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PubMed1992

Determinants of perinatal and infant mortality in Italy.

Determinants of stillbirths, perinatal and infant mortality in Italy have been analyzed using information collected routinely by the Italian Central Institute of Statistics on more than 2,400,000 births and 33,000 infant deaths in the period 1980-1983. Individual records included data on maternal (i.e. age, education, obstetric history) and fetal characteristics (sex, birth weight, gestational week at birth). The Italian stillbirth, perinatal and infant (1st-365th day of life) mortality rates in the period considered were respectively 7.7/1000 births, 16.4/1000 births and 13.5/1000 livebirths. Perinatal and infant mortality was extremely elevated in the very-low-birth-weight category. About 90% of liverbirths weighing less than 1000 g died within the first year of life, but this fell to about 45% in babies weighing 1000-1499 g. Among other factors, stillbirth, perinatal and infant mortality rates were elevated among males, born to older women and in higher birth rank and multiple pregnancies. These findings persisted, although less markedly, after adjustment for weight. Mortality rates were about 50-70% higher in less educated women. This finding was not markedly changed after adjustment for birth weight and maternal age, suggesting that socio-economic factors are per se important determinants of perinatal and infant mortality in Italy.

Birth Weight↗
PubMed2006

Predicting the impact of in vitro fertilisation and other forms of assisted conception on perinatal and infant mortality in England and Wales: examining the role of multiplicity.

The increased risk of perinatal and infant mortality observed among in vitro fertilisation (IVF) births and other assisted conception births is thought to be largely attributable to multiplicity. Using mortality statistics and estimates of the proportion of births following infertility treatment, we predicted the excess stillbirths and infant deaths associated with twins and higher order births resulting from assisted conception in England and Wales. According to our results, approximately 73 deaths could have been avoided in 2001 if all IVF infants had been born as singletons or as naturally occurring monozygotic twins, equating to a population attributable risk fraction of around 1% for perinatal and infant deaths. If we include all types of assisted conception, this figure was estimated to be around 4% of deaths-more than 220 perinatal and infant deaths in 2001. We confirm the public health importance of multiple births associated with assisted conception.

England↗
PubMed1997

A study on profile of stillbirths.

The incidence of stillbirths in "one year period" was studied by record analysis in a teaching hospital. A stillbirth rate of 38.4 per 1000 live births was observed. On admission 96.3% cases had some adverse foetal conditions detected readily. Leading factor detected was intra-uterine growth retardation (45.4%). Other major conditions observed were intra-uterine hypoxia (18.4%), malpresentation (11.9%), multiple pregnancy (8.3%). Birth weight was below 2000 g in 53.1% cases. Records showed 78.5% mothers had not received antenatal care.

Female↗
PubMed2006

The influence of childbirth expectations on Western Australian women's perceptions of their birth experience.

OBJECTIVES: to explore and describe the influence of childbirth expectations on women's perception of their birthing experience and expectations for subsequent births. This was the second phase of a study, the purpose of which its purpose was to determine the childbirth expectations of a cohort of Western Australian women and ascertain factors that influenced these expectations. DESIGN: a qualitative study which used an exploratory descriptive design. Data were collected from in-depth individual interviews. SETTING: Perth, Western Australia. PARTICIPANTS: 20 women, 11 primiparae and nine multiparae, who between them had experienced 31 births. These women had participated in phase one when they were either pregnant or had birthed within the preceding 12 months. Phase two interviews occurred 5-6 months after phase one. FINDINGS: the themes and sub-themes revealed in phase one of the study were supported in phase two. Although women held multiple expectations for birth, specific expectations were regarded as priority. Consequently, to perceive birth as positive, a woman had to achieve her priority expectations. Multiparae reported more positive birth experiences, having altered expectations as a result of previous experiences. Unaffirming birth experiences due to unmet expectations were more common after a first birth. Women with unfulfilled expectations subsequently adapted their expectations to be more achievable thus avoiding disappointment. Supportive behaviours of maternity health-care providers assisted women to evaluate their birth experience as positive even when expectations could not be achieved. IMPLICATIONS FOR PRACTICE: the evaluation of birth experiences as positive or negative is contingent upon achieving most, or at least the priority, childbirth expectation. Knowing a woman's expectations assists the midwife in her advocacy role. This role in assisting women to achieve their expectations is reinforced by this research. Caregivers become even more important when expectations are not able to be realised. Behaviours that encourage involvement and participation in decision-making during birth promote feelings of control, coping and feeling supported, which ultimately are needed for women to assess their birth experience as positive. Achievable expectations, such as 'being flexible' and 'only having a healthy baby' could be regarded as a lessening of ideals. The issue of whether these changing expectations are contributing to the increasing technocratic approach to birth and the resulting devaluing of the normal birth experience requires further debate.

Adult↗
PubMed1977

[Can the high percentage of premature twins be reduced? Thoughts based on an analysis of 243 twin births].

243 twinpregnancies of the university hospital at Hamburg between 1960 to 1969 have been analysed retrospectively (1960 to 1964 = Group A, 1965 to 1969 = Group B). It was found that the main risk factors of gemellary gravidity are the high rate of born before term babies the high rate of EPH-gestosis, and the high rate of perinatal mortality. 57 respectively 65% of all gemellipara had one or more symptoms of EPH-gestosis. Measured by birth weight (less than 2500 g = pre-term and small for gestational age infants) greater than 50% of the twins of group A and B were of low birth weight. The perinatal mortality of multiple pregnancy of all groups of birth weight was 11.6% in group A and 13.3% in group B. The perinatal mortality of not premature newborn with greater than 2500 g was 10 times lower and has been corrected from 1.1% (group A) to 0.5% (group B). Gemellipara, younger than 20 and elder than 30 years of age, show the maximum rate of perinatal mortality. Twins should be diagnosed in time of pregnancy. This allows pre-term hospitalisation with routine testing of placental function and if necessary prophylactic therapy of immature labour. This offers more promise to prevention of prematurity and leads to progress satisfactorily with multiple pregnancy.

Birth Weight↗
PubMed2006

Practitioner reporting of birth defects in children born following assisted reproductive technology: Does it still have a role in surveillance of birth defects?

BACKGROUND: National assisted reproductive technology (ART) data collections that rely on practitioners' reports of birth defects have consistently reported lower proportions of children with birth defects than record linkage studies that link ART infants to birth and malformation registers. METHODS: We compared the birth defect data reported to the national Australian Assisted Conception Data Collection (ACDC) by practitioners at three Western Australian ART clinics with the birth defect data identified on the Western Australian Birth Defects Registry (WABDR) through record linkage of all the pregnancies conceived at these clinics to the WABDR. Cases are reported to the WABDR by multiple statutory and voluntary sources. RESULTS: We found that the national ACDC significantly underestimated the prevalence of birth defects in WA-born ART infants. Less than one-third of ART children identified with a major birth defect on the WABDR were reported to the ACDC. CONCLUSIONS: Although national ART data collections provide valuable information on pregnancy rates and short-term pregnancy outcomes such as multiple birth and birth weight, we strongly recommend that birth defect information used for patient counselling is preferentially drawn from large studies that have used record linkage to high-quality birth defect registers.

Congenital Abnormalities↗
PubMed2000

Oligodendrocyte survival, loss and birth in lesions of chronic-stage multiple sclerosis.

One of the hallmarks of the human demyelinating disease multiple sclerosis is the inability to compensate adequately for the loss of myelin and of oligodendrocytes, the myelin-forming cells of the CNS. Oligodendrocyte precursor cells, a potential source of oligodendrocytes, have been identified in lesions of chronic multiple sclerosis, but it is not known whether they develop into new, fully differentiated oligodendrocytes, capable of remyelination. Sections of post-mortem multiple sclerosis tissue were therefore immunolabelled with antibodies to galactocerebroside (GalC), the first oligodendrocyte-specific molecule to be expressed by differentiating oligodendrocyte precursor cells, and myelin oligodendrocyte glycoprotein (MOG), a marker for mature oligodendrocytes. In total, 23 lesions from 15 subjects with chronic progressive multiple sclerosis were analysed. The immunolabelling revealed that chronic multiple sclerosis lesions contain only small numbers of immature, process-bearing, GalC-positive oligodendrocytes (0-2 cells/mm(2) in 10 micrometer thick sections); they had a relatively large, pale nucleus (maximum diameter: 9.9 +/- 0.9 micrometer). Although they appeared to make contact with surrounding demyelinated axons, most immature oligodendrocytes appeared not to be engaged in myelination. These findings suggest that oligodendrocyte differentiation of precursor cells is a rare event in chronic multiple sclerosis, which is consistent with the general failure of myelin repair during the later stages of this disease. The lesions in the collection, in particular those with recent demyelinating activity, contained another distinct population of oligodendrocytes. It consisted of small, round cells with a small, dense nucleus (maximum diameter: 6.8 +/- 0.8 micrometer) that expressed both GalC and MOG but lacked processes, suggesting that these cells were mature oligodendrocytes that had survived the loss of their myelin sheaths, i.e. they were demyelinated oligodendrocytes. In the most recent lesions in the collection, the demyelinated oligodendrocytes were found in large numbers throughout the centre of the lesion (up to 700 cells/mm(2)), while in the older lesions they were found only at the edges. Moreover, when the borders of these older lesions still contained numerous macrophages, they tended to contain more demyelinated oligodendrocytes than those lacking macrophages. These findings suggest that mature, demyelinated oligodendrocytes gradually disappear from lesion areas with increasing age of the lesion. The present study thus suggests that the failure of myelin repair in at least some cases of chronic multiple sclerosis is due to (i) the loss of demyelinated oligodendrocytes from lesion areas and (ii) the failure of the oligodendrocyte precursor population to expand and generate new oligodendrocytes. Gaining further insight into these processes may prove crucial for the development of remyelination promoting strategies.

Adult↗
PubMed2006

Effects of low birth weight in 8- to 13-year-old children: implications in endothelial function and uric acid levels.

Low birth weight has been associated with an increased incidence of adult cardiovascular disease. Endothelial dysfunction and high levels of serum uric acid are associated with hypertension. In this study, we have determined whether uric acid is related to blood pressure and vascular function in children with low birth weight. We evaluated vascular function using high-resolution ultrasound, blood pressure, and uric acid levels in 78 children (35 girls, 43 boys, aged 8 to 13 years). Increasing levels of uric acid and systolic blood pressure were observed in children with low birth weight. Birth weight was inversely associated with both systolic blood pressure and uric acid; on the other hand, uric acid levels were directly correlated with systolic blood pressure in children of the entire cohort. Low birth weight was associated with reduced flow-mediated dilation (r=0.427, P<0.001). Because the children with low birth weight had elevated uric acid as well as higher systolic blood pressure levels, we evaluated the correlation between these variables. In the low birth weight group, multiple regression analysis revealed that uric acid (beta=-2.886; SE=1.393; P=0.040) had a graded inverse relationship with flow-mediated dilation, which was not affected in a model adjusting for race and gender. We conclude that children with a history of low birth weight show impaired endothelial function and increased blood pressure and uric acid levels. These findings may be early expressions of vascular compromise, contributing to susceptibility to disease in adult life.

Adolescent↗
PubMed2004

Methodological issues in the measurement of birth preparedness in support of safe motherhood.

Behavior change interventions focusing on birth preparedness for pregnant women, their husbands, and adults in the community are common components of community-oriented Safe Motherhood programs in developing countries. Few studies have examined the effectiveness of these interventions, and existing studies are flawed due to study and sample design. This article highlights methodological issues that are often overlooked when measuring indicators of birth preparedness among multiple audiences for program evaluation purposes in household-based surveys. Solutions are proposed to address each of these problems in an effort to improve future research.

Birth Rate↗
PubMed1980

Patients in a clinic for children with multiple handicaps: a retrospective diagnostic evaluation.

This study illustrates the effectiveness of an outpatient facility in evaluating patients with a variety of handicapping disorders. A multidisciplinary approach, such as the one used in the Child Study Clinic, is the most effective and most efficient mode of evaluating handicapped children, though hospitalization is occasionally required to further evaluate such complicated problems. Every child with mental retardation, birth defects, or multiple handicaps requires a thorough evaluation for the purposes of diagnosis, treatment, and the prescription of long-term educational and occupational goals. Family history often indicates the need for genetic counseling.

Abnormalities, Multiple↗
PubMed2003

Hyperechogenic fetal bowel: a large French collaborative study of 682 cases.

Hyperechogenic fetal bowel is detected in 0.1-1.8% of pregnancies during the second or third trimester. This ultrasound sign is associated with cystic fibrosis or other conditions (e.g., chromosomal anomalies, viral infection) but no large-scale prospective studies have been conducted. This 1997-1998 multicenter study in 22 molecular biology laboratories identified 682 cases of hyperechogenic fetal bowel detected by routine ultrasound examination during the second (86%) or third trimester. The fetal bowel was considered hyperechogenic when its echogenicity was broadly similar to, or greater than, that of the surrounding bone. Karyotyping, screening for viral infection, and screening for cystic fibrosis mutations were performed in all cases. Pregnancy outcome and postnatal follow-up were obtained in 656 of the 682 cases (91%). In 447 cases (65.5%), a normal birth was observed. Multiple malformations were observed in 47 cases (6.9%), a significant chromosomal anomaly was noted in 24 (3.5%), cystic fibrosis in 20 (3%), and viral infection in 19 (2.8%). In utero unexplained fetal death occurred in 1.9% of cases, toxemia in 1.2%, IUGR in 4.1%, and premature birth in 6.2%. This study demonstrates that this ultrasound sign is potentially associated with medically significant outcomes. Having established that the bowel is hyperechogenic, recommended investigations should include a detailed scan with Doppler measurements, fetal karyotyping, cystic fibrosis screening, and infectious disease screening. After birth, newborns require pediatric examination because a surgical treatment may be necessary. This should be combined with clear counseling of the parents.

Chromosome Aberrations↗
PubMed1991

Birth of the first 100 babies in Hawaii after conception in-vitro: experience at the Pacific In-Vitro Fertilization Institute.

This paper reports on the first 100 infants delivered consecutively the result of 63 pregnancies after conception in-vitro at the Pacific In-Vitro Fertilization (IVF) Institute. These pregnancies were established prior to the introduction of embryo-cryopreservation into the program. Ninety-seven percent (97%) of singleton pregnancies delivered after 36 weeks; only 5/31 (16%) required tocolytic therapy. The overall multiple gestation rate was 51%, higher than in many other IVF centers. Maternal complications and neonatal morbidity were associated primarily with these multiple gestations. Forty-one percent (41%) delivered in less than 36 weeks, and tocolytics were administered in 22/27 (81%) of twin and 5/5 (100%) of triplet gestations. Neonatal morbidity was noted in 39 infants (33 from multiple gestations); 28 neonates were admitted to the intensive care unit (27 from multiple gestations). Nine births had or developed minor abnormalities (hernias, pyloric stenosis). One case of Trisomy 21, and one infant death at 11 months occurred in the group. The caesarean section rate for all IVF deliveries was 65%. It is concluded that IVF is clearly established in Hawaii for infertility refractory to other methods of treatment. The risk associated with IVF stem from the possibility of multiple gestations, not whether the pregnancy was initiated in-vitro. In the future, embryo cryopreservation may help to reduce the risk of multiple pregnancy.

Adult↗
PubMed2002

Interactions of stress and reproduction - a personal view.

In the first part of this article, the authors discuss the effect of stress upon reproduction. The paper begins with a discussion of the various stressful factors that influence the functions of reproductive organs under various circumstances, including menarche, gestation and lactation. In general, physical and emotional stress has a negative impact upon reproductive function. Chronic stress may delay pubescence and, during the reproductive years, may impair oogenesis and spermatogenesis. This process may result in transitory infertility in women and permanent sterility in men. If associated with pregnancy, stress may be conducive to spontaneous abortion or premature birth. The second part of the article deals with stressful stimuli attributable to the reproductive process, the problem of infertility, techniques of assisted reproduction, and the management of unwanted gestations including induced abortion, fetal reduction, spontaneous miscarriage as well as in utero fetal death. The stress generating effects of singleton and multiple pregnancies and births are also outlined in some detail. In the third part of this article discuss effect of stress upon the fetus directly or through the maternal organism.

Female↗
PubMed1995

The impact of very low-birth-weight infants on the family is long lasting. A matched control study.

OBJECTIVE: To test the hypothesis that parental stress associated with long-term morbidity of very low-birth-weight infants (VLBWIs) is long lasting. DESIGN: Matched case-control study. SETTING: High-risk newborn follow-up program, Winnipeg, Manitoba. PARTICIPANTS: Parents of 96 Manitoban VLBWIs born from July 1986 through June 1990, compared with parents of full-term controls matched for age, sex, race, domicile, singleton or multiple pregnancy, and birth order. MAIN OUTCOME MEASURES: Mailed questionnaire, including Stein's Impact on Family Scale, positive impact of parenthood, and attitudes toward treating VLBWIs. RESULTS: Families were demographically similar. The parents of VLBWIs had higher scores for financial burden, familial/social impact, personal strain, and mastery (P < .0001). The parents of VLBWIs experienced more impact when children had a functional handicap or low adaptive developmental quotient. Scores were highest when the adaptive developmental quotient was 70 to 85. High scores were associated with low family income and less parental education. Impact did not change over time. Only half of the parents in each group felt that "doctors should try to save every baby." The parents of VLBWIs felt more strongly that cost should never enter into the decision to treat a tiny baby (P < .005). The families of VLBWIs expressed a stronger desire for more children (P < .01), but control families were more likely to have given birth again (46.3% vs 28.2%). CONCLUSIONS: The birth and upbringing of a VLBWI is associated with more long-term stress, even for well-educated nuclear families whose health care is financed by government. Caregivers need increased awareness of the needs of these families so that their medical and social needs are met effectively. Support services should be targeted toward low income, poorly educated parents whose children have functional handicaps.

Adaptation, Psychological↗
PubMed2006

Maternal panic disorder and congenital abnormalities: a population-based case-control study.

BACKGROUND: Maternal panic disorder in pregnancy is the most common manifestation of anxiety disorders in Hungary. The association between panic disorder during pregnancy and structural birth defects, i.e., congenital abnormalities, was studied. METHODS: The prevalence of maternal panic disorder in cases with different congenital abnormalities was compared to that of matched controls in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities. RESULTS: Of 22,843 cases with congenital abnormalities, 210 (0.9%) had mothers with panic disorder during pregnancy compared to 187 (0.5%) of 38,151 controls (adjusted prevalence odds ratio [POR] 1.6; 95% CI, 1.3-2.0). Specific groups of congenital abnormalities were also assessed versus controls. Cases with isolated cleft lip with or without cleft palate (CL/P) (adjusted POR, 3.4; 95% CI, 1.3-9.0) and multiple congenital abnormalities (adjusted POR, 3.0; 95% CI, 1.2-7.2) were more likely to have had mothers with panic disorder during the study pregnancy. Notably, among mothers with panic disorders, the associations were found only in offspring of untreated mothers. CONCLUSIONS: A higher rate of isolated CL/P and multiple congenital abnormalities may be caused by the direct biological effect of panic disorder or by the interaction of maternal panic disorder and lifestyle factors. Antipanic drug treatment seems to have a protective effect for isolated CL/P and multiple congenital abnormalities. Birth Defects Research (Part A), 2006.

Abnormalities, Multiple↗
PubMed2001

[Breast feeding in Tromsö before and after the baby-friendly-hospital initiative].

BACKGROUND: "The-Baby-Friendly Hospital Initiative" was introduced in the early 1990s by WHO/UNICEF to reverse a declining trend in breastfeeding worldwide. We wanted to investigate factors influencing breastfeeding and whether this initiative, introduced between 1993 and 1996, had improved breastfeeding in our region, Tromsø, a mid-sized city in northern Norway. MATERIAL AND METHODS: Medical records at maternal and child health centres of 1,374 infants born 1992 (n = 653) and 1997 (n = 721) were studied. The number of mothers breastfeeding, duration of lactation, parents' age, their occupation and education, maternal marital status and parity were registered. RESULTS: In a multiple regression analysis, birth, year 1997, high parental level of education/occupational prestige, and higher maternal age significantly prolonged the total period of breastfeeding. Parental age, education/occupation, the number of women starting breastfeeding, the duration of exclusive breastfeeding and the total lactation period significantly increased from 1992 to 1997. When correcting for parental age and education/occupation in a multiple regression analysis we found an increase in exclusive breastfeeding and the total lactation period by 0.5 month (mean (95% CI)) 0.5 (0.2-0.8) and 1.1 month (0.6-1.5) respectively. INTERPRETATION: This improvement might be due to "the Baby-Friendly Hospital Initiative", but also to unknown factors.

Attitude to Health↗