registration systems is essential to understanding the reliability and usefulness of disease surveillance and research findings resulting from the use of registry data. Since the New York State Congenital Malformations Registry (CMR) uses passive case ascertainment, the completeness of the registry data is an important aspect of the quality of information. This paper presents the results of hospital audits, which were conducted to capture the unreported cases using hospital discharge files, and evaluates the effectiveness of the audits. METHODS: Children age 2 years or younger and diagnosed with reportable birth defects for the birth years 1998-2000 were selected from hospital discharge files of all reporting hospitals in the New York Statewide Planning and Research Cooperative System (SPARCS) and matched to the CMR database for the same birth year period. The unmatched reports from the SPARCS hospital discharge files that the CMR possibly missed were sent to hospitals, requesting submission of the missed reports. Two audits on all reporting hospitals in New York State were conducted: 1) 1998 and 1999 birth cohorts audited from June 2000 to March 2002, and 2) 2000 birth cohort audited from November 2001 to November 2002. RESULTS: Hospital audits using SPARCS hospital discharge data identified 5,460 reports that the CMR missed for the selected 66 hospitals analyzed. About 86% of these reports had reportable conditions and were added to the CMR, which comprised 21.4% of all reports from the 66 hospitals for the birth years 1998-2000. The number of reports that would have been missed without audits decreased from the 1998 and 1999 birth cohort (25.1%) to the 2000 birth cohort (13.9%). Low reporting rates and, thus, a high percent of added reports, were found for hospitals with a relatively small number of annual reports and for some specific birth defects such as chromosomal anomalies, anencephalus and congenital anomalies of the urinary system. CONCLUSION: The current study demonstrates that using hospital discharge data to improve case ascertainment is a valuable and effective method of enhancing birth defect surveillance, particularly for those hospitals with low reporting rates.

Abnormalities, Multiple↗
PubMed2002

Annual summary of vital statistics--2001.

The number of births, the crude birth rate (14.5 in 2001), and the fertility rate (67.2 in 2001) all declined slightly (by 1% or less) from 2000 to 2001. Fertility rates were highest for Hispanic women (107.4), followed by Native American (70.7), Asian or Pacific Islander (69.4), black (69.3), and non-Hispanic white women (58.0). During the early to mid 1990s, fertility declined for non-Hispanic white, black, and American Indian women. Rates for these population groups have changed relatively little since 1995; however, fertility has increased for Asian or Pacific Islander and Hispanic women. The birth rate for teen mothers continued to fall, dropping 5% from 2000 to 2001 to 45.9 births per 1000 females aged 15 to 19 years, another record low. The teen birth rate has fallen 26% since 1991; declines were more rapid (35%) for younger teens aged 15 to 17 years than for older teens aged 18 to 19 years (20%). The proportion of all births to unmarried women remained about the same at one-third. Smoking during pregnancy continued to decline; smoking rates were highest among teen mothers. The use of timely prenatal care increased slightly to 83.4% in 2001. From 1990 to 2001, the use of timely prenatal care increased by 6% (to 88.5%) for non-Hispanic white women, by 23% (to 74.5%) for black women, and by 26% (to 75.7%) for Hispanic women. The number and rate of twin births continued to rise, but the triplet/+ birth rate declined for the second year in a row. For the first year in almost a decade, the preterm birth rate declined (to 11.6%); however, the low birth weight rate was unchanged at 7.6%. The total cesarean delivery rate jumped 7% from 2000 to 2001 to 24.4% of all births, the highest level reported since these data became available on birth certificates (1989). The primary cesarean rate rose 5%, whereas the rate of vaginal birth after a previous cesarean delivery tumbled 20%. In 2001, the provisional infant mortality rate was 6.9 per 1000 live births, the same as in 2000. Racial differences in infant mortality remain a major public health concern, with the rate for infants of black mothers 2.5 times those for infants of non-Hispanic white or Hispanic mothers. In 2000, 66% of all infant deaths occurred among the 7.6% of infants born low birth weight. Among all states, Maine and Massachusetts had the lowest infant mortality rates. The United States continues to rank poorly in international comparisons of infant mortality. The provisional death rate in 2001 was 8.7 deaths per 1000 population, the same as the 2000 final rate. In 2000, unintentional injuries and homicide remained the leading and second-leading causes of death for children 1 to 19 years of age, although the death rate for homicide decreased by 10% from 1999 to 2000. Among unintentional injuries to children, two-thirds were motor vehicle-related; among homicides, two-thirds were firearm-related.

Adolescent↗
PubMed2004

Maternal Ramadan fasting and neonatal health.

This retrospective cohort study sought to determine the effects of maternal Ramadan fasting during pregnancy on neonatal birth weight as an important aspect of fetal health. It was carried out among healthy women who were admitted for their neonate delivery at two medical centers in Tehran from January to September 2000. Neonates of 284 mothers with a history of Ramadan fasting during pregnancy were compared with neonates of 255 mothers who did not have a history of fasting during their pregnancies. On univariate analysis, neonatal birth weight of the fasted group was 100 g more than those of the nonfasted group (p=0.009). However, body mass index (BMI) of the fasted mothers was greater than that of the nonfasted mothers. When controlling for maternal BMI on neonatal birth weight, multiple linear regression models showed that neonates of fasted women were 71 g heavier than those of the nonfasted group, which was not statistically significant (p=0.1). We conclude that maternal fasting during Ramadan did not have a significant effect on the neonatal birth weight. Other health effects that we did not observe could have occurred.

Adult↗
PubMed2006

[Screening analysis of retinopathy of prematurity and treatment of threshold retinopathy of prematurity].

OBJECTIVE: To investigate the incidence and the risk factors associated with the development of retinopathy of prematurity (ROP) by ROP screening in the premature infants and to evaluate the treatment effect of threshold ROP. METHODS: From March 2000 to December 2004, 108 premature infants with birth weight less than 2.0 kg or gestational age less than 37 weeks admitted to the Neonatal Intensive Care Unit at Guangdong Provincial People's Hospital were enrolled in the present study. They were examined with binocular indirect ophthalmoscope. The perinatal variables of the premature infants were analyzed to evaluate their correlation with the development of ROP. The infants with threshold ROP were treated with retinal photocoagulation or cryotherapy. RESULTS: The overall incidence of ROP was 21.3% (23 of 108). Among 23 premature infants with ROP, 56.5% (13 of 23) were in stage 1, 13.0% (3 of 23) in stage 2 and 30.4% (7 of 23) in stage 3. All infants with ROP stage 3 fulfilled the criteria of threshold ROP. As compared with non-ROP group, ROP infants had lower birth weight [(1.43 +/- 0.25) kg; t = 4.059, P < 0.001], shorter gestation age [(31.0 +/- 2.3) W; t = 2.637, P = 0.013], longer median time of oxygen supplementation (17 d; Z = -3.630, P < 0.001) and more demand of mechanical ventilation (chi(2) = 12.009, P = 0.001). Cases with multiple gestational births in ROP group were not significantly different from that in non-ROP group (chi(2) = 1.013, P = 0.314). Multivariate logistic regression analysis showed that low birth weight (beta = -2.542, OR = 0.079, P = 0.032) and mechanical ventilation (beta = 1.341, OR = 3.823, P = 0.025) were significantly associated with the development of ROP. In a total of seven cases with threshold ROP, six cases were treated with retinal laser photocoagulation or transscleral cryotherapy timely. After followed up for two months to two years, all treated eyes had normal pupil response to the light. The optic disk, macula and posterior retina appeared normal. No abnormal retinal vessels and proliferative vitreoretinopathy were found. One premature infant with threshold ROP, not treated by laser photocoagulation or transscleral cryotherapy, developed retinal detachment in both eyes. CONCLUSIONS: Premature infants with low birth weigh, shorter gestational age, longer history of oxygen supplemental and the using of mechanical ventilation have more chance of developing ROP. The analysis of risk factors will be helpful in understanding and prediction of development of ROP. ROP screening and timely treatment for threshold ROP are very important for preventing the development of advanced ROP in premature infants.

Female↗