Education Outcomes of Children Born Late Preterm: A Retrospective Whole-Population Cohort Study

Maternal and Child Health Journal - Early life exposures can have an impact on a child’s developmental trajectory and children born late preterm (34–36 weeks gestational age)...     

The influence of adolescent mothers' breastfeeding confidence and attitudes on breastfeeding initiation and duration

A prospective correlational study was conducted to examine the influence of adolescent mothers' breastfeeding attitudes and confidence on breastfeeding initiation and duration. A convenience sample of 100 pregnant adolescents who were contemplating breastfeeding completed the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) and the Breastfeeding Attitude Questionnaire (BAQ). The BSES-SF was readministered during the first week postpartum to those adolescents who initiated breastfeeding (n=84). Adolescents who were breastfeeding at the initial contact received a follow-up contact at 4 weeks postpartum. Comparisons were made between those adolescent mothers who initiated breastfeeding (n=84) and those who did not (n=16). Significantly more mothers with higher prenatal attitude scores initiated breastfeeding. Mothers with higher prenatal breastfeeding attitude scores and higher prenatal and postnatal confidence scores were more likely to continue breastfeeding to 4 weeks postpartum. Health professionals are encouraged to develop strategies to enhance breastfeeding attitudes and confidence among adolescent mothers.     

Examining Early Childhood Health Outcomes of Children Born Late Preterm in Urban Manitoba

Objective The late preterm population [34–36 weeks gestational age (GA)] is known to incur increased morbidity in the infancy stage compared to the population born at term (39–41 weeks GA). This study aimed to examine the health of these children during their early childhood years, with specific attention to the role of socioeconomic status. Methods A retrospective cohort study was conducted using data from the Manitoba Centre for Health Policy, including all live-born children born at 34–36 and 39–41 weeks GA in urban Manitoba between 2000 and 2005 (n?=?28,100). Multivariable logistic regression was used to examine the association of GA with early childhood morbidity after controlling for maternal, child and family level variables. Results The late preterm population was found to have significantly greater adjusted odds of lower respiratory tract infections in the preschool years (aOR?=?1.59 [1.24, 2.04]) and asthma at school age (aOR?=?1.33 [1.18, 1.47]) compared to the population born at term. The groups also differed in health care utilization at ages 4 (aOR?=?1.19 [1.06,1.34]) and 7 years (aOR?=?1.24 [1.09, 1.42]). Additional variables associated with poor outcomes suggest that social deprivation and GA simultaneously have a negative impact on early childhood development. Conclusions for Practice Adjustment for predictors of poor early childhood development, including socioeconomic status, were found to attenuate but not eliminate health differences between children born late preterm and children born at term. Poorer health outcomes that extend into childhood have implications for practice at the population level and suggest a need for further follow-up post discharge.     

Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery

OBJECTIVE: This study was undertaken to assess the safety of trial of labor after previous cesarean delivery. STUDY DESIGN: Retrospective cohort study of 308,755 Canadian women with previous cesarean delivery between 1988 and 2000. Occurrences of in-hospital maternal death, uterine rupture, and other severe maternal morbidity were compared between women with a trial of labor and those with an elective cesarean section. RESULTS: Rates of uterine rupture (0.65%), transfusion (0.19%), and hysterectomy (0.10%) were significantly higher in the trial-of-labor group. Maternal in-hospital death rate, however, was lower in the trial-of-labor group (1.6 per 100,000) than in the elective cesarean section group (5.6 per 100,000). The association between trial of labor and uterine rupture was stronger in low volume (<500) than in high volume (> or =500 births per year) obstetric units. CONCLUSION: Trial of labor is associated with increased risk of uterine rupture, but elective cesarean section may increase the risk of maternal death.     

Conducting a national survey of women's perinatal experiences in Canada: sampling challenges

In 1999, the Canadian Perinatal Surveillance System of Health Canada decided to undertake a national survey of Canadian women's experiences of their pregnancy, birth and postpartum care. The challenges encountered in selecting a representative sampling frame and developing a sound methodology for conducting a survey of Canadian women at six months after birth are addressed. We considered the advantages and disadvantages of six different sampling options. A sample based on the Census emerged as the optimal approach for providing the most reliable and representative sample.