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PubMed2006

Multiple gestation: side effects of antepartum bed rest.

The birth rate for higher order multiples has dramatically increased in recent decades. Multiple gestation pregnancies are considered to be at high obstetric risk. Antepartum bed rest is often prescribed to offset complications despite the lack of evidence for its effectiveness in preventing complications. This longitudinal repeated-measures study identified side effects of antepartum bed rest treatment for 31 hospitalized women with twin or triplet gestation. Maternal weight gain and infant birth weight were recorded. Antepartum stressors were measured by the Antepartum Stressors Hospital Inventory, and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Antepartum and post-partum side effects of bed rest were also assessed by the Antepartum and Postpartum Symptom Checklists. The weekly rate of maternal weight gain during hospitalization was significantly less than recent recommendations for multiple gestation weight gain (t = - 2.14, p = .04). Infant birth weights were appropriate for gestational age. There were fewer than expected small-for-gestational-age infants. Concerns regarding family status and separation from family were the major antepartum stressors. Women reported a high number of symptoms during bed rest (M = 22), which did not significantly change across 2 weeks. CES-D scores for depressive symptoms were high on antepartum hospital admission. Postpartum symptoms were initially high but had significantly declined by 6 weeks: F(1, 27) = 15.68, p = .00. These findings suggest that interventions are needed to reduce antepartum maternal weight loss, stress, physiologic and psychosocial symptoms, and depressive symptoms, as well as reduce postpartum symptoms of maternal morbidity.

Adolescent↗
PubMed1996

The risk of prematurity and small-for-gestational-age birth in Mexico City: the effects of working conditions and antenatal leave.

OBJECTIVES: This study examined the effect of working conditions, occupational stress, and antenatal leave on risk of small-for-gestational age and premature births in Mexico City. METHODS: Over a 3-month period, 2663 (96.2%) of 2767 women who gave birth at three major hospitals and worked at least 3 months during pregnancy were interviewed shortly after delivery. After the exclusion of multiple gestations and birth defects, 261 (10.0%) small-for-gestational-age and 288 (11.0%) preterm births were identified. RESULTS: For small-for-gestational-age births, working more than 50 hours a week (odds ratio [OR] = 1.59), standing more than 7 hours a day (OR = 1.40), and no antenatal leave (OR = 1.55) were associated with an increased risk. Women with no antenatal leave were also much more likely to give birth prematurely (OR = 3.04). CONCLUSIONS: In this study, arduous working conditions and lack of antenatal leave benefits were found to increase the risk of poor birth outcome in Mexican women. Enforcement of existing antenatal leave laws and provision of comparable benefits for the uninsured may reduce the incidence of small-for-gestational-age births and prematurity.

Adult↗
PubMed1997

Critical periods of maternal weight gain: effect on twin birth weight.

OBJECTIVE: Our purpose was to evaluate the association between maternal weight gain and twin birth weight. STUDY DESIGN: This historic cohort study was based on 646 live-born twin births of > or = 28 weeks from Baltimore, Maryland, Miami, Florida, and Ann Arbor, Michigan. The sum of twin-pair birth weight was modeled as a function of either net maternal weight at delivery or rates of maternal weight gain with use of multiple regression. RESULTS: Birth weight was significantly associated with weight gain before 20 weeks in underweight women, before 20 weeks and after 28 weeks in overweight women, and during all three gestational periods in normal-weight women. Weight gain before 20 weeks had the largest effect on infants of underweight women, less of an effect on infants of normal-weight women, and half as much effect on infants of overweight women. Weight gain after 28 weeks significantly affected the infant birth weights of normal-weight and overweight women, but the effect was half as great among infants of the latter group. CONCLUSIONS: These findings suggest that weight gain during critical periods of gestation significantly influences twin birth weight; these critical periods vary by maternal pregravid weight status.

Adult↗
PubMed2003

Descriptive epidemiology of infantile cataracts in metropolitan Atlanta, GA, 1968-1998.

BACKGROUND: Infantile cataract is an important cause of childhood visual impairment. Surgery before 6 weeks of age is recommended for optimal visual outcome. Description of the epidemiologic characteristics of cataracts is important for an improved understanding of the condition. OBJECTIVES: To identify at-risk populations and facilitate successful treatment of patients with infantile cataracts. METHODS: Infants with cataracts diagnosed in the first year of life were identified using the Metropolitan Atlanta Congenital Defects Program, a birth defects surveillance program with active methods of case ascertainment, for the years 1968-1998. Several factors were analyzed, including year of birth, sex, race, maternal age, plurality (single vs multiple gestation), gestational age, birth weight, laterality, seasonality, and age at diagnosis. RESULTS: A total of 199 infants with cataracts were identified, for a rate of 2.03 per 10 000 births. In 117 infants (59%), cataracts occurred as an isolated defect; in 43 infants (22%), cataracts occurred as part of a syndrome; and in 39 infants (20%), additional, unrelated, major birth defects were also present. Rates were higher for low-birth-weight infants (those weighing <1500 g; risk ratio [RR], 6.01; 95% confidence interval [CI], 3.83-9.43) and preterm infants (RR, 1.70; 95% CI, 1.21-2.40). Of the cases that occurred as an isolated defect, 38% were diagnosed after 6 weeks. CONCLUSIONS: This population-based study provides 31 years of data from a diverse US population and allows identification of risk factors for infantile cataracts. The finding that a number of infants with cataracts continue to have their conditions diagnosed after 6 weeks of age emphasizes the need for direct ophthalmoscopic examination of the red reflex in the newborn period to facilitate early detection and improve outcomes.

Abnormalities, Multiple↗
PubMed2005

Primary predictors of preterm labour.

Spontaneous preterm birth accounts for 60% of all preterm births in developed countries. With the increase in multiple pregnancies, induced preterm birth and the progress in neonatal care for extremely preterm neonates, spontaneous preterm birth for singleton pregnancies in developed countries has probably decreased over the past 30 years. This decrease is likely to be related to better prenatal care for all pregnant women because the recognition of primary risk factors in early or late pregnancy remains a basic part of prenatal care. The failure to distinguish between induced and spontaneous preterm labour in most population-based studies makes it difficult to interpret results with respect to the primary predictors of preterm labour. Many such primary predictors of preterm labour have been used over the past 20-30 years. These include individual factors, socio-economic factors, working conditions and obstetric and gynaecological history. Risk scores have been proposed in order to produce these data. Unfortunately, the predictive value of these scores, especially their specificity, is poor, mainly because all of these factors are indirect. We still cannot identify the mechanisms that lead to preterm labour and birth. New markers more directly related to preterm labour have recently been proposed, some of which relate to direct causes of preterm labour such as cervical ultrasound measurement, fetal fibronectin (FFN), salivary estriol, serum CRH and bacterial vaginosis. Several of these have predictive values, which are potentially useful for clinical practice. Nonetheless, pregnant women in developed countries are already closely monitored throughout pregnancy. Before proposing new screening tests to be applied systematically to all pregnant women, their advantages and drawbacks must be fully evaluated.

Biomarkers↗
PubMed1977

Prediction of birth weight by ultrasound measurements of the fetus.

Fetal biparietal diameter, transverse thoracic diameter abdominal circumference and area were measured by ultrasound in 50 pregnant women at term not more than 48 hours before delivery. Multiple regressions correlating birth weight with all these parameters were obtained and estimated birth weight (calculated from the regressions) was compared with the actual birth weight. The error in prediction was under 200 g in 56%, under 300 g in 66% and under 400 g in 84% of patients when all fetal measurements were used. It was under 200 g in 48%, under 300 g in 66% and under 400 g in 74% when only the abdominal area was used; and it was under 200 g in 46%, under 300 g in 56% and under 400 g in 82% when the abdominal circumference alone was used. Biparietal diameter and transverse thoracic diameter alone were not useful in predicting birth weight.

Abdomen↗
PubMed1992

Performance of Polypay, Coopworth, and crossbred ewes: I. Reproduction and lamb production.

Six ewe genotypes, generated by mating Coopworth (C), Polypay (P), and Suffolk (S) rams to Polypay and Coopworth-type (Ct) ewes, were exposed to Hampshire rams for spring lambing from 1986 through 1990. Data from 1,092 exposures and 1,044 resultant lambings were used to analyze reproductive traits and lamb growth rates. Overall conception rate averaged 95% and ranged from 93% for S x Ct ewes to 97% for P x Ct ewes. Mean litter size at birth averaged 1.63 and ranged from 1.45 for C x C ewes to 1.75 for S x P ewes. Ewes from P dams had higher mean litter size (P less than .01) than those from Ct dams (1.73 vs 1.54), but differences between sire breeds were not significant. Incidence of lambing assistance was similar for ewes producing single or multiple lambs. Lamb birth weight influenced the level of assistance rendered to single-bearing but not to multiple-bearing ewes. Lambing assistance was not related to lamb survival, probably because the high surveillance level minimized trauma before assistance was rendered. Incidence of required assistance declined over subsequent parities. Lamb birth weights were affected by ewe genotype and increased with increasing ewe age. Survival of single-born lambs averaged 94% and was not affected by dam genotype. Survival of twins averaged 85%, ranging from 79% for lambs from S x Ct ewes to 89% for lambs from P x P ewes. Suffolk-sired ewes produced the heaviest mean birth and weaning weights for both singles and twins. Coopworth-sired ewes weaned heavier single lambs but lighter twins than P-sired ewes.

Age Factors↗
PubMed1995

Perinatal outcome after in vitro fertilisation.

A prospective series of 90 consecutive pregnancies (70 singleton, 16 twin and 4 triplet pregnancies) resulting in births of 114 infants after in vitro fertilisation (IVF) at Rigshospitalet were compared to a control group of pregnancies and deliveries in 70 non-IVF infertility patients with singleton pregnancies and 20 women with normal fertility with twin (n = 16) or triplet (n = 4) pregnancies. No differences in the incidence of third trimester pregnancy complications, abnormal fetal karyotypes or malformations were found. The number of women with spontaneous onset of labor and the gestational age at delivery were similar in the IVF and control groups. In singleton deliveries, the birth weight was lower (p < 0.025) in the IVF group (median 3145 g, range 890-4300 g) than in the control group (3399 g, 2592-4850 g), whereas in multiple gestation similar birth weights were found in the IVF and control groups. We conclude that the birth weight in singleton deliveries after IVF is lower than the birth weight in infertility patients treated differently. The cause of this difference remains obscure.

Adult↗
PubMed2003

Multiple attractors in stage-structured population models with birth pulses.

In most models of population dynamics, increases in population due to birth are assumed to be time-independent, but many species reproduce only during a single period of the year. A single species stage-structured model with density-dependent maturation rate and birth pulse is formulated. Using the discrete dynamical system determined by its Poincaré map, we report a detailed study of the various dynamics, including (a) existence and stability of nonnegative equilibria, (b) nonunique dynamics, meaning that several attractors coexist, (c) basins of attraction (defined as the set of the initial conditions leading to a certain type of attractor), (d) supertransients, and (e) chaotic attractors. The occurrence of these complex dynamic behaviour is related to the fact that minor changes in parameter or initial values can strikingly change the dynamic behaviours of system. Further, it is shown that periodic birth pulse, in effect, provides a natural period or cyclicity that allows multiple oscillatory solutions in the continuous dynamical systems.

Animals↗
PubMed2004

Molecular evidence of an interaction between prenatal environmental exposures and birth outcomes in a multiethnic population.

Inner-city, minority populations are high-risk groups for adverse birth outcomes and also are more likely to be exposed to environmental contaminants, including environmental tobacco smoke (ETS), benzo[a]pyrene (BaP), and other polycyclic aromatic hydrocarbons (PAHs) found in urban air. In a sample of nonsmoking African-American and Dominican women, we evaluated the effects on birth outcomes of prenatal exposure to ETS, using questionnaire data and plasma cotinine as a biomarker of exposure, and environmental PAHs using BaP-DNA adducts as a molecular dosimeter. We previously reported that among African Americans, high prenatal exposure to PAHs estimated by prenatal personal air monitoring was associated with lower birth weight (p = 0.003) and smaller head circumference (p = 0.01) after adjusting for potential confounders. In the present analysis, self-reported ETS was associated with decreased head circumference (p = 0.04). BaP-DNA adducts were not correlated with ETS or dietary PAHs. There was no main effect of BaP-DNA adducts on birth outcomes. However, there was a significant interaction between the two pollutants such that the combined exposure to high ETS and high adducts had a significant multiplicative effect on birth weight (p = 0.04) and head circumference (p = 0.01) after adjusting for ethnicity, sex of newborns, maternal body mass index, dietary PAHs, and gestational age. This study provides evidence that combined exposure to environmental pollutants at levels currently encountered in New York City adversely affects fetal development.

Adolescent↗
PubMed2003

Factors related to the risk of neonatal mortality, birth-weight and serum immunoglobulin concentration in lambs in the UK.

Neonatal-lamb mortality represents an economic loss and welfare concern. Two factors often associated with the risk of mortality are birth-weight and serum immunoglobulin concentration. We used data from two studies to investigate risk factors for mortality between 2 and 14 days of age and factors affecting birth-weight and serum immunoglobulin concentration at 48h of age. Dataset 1 included 1339 lambs born on eight farms during the 1995 spring lambing season; dataset 2 included 3172 lambs on seven farms during the 1991 spring lambing season. To account for some of the potential clustering within the data, multilevel models were used. Most (>75%) of the variation in the risk of mortality was at the lamb level. In dataset 1, factors significantly associated with increased odds of lamb mortality included low birth-weight and low serum immunoglobulin concentration. In dataset 2, significant risk factors for mortality included low birth-weight, ewe body-condition score, being born late in the season (relative to other lambs on the farm) and being born in multiple litters. There was a significant interaction between the effects of litter size and birth-weight. (Serum immunoglobulin concentration was not available for dataset 2.) More than half of the variation in birth-weight was at the ewe level, 27% at the lamb level, and 18% at the farm level (dataset 1). Single birth and being male were associated with increased birth-weight in both datasets. In dataset 2 only, increasing ewe condition score and birth early in the study period were also associated with increased birth-weight. Fifty-six percent of the variation in immunoglobulin concentration was at the lamb level, 36% at the ewe level and only 7% at the farm level. Factors associated with reduced serum immunoglobulin concentration included early or late birth in the lambing season, being born later than 14 days after the first lamb born on the farm, multiple-birth litters and maternal mastitis.

Animal Husbandry↗
PubMed1996

The impact of the Women, Infants and Children Food Supplement Program on birth outcome.

OBJECTIVE: Our purpose was to compare the birth outcomes of pregnant women in the Women, Infants and Children Food Supplement Program with women not in the program. STUDY DESIGN: The vital records of 4713 women, 2895 enrolled in the Women, Infants and Children Food Supplement Program and 1812 not enrolled in the program, whose infants were delivered at Wishard Memorial Hospital over 18 months were reviewed with respect to age, education, race, substance habits, trimester of entry into prenatal care, maternal weight gain, and status in the program. The primary outcome variables evaluated were low birth weight, as defined by the delivery of an infant < 2500 gm, and infant mortality. The primary predictor was program participation versus nonparticipation. Analysis was by t test, chi2, and logistic regression models. RESULTS: Black women, women with no prenatal care, and women who smoke were more likely to deliver a low-birth-weight infant. The incidence of low birth weight was 13.1% for nonparticipants versus 10.2% for program participants (p < 0.05). Univariate analysis confirmed program participants to be at significantly less risk for a low-birth-weight delivery (odds ratio = 0.75, p < 0.05). This relation, however, was not significant in the multivariate model (odds ratio = 0.88), indicating that the effect of participating in the program is being confounded by race, entry into prenatal care, and smoking. The overall infant mortality rate was 12.4 per 1000 for participants and 16 per 1000 for nonparticipants (p = not significant). CONCLUSION: Nutritional and nonnutritional benefits to participation in the Women, Infants and Children Food Supplement Program were confirmed. Women enrolled in the program were less likely to deliver a low-birth-weight infant. Multiple variables likely contribute to the poorer outcome for nonparticipants.

Birth Weight↗
PubMed1996

Parent and sibling influences on adolescent alcohol use and misuse: evidence from a U.S. adoption cohort.

OBJECTIVE: Although adolescent alcohol use has been consistently associated with parental drinking behavior, sibling drinking behavior and family functioning, the extent to which these associations owe to genetic or shared environmental influences has not been previously investigated. Using an adoption study design, we sought to determine whether the familial correlates of adolescent alcohol involvement were due to common genetic or common environmental effects. METHOD: The sample consisted of 653 adopted families ascertained through adoption agencies in four U.S. states. Each family consisted of a target adopted adolescent, an adoptive mother and an adoptive father. In addition, 68 birth adolescents (i.e., biological offspring of the adoptive parents) and 187 second adopted adolescents from these families participated in the study. All participants completed a mail survey that included assessment of drinking behavior and family functioning. RESULTS: The relationship between parental problem drinking and adolescent alcohol involvement was moderate and significant among birth offspring (corrected multiple correlation, Rc = .30), but small and non-significant among adoptive offspring (Rc = .00). The relationship between adolescent alcohol involvement and family functioning was substantial for birth offspring (Rc = .39), but only modest for adoptive offspring (Rc = .16). The nonbiological sibling correlation for involvement with alcohol was significant (r = .24) and moderated by sibling pair demographic similarity, such that same-sex, similar-age siblings were substantially more similar (r = .45) than opposite-sex, dissimilar-aged siblings (r = .01). CONCLUSIONS: These findings suggest that adolescent alcohol use is affected minimally by the environmental consequences of parent problem drinking and family functioning, but substantially by sibling environmental effects.

Adolescent↗
PubMed2001

Effects of early erythropoietin therapy on the transfusion requirements of preterm infants below 1250 grams birth weight: a multicenter, randomized, controlled trial.

OBJECTIVES: Infants of </=1250 g birth weight receive multiple erythrocyte transfusions during their hospitalization. We hypothesized that early erythropoietin (Epo) and iron therapy would 1) decrease the number of transfusions received (infants 401-1000 g birth weight; trial 1) and 2) decrease the percentage of infants who received any transfusions (1001-1250 g birth weight; trial 2). METHODS: A total of 172 infants in trial 1 and 118 infants in trial 2 were randomized to treatment (Epo, 400 U/kg 3 times weekly) or placebo/control. Therapy was initiated by 4 days after birth and continued through the 35th postmenstrual week. All infants received supplemental parenteral and enteral iron. Complete blood and reticulocyte counts were measured weekly, and ferritin concentrations were measured monthly. Transfusions were administered according to protocol. Phlebotomy losses and transfusion data were recorded. RESULTS: Treated and placebo/control infants in trial 1 received a similar number of transfusions (4.3 +/- 3.6 vs 5.2 +/- 4.2, respectively). A similar percentage of treated and control infants in trial 2 received at least 1 transfusion (37% vs 46%). Reticulocyte counts were higher in treated infants during each week of the study in both trials. Hematocrits were higher among treated infants from week 2 on in both trials. Ferritin concentrations were higher in placebo/controls than in treated infants at weeks 4 and 8 in trial 1 and at week 4 in trial 2. No adverse effects of Epo or supplemental iron occurred. CONCLUSION: The combination of early Epo and iron as administered in this study stimulated erythropoiesis in infants who were </=1250 g at birth. However, the lack of impact on transfusion requirements fails to support routine use of early Epo.neonate, intravenous iron, donor exposure.

Anemia, Neonatal↗
PubMed1999

Changing pregnancy outcomes of Samoan women in Hawaii.

In the state of Hawaii, Samoan mothers are known for the large average birthweight and low percentage of low birthweight (< 2500 g) of their infants, in spite of the relatively low socio-economic status of the population. This paper reports the findings of a temporal trend analysis of birth outcomes of Samoan women and identifies worrying changes. Data were obtained from Hawaii birth certificates. Single live births to Hawaii-resident Samoan and Caucasian women from 1979 to 1994 were included in the study. Infants of Samoan women experienced a 75 g decline in mean birthweight and an increase in the percentage of low (< 2500 g) and very low (< 1500 g) birthweight from 2.6 and 0.4 to 3.8 and 0.8 respectively. During the same time, infants of Caucasian mothers experienced an increase in mean birthweight and a decline in low birthweight, while very low birthweight did not change. Maternal socio-demographic characteristics explained only part of the findings and use of prenatal care did not appear to be associated with any birth outcome indicators. Multiple regression analyses identified an adjusted loss of 50.8 g in birthweight and a 1.48 increase in the odds ratio of small-for-gestational-age associated with birth at the end (1991-4) compared with the beginning (1979-82) of the study period. Further studies focusing on maternal health status and psycho-social variables, including the effect of acculturation-related stress, are warranted to identify at least some of the determinants of the changes identified by this analysis.

Adolescent↗
PubMed1981

Birth prevalence of five congenital abnormalities of medium frequency in Budapest.

In Budapest, 1970-1977, the birth prevalence of isolated renal agenesis, exomphalos-omphalocele, anal atresia, tracheo-oesophageal fistula with oesophageal atresia or stenosis, and diaphragmatic hernia was 0.23, 0.20, 0.18, 0.18 and 0.16, respectively, per 1000 total births. The birth prevalences of multiple abnormalities which were sharply distinguished from the isolated cases were in the order of the above-mentioned abnormalities 0.13, 0.19, 0.18, 0.14 and 0.19, respectively, per 1000 total births. The last ones are partly associations (e.g. VAcTERL) and partly random combinations. The rates of the capital Budapest might be representative for the birth prevalences of these congenital abnormalities in Hungary in the 1970's.

Anal Canal↗
PubMed2000

Racial differences in birth health risk: a quantitative genetic approach.

In the United States the gap between black and white babies' birth weights has remained largely unexplained. Rather than trying to measure all relevant variables, we used a genetically informative design to study the relative importance of genetic and environmental factors. Employing multiple indicators of "birth health risk," we found that the racial differences increased with the magnitude of the shared environmental effects. This suggested that possible genetic effects would not pertain to fetal genes, although genes affecting the mother's physical or physiological characteristics could be important because they contribute to shared environment in our analysis.

Adolescent↗
PubMed2003

Comparison of morbidity among twins and triplets.

This study aims to compare morbidity indicators between twins and triplets. This was a retrospective, observational study, and involved a review of twins and triplets born in Basildon Hospital between 1991 and 2000. The main outcome measures were mean birth weight, gestational age at delivery, mode of delivery and length of stay in the intensive care unit. The mean birth weight is comparable between twins and triplets (1.877 kg at 33+4 weeks of gestation vs. 1.905 kg at 34+4 weeks of gestation). Triplets stayed a longer period in the intensive care baby unit. In this study birth weight in multiple pregnancies was as expected for gestational age. Triplets required longer neonatal intensive care.

Birth Weight↗