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Causes of low birth weight births in public and private patients.

This examination of the cause of low birth weight births in two model populations, one of public and one of private patients, finds significant differences in the reasons for low birth weight births in the two groups. Idiopathic premature labor was related to 47.1% of private low birth weight births, but only 24.8% of public births; low birth weight term (26.7%) and premature rupture of fetal membranes (33.7%) were more common in public low birth weight births than in private births (13.8% and 23.0%, respectively). Medical problems were related to 16.1% of private and 14.9% of public low birth weight births. Since current prematurity prevention methods are most likely to prevent low birth weight births related to idiopathic premature labor, the relative success of such programs in reducing the rate of low birth weight births is likely to depend on the characteristics of the patient population to which the programs are directed.

Ethnicity↗

Breed effects and heterosis in advanced generations of composite populations for birth weight, birth date, dystocia, and survival as traits of dam in beef cattle.

Heterosis effects were evaluated as traits of the dam in F2 progeny of F1 dams and F3 and 4 progeny of F2 and 3 dams in three composite populations of beef cattle. Traits included birth weight, birth date, calving difficulty percentage, and survival percentage at birth, 72 h, and weaning for calves with dams of different age classes. Breed effects were evaluated for the nine parental breeds (Red Poll [R], Hereford [H], Angus [A], Limousin [L], Braunvieh [B], Pinzgauer [P], Gelbvieh [G], Simmental [S], and Charolais [C]) that contributed to the three composite populations (MARC I = 1/4 C, 1/4 B, 1/4 L, 1/4 H, 1/8 A; MARC II = 1/4 G, 1/4 S, 1/4 H, 1/4 A; and MARC III = 1/4 R, 1/4 P, 1/4 H, 1/4 A). Among calves with 2-yr-old dams, breed effects were significant for birth weight, birth date, calving difficulty percentage, and survival percentage at birth but not at 72 h and weaning. Calf survival at weaning was lowest for smallest (less than mu - 1.5 sigma) and largest (greater than mu + 1.5 sigma) birth weight classes and did not differ among intermediate birth weight classes. Calves with difficult births with 2-yr-old dams were significantly heavier at birth (39.6 vs 35.4 kg) and had significantly lower survival at 72 h (87.1 vs 92.2%) and at weaning (77.4 vs 85.1%) than calves with 2-yr-old dams that did not experience difficult births. Among calves with dams greater than or equal to 3 yr old and from dams of all ages, breed group effects generally were significant for the traits analyzed. Important breed group effects on dystocia and survival traits were observed independent of breed group effects on birth weight. Effects of heterosis were significant for birth weight for each generation of each composite population and for the mean of the three composite populations. Generally, heterosis effects for calving difficulty percentage were not significant. Effects of heterosis generally were significant for date of birth (earlier) for each composite population and for the mean of the three composite populations. Heterosis effects on survival to weaning percentage generally were positive but generally were not significant. Heterosis retained for birth weight, birth date, and survival percentage in combined F3 and 4 generation progeny of combined F2 and 3 generation dams did not differ (P greater than .05) from expectation based on retained heterozygosity. These results support the hypothesis that heterosis in cattle for these traits is the result of dominance effects of genes.

Analysis of Variance↗

Inverse association between birth weight, birth length and serum total cholesterol in adulthood.

OBJECTIVES: To investigate whether impaired fetal growth, measured by low birth weight and short birth length, is linked with raised levels of serum lipids and increased risk and mortality of coronary heart disease. DESIGN: The association between birth length, birth weight, Ponderal Index and total serum cholesterol was examined in 545 Danish men and women aged 31 to 51 years who participated in the Ebeltoft Health Promotion Project in Denmark. RESULTS: No associations were found in women. For men, a negative association was found between birth weight and serum total cholesterol, with a fall in mean serum total cholesterol from 6.03 mmol/l at birth weight below 3300 g to 5.64 mmol/l at birth weight above 4000. A similar association was found between birth length and serum cholesterol, with a mean value of 6.23 mmol/l at birth length below 51 cm and a mean value of 5.56 mmol/l at birth length above 54 cm. No associations were found for Ponderal Index. Between 3% and 8% of the variance in serum total cholesterol could be explained by the statistical models used in this study. CONCLUSION: Our findings support the hypothesis of a negative association between birth weight, birth length and elevated serum cholesterol in adult life, but only in men.

Adult↗

Reference values for the weight of freshly delivered term placentas and for placental weight-birth weight ratios.

BACKGROUND: There is evidence for a correlation between placental weight and future chronic disease, notably hypertension and diabetes. However, there are no reference scales for placentas that are readily weighed in the delivery room. METHODS: This cross-sectional study generated reference values for the weight of freshly delivered untrimmed placentas, and placental weight-birth weight (pw/bw) ratios from a database of 11,141 uncomplicated singleton term pregnancies (37-42 weeks). The data analysis followed stringent validated and state of the art methodological recommendations. A regression model was fitted to estimate the mean and standard deviation for placental weight and pw/bw ratios at each week of gestational age. RESULTS: Reference scales, percentile tables and regression equations are presented for placental weights according to the mode of delivery and for pw/bw ratios. Mean placental weight from vaginal deliveries was 76 g lighter than from Caesarean sections (545+/-107 g versus 621+/-139 g, respectively, P<0.05). Mean placental weight increased by 60 g from 37 to 42 weeks irrespective of the mode of delivery. The pw/bw ratio decreased from 17.6 to 15.6 between 37 and 42 weeks. CONCLUSION: For the first time, reference values for freshly delivered term placental weights depending on the mode of delivery were generated. In the light of growing evidence for a correlation of placental weight with chronic diseases in later life, these values provide the possibility to judge placentas at site for abnormalities in weight and to estimate the potential risks for chronic diseases in later life.

Birth Weight↗

A randomized trial of nurse intervention to reduce preterm and low birth weight births.

OBJECTIVE: To test the effect of telephone calls from registered nurses to low-income pregnant women on the rates of low birth weight (LBW) and preterm births. METHODS: A total of 1554 women receiving prenatal care in a public clinic who met study criteria and who consented were assigned randomly to intervention and control groups. Women in the intervention group received telephone calls from a registered nurse, one or two times weekly from 24 weeks' through 37 weeks' gestation. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. RESULTS: Low birth weight rates were 10.9% in the intervention group and 14.0% in the control group (RR 0.75; 95% CI 0.55, 1.03; P = .072). For gestational age less than 37 weeks, rates were 9.7 in the intervention group and 11.0 in the control group (RR .87; 95% CI 0.62, 1.22; P = .415). In the subgroup of low-income black women 19 years of age and older, a statistically significant difference was found in preterm birth rates before 37 weeks (8.7% in the intervention group versus 15.4% in the controls [RR 0.56; 95% CI 0.38, 0.84; P = .004]). CONCLUSION: There was no difference in LBW or preterm births between intervention and control groups in the total sample. In a secondary analysis of black subjects 19 years of age and older, there was a significant difference in preterm birth rates.

Adolescent↗

Effect of opening midlevel neonatal intensive care units on the location of low birth weight births in California.

OBJECTIVE: Despite evidence and recommendations encouraging the delivery of high-risk newborns in hospitals with subspecialty or high-level NICUs, increasing numbers are being delivered in other facilities. Causes for this are unknown. We sought to explore the impact of diffusion of specialty or midlevel NICUs on the types of hospitals in which low birth weight newborns are born. DESIGN: We used birth certificate, death certificate, and hospital discharge data for essentially all low birth weight, singleton California newborns born between 1993 and 2000. We identified areas likely to have been affected by the opening of a new nearby midlevel unit, analyzed changes over time in the share of births that took place in midlevel NICU hospitals, and compared patterns in areas that were and were not likely affected by the opening of a new midlevel unit. We also tracked the corresponding changes in the share of births in high-level hospitals and in those without NICU facilities (low-level). RESULTS: The probability of a 500- to 1499-g infant being born in a midlevel unit increased by 17 percentage points after the opening of a new nearby unit. More than three quarters of this increase was accounted for by reductions in the probability of birth in a hospital with a high-level unit (-15 points), and the other portion was resulting from reductions in the share of newborns delivered in hospitals with low-level centers (-2 points). Similar patterns were observed in 1500- to 2499-g newborns. CONCLUSIONS: The introduction of new midlevel units was associated with significant shifts of births from both high-level and low-level hospitals to midlevel hospitals. In areas in which new midlevel units opened, the majority of the increase in midlevel deliveries was attributable to shifts from high-level unit births. Continued proliferation of midlevel units should be carefully assessed.

Adult↗

Relation of cord serum levels of growth hormone, insulin-like growth factors, insulin-like growth factor binding proteins, leptin, and interleukin-6 with birth weight, birth length, and head circumference in term and preterm neonates.

OBJECTIVES: Fetal growth process is governed by multiple factors. We investigated the relation of insulin-like growth factors (IGFs), IGF binding proteins (IGFBPs), leptin, and interleukin-6 (IL-6) with intrauterine growth in preterm and term neonates. METHODS: Thirty-eight preterm and 43 term neonates were recruited. Anthropometric measures were recorded and umbilical cord blood samples were collected at birth. RESULTS: Birth weight (BW), birth length (BL), ponderal index, head circumference (HC), and cord serum levels of albumin, prealbumin, retinol-binding protein (RBP), total and free IGF-I, IGF-II, IGFBP-3, acid-labile subunit (ALS), and leptin were significantly lower, whereas levels of IGFBP-1, IGFBP-2, and IL-6 were significantly higher in preterm than in term neonates (P < 0.05). Total and free IGF-I, ALS, and leptin had significantly positive correlations, whereas IGFBP-2 had a significantly negative correlation, with BW and BL in preterm plus term neonates. Forward stepwise multivariate regression analysis showed that gestational age (GA), IGFBP-2, leptin, and free IGF-I are significant predictors of BW; GA, IGFBP-2, ALS, transferrin, and leptin are significant predictors of BL; and GA and free IGF-I are significant predictors of HC in preterm and term neonates. CONCLUSIONS: Our results suggest that IGF-I, IGF-II, IGFBP-2, ALS, and leptin play important roles in intrauterine growth.

Anthropometry↗

Birth weight, birth length, and bone density in prepubertal children: evidence for an association that may be mediated by genetic factors.

There is an incomplete understanding of the contribution of early growth to bone accrual in childhood. The aims of this longitudinal study were to examine the association between growth variables at birth, 1 month, and 8 years and bone density in prepubertal children. Weight and length at both birth and 1 month of age were measured in 1988 as part of a prospective study for sudden infant death syndrome. A total of 330 children (47%) and 278 of their mothers were then contacted in 1996 for measurement of anthropometrics and bone density. Birth weight, birth length, and length gain (but not weight gain) in the first month all made significant contributions to areal bone density (BMD, g/cm(2)) at all sites at age 8 even after taking into account subsequent weight and height gain (model R(2) 14-39% depending on variable and site). Adjustment for potential environmental confounders did not alter these findings, however, adjustment for maternal BMD markedly reduced the early life associations (particularly for birth weight). Though early life factors were weakly associated with bone mineral apparent density (BMAD, g/cm(3)) in correlation analysis, subsequent height and weight gain were the only significant independent contributors to BMAD. In conclusion, early life anthropometrics make little contribution to BMAD (other than through their correlation with later growth) but make significant independent contributions to BMD suggesting that the growth trajectory of bone is determined very early in life. In addition, the contribution of body size at birth to bone growth in early life appears to be mediated by genetic factors although it is possible that it may be mediated by poorly measured or as yet unidentified determinants of body size at birth.

Absorptiometry, Photon↗

Changes in birth weight, birth length and head circumference of Hungarian children in the county Baranya between 1968 and 1979-1981.

Possible secular changes of newborn's body measurements were investigated in a cross-sectional growth study in the County Baranya (South Hungary) in 1979-1981. The total sample includes 2,130 children. The results were compared with those obtained by Fekete et al. (1968, 1974) in the same region on 3,567 neonates. During the 12-years interval the birth weight increased slightly. The head circumference did not change in girls, but decreased slightly in boys. The birth length values could not be evaluated because of technical reasons. According to the present results secular changes in the body measurements of the newborns could not be seen during the investigated period. The fetal growth standard values ascertained by Fekete et al. (1968, 1974) are still suitable. A repeated anthropometric investigation of newborns is necessary in the near future.

Birth Weight↗

Very low birth weight births at non-NICU hospitals: the role of sociodemographic, perinatal, and geographic factors.

PURPOSE: The purpose of this study was to assess the extent of variation in the percentage of very low birth weight (VLBW) infants born at perinatal Level 1 hospitals (no Neonatal Intensive Care Unit [NICU]) across California's nine geographic Perinatal regions. The role of sociodemographic, perinatal, and geographic factors was also assessed. METHODS: Multivariate analysis of California birth certificate files between 1989 and 1993, for 24,094 live-born infants weighing between 500 and 1499 gm, was conducted to identify factors associated with delivery at a Level 1 hospital. Analyses specific for race and ethnicity were also conducted for Hispanic, African American, and white cohorts. RESULTS: In the 5-year study period, 1989 through 1993, 10.5% (24,094) of all live-born VLBW infants were delivered in Level 1 hospitals. Significant variation across regions was evident, ranging from a regional low of 3.1% to a high of 24.3%. After controlling for multiple factors, the odds of delivering at a Level 1 hospital were decreased for African Americans and South East Asians and increased in Hispanic women as compared with white non-Hispanic women. For all women, less then adequate prenatal care, living in a 50% to 75% urban zip code, and living greater then 25 miles from the nearest NICU significantly increased the odds of VLBW delivery at a Level 1 hospital. For Hispanics, teen pregnancy and having two or more prior infant deaths increased the odds, whereas Medi-Cal as the payer source for delivery and two or more pregnancy complications decreased the odds of a Level 1 VLBW delivery. After taking these factors into account, when compared with Los Angeles, the odds of inappropriate delivery site ranged from 0.37 to 2.75 across California's nine geographic perinatal regions. Of this variation, 78% could be accounted for by the percentage of total births that delivered at a region's Level 1 hospitals. CONCLUSION: The overall state average of 10.5% deliveries of VLBW at Level 1 hospitals, although close to the 10% national objective for the year 2000, did not indicate the wide variation seen across California's nine geographic regions. Risk-adjusted regional differences in the likelihood of inappropriate delivery site for the high-risk VLBW infants suggest that reaching the Healthy People 2000 objective will require further strengthening of California's perinatal regional networks, especially in those regions where a high percentage of total births deliver at Level 1 hospitals.

California↗

Is periodontitis associated with an increased risk of coronary heart disease and preterm and/or low birth weight births?

The objective of this systematic review was to determine whether periodontal disease is associated with an increased risk for coronary heart disease (CHD) and preterm and/or low birth weight deliveries (PLBW). A literature search was performed to identify cross-sectional, case-control, and cohort studies as well as clinical trials addressing different aspects of periodontal disease (clinical, microbial, immunological) and clinical outcomes of CHD or PLBW. The periodontitis-CHD association was evaluated in eight cohort, four case-control- and four cross-sectional studies. Meta-analysis was not performed due to the extensive heterogeneity of the studies, particularly with regard to periodontitis measures, which varied from full mouth probing assessments to questionnaires. Percentage-wise, 50% of the cohort studies (4/8), 75% of the case-control studies (3/4) and 50% of the cross-sectional studies (2/4) reported a significant association between clinical measures of periodontitis and CHD (excess risk ranged from 0 to 3.3-fold). The periodontitis-PLBW association was evaluated in one cohort and two case-control studies. The cohort study as well as one of the two case-control studies reported a significant association between periodontitis and PLBW (odds ratios 4.4-7.9). From two additional case-control studies microbiological data could be extracted. Bacteroides forsythus was found to be associated with PLBW in both studies. In conclusion, the evidence linking periodontitis with an increased risk for CHD and PLBW is limited. There is a clear need for new, well designed observational and intervention studies to confirm the thus far observed associations, explore the validity of the associations in diverse populations, establish whether they are causal in nature and determine potential benefits of periodontal intervention in reducing the risk for these conditions.

Coronary Disease↗

Influence of increased survival in very low birth weight, low birth weight, and normal birth weight infants on the incidence of sudden infant death syndrome in the United States: 1985-1991.

OBJECTIVE: To examine the relationship between infant survival and the rates sudden infant death syndrome (SIDS) in very low birth weight (VLBW), low birth weight (LBW), and normal birth weight (NBW) infants from 1985 to 1991. METHODS: The National Center for Health Statistics Birth Cohort Linked Birth/Infant Death Data Sets were used to determine birth weight, age at death, and cause of death for US-born singleton infants with birth weights of 500 g or more. RESULTS: Increasing infant and postneonatal survival rates were greatest in VLBW infants. In contrast, SIDS rates did not change in VLBW infants (3.66 to 3.69; P = .70) but declined in both LBW (3.51 to 3.32; P = .041) and NBW (1.07 to 1.03; P = .008) infants. Postneonatal SIDS rates (per 1000 neonatal survivors) did not change in VLBW (4.93 to 4.58; P = .58) or LBW (3.36 to 3.22; P = .07) infants but declined in NBW infants (1.00 to 0.97; P = .018). Although there were differences among the slopes of survival rates, there was no statistical evidence of differences in the slope of SIDS rates among the three groups. CONCLUSIONS: The marked increase in survival of VLBW infants increased the pool of babies at potential risk for SIDS. VLBW infants' SIDS rates have not changed while they have declined in NBW and LBW infants.

Birth Weight↗

Poor agreement between self-reported birth weight and birth weight from original records in adult women.

Data from an ongoing prospective population study of women in Göteborg, Sweden, were used to assess agreement between self-reported birth weight and birth weight obtained from original delivery records of women aged 44-60 years. Of the eligible population with traced delivery records (n = 693), only 28% (n = 192) could report their own birth weight. Spearman correlation between self-reported birth weight and birth weight from original records was r = 0.76. However, a difference plot, with limits of agreement at -1,028 to 1,038 g (95% confidence limits: lower limit, -1,157 to -901 g, upper limit, 910 to 1,166 g) revealed poor agreement between methods. Of the self-reported birth weights, 53% were in error by 250 g or more, and 31% were positively or negatively discordant by 500 g or more. Application in an analysis of cardiovascular risk factors in adulthood found conflicting results between self-reported and recorded birth weights. Low reporting rate, poor reporting accuracy, and misleading findings in application led to the conclusion that self-reported birth weights from middle-aged women would not be a satisfactory replacement for birth weights from original records.

Adult↗