Psychosocial factors, lifestyle, and fetal growth: the added value of both pre- and post-natal assessments

BACKGROUND: Psychosocial resources as well as lifestyle habits during pregnancy have been shown to effect the risk of having a small-for-gestational-age (SGA) child. Most previous studies are based on a single assessment of these exposures, which does not take into account the possibility of different effects during early and late stages of pregnancy. METHODS: The impact of psychosocial and lifestyle factors on the risk of giving birth to an SGA child (as measured by ultrasound) was examined among 747 nulliparous Swedish women who completed both a prenatal baseline, and a post-partum assessment. RESULTS: Those registering low social participation on both assessments showed increased risk of giving birth to an SGA infant (OR = 2.44 and 95% CI: 1.06-5.66), while at one assessment (OR = 1.70 and 95% CI: 0.74-3.91). Maternal smoking confirmed by both or one assessments yielded an OR = 2.72 and 95% CI: 1.37-5.39 and OR = 1.60 and 95% CI: 0.58-4.46, respectively. During early pregnancy, poor instrumental support, maternal smoking, or passive smoking yielded increased risks of SGA, adjusted for confounding (OR = 2.39 and 95% CI: 1.11-5.17; OR = 2.38 and 95% CI: 1.27-4.49; OR = 2.92 and 95% CI: 1.17-7.32, respectively). In late pregnancy, only maternal smoking yielded a significant association (OR = 2.34 and 95% CI: 1.24-4.41). CONCLUSION: Scheduling repeated assessments of psychosocial resources and lifestyle factors during pregnancy yielded additional information. The findings suggest that there can be differential effects of such exposures depending on gestational stage. This information is of importance when designing appropriate intervention strategies for maternal health services as well as for public health relevant policy formulation (e.g. regarding exposure to environmental tobacco during pregnancy).     

Intergenerational and environmental factors influencing pregnancy outcomes

PURPOSE: Factors that relate to the mother's own course of growth and development might influence later reproductive performances. This study examines the effect of maternal birth weight and maternal height and maternal weight gain, on term-small for gestational age (SGA) and preterm delivery.METHODS: Data used for this study were from the South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) and birth certificate files for 1993-1995. Since PRAMS data were weighted to adjust for sampling probabilities, non-response and survey design, Survey Data Analysis (SUDAAN) software was used in all analyses.RESULTS: Maternal birth weight was strongly associated with term SGA (OR = 3.65; 95% CI = 1.83-7.29), but not preterm delivery among black mothers; it was associated with preterm delivery (OR = 1.86; 95% CI = 1.09-3.17), but not term-SGA for white mothers. Maternal birth weight was associated with term SGA among nonsmokers only (OR = 2.34; 95% CI = 1.33-4.11). Maternal weight gain modified the effect of height on birth outcomes. Among women with inadequate weight gain, there was a 3-fold increase in risk for term-SGA (OR = 3.06; 95% CI = 2.41-3.89) for short maternal height, but not for preterm delivery. Among women with adequate plus weight gain, the association between short maternal height and term-SGA was 2.7 (95% CI = 0.55-9.43) compared to 3.67 (95% CI = 0.1.41-9.56) between short maternal height and preterm delivery. Maternal weight gain also modified the effect of maternal height on both outcomes for black mothers and for nonsmokers only.CONCLUSIONS: Findings indicate the need for interventions directed to those women who can benefit most from appropriate targeted weight gain recommendations. Therefore, prevention methods should be implemented to encourage short stature women to gain adequate weight during pregnancy.     

Maternal ethnicity and pre-eclampsia in New York City, 1995-2003

Studies on ethnic differences in the risk of pre-eclampsia are limited. We linked birth records for 902,460 singleton births for the period 1995-2003 in New York City with hospital discharge data to evaluate the association between ethnicity and the risk of pre-eclampsia and compare risks between US-born and foreign-born women. Logistic regression models adjusted for maternal age, maternal education, parity, self-reported pre-pregnancy maternal weight, smoking during pregnancy and year of delivery were used to compare each ethnic group with non-Hispanic White women. The prevalence of pre-eclampsia in this study population was 3.2%. Among the major ethnic groups considered in our study, East Asian women had the lowest risk of pre-eclampsia (1.4%) and Mexican women had the highest risk (5.0%). Compared with non-Hispanic White women, there was a slightly decreased risk for East Asian women (adjusted OR = 0.8, [95% CI 0.7, 0.8]), similar risk for North African women (adjusted OR = 1.1, [95% CI 0.9, 1.3]), and increased risk for all other major ethnic groups (adjusted ORs: 1.3, 2.9), with the highest risk for Mexican women (adjusted OR = 2.9, [95% CI 2.7, 3.1]). No difference in risks was observed for US- vs. foreign-born women with the exception that foreign-born South-East Asian and Pacific Islanders had an increased risk of pre-eclampsia (adjusted OR = 1.8, [95% CI 1.0, 3.1]) relative to those born in the US. We concluded that there was ethnic heterogeneity in the development of pre-eclampsia among women in New York City and that Asian subgroups should be examined separately in future studies on ethnicity. Our results should contribute to screening for pre-eclampsia taking ethnic variation into account, and may help to suggest leads for the study of the aetiology of the condition.     

Maternal occupation and adverse pregnancy outcomes: a Finnish population-based study

BACKGROUND: There is accumulating evidence that the type of work and environmental exposures in the working environment may have adverse effects on foetal development. AIM: To compare the risk of low birth weight (LBW), small-for-gestational age (SGA) and pre-term delivery (PD) in broad categories of maternal occupation including farming and forestry; factory, mining and construction; office, non-manual and service work and housewives. METHODS: The study population consisted of 2568 singleton newborns of women who participated in The Finnish Prenatal Environment and Health Study after the delivery (response rate 94%). Information on maternal occupation and work during pregnancy was collected after the delivery. The health outcomes were LBW (<2500 g), SGA and PD (<37 weeks). RESULTS: In newborns of women working in factories, mining and construction, the risk of LBW (adjusted odds ratio [OR] 3.66, 95% confidence interval [CI] 1.15-11.62), SGA (adjusted OR 1.53, 95% CI 0.73-3.21), but not the risk of PD (adjusted OR 0.64, 95% CI 0.19-2.22), was higher compared with newborns of housewives. In newborns of farmers and forestry workers, the risks of PD (adjusted OR 2.38, 95% CI 1.01-5.65), LBW (adjusted OR 2.86, 95% CI 0.78-11.58) and SGA (adjusted OR 1.51, 95% CI 0.62-3.65) were all elevated. In office, non-manual and service workers, the corresponding estimates were lower (LBW: 1.62, 0.67-3.95; SGA: 1.45, 0.92-2.28; PD: 1.18, 0.69-2.01). CONCLUSIONS: There were substantial differences in the risk of adverse pregnancy outcomes between the main branches of industry.     

Perinatal risk factors for infantile autism

BACKGROUND: Etiologic hypotheses in infantile autism suggest a strong genetic component, as well as possible environmental risks linked to early fetal development. We evaluated the association of maternal, pregnancy, delivery, and infant characteristics and risk of infantile autism. METHODS: We conducted a case-control study nested within a population-based cohort (all Swedish children born in 1974-1993). We used prospectively recorded data from the Swedish Birth Register, which were individually linked to the Swedish Inpatient Register. Cases were 408 children (321 boys and 87 girls) discharged with a main diagnosis of infantile autism from any hospital in Sweden before 10 years of age in the period 1987-1994, plus 2,040 matched controls. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The risk of autism was associated with daily smoking in early pregnancy (OR = 1.4; CI = 1.1-1.8), maternal birth outside Europe and North America (OR = 3.0; CI = 1.7-5.2), cesarean delivery (OR = 1.6; CI = 1.1-2.3), being small for gestational age (SGA; OR = 2.1; CI = 1.1-3.9), a 5-minute Apgar score below 7 (OR = 3.2, CI = 1.2-8.2), and congenital malformations (OR = 1.8, CI = 1.1-3.1). No association was found between autism and head circumference, maternal diabetes, being a twin, or season of birth. CONCLUSIONS: Our findings suggest that intrauterine and neonatal factors related to deviant intrauterine growth or fetal distress are important in the pathogenesis of autism.     

Determinants of Small for Gestational Age Birth at Term

Background: Being born small for gestational age (SGA) is an indicator of intrauterine growth restriction (IUGR) and later health risks. This study investigated determinants of severe and moderate SGA (respectively, birthweight <3rd percentile and 3rd to <10th percentile for gestational age and sex). Methods: A total of 2195 term pregnancies from a prospective cohort were studied. Prenatal data arose from maternal interview at 10–22 weeks of gestation and perinatal data were collected from hospital charts. Severe and moderate SGA were classified by Canadian population standards. Risk factors for SGA were identified from fitting multivariable logistic regression models. Results: Multivariable associations with severe SGA were: maternal age ≥ 35 [odds ratio (OR) 3.2 [95% confidence interval (CI) 1.4, 6.9]], maternal smoking during pregnancy (OR 5.3 [95% CI 2.4, 11.7]), preeclampsia (OR 4.6 [95% CI 1.6, 13.2]) and threatened preterm labour (OR 3.9 [95% CI 1.3, 11.4]). Primiparity was associated with both severe and moderate SGA with OR 2.4 [95% CI 1.1, 5.1] and OR 1.9 [95% CI 1.3, 2.9] respectively. Underweight pre‐pregnancy body mass index was associated with moderate SGA (OR 2.4 [95% CI 1.2, 5.0]). Inclusion of placental weight, in the final model attenuated the associations. Conclusions: This study demonstrated different determinants for severe and moderate SGA. We speculate that the majority of severe SGA infants are IUGR while moderate SGA infants may be a mixture of IUGR and constitutionally small newborns. This study has also contributed evidence linking preterm labour and SGA as two, potentially related, outcomes of overlapping causal mechanisms reflective of ischaemic placental disease.     

Risk factors for early infant mortality in Sarlahi district, Nepal

OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies. METHODS: Over the period 1994-97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR = 1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). CONCLUSION: Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy.     

母亲出生体重与新生儿出生体重的关系研究

目的 探讨母亲出生体重与新生儿出生体重的关系,以便为研究母亲宫内发育不良对子代发育的影响提供线索。方法 通过巢式病例对照研究,采用多重线性回归分析了解母亲出生体重与新生儿出生体重的关系,并以非条件Logistic回归分析进一步探讨母亲出生体重对小于胎龄儿（small for gestational age,SGA）、大于胎龄儿（large for gestational age,LGA）的影响。结果 SGA的发生率为7.04%,LGA发生率为14.65%。多重线性回归分析结果显示,母亲出生体重与新生儿出生体重呈正相关,母亲出生体重每增加1 kg,新生儿出生体重增加174 g（β=0.174,95% CI:0.134~0.213）。随母亲出生体重的增加,SGA发生率递减（χ_趋势2=13.791,P<0.001）,LGA的发生率递增（χ_趋势2=7.900,P=0.005）,母亲低出生体重（<2 500 g）是SGA的危险因素（OR=2.458,95% CI:1.333~4.534）;以孕期增重分层分析后,结论一致,但出生体重较低的孕妇（＜2 500 g）孕期增重不足会导致SGA发生风险增高。结论 孕妇出生体重低是分娩SGA的危险因素,随着孕妇出生体重增加,新生儿出生体重增大,但未发现LGA与孕妇出生体重有关。     

Association of periconceptional multivitamin use and risk of preterm or small-for-gestational-age births

The authors' objective was to determine the relation between periconceptional multivitamin use and the risk of small-for-gestational-age (SGA: <5th percentile; 5th-<10th percentiles) or preterm (<34 weeks; 34-<37 weeks) births. Women in the Pregnancy Exposures and Preeclampsia Prevention Study (1997-2001) reported at enrollment their regular multivitamin use in the past 6 months (n=1,823). Women were classified as users or nonusers in multinomial logistic models. After adjustment for race, age, education, enrollment gestational age, and household density, periconceptional multivitamin use was associated with a reduced risk of preterm births (<34 weeks) (odds ratio (OR)=0.29, 95% confidence interval (CI): 0.13, 0.64) and spontaneous preterm births (<34 weeks) (OR=0.40, 95% CI: 0.16, 0.99). Risk of SGA (<5th percentile) was marginally lower (OR=0.64, 95% CI: 0.40, 1.03) after adjustment for smoking, education, parity, enrollment gestational age, and body mass index. Prepregnancy body mass index modified this relation. Nonobese users had a reduction (OR=0.54, 95% CI: 0.32, 0.91) in risk of SGA (<5th percentile); there was no effect among obese women. There was no effect of multivitamin use on risk of preterm births (34-<37 weeks) or SGA (5th-<10th percentiles). Sensitivity analysis for unmeasured confounding by folate intake supported these findings. Study results indicate lower rates of severe preterm births and extreme SGA in women who report periconceptional vitamin use, although these should be considered cautiously until replicated.     

Socioeconomic health inequalities in Latvia: a cross-sectional study

AIMS: Socioeconomic health differences have been studied elaborately for many Western societies. Relatively little is know about the social variations in health in the former communist states of Eastern Europe. This study investigated socioeconomic health inequalities in Latvia. METHODS: Cross-sectional analysis was undertaken of the 1999 Norbalt-II Living Conditions Survey, a random population-based sample in Latvia, and included males and females aged 25 to 70. RESULTS: Lower educated subjects had higher rates of self-assessed poor health than those with tertiary education (men OR 2.21; 1.31-3.71 95% CI, and women OR 2.48; 1.74-3.54 95% CI). After adjusting for income, educational differences were significant only for women. Income differences were larger than educational differences in self-assessed poor health for both genders (OR of highest vs. lowest quintile for men: 5.10; 2.26-11.5 95% CI, women: OR 3.26; 1.92-5.51 95% CI). For long-standing health problems socioeconomic differences were smaller. After adjusting for income no educational differences were found, but income differences were significant (men: OR 2.06; 1.15-3.69 95% CI, women: OR 1.42; 1.12-2.63 95% CI). The economically non-active were in worse health than the (self-)employed subjects (men: OR 6.12; 3.65-10.3 95% CI, women: OR 2.79; 1.66-3.39 95% CI). CONCLUSIONS: Substantial social inequalities in self-assessed poor health and longstanding health problems exist in Latvia for both sexes. Inequalities by material circumstances, as measured by income, appear to be larger than educational differences. Economic activity was also strongly associated with health. There were no inequalities with regard to urbanization and ethnic differences were found only for long-standing health problems among women.     

Suboptimal maternal vitamin D status and low education level as determinants of small-for-gestational-age birth weight

Purpose

This study aimed firstly to investigate the contribution of maternal 25(OH) vitamin D to the association of maternal education and small-for-gestational-age birth weight (SGA) and secondly to examine whether the contribution of 25(OH) vitamin D differs by overweight, season, and maternal smoking.

Methods

Logistic regression analysis was carried out in this study, using data of 2,274 pregnant women of Dutch ethnicity from the ABCD study, a population-based cohort study in the Netherlands. Maternal 25(OH) vitamin D was measured in early pregnancy. Stratified analyses were conducted for overweight, season of blood sampling, and smoking.

Results

Low-educated women had lower 25(OH) vitamin D levels compared to high-educated women, and women in the lowest 25(OH) vitamin D quartile had a higher risk of SGA offspring. In addition, low-educated women had a higher risk of SGA offspring (OR 1.95 [95% CI: 1.20–3.14]). This association decreased with 7% after adjustment for 25(OH) vitamin D (OR 1.88 [95% CI 1.16–3.04]). In stratified analyses, adjustment for 25(OH) vitamin D resulted in a decrease in OR of about 17% in overweight women and about 15% in women who conceived in wintertime.

Conclusions

25(OH) vitamin D appears to be a modifiable contributor to the association between low maternal education and SGA offspring, particularly in overweight women and women who conceived in the winter period. In those women, increasing the intake of vitamin D, either through dietary adaptation or through supplementation in order to achieve the recommendation, could be beneficial.     

孕期HBV感染及肝内胆汁淤积症对小于胎龄儿与低出生体重的交互影响

  目的  探讨妊娠期乙型肝炎病毒（hepatitis B virus，HBV）感染及肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）对小于胎龄儿（small for gestational age infant，SGA）与低出生体重儿（low birth weight infant，LBW）发生风险的影响，并分析其交互效应。  方法  以2017年1月~2018年4月在某三甲医院建卡就诊并在本院分娩的孕妇为研究对象，采用化学发光法测定孕妇外周血乙型肝炎表面抗原（hepatitis B surface antigen，HBsAg）及总胆汁酸。以Logistic回归模型分析HBV感染及ICP孕妇发生不良妊娠结局的风险，用相乘与相加模型分析其交互作用。  结果  在控制混杂因素后，与正常孕妇相比，孕期仅感染HBV或仅患有ICP均不增加SGA与LBW的发生风险，但孕期HBV感染合并ICP使未足月SGA和LBW的发生风险分别增加了76%（OR=1.76，95%CI:1.16~2.65，P=0.007）与85%（OR=1.85，95%CI:1.44~2.38，P<0.001）；孕期HBV感染与ICP对未足月SGA[RERI（95%CI）=6.54（0.14~12.94），AP（95% CI）=0.90%（0.68%~1.13%），S（95% CI）=7.03（1.38~42.64）]和LBW[RERI（95%CI）=5.69（0.48~10.90），AP（95%CI）=0.76%（0.55%~0.97%），S（95%CI）=8.02（1.92~33.43）]存在相乘与相加的交互作用，其发生风险分别是两因素单独存在风险之和的7.03倍和8.02倍。  结论  妊娠期HBV感染合并ICP增加了未足月SGA和LBW的发生风险，怀孕后积极防治HBV感染与ICP可降低SGA和LBW的出生。     

Area deprivation and trends in inequalities in self-rated health in Spain, 1987--2001

AIMS: This study examined the impact that individual social position and municipal area deprivation levels had on trends in inequalities in self-rated health in Spain, between 1987 and 2001. METHODS: The study was based on cross-sectional data of the National Health Surveys of Spain for the years 1987, 1993, 1995, 1997, and 2001 (n=84,567). The indicators used were educational level and occupational class, and deprivation level as the indicator of municipal areas. Multilevel logistic regression models were made, with individuals nested into municipal areas. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. To evaluate trends, the relative index of inequality was calculated. RESULTS: At the individual level, the likelihood of less-than-good health between those with no formal education as compared to those with graduate-level education increased from OR=2.66 (95% CI: 2.06-3.38) in 1987 to OR=3.62 (95% CI: 2.95-4.63) in 2001 among women. The values for men were OR=2.27 (95% CI: 1.89-2.72) and OR=2.94 (95% CI: 2.36-3.68) respectively. Living in areas with the highest deprivation levels as compared to the lowest systematically increased the likelihood of less-than-good health. The likelihood of reporting less-than-good health among women with no formal education as compared to women with graduate-level education in municipal areas with the highest deprivation levels increased from OR=3.61 (95% CI: 2.39-5.45) in 1987 to 4.85 (95% CI: 3.06-7.69) in 2001. Among men, the corresponding magnitudes were OR=2.07 (95% CI: 1.39-3.08) and OR=4.16 (95% CI: 2.52-6.89). CONCLUSIONS: Inequalities in self-rated health increased in Spain in this period. These inequalities may be explained by the social conditions existing throughout the period of reference, and the pattern varies according to gender, municipal area deprivation levels, and the individual indicator of social position used.     

Contraceptive and reproductive risk factors for cervical intraepithelial neoplasia in American Indian women

OBJECTIVES: To evaluate contraceptive and reproductive risk factors for cervical intraepithelial neoplasia (CIN) in southwestern American Indian women. METHODS: We conducted a clinic-based case-control study. Cases were American Indian women with biopsy-proven CIN I, CIN II or CIN III. Controls were from the same clinics and had normal cervical epithelium. All subjects underwent structured interviews focused on contraceptive and reproductive factors. Laboratory assays included polymerase chain reaction (PCR)-based tests for cervical human papillomavirus (HPV) infection. RESULTS: We enrolled 628 women in the study. The strongest risk factors for CIN II/III included HPV infection (adjusted odds ratio [OR] = 7.9, 95% CI : 4.7-13.2), and low income (OR = 3.1, 95% CI : 1.7-5.7). The use of an intrauterine device (IUD) ever (OR = 3.0, 95% CI : 1.4-6.1) and currently (OR = 4.1, 95% CI : 1.1-14.6), and > or = 3 vaginal deliveries (OR = 5.2, 95% CI : 2.4-11.1) were associated with CIN II/III. History of infertility was also associated with CIN II/III (OR = 2.1, 95% CI : 1.0-4.2). CONCLUSIONS: The data suggest that history of infertility, IUD use and vaginal deliveries were associated with CIN among American Indian women.     

Education, socioeconomic status and risk of cancer of the colon and rectum.

BACKGROUND: Socioeconomic correlates of cancer of the large bowel differ in various countries and calendar periods and may differ for the colon and rectum. Thus, the relationship between education and social class and risk of cancers of the colon and rectum was considered. METHODS: Combination of two hospital-based case-control studies conducted in six Italian centres between 1985 and 1996. Cases were 3533 patients aged < 79, with histologically confirmed cancer of the colon (n = 2180) or rectum (n = 1353), and controls were 7062 patients admitted to hospital for a wide spectrum of acute, non-neoplastic, non-digestive tract diseases. RESULTS: Compared to individuals with < 7 years of education the multivariate odds ratios (OR) of colon cancer for those with > or = 16 years were 2.45 (95% confidence interval [CI]: 1.87-3.23) in men and 1.29 (95% CI: 0.88-1.90) in women, with significant trends in risk. No significant association emerged between education and risk of rectal cancer, with OR of 1.18 (95% CI: 0.83-1.70) and 1.01 (95% CI: 0.61-1.67) respectively for men and women in the highest educational category compared to the lowest. Social class was also related to colon cancer risk: the OR were 2.30 (95% CI: 1.82-2.90) in men and 1.33 (95% CI: 1.03-1.73) in women in the highest versus the lowest social class. No association was found between social class and rectal cancer risk, with OR of 1.18 for either men or women in the highest as compared to the lowest social class. No significant heterogeneity was found for the association between education and colon cancer risk in either sex across strata of age at diagnosis, coffee, alcohol and vegetable intake, family history of the disease, and in anatomical subsites within the colon. CONCLUSION: This study, based on a uniquely large dataset, indicates that there are different social class correlates for colon and rectal cancer. Consequently the two sites should not be combined in studies considering lifestyle factors in the aetiology of these neoplasms.     

Regional variation and time trends in mortality from ischaemic heart disease: East and West Germany 10 years after reunification

STUDY OBJECTIVE: Within Europe, a pronounced geographical gradient of mortality from ischaemic heart disease has been observed with the highest burden in the north east and the lowest in the south west. The study objective was to compare mortality from ischaemic heart disease between former East and West Germany since reunification. DESIGN: Analyses of age standardised mortality rates from ischaemic heart disease (ICD-9 410-414, ICD-10 I20-I25) between 1990-1991 and 2000. SETTING: Former East and West Germany. MAIN RESULTS: After a peak in the early 1990s, mortality from ischaemic heart disease has substantially declined in both parts of Germany (from 222 to 169 per 100 000 in the East and from 150 to 116 per 100 000 in the West). The regional difference, however, remained rather constant: the rate ratio between the pooled mortality in the East compared with the West was 1.51 (95% CI 1.46 to 1.56) in 1991 and 1.45 (95% CI 1.39 to 1.50) in 2000. These rate ratios were higher in women (1.63 in 1991 and 1.52 in 2000) compared with men (1.45 and 1.44, respectively). CONCLUSIONS: Within Germany, there has been a pronounced east-west gradient of mortality from ischaemic heart disease since reunification. Further insight into possible underlying reasons may lead to improved preventive strategies.     

A case-control study of maternal alcohol consumption and intrauterine growth retardation

PURPOSE: Heavy maternal drinking during pregnancy causes fetal alcohol syndrome, but whether more moderate alcohol consumption is associated with such adverse pregnancy outcomes as intrauterine growth retardation (IUGR) remains controversial. METHODS: Using data from a case-control study, we examined the association between maternal alcohol consumption and risk for IUGR among 701 case and 336 control infants born during 1993-1995 in Monroe County, New York. RESULTS: Our results provide no evidence of an independent association between moderate maternal alcohol consumption (<14 drinks per week) and risk for IUGR. The risk for IUGR among heavy drinkers (> or =14 drinks per week) around the time of conception was OR = 1.4 (95% CI 0.7-2.6) for IUGR < or = 5th percentile and OR = 1.4 (95% CI 0.7-2.8) for IUGR 5th-10th percentile. For heavy drinkers during the first trimester, the OR was 1.3 (95% CI 0.4-4.5) for IUGR < or = 5th percentile and OR = 1.3 (95% CI 0.4-4.8) for IUGR 5th-10th percentile. CONCLUSIONS: Since IUGR is a heterogeneous outcome with a possible multifactorial origin, further studies are needed to examine the combined effects of alcohol and other environmental and genetic factors on IUGR risk for subgroups of IUGR.     

0～1岁婴儿母亲喂养焦虑情绪的影响因素研究

目的 探讨影响母亲喂养焦虑情绪的因素,为科学指导产妇预防、缓解喂养焦虑情绪提供依据。方法 以0～1岁婴儿及其母亲为研究对象。问卷调查母亲和婴儿的基本信息,《0～1岁婴儿母亲喂养焦虑情绪评价量表》评价母亲的喂养焦虑情绪,应用非条件logistic回归分析影响母亲产生喂养焦虑情绪的因素。结果 调查对象喂养焦虑阳性率为45.25%。母亲的文化程度（OR = 0.46, 95%CI: 0.22～0.97）、产检次数 (OR = 0.88, 95%CI: 0.79～0.99)和身高 (OR = 0.95, 95%CI: 0.91～0.99)与喂养焦虑情绪显著相关,但身高对母亲产生喂养焦虑情绪的影响较小。结论 母亲喂养焦虑情况不容乐观,母亲的文化程度和产检次数是影响母亲喂养焦虑情绪的主要因素。     

Influenza vaccination coverage in adults belonging to defined target groups, Germany, 2003/2004

In 2003, a nationwide cross-sectional study was conducted to assess the current influenza vaccination coverage of the adult population of Germany, especially in persons belonging to defined target groups. Of 666 surveyed persons, 190 (adjusted 24%) had received influenza vaccination and 419 participants belonged to at least one target group. Of those, 28% (95% confidence interval (CI) 22-35%) in former West Germany and 45% (95% CI 38-52%) in former East Germany had received influenza vaccination. The offer for vaccination by a physician was associated with a high likelihood for vaccination (odds ratio (OR) 19.0; 95% CI 8.9-40.6). Another important factor influencing vaccination uptake was having received influenza vaccination in prior seasons (OR 7.1; 95% CI 3.8-13.2). Vaccination coverage in the adult population of Germany remains unsatisfactory. Physicians have an important role and should be targeted for campaigns to offer the vaccination more frequently in particular to persons belonging to target groups.