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PubMed2005

A Swedish interview study: parents' assessment of risks in home births.

OBJECTIVE: to describe home-birth risk assessment by parents. DESIGN: interviews using a semi-structured interview guide. Data were analysed using a phenomenological approach. SETTING: independent midwifery practices in Sweden. PARTICIPANTS: five couples who had had planned home births. FINDINGS: the parents had a fundamental trust that the birth would take place without complications, and they experienced meaningfulness in the event itself. Risks were considered to be part of a complex phenomenon that was not limited to births at home. This attitude seems to be part of a lifestyle that has a bearing on how risks experienced during the birth were handled. Five categories were identified as counterbalancing the risk of possible complications: (1) trust in the woman's ability to give birth; (2) trust in intuition; (3) confidence in the midwife; (4) confidence in the relationship; and (5) physical and intellectual preparation. KEY CONCLUSIONS: although the parents were conscious of the risk of complications during childbirth, a fundamental trust in the woman's independent ability to give birth was central to the decision to choose a home birth. Importance was attached to the expected positive effects of having the birth at home. IMPLICATIONS FOR PRACTICE: knowledge of parents' assessment can promote an increased understanding of how parents-to-be experience the risks associated with home birth.

Adult↗
PubMed1992

Birth Order and health: major issues.

Birth Order has been described as a variable with a complex relationship to child and adult outcomes. A review of the medical literature over the past 5 years identified 20 studies that investigated the relationship between Birth Order and a health outcome. Only one of the studies established a relationship between Birth Order and a health outcome: third and fourth-born children have a higher incidence of accidents that result in hospitalization. The other demonstrated relationships are each explained by intervening variables or methodological limitations. Although Birth Order is not a strongly independent explanatory factor in understanding health outcomes, it is an important marker variable. Statistically significant relationships between Birth Order and health outcomes yield insights into the ways a family influences an individual's health.

Birth Order↗
PubMed1985

Do maternal energy reserves limit fetal growth?

Birth weight and maternal anthropometric measurements were made in a sample of 2456 deliveries in a poor, African peri-urban community. Maternal anthropometry was similar to that observed in affluent societies, whereas birth weight was significantly lower, even when adjusted for maternal weight and parity. Moreover, multiple stepwise regression showed that for a given maternal weight, fatter women had smaller babies. This is at odds with the classical hypothesis that a maternal energy deficit limits fetal growth.

Anthropometry↗
PubMed1993

[Pre-eclampsia--the delivery and outcome for newborn infants].

In the present research 50 patients have been examined having average and heavy form of preeclampsia who have entered and have been treated at the university hospital. The percentage of the Caesarean sections for the heavy forms is 72% while for the average forms it is 63%. The impression is that the heavier the preeclampsia is the more often operative delivery is practiced. On the other hand the heavier the preeclampsia is the quicker the delivery completes: approximately 50% of the heavy forms end with operative delivery up to the 32 gestational weeks while for the average forms the percentage is 6.6%. The birth information is compared to the values of Apgar score on the 1st and 5th minutes for the newborn and their outcome in the neonatal period. The general conclusion which is done concerns the optimal gestational time limit for birth in these cases in order to successful outcome for the newborn.

Adolescent↗
PubMed2000

Seasonality of birth in patients with mood disorders in Japan.

BACKGROUND: Findings about seasonality of birth in individuals with mood disorders have been inconsistent. METHODS: Data were collected from the governmental statistics, the Patient Survey in Japan in 1996. The number of patients with mood disorders was 13,969. We obtained information about each patient's date of birth, sex, and diagnosis according to ICD-10. Distributions of monthly birth numbers of patients with mood disorders were compared to those of the general population. RESULTS: Birth excess was observed from winter to early-spring in both sexes, compared to births of the general population. The magnitude of the excess was larger in females than in males. Although the same tendencies were observed in patients with bipolar disorder and depressive disorder, the differences were more marked in females. LIMITATIONS: Insufficient birth data in the general population before 1940 and hospital diagnosis. CONCLUSION: Among Japanese patients with mood disorders, there are excess births from winter to early-spring, compared to the general population. This difference is more marked in females than in males.

Adult↗
PubMed2003

Cardiac troponin I, cardiac troponin T and creatine kinase MB concentrations in umbilical cord blood of healthy term neonates.

AIMS: To measure and compare cardiac troponin I, cardiac troponin T and creatine kinase MB concentrations in the umbilical cord blood of healthy term infants and to investigate the relationship between maternal and neonatal troponin values at birth. METHODS: Troponin I, troponin T and creatine kinase MB concentrations were measured from the umbilical cord samples of 85 healthy term neonates and in the blood samples of their respective mothers at birth. RESULTS: Median (interquartile range) umbilical cord concentrations were 0 microg/L (0-0) for troponin I, 0 microg/L (0-0.019) for troponin T and 4.90 microg/L (3.90-6.61) for creatine kinase MB. Troponin I and T concentrations were higher than the detection limit for the assay in 2 (2.3%) and 41 (48.2%) neonates, respectively. Two mothers (2.3%) had cTnT levels above the detection limit; none of them had increased levels of cTnI. CONCLUSION: Probably owing to differences in expression and assay detection limits, cord blood troponin T concentrations are frequently over the detection limit at birth, while troponin I is mostly undetectable and comparable with that in healthy pregnant women. These cardiac regulatory proteins are of neonatal origin and are not influenced by maternal levels.

Creatine Kinase↗
PubMed1995

Growth hormone limits the brain/body development before birth in relation to sex, grasp-reflex asymmetry and familial sinistrality of human neonates.

Since there is no theological explanation for high growth hormone (GH) concentrations in perinatal blood, GH concentrations from umbilical cord blood were studied in relation to body weight and head circumference (brain weight) in the human neonates. GH exhibited inverse correlations with body weight and head circumference in these subjects, which depended upon sex, familial sinistrality (FS), and grasp-reflex dominance. This implies that GH may adversely influence the brain/body development during perinatal development on the basis of a genetically predetermined brain organization. It was suggested that the lipolytic and anti-insulin GH effects may be responsible for its body-weight reducing effects; the anti-insulin GH actions may be responsible for its brain-weight reducing effects. As a result of these actions, GH may limit the brain/body development, to induce a balanced growth during perinatal period.

Birth Weight↗
PubMed1984

[Data and comments on the general validity of the weight limit of 2500 g for low-birth-weight infants].

The authors describe the role of maternal body weight, duration of pregnancy and sex of newborn in the intrauterine growth of the fetus, more exactly in the development of birth weight. In this context they dealt with the validity of the 2500 g upper limit of low-birth-weight-infants in ethnically different populations. From the findings of their studies they draw the conclusion that the weight limit of 2500 g cannot be regarded as valid for all the populations at the statement of the proportion of low-weight births. In the authors view the question of the upper limit of low-weight newborns should be revised. At the statement of the weight limit a differentiation is necessary taking into consideration the constitutional difference in the populations as well as the average birth weight of the newborn and the sex. Authors find it permissible to use the weight value of 2500 g in comparative studies only in case of some populations with identical constitutional characteristics.

Body Weight↗
PubMed2003

Hindrances to family planning program: findings from Banke, Nepal.

Reducing population growth through programs is a high priority for many developing countries. Why particularly in the rural regions of these countries, do these initiatives fail? Using a case study of a recent initiative in rural Nepal between 1998 and 2002 as an example, this opinion piece discusses possible reasons for such failure and recommends that a broader strategic approach is necessary, particularly in relation to empowering women in these communities. Banke district, Nepal, is mainly rural, consisting of 47 villages. Scarcity of family planning provisions is a dominant problem in most parts of the district. District Public Health Office (DPHO), the major family service provider lacks resources and technical capabilities. In recent years, non-government organizations (NGOs) have been collaborating and coordinating their efforts with DPHO in order to cover the larger section of the district population. A local NGO called Banke Mahila Arthick Swawlamban Sangathan (BMASS) provided family planning services in 5 of the 47 villages of Banke district, Nepal, from 1998 through 2002. Outreach activities and clinical services were the two major components of BMASS family planning program. Outreach activities included door-to-door/mass counseling, street drama, and condom distribution. Clinical services that included counseling, testing, temporary sterilization, and referrals for permanent sterilization were provided through a centrally located static clinic and mobile clinics. BMASS family planning program had almost no impact in the target villages. There was no significant increase in contraceptive use, people's motivation to limit fertility, and number of people preferring a smaller family size. The contraceptive prevalence rate increased by less than 2% after 2 years of family planning program intervention. More than 80% of the family planning clients were reported to have discontinued contraceptive use within six months. The mean age of women at the time of first child delivery (16.2 years), total fertility rate (six children per woman), and the birth intervals (13-18 months) were reported to be the same for both periods: before and two years after family planning program intervention. Further assessment of the local factors revealed that women's lack of control over fertility and higher number of desired children could have hindered the community's response to BMASS family planning program. In the target villages a woman's fertility is dependent upon the preference of husbands and in-laws. The women in general are not empowered to voice their opinion with regards to delaying fertility, spacing child-births, and limiting the number of children to be born to them. Higher number of desired children in the target villages is the outcome of low cost of child rearing and high benefits from the children. Children not only contribute significantly in household economy and provide old age security to their parents, but also consume less. To be effective, family planning programs need to be integrated into broader societal reforms that address rural economic development and the role of women in society.

Journal Article↗
PubMed2003

Ethical considerations in the management of infants born at extremely low gestational age.

With ongoing improvements in technology and the understanding of neonatal physiology, there has been increasing debate regarding the gestational age and birth weight limits of an infants' capability of sustaining life outside the womb and how this is to be determined. The objective of this review was to address this issue with an analysis of current data (following the introduction of surfactant therapy in 1990) from published studies of survival in extremely low gestational age infants. We found that survival was possible at 22 completed weeks of gestation but only in < 4% of live births reported. Survival increased from 21% at 23 weeks gestational age to 46% at 24 weeks gestational age. Historically, despite continual advances in neonatology, the mortality at 22 weeks has not improved over the past three decades. Combining the data from studies on survival with evidence from developmental biology, we believe that it is not worthwhile to pursue aggressive support of infants born at < 23 weeks gestational age. Given the complicated issues related to morbidity and mortality in infants born at 22 to 25 weeks gestational age and the ethical implications of the available evidence, we propose the need for a consensus derived framework to help in decision-making.

Ethics, Medical↗
PubMed2001

Ontogeny of P-glycoprotein in mouse intestine, liver, and kidney.

BACKGROUND: P-glycoprotein (Pgp) is an ATP-dependent, integral plasma-membrane efflux pump that is constitutively expressed on (i) adult apical brush-border epithelial cells of the intestine, (ii) the bile canalicular face of hepatocytes, and (iii) the brush border epithelium of renal proximal tubules. This Pgp tissue distribution and localization affects the absorption, distribution, metabolism, and excretion of Pgp substrates. Little is known regarding the ontogeny of Pgp expression in these tissues. METHODS: Postnatal expression of Pgp on brush border membranes of small intestine, liver, and kidney as a function of maturity from birth through adulthood was determined using Western immunoblotting and immunohistochemical techniques. Tissue was isolated from FVB mice at four different ages: day of life 0 (D0), day of life 7 (D7), day of life 21 (D21), and adult (Ad). The relative expression of Pgp protein on Western immunoblots was assessed by scanning densitometry and indexed as a percentage (mean+/-SEM) of the adult levels. RESULTS: On Western immunoblots, Pgp expression was limited at birth (19+/-6% of Ad) and increased significantly with maturation in intestine (ANOVA, P<0.005). In contrast, hepatic (113+/-12% of Ad) and renal (96+/-15% of Ad) Pgp expression were at adult levels at birth. The tissue-specific developmental pattern of Pgp expression was confirmed by immunohistochemistry. CONCLUSIONS: We conclude that Pgp is expressed in a tissue-specific and developmentally regulated fashion and speculate that developmental modulation of intestine-Pgp expression may affect the oral bioavailability of Pgp substrates.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1992

Hmong women: characteristics and birth outcomes, 1990.

Current demographic characteristics and pregnancy outcomes of immigrant Hmong women in a small town in southeastern United States were documented in a retrospective study. Interviews and review of existing records were used to determine prenatal practices and perceived problems. Sixteen health professionals and two women from the community were interviewed, and the labor and delivery records from 1985 to 1990 were reviewed for parity, child spacing, and health status of the women and newborns. The greatest concerns voiced by health caregivers were multiparity and the need for contraceptive compliance. Seventy-eight full-term infants were born to 64 women in five years, with 2 stillbirths. No eclampsia, diabetes, or Rh incompatibilities were noted. Evidence is limited that birth frequency or outcome for Hmong women is a problem. Their perinatal difficulties were thought to be sociocultural rather than medical. Further study of the effects of acculturation on maternal family position, perinatal risks, and birth outcomes is imperative as lifestyle and environment change for these immigrant women.

Adolescent↗
PubMed1994

Glucose, galactose, and glutamine metabolism in pig isolated enterocytes during development.

In the pig, the gastrointestinal tract grows rapidly after birth and undergoes a short postnatal maturation. The objective of the present work was to assess the metabolic characteristics of the small intestinal mucosa during this period by investigating glucose, galactose, and glutamine metabolism in pig isolated enterocytes. Piglets were used immediately after birth or at various stages during suckling or postweaning. Fed animals were taken in a postabsorptive state. The jejunoileum was excised and perfused with an EDTA (5 mM)-containing buffer. The epithelial cell layer was further dissociated in the presence of hyaluronidase (0.01%). The resulting cell suspension (95% absorbing enterocytes; viability greater than 90%) was incubated with 14C-labeled substrates to measure 14CO2 production in parallel with substrate disappearance. The capacity to utilize glutamine was high and remained steady during the suckling period. Glucose utilization capacity was limited at birth and increased more than 3-fold during the first week of suckling. Such an increase was not observed in piglets kept unsuckled since birth. Galactose utilization capacity remained steady during the first week but afterward gradually disappeared. Lactate and pyruvate production through glycolysis was the major pathway accounting for glucose or galactose disappearance. A capacity for a net glucose production from galactose was evidenced during the first week of suckling. Thus, isolated newborn pig enterocytes exhibit specific and transient metabolic characteristics during the first postnatal week.

Animals↗
PubMed1993

Intestinal arginine metabolism during development. Evidence for de novo synthesis of L-arginine in newborn pig enterocytes.

The capacity for L-arginine metabolism was studied in villus enterocytes isolated from pigs at birth, after 2-8 days suckling and after weaning. Immediately after birth, enterocytes were able to convert 1 mM L-citrulline, 2 mM L-glutamine or 1 mM L-ornithine to L-arginine. In 2-8-day-old animals, the net production of L-arginine from L-citrulline (2.00 +/- 0.45 nmol x 10(6) cells-1 x 30 min-1), or from L-ornithine (0.29 +/- 0.06 nmol x 10(6) cells-1 x 30 min-1) was similar to the values obtained at birth. Furthermore, 40% of L-arginine synthetized de novo from L-citrulline were released into the incubation medium. In 2-8-day-old animals, the production of L-arginine from L-glutamine represented only 5% of the production at birth (the latter being 0.73 +/- 0.15 nmol x 10(6) cells-1 x 30 min-1). In enterocytes isolated from post-weaned pigs, no significant production of L-arginine from either L-glutamine or L-ornithine was detected. In contrast, although the L-arginine production from L-citrulline was very low in post-weaned animals, it was significantly enhanced in the presence of L-glutamine, representing 23% of the production measured in suckling animals. The capacity of enterocytes to cleave L-arginine to L-ornithine and urea was very limited at birth, but was increased more than threefold in 2-day-old animals. This was concomitant with a marked increase in arginase activity. In post-weaned animals, the flux through arginase in intact enterocytes, and the arginase activity were both threefold higher than in 2-8-day-old animals. It is concluded that enterocytes isolated from neonatal pigs exhibit the capacity for a net production of L-arginine since the metabolism of this amino acid is oriented to anabolism rather than catabolism. The results are discussed in relation to L-arginine metabolism in the neonatal liver.

Animals↗
PubMed1982

A comparison of spontaneous and CSF added CFU-MG colony formation in healthy, sick and hypotrophic pre-term infants.

Myelopoietic progenitor cells (CFU-MG) have been studied from peripheral blood of healthy, sick, and hypotrophic pre-term infants. Methylcellulose cultures were prepared simultaneously with and without exogenous colony stimulating factor. It was found that large numbers of circulating CFU-M are present at birth in healthy infants, smaller numbers in sick infants, and very few in hypotrophic infants. Exogenous CSF increases the number of colonies in cultures of healthy infants at birth. A limiting factor in spontaneous colony formation is the production of CSF by the cells in culture. This is particularly evident in sick infants. During the postnatal course similar levels of circulating CFUc, higher than in adult blood, are found in all three groups of pre-term infants.

Colony-Stimulating Factors↗
PubMed1987

Attitudes towards family size and family planning among women at an antenatal clinic in Maiduguri, Nigeria.

"This report describes a family planning survey [involving 172 women] conducted at an antenatal clinic in Maiduguri, Nigeria between June and August 1984. The level of education of respondents is generally low and appears to have a negative effect on knowledge, approval, and use of family planning. Breast feeding is widespread but not many respondents practiced it as a method of family planning. While there is limited knowledge and some approval of family planning, a desire for large families continues and there is relatively little practice of family limitation. The prospects for a decrease in fertility in the near future is not encouraging."

Africa↗