Effects of in vitro fertilization on low birth weight, preterm delivery, and multiple birth

PURPOSE: To quantify the contribution of in vitro fertilization (IVF) on changes in the rates of low birth weight (LBW), preterm delivery, very low birth weight, and multiple births during the past 3 years. METHODS: Data on IVF pregnancies from 1994 to 1996 within Alberta were reviewed. Population data were obtained from the Provincial notice of a live or stillbirth. RESULTS: The IVF component of increased LBW rate in the province was 17.8% for infants <2500 g and 43.5% for those born <1500 g. IVF accounted for 10.5% of the provincial rate increase in deliveries <37 weeks' gestation and 66.2% of those <30 weeks' gestation. IVF accounted for 21.4% of the twins and all of the sets of triplets in the province. CONCLUSION: During a 3-year period IVF has affected the incidence of LBW, preterm delivery, and multiple birth. IVF is a substantial contributor to changes in very low birth weight and delivery before 30 weeks, which is partly related to multiple births.     

Low birthweight in Hausa infants

As infants with low birth weights (LBWs) constitute a group in need of specialized care, the problems of LBW among the Hausas of Nigeria were evaluated. The case records of all liveborn infants of Hausa parents, born at the Maternity Hospital in Katsina, Nigeria between January 1, 1974 and December 31, 1977, were selected for study. The LBW infants i.e., those weighing 2500 g or below were separated, their characteristics studied, and possible etiological factors identified. A comparison of this group was then made with those neonates who weighed more than 2500 g. The duration of gestation was determined from the menstrual history and by appropriate clinical examination before delivery. As data were not considered to be very reliable, no attempt was made to correlate the birth weights with duration of pregnancy. Infants born before the 37th week of pregnancy were labeled as premature. During the study period, 3890 live Hausa infants (2111 males and 1779 females) were born to 3780 mothers. Of these 3890 infants, 408 males and 420 females weighed 2500 g or less. These 828 infants were born to 774 mothers and included 91 sets of twins and 5 sets of triplets though the outcome of all multiple pregnancies were not live births. The maternal age ranged from 13-45 years. The parity ranged from 0-14 but there were more primigravida compared to other parities. All mothers belonged to lower and middle socioeconomic classes. 70% were urban and 30% were rural. The incidence of LBW was 213/1000 live births or 21.3%. 71.1% of these babies weighed between 2000 g and 2500 g; only 1.6% weighed less than 1000 g. The percentage of females among LBW infants was higher (50.7%) as compared to that of males (49.3%). The incidence of LBW was 19.3% among males and 23.6% among females. The monthly and seasonal incidence of LBW was uniform and no seasonal variation could be found. The incidence of LBW was 18.4% among urban women and 23.4% among rural women. The difference was highly significant. The highest percentage of deaths in the present study occurred among infants weighing less than 1000 g and the immediate neonatal death rate declined in each successive higher weight group, exhibiting a strong relationship between LBW and immediate neonatal mortality. Only 1 child died out of 589 who weighed between 2001-2500 g.     

Factors associated with low birth weight in Tunisian Sahel

The aim of this study, which was carried out in the area of Monastir from September 1st to December 31, 1989 was to evaluate the incidence of and to identify the factors associated with low birth weight (LBW). The results showed that LBW neonates make up 7.6% (n = 413) of the 5,419 live births, 57.4% of which being small for dates at term. 48% of prematures also had intra-uterine growth retardation. The average LBW was 1,913 +/- 497 g (20% of the LBW neonates had a weight below 1,500 g). Factors associated with LBW were: extreme ages of the mothers, illiteracy, working class, previous history of stillbirth or death before 1 year of age, abnormal issue of the previous pregnancy, multiple pregnancies, insufficient medical supervision and prenatal care, congenital malformations in the child. Improvement in prenatal care and adequate monitoring of at risk pregnancies might decrease the occurrence of LBW in this Tunisian area.     

Low birthweight in Riyadh, Saudi Arabia: incidence and risk factors.

In a multicentre prospective study, we have determined the incidence of low birthweight (LBW) and the main predisposing risk factors. Among 4651 consecutive births over a 5-month period in five hospitals in Riyadh, the overall incidence of LBW was 8.4%. When stillbirths were excluded the incidence of LBW was 7.4% of all live births. Statistical analysis was performed among 638 births (319 LBW infants, i.e. less than or equal to 2499 g and 319 babies weighing 2500 g or more). Of the 28 antenatal risk variables analysed, 13 were found to be significant when studied separately. Of these 13 variables, six were found to be significant predictors of LBW, using stepwise multiple logistic regression. These six variables together correctly predicted 72% and 88% of the LBW babies or normal birthweight babies, respectively. The risk factors thus identified were (i) short gestation, (ii) multiple gestation, (iii) low maternal body mass index, (iv) nulliparity, (v) availability of housework help, and (vi) absence of consanguinity. Measures for reducing these factors are also discussed.     

Macrosomic newborns: a 3-year review

The objective of this study was to determine the incidence, perinatal complications and the outcome of macrosomic infants. A retrospective analysis was made of macrosomic deliveries and of those admitted into the Neonatology Unit. A control group of 854 deliveries weighing between 2500-4000 g was randomly composed. The incidence of macrosomic deliveries, stillbirth rates, sex, parity, maternal age, mode of delivery, perinatal complications like birth traumas, hypoglycemia, polycythemia, asphyxia, admission rate into the neonatal intensive care unit (NICU), and outcome were analyzed. Among a total of 11,827 deliveries, 829 (7%) were macrosomic neonates. Statistical analysis showed male predominance (p = 0.0001), a significant increase in cesarean section (p = 0.0001), and higher parity for the macrosomic group (p = 0.0001). The mothers of macrosomic newborns were older (p = 0.0001). The admission frequency of macrosomic deliveries into the NICU was almost two-fold. Birth injuries were found in 53 (6.4%) macrosomic infants, and macrosomic deliveries had a two-fold risk for birth injuries. Statistical analysis showed a significant difference between macrosomics and the control group for the frequency of birth traumas (p = 0.0007), hypoglycemia (p = 0.0001) and polycythemia (p = 0.0006). There were two deaths in macrosomic group versus one among control cases. Regarding the high birth trauma and NICU admission rates of macrosomic infants, it is important to emphasize the significance of prenatal diagnosis of fetal macrosomia and of management of these high-risk pregnancies in tertiary level hospitals.     

Risk factors for low birth weight in Nepali infants

A detailed information on a total of 448 consecutive Nepali births which occurred between January 1, 1985 and December 31, 1994 was collected from the birth registers of the Khasi-Jaintia Presbetyrian Synod Hospital of Shillong, Meghalaya. After the exclusion of still and twin births, and the cases of missing information of birth weight, 418 single live births were considered to find out the distribution of birth weight and the risk factors of low birth weight (LBW) among the Nepali babies of this state. The incidence of LBW was 21.53%. The results of univariate analysis revealed that sex, maternal age, parity, gestation period, economic condition and maternal education were significantly related to the incidence of LBW. Multiple logistic regression analysis revealed that all the above mentioned factors had independent risk for LBW except the economic condition and father’s education. Thus, the present results suggest conducting further studies among other ethnic groups of North-East India to understand the problem of LBW at the population level which may help to formulate an effective maternal and child health care program in this region.     

Low birthweight and mortality in Australian Aboriginal babies at the Royal Darwin Hospital: a 15 year study

A retrospective analysis was made of all births at the Royal Darwin Hospital from 1 January 1969 to 31 December 1983. The births were divided into weight categories and racial groups (Aboriginal and non-Aboriginal). The study showed that there was a 23.2% incidence of low birthweight (LBW) babies (less than 2500 g) in Aboriginals compared with an incidence of 6.4% in non-Aboriginals. It was found that Aboriginals had a better chance of surviving the neonatal periods than non-Aboriginals of the same birthweight for all birthweights up to 2500 g. It is suggested that this occurred because most LBW Aboriginals were more mature than their birthweight would have suggested. The perinatal and neonatal mortality, however, remains high in the Aboriginal babies and this can also be attributed to the high incidence of LBW babies in this group, and perhaps to the limited use of antenatal care by the Aboriginal mothers.     

Low birthweight and mortality in Australian Aboriginal babies at the Royal Darwin Hospital: A 15 year study

Abstract A retrospective analysis was made of all births at the Royal Darwin Hospital from 1 January 1969 to 31 December 1983. The births were divided into weight categories and racial groups (Aboriginal and non-Aboriginal).
The study showed that there was a 23.2% incidence of low birthweight (LBW) babies (less than 2500 g) in Aboriginals compared with an incidence of 6.4% in non-Aboriginals. It was found that Aboriginals had a better chance of surviving the neonatal periods than non-Aboriginals of the same birthweight for all birthweights up to 2500 g. It is suggested that this occurred because most LBW Aboriginals were more mature than their birthweight would have suggested.
The perinatal and neonatal mortality, however, remains high in the Aboriginal babies and this can also be attributed to the high incidence of LBW babies in this group, and perhaps to the limited use of antenatal care by the Aboriginal mothers.     

Residential environmental tobacco smoke exposure during pregnancy and low birth weight of neonates: Case control study in a public hospital in Lucknow, India

Objective

To determine whether residential environmental tobacco smoke (ETS) exposure during pregnancy is associated with low birth weight (LBW) neonates and establish a dose response relationship.

Design

Case control study.

Setting

Tertiary care hospital.

Methodology

Mothers giving birth to LBW neonate (<2.5 kg) were cases and those whose neonates weighed ≥2.5 kg at birth were controls. Excluded were women smokers and tobacco chewers, high parity (>3), multiple pregnancy and still births. Included were 100 cases and 200 controls, aged 20 to 30 years. Information was collected on ETS exposure and other risk factors of LBW within 24 hours of delivery. Clinical information like maternal haemoglobin levels, birth weight and gestational age of the neonate was extracted from hospital records.

Results

On univariate analysis, preterm pregnancy, low socioeconomic status, previous LBW neonate, no utilization of antenatal care (ANC), severe anemia and ETS exposure were statistically significantly associated with LBW neonate and controlling for these in logistic regression analysis, adjusted Odds ratio for ETS exposure association with LBW neonate was 3.16 (95% CI=1.88–5.28). A dose response relationship was also found which was statistically significant (10–20 cigarettes smoked/day: OR = 4.06, 95% CI=1.78–9.26 and >20 cigarettes smoked/day, OR = 17.62, 95% CI= 3.76–82.43).

Conclusion

Exposure to ETS during pregnancy is associated with LBW of neonates. Hence, there is an urgent need to increase awareness about health hazards of ETS during pregnancy and bring about behavioural changes accordingly as a one of the strategies to reduce LBW deliveries in India.     

Septicaemia and meningitis in neonates and during early infancy in the Göteborg area of Sweden

In a retrospective study of neonatal septicaemia and meningitis carried out in 1987–1996 in the Göteborg area of Sweden, 305 cases during the first 28 d of life were found. The incidence was 3.7/1000 live births, which was higher than that found in a study from 1975 to 1986 in the same area, 2.8/1000 live births. The most common pathogens were group B streptococci, aerobic Gram‐negative rods, Staphylococcus aureus and enterococci. The cases were approximately equally divided between very early, early and late onset infections. The case‐fatality rate was lower in the present study (9%) than that in the previous study (15%). The case‐fatality rate varied between 23% in neonates with a gestational age of ≤29 wk and 3% in full‐term neonates. Eighty‐three very late onset infections occurred between days 28 and 120 after birth, corresponding to an incidence of 1.0/1000 live births. Of those, 47 occurred in preterm neonates. The most common organisms were aerobic Gram‐negative rods. Coagulase‐negative staphylococci (CoNS) were studied separately. This organism was isolated in 60 and 32 cases during the first 28 d of life and between days 28 and 120, respectively, in neonates fulfilling the criteria of the Yale‐New Haven Hospital for infections caused by commensal species. The incidence rates of CoNS infections were 0.7 and 0.4/1000 live births, respectively. Conclusion: The incidence of neonatal infections increased and the case‐fatality rate decreased in the Göteborg area compared to the findings of a previous study. Very late onset infections should be added to the total burden of neonatal infections. CoNS are important pathogens but their role is difficult to determine since they are both pathogens and contaminants of cultures from blood and cerebrospinal fluid.     

The rise of multiple births in Brazil

AIM: The aim of this study was to assess the rise in multiple births and its influence on trends of low birth weight (LBW) rates in Porto Alegre, Brazil. METHODS: This is a registry-based study of live births from 1994 to 2005 obtained from the national live birth information system. Chi-square tests for trends were assessed for LBW and multiple birth rates. The impact of multiple births on LBW trends was assessed by sequential modelling, including year and further adjustment for multiple births. Risk factors for multiple births were assessed using the Poisson regression. RESULTS: A total of 263 252 live births were studied. The LBW rate increased from 9.70% to 9.88% (p < 0.001) and the multiple birth rate rose from 1.95% to 2.53% (p < 0.001). LBW rate increased among twins, from 57.14% to 63.46% (p = 0.001). The twin birth rate rose by 24.7%, while the rate of triplets or higher-order increased by 150%. Multiple births may be responsible for 23.9% of the increase in the LBW rate over the period. Mothers with higher levels of schooling, older mothers and mothers delivering in private hospitals were more likely to deliver multiple births. CONCLUSIONS: It seems that both the increase in multiple births and in the LBW among multiple births contributed to this rise in overall LBW rate.     

A study of low birth weight infants in a teaching hospital

Summary The incidence of LBW was 29.5 per cent among 1261 live births seen during a period of 17 months in a teaching hospital of Kanpur. Birth weight of less than 2000 G. was recorded by us with a much higher frequency than that observed by other workers. Of the various aetiological factors studied, parity and maternal disease had a highly significant relationship with LBW while the influence of maternal age was also found to be significant. Religion, sex, and nature of delivery had no association with LBW. Among LBW infants, a high mortality (57.2 per cent) was observed within the first week of life. From the Department of Social and Preventive Medicine, L.L.R.M. Medical College, Meerut.     

Risk factors and outcomes associated with low birthweight delivery in the Australian Capital Territory 1989-90

: The objectives of this study were to describe outcomes of low birthweight (LBW; >2500g) babies born in the Australian Capital Territory (ACT) and to identify risk factors associated with LBW in the ACT. A cohort study was conducted involving all births recorded in the ACT Maternal and Perinatal Data Collection sets for 1989-90.
Status at discharge is presented for 9373 births each weighing more than 499 g born in the ACT in 1989 and 1990, classified by birthweight. Other outcomes are given for live births (n = 9309) only. Adjusted odds ratios for significant risk factors for LBW are given for 9084 singleton births whose computer records contained all relevant information.
Perinatal mortality rates for LBW babies are consistent with other States, apart from 500-999 and 1500-1999g babies which have higher rates. Eighteen per cent of LBW babies are transferred to other hospitals. Low birthweight babies are more likely than normal birthweight babies to have 1 and 5 min Apgar scores less than 7, to need resuscitation and to take more than 5 min to establish respiration. Risk of LBW is associated with maternal primiparity, age 35 years or more in primiparous women, history of one or more spontaneous abortions, induced abortions or perinatal deaths, chronic illness, public health insurance and single marital status, and with fetal female sex and congenital anomalies.
Babies born weighing less than 2500 g in the ACT have more adverse outcomes and are much more likely to be transferred than normal birthweight babies. Modifiable risk factors for LBW relate to lower maternal socio-economic status. Measures to decrease the incidence of LBW and its subsequent costs will have greatest gains in this group of women.     

Neonatal group B streptococcal infection at the University Hospital of the West Indies, Jamaica: a 10-year experience

AIM: To describe the incidence, clinical presentation and outcome of neonatal group B streptococcal (GBS) infection at the University Hospital of the West Indies (UHWI). METHODS: A 10-year retrospective review of all inborn neonates admitted to the neonatal unit of UHWI with GBS infection between 1 January 1991 and 31 December 2000 was conducted. Differences in maternal and neonatal characteristics between early- and late-onset disease (EOD, LOD) were determined. RESULTS: There were 32,029 live births and 29 neonates were admitted for GBS infection, an incidence of 0.91/1000 live births (95% CI 0.58-1.23/1000). Twenty-one (72%) neonates had EOD, a rate of 0.66/1000 live births (95% CI 0.38-0.94/1000) and eight (28%) had LOD, a rate of 0.23/1000 (95% CI 0.08-0.42/1000). Seventeen of the 21 (81%) cases of EOD occurred within the 1st 24 hours of life. The most common clinical diagnosis was septicaemia (17, 61%), followed by pneumonia (8, 28%) and meningitis (3, 11%). All five (100%) babies whose mothers' membranes were ruptured for >18 hours had EOD. The babies of all six (100%) women with intrapartum pyrexia went on to have EOD. A greater proportion of babies (63%) with LOD were preterm and of low birthweight. The most common presenting symptom was respiratory distress which occurred more frequently in neonates with EOD, p=0.006. One neonate died, giving a case fatality rate of 3.6%. CONCLUSION: Although the incidence of GBS infection is relatively low at UHWI, further reduction in the incidence might be achieved by implementation of measures to prevent perinatal transmission.     

Incidence and spectrum of congenital heart disease in Oman

We analysed the incidence and spectrum of congenital heart disease (CHD) in the Sultanate of Oman from 1994 to 1996. CHD was detected in 992 of 139,707 live births (incidence 7.1/1000 live births). The common CHDs were ventricular septal defect (24.9%), atrial septal defect (14.4%) and patent ductus arteriosus (10.3%). The frequency of atrioventricular septal defects (5.9%) was higher than reported from other countries. Age at diagnosis was under 1 month in 38% and 1-12 months in 40%. Cyanotic CHD was found in 21.7% of the whole group and 35% of neonates. Although this was a hospital-based study, we believe we included almost all the infants and children with CHD in the country. The incidence and pattern of CHD in Oman were similar to those reported from developed countries in Europe and America, except for a higher frequency of atrioventricular septal defects. The high prevalence of consanguinity in the country did not affect the overall incidence of CHD.     

The impact of neonatal mortality on subsequent survival in rural Ethiopia

In countries where most deliveries occur at home and most available information is hospital-based, accurate information on neonatal mortality is difficult to obtain. This study was conducted in a rural community in Ethiopia that has been under monthly demographic surveillance since 1987. The analysis in this paper was based on data collected in the 1st decade (1987-96) and this database was used to calculate mortality incidence rates and analyse survival. The overall neonatal mortality rate was 27/1000 live births (95% CI 24.5-29.5). The rates in the early and late neonatal periods were 20 and 8/1000 live births, respectively (95% CIs 18.0-22.9 and 6.6-9.4). The mortality incidence rates show that, every day, three of every 1000 newborns die in their 1st week of life. Neonatal mortality accounted for 43% of infant mortality. If all neonates survived the 1st week of life, life expectancy would increase by 1 year. Increased risk of neonatal mortality was found to be associated with living in a rural lowland area, twin births and male gender. This paper also addresses the need for further identification of the complex environmental and behavioural risk factors for neonatal mortality and for instituting appropriate and affordable interventions to reduce neonatal mortality.     

A study of twin births in Jabalpur City

Summary A study to find the occurrence of twin birth was taken up at Jabalpur city, Madhya Pradesh. A total of 43,652 deliveries were studied, covering the period from 1960 to 1969. The frequency of twinning was found to be 0.87 per cent. A majority (87.5 per cent) of the mothers was Hindus. The maximum number of mothers who gave birth to twins belonged to the age group of 21·30 years (59.88 per cent) and the next highest frequency was in the age group of 30–40 years (27.6 per cent). The incidence of twinning was found to increase from the 3rd parity and the highest incidence was in the 6th para. The sex ratio showed a higher incidence of male births than female births. The average weight of the twins was 2.0 kg. The birth weight was more in male infants than in females. A very high mortality was found among twins; 104 per 1000 died within 24 hours after birth and 170.5 per 1000 died within the 1st week of birth. Only 3 couples had a family history of twinning. From the Department of Preventive and Social Medicine, Medical College, Jabalpur.     

Occurrence of supernumerary nipples in newborns

A prospective study on supernumerary nipples (SNNs) was performed on 1,691 consecutively born neonates. We used a new technique for easier routine detection of SNNs. The incidence of this anomaly was one per 40 or 25 per 1,000 live births. Association of other congenital abnormalities with SNNs was not found.     

Coagulase negative staphylococcal septicemia in newborns

A retrospective analysis of 254 newborns having blood cultures positive for coagulase negative staphylococci (CONS), and admitted in the neonatal unit of a Rural Medical College Hospital over a period of five years, was done for various clinical and perinatal characteristics as well as antimicrobial sensitivity profile of isolates. Of them, 118 (46.5%) neonates had clinical evidence of sepsis with CONS as the only growth in blood culture, and were designated as having CONS septicemia. Majority of them were delivered in this hospital itself and by normal vaginal delivery. Preterms and LBW babies constituted 23.7 and 59.4% of total cases, respectively. Other high risk perinatal factors for infection were present in 66.1% cases. Approximately two third of these cases developed sepsis within first three days of life. Early onset sepsis was more frequently seen in neonates with history of assisted delivery or perinatal asphyxia. Overall mortality in these cases was 15.6%, being significantly higher in offspring of outside deliveries and normal vaginal deliveries, in preterm and LBW babies and slightly higher in presence of birth asphyxia. Only 15.3% CONS isolates were resistant to all routinely used antibiotics and sensitivity was maximum with gentamicin followed by ampicillin. A difference in sensitivity pattern of CONS causing EOS and LOS was also recorded.     

Low birthweight in an urban community in Nigeria

Six thousand, one hundred and thirty-five consecutive live births in six major health centres in the city of Ibadan were studied between September 1982 and March 1983 in order to assess the incidence, distribution and causes of low birthweight (LBW) in an urban community in Nigeria. Of the 6135 live births, 504 (8.2%) were of LBW. Two hundred and thirty-six (62%) of the LBW were small-for-gestational-age (SGA), while 146 (38%) were appropriate-for-gestational-age (AGA). Two hundred and five (87%) of the SGA were term while 115 (79%) of the AGA infants were preterm. Multiple pregnancy was an important cause of LBW, occurring in 4.4% of pregnancies. One hundred and forty-six (2.6%) of the 5631 infants who weighed 2500 g or over and 122 (24.2%) of the LBW infants were products of multiple pregnancy (P less than 0.001). The young (less than 20 years), short statured (less than 155 cm) and primigravid mothers were more likely than the others to give birth to LBW infants (P less than 0.001). Of the obstetric and medical factors examined, pre-eclamptic toxaemia (PET) (P less than 0.01), ante-partum haemorrhage (APH) (P less than 0.01) and anaemia (P less than 0.02) significantly increased the risk of LBW. Pre-eclamptic toxaemia, eclampsia, hypertension and renal diseases tended to be associated with SGA while APH and anaemia were found more often with prematurity. Multiple pregnancy contributed equally to the delivery of preterm and growth-retarded infants. Although no obvious cause could be identified in about two-thirds of the cases, pre-conceptional maternal malnutrition and poor diet in pregnancy might play an important role.