Descriptive epidemiology of hemivertebrae, Hawaii, 1986-2002

The intent of this study was to report on the epidemiology of hemivertebrae. Cases were derived from a population-based birth defects registry in Hawaii and comprised all infants and fetuses with hemivertebrae delivered during 1986-2002. Hemivertebrae rates per 10 000 births were determined for selected factors and comparisons made by calculating the rate ratio (RR) and 95% confidence interval (CI). Forty-two cases of hemivertebrae were identified, for a total rate of 1.33. Forty-one of the cases were live births, of which 26.83% expired within one year after delivery. Other major structural birth defects were found in 95.24% of the cases. The most frequent associated defect was scoliosis, affecting 54.76% of the cases. The rate among females was significantly lower than among males (RR 0.48, 95% CI 0.23-0.94). The rate was lower with maternal age > or =35 years (RR 0.50, 95% CI 0.10-1.57) and higher with birth weight < 2500 g (RR 5.96, 95% CI 2.84-11.90) and gestational age < 38 weeks (RR 3.94, 95% CI 2.01-7.64). The majority of hemivertebrae cases had other major structural birth defects. Hemivertebrae occurred predominantly among males and risk was lower with increased maternal age. Rates for hemivertebrae were higher with lower birth weight and gestational age. Further population-based research involving larger study populations are recommended to confirm these observations.     

Early child health in Lahore, Pakistan: II. Inbreeding

The prevalence of consanguineous marriages was studied in 940 families belonging to four different socio-economic groups in and around Lahore, Pakistan. The births occurring in these families from September 1984 to March 1987 were also investigated for birth defects. The overall prevalence of consanguineous marriages was 46%. The first cousin marriages were most common (67%), followed by the marriages between second cousins, 19%. The prevalence of consanguineous marriages was clearly associated with the socio-economic status of the study groups; 50% of the marriages was related in the periurban slum, 49% in the village, 44% in the urban slum and 31% in the upper middle class. The birth defects were also more prevalent in the poorer areas, being highest in the periurban slum (17.7%) followed by the urban slum (15.6%) and then the village (14.8%) and lowest in the upper middle class (12.3%). Although, the frequency of both consanguinity and birth defects were related with the socio-economic levels of the study groups, there was no association between inbreeding and birth defects. Perhaps, deleterious recessive genes for birth defects have been "bred out", because of continuous inbreeding over generations in this population. There was a significant predilection of major birth defects in boys without clear sex linkage. The conclusion is that the rate of consanguineous marriages was high, especially in the poorer areas, but the relationship between consanguineous marriages and birth defects was little or none. However, other child health indicators may be affected by consanguineous marriages.     

OUTCOME OF TWIN BIRTH Review of 1636 Children Born in Twin Birth

Abstract. During the five-year period 1964–68 96733 births were registered in the 28 hospitals equipped with maternity facilities in the Uppsala hospital region. Of these babies, 1636 were born in 818 twin deliveries. Data on gestational age, sex, weight and length at birth, birth order, hospital type, congenital malformations and perinatal mortality are analysed. Altogether 17.3 per 1000 of the children born during this period were born in multiple births. The perinatal mortality for the twin babies was 64 per 1000 born, with the mortality higher in the less specialized hospitals than the others. Twin no. 1 suffered perinatal death in 67 cases per 1000 and twin no. 2 in 60 cases per 1000. For twins of primiparae the losses were 92 per 1000 children and for twins born to multiparae 51 per 1000. Altogether 72 per 1000 male twins died perinatally compared to 52 per 1000 female twins. The most heavy losses occurred among the low-weight premature twins and in these cases both twins often suffered perinatal death.     

Early rapid weight gain and current overweight in relation to asthma in adolescents born with very low birth weight

Early catch-up growth and subsequent overweight are suggested to be associated with later cardiovascular diseases and later type II diabetes. However, the impact of early catch-up growth and childhood overweight on the development of asthma has been less studied, particularly in children born with very low birth weight (VLBW). A birth cohort of 74 VLBW children (birth weight < or = 1500 g) was followed from birth and investigated on asthma at 12 yr of age. Early rapid weight gain was in one way defined as an increase of weight > or =1 standard deviation score (SDS) at 6 months of corrected postnatal age. Current overweight was defined by body mass index (BMI) exceeding 21.2 and 21.7 kg/m(2), respectively, for boys and girls at 12 yr of age. Current asthma was diagnosed by a pediatrician, according to asthma ever in combination with a positive response to hypertonic saline bronchial provocation test and/or wheeze at physical examination at 12 yr old. Being overweight at 12 yr of age was associated with an increased risk for current asthma in the VLBW children [crude odds ratio (OR): 5.5, 95% confidence interval (CI): 1.3-22.2]. After adjustment for early weight gain and neonatal risk, the OR of overweight increased nearly three times (adjusted OR: 15.3, 95% CI: 2.5-90.6). Early rapid weight gain seemed to be inversely associated with current asthma (adjusted OR: 0.49 for an increase of weight equal to 1 SDS, 95% CI: 0.23-1.02, p = 0.06). In addition, early rapid weight gain was inversely associated with the magnitude of bronchial responsiveness at 12 yr (coefficient -1.15, p < 0.01). There was a strong and positive association between overweight and asthma at 12 yr of age in the VLBW children. This strong association had been reduced by early rapid weight gain, possibly via the reduction of bronchial responsiveness.     

Chemical and physical exposures of parents: effects on human reproduction and offspring

The effect of maternal smoking during pregnancy on birth weight was studied in 12,068 births, the mothers in 1819 of which were regarded as smokers. The children of the smokers were compared with those of controls of similar age, parity, marital status and place of residence. Maternal smoking reduced birth weight in a dose-related manner. Birth weight was least affected among young, primiparous mothers who smoked only slightly, a difference which was, however, entirely caused by those mothers who stopped smoking for the last 3 mth of pregnancy, and this subgroup showed similar figures for postneonatal mortality and morbidity up to the age of 5 to those of their controls. Postneonatal mortality was higher in the total group of the smokers than among their controls, the primiparous or young mothers not differing in this respect from the others. Morbidity up to the age of 5 was significantly higher (P< 0.001) among the children of the smokers, the children of the primiparas and young mothers being affected in a similar way to the others. The low birth weight infants of the smokers had a higher mean birth weight and lower perinatal mortality than the low birth weight infants of the controls, but morbidity up to age of 5 and postneonatal mortality were higher among the smokers in respect of both low birth weight infants and others.     

Birth Characteristics of Childhood Cancer Cases, Controls, And Their Siblings

Reproductive characteristics of childhood cancer cases, controls, and their siblings were examined using data from a case-control study in the Denver, Colorado metropolitan area, Childhood cancer patients (n=356) diagnosed from 1976 to 1983 were identified, and 242 were interviewed. Controls were selected by random digit dialing, with 212 interviews being completed (60% of eligibles). Extremes of birth weight were more common only among brain cancer cases. Patients were more often born preterm, particularly those with brain tumors [odds ratio (OR) = 6.1; 95% confidence interval (CI), 1.6-23.4] and were more likely to have birth defect F (OR = 2.1; 95% CI, 0.9-5.0). Twins were more common among case siblings (OR = 2.6; 95% CI, 0.8-8.2). Low birth weight and preterm delivery among siblings were related only to soft tissue sarcoma. Birth defects were more common among case siblings, particularly leukemia cases (OR = 3.2; 95% CI, 1.3-7.7). Previous reports of elevated birth weight among cases and increased risk of miscarriage in case mothers were not corroborated, but associations with preterm delivery, high birth order, and birth defects among cases and birth defects and twinning among case siblings encourage additional evaluation.     

Pregnancy Outcome and Social Indicators in Sweden

ABSTRACT. Perinatal mortality, birth weight, the distribution of gestational age, and the relationship between gestational age and birth weight have been studied with regard to births reported to the Register of Births during 1976–77. In order to determine the influence of socio-economic factors on the parameters studied, the information from the birth register has been combined with that from the 1975 census in Sweden (including occupation of the mother, income of the family, type of family and housing standard). The total population of 190024 infants was divided into three groups; 6915 infants (3.6 %) were assigned to the most privileged group (group I) and 26430 (13.9 %) to the less privileged group (group III). The perinatal mortality rate did not differ significantly between group I and III. A comparison of the three groups showed a socio-economic difference as regards birth weight and the incidence of preterm as well as of postterm births. The less privileged group had a greater proportion of infants of low birth weight and of infants that were small for gestational age.     

Prevalence and aetiology of congenital birth defects, infant mortality and mental retardation in Lahore, Pakistan: a prospective cohort study

AIM: To study the health and development of children in a developing and low-income country. METHODS: The health and development of children in Lahore in northern Pakistan have been studied since 1981 in a collaborative project between Pakistani and Swedish university institutions and the Swedish Agency for Research Cooperation with Developing Countries (SAREC). The study described in this paper comprised four different areas in Lahore with different degrees of urbanization and different social conditions. All pregnancies in the four areas were registered during the period March 1984 to July 1986 and were followed up from the 5th month of pregnancy. All 1476 children born after 1 September 1984 were followed up from birth to 12 y of age. RESULTS: The perinatal mortality in the whole material was 5.4%. It was highest in the periurban slum (7.5%) and lowest in the upper-middle class cohort (3.3%). Overall infant mortality was 10%. It was highest (14%) in the periurban slum and lowest (2%) in the upper-middle class group. Overall incidence of serious birth defects was 5%. It was highest in the periurban slum community (7%) and lowest in the upper-middle class cohort (3%). The overall cumulative incidence of severe mental retardation per 100 live births was 1.1. It was highest (2.2) in the periurban slum and lowest (0.4) in the upper-middle class group. The overall prevalence of mild mental retardation among 6-10-y-old children was 6.2 per 100. It was highest in the periurban slum (10.5) and lowest (1.3 per 100) in the upper-middle class group. Poverty, malnutrition, birth trauma and consanguinity were common causes of infant mortality and mental retardation in Lahore, Pakistan. CONCLUSION: Preventive measures with provision of obstetric and health services, services for genetic information and risk evaluation, vaccination programmes and identification of children with retarded development for specific stimulation and habilitation measures, e.g. organized play activities, are important in developing and low-income countries.     

Parental and perinatal factors affecting childhood anthropometry of very-low-birth-weight premature infants: a population-based survey

Background: The perinatal–neonatal course of very-low-birth-weight (VLBW) infants might affect their childhood growth. We evaluated the effect of parental anthropometry and perinatal and neonatal morbidity of VLBW neonates on their childhood growth.
Methods: We obtained parental anthropometry, height and weight at age 6–10.5 years of 334 children born as VLBW infants. Parental, perinatal and neonatal data of these children were tested for association with childhood anthropometry.
Results: (1) Maternal and paternal weight standard deviation score (SDS) and discharge weight (DW) SDS were associated with childhood weight SDS (R²= 0.111, p < 0.00001); (2) Maternal and paternal height SDS, corrected gestational age (GA) at discharge, maternal assisted reproduction and SGA status were associated with childhood height SDS (R²= 0.208, p < 0.00001); (3) paternal weight SDS, DW SDS and surfactant therapy were associated with childhood body mass index (BMI) SDS (R²= 0.096, p < 0.00001). 31.1% of VLBW infants had DW SDS < −1.88, and are to be considered small for gestational age ('SGA'). One quarter of these infants did not catch up by age 6–10.5 years.
Conclusion: Childhood anthropometry of VLBW infants depends on parental anthropometry, postnatal respiratory morbidity and growth parameters at birth and at discharge. Almost one-third of VLBW premature infants had growth restriction at discharge from neonatal intensive care unit (NICU), a quarter of whom did not catch up by age 6–10.5 years.     

Which modifiable prenatal factors mediate the relation between socio‐economic position and a child's weight and length at birth?

Although several studies have shown a positive association between socio‐economic position and size at birth, not enough is known about the modifiable factors that may be involved. We aimed to investigate whether maternal prepregnancy body mass index (BMI), smoking, diet, and depression during pregnancy mediate the positive association between maternal education and birth size. Weight and length z‐scores specific for gestational age and sex were calculated for 1,500 children from the EDEN mother–child cohort. A mediation analysis of the associations between maternal education and birth size was conducted with a counterfactual method, adjusted for recruitment centre, parity, maternal height, and age. In the comparison of children of mothers with low versus intermediate education levels, maternal smoking during pregnancy explained 52% of the total effect of education on birth weight. Similar findings were observed with birth length z‐score (37%). The comparison of children of mothers with high versus intermediate education levels yielded a non‐significant total effect, which masked opposite mediating effects by maternal BMI and smoking during pregnancy on both birth weight and length. Prepregnancy BMI and maternal smoking during pregnancy mediate the positive association between maternal education and birth weight and length z‐scores. These mediators, however, act in opposite directions, thereby masking the extent to which healthy prenatal growth is socially differentiated.     

Birth Characteristics of Childhood Cancer Cases,Controls, And Their Siblings

Reproductive characteristics of childhood cancer cases, controls, and their siblings were examined using data from a case-control study in the Denver, Colorado metropolitan area, Childhood cancer patients (n=356) diagnosed from 1976 to 1983 were identified, and 242 were interviewed. Controls were selected by random digit dialing, with 212 interviews being completed (60% of eligibles). Extremes of birth weight were more common only among brain cancer cases. Patients were more often born preterm, particularly those with brain tumors [odds ratio (OR) = 6.1; 95% confidence interval (CI), 1.6–23.4] and were more likely to have birth defect F (OR = 2.1; 95% CI, 0.9–5.0). Twins were more common among case siblings (OR = 2.6; 95% CI, 0.8–8.2). Low birth weight and preterm delivery among siblings were related only to soft tissue sarcoma. Birth defects were more common among case siblings, particularly leukemia cases (OR = 3.2; 95% CI, 1.3–7.7). Previous reports of elevated birth weight among cases and increased risk of miscarriage in case mothers were not corroborated, but associations with preterm delivery, high birth order, and birth defects among cases and birth defects and twinning among case siblings encourage additional evaluation.     

Neonatal mortality rate: Relationship to birth weight and gestational age

A total of 2063 live births were studied during one year period from July 1994 to June 1995. Neonatal mortality rate (NMR) was 35.4 per thousand live births. The case fatality rate among low birth weight and preterms was 10.1% and 18.1% respectively. Though, low birth weight babies accounted for 27.8% of the live births but contributed for 79.5% of neonatal deaths [p<0.001]. Similarly, preterm babies accounted for 13.2% of the live births but contributed for 69.9% of neonatal deaths [p<0.001]. The causes of neonatal deaths found were birth asphyxia (31.1%), infections (23.3%), immaturity (17.8%), hypothermia (9.6%), hyaline membrane disease (2.7%) and cogenital malformation (1.4%). There is need to identify strategies to reduce the incidence of prematurity and low birth weight babies. Comprehensive antenatal coverage and adequate care followed by optimal management of newborns at birth is likely to reduce NMR and improve quality of life among survivors.     

Birth weight charts for gestational age in 63 620 healthy infants born in Peruvian public hospitals at low and at high altitude

Aim: To construct distribution curves for birth weight, length and head circumference using a large sample of infants born at low (150 m) and high (3000–4400 m) altitude.
Methods: Cross-sectional analysis of a perinatal database. All live singleton deliveries from public hospitals during 2001–2006 (gestational age from 26 to 42 weeks) with no history of perinatal deaths or smoking and no current obstetric complications (n = 63 620) were included. Fractional polynomial regression models were used to smooth curves for each gestational age.
Results: Mean and median birth weight differences between those born at low and high altitudes reached statistical significance after 35 and 33 weeks, respectively. Values of the 10th percentile were higher at low altitude from 36 weeks, whereas values at the 90th percentile were different from 34 weeks. In the Peruvian growth curves, birth weight was greater at each gestational age than in the curves derived by Lubchenco.
Conclusion: Altitude affects growth patterns; these growth standards will provide useful references for the care of the newborn in highland populations. In addition, the data have implications for the antepartum management of pregnant patients undergoing sonographic evaluation of fetal weight in whom new definitions of what represents small or large for gestational age in utero can result in differences in time or mode of delivery.     

Benn Index at birth is associated with postnatal linear growth

While previous research has suggested that body thinness is related to subsequent linear growth in children, it is unclear whether thinness at birth is related to linear growth in newborns and catch-up growth in small-forgestational age newborns. Drawing on data from a longitudinal growth study of 3,650 full-term Swedish babies, this study examines linear growth from birth to 6 months of age in three groups of newborns with short (< -2 SDS), appropriate (-2 to 2 SDS) and long (> 2 SDS) body length for gestational age. Among infants short at birth, the Benn Index (kg/m2.69) at birth was not related to the odds of short stature (< -2 SDS) at age 6 months (odds ratio = 1.03; p > 0.10). Nonetheless, the Benn Index was positively related to growth velocity in the first 6 months of life in the short (p = 0.060), appropriate (p < 0.05), and tall (p < 0.05) for gestational age newborns. Use of the Ponderal Index (kg/m3) would give similar results. The findings suggest that nutritional status at birth is related to linear growth velocity in newborns.     

A study on the health status of twin babies

A study on twin births was conducted from May 1993 to April 1994 at S.A.T. Hospital, Thiruvananthapuram. The twinning rate in this period was found as 17.33 per 1000 births. 79.6% babies in the twin pairs were of like sex and 20.4% were of unlike sex. The incidence of low birth weight twin babies in this study was 68.9%. There was no significant difference in the physical parameters (birth weight, body length and head circumference) of twin babies in relation to sex. The incidence of twin birth was higher among primipara mothers and in the mothers of age group 21 to 25 years. The first born baby (twin A) was found to be heavier than the second born baby (twin B) in 44.78% twin pairs and their mean birth weight difference was 438 g, while the second born baby (twin B) was found to be heavier than the first born (twin A) in 38.31% twin pairs and their mean birth weight difference was 291 g. Statistical analysis showed that the difference between the mean birth weight difference in the case of twin A>B was significantly greater when compared to that of twin A<B.     

High birth weight, asthma and atopy at the age of 16 yr

The association between high birth weight and asthma has been suggested. The Northern Finland Birth Cohort 1986, a longitudinal cohort originally including 9479 participants, has been followed up since birth until the age of 16 yr. Using the data of this study, we analyzed the association of high birth weight with asthma and atopic sensitization at the age of 16 yr. The analysis included the 5995 subjects with complete skin prick test data and the 5500 subjects with data on doctor-diagnosed asthma (written questionnaire) at the age of 16 yr. Atopy was defined as at least one positive skin prick test reaction, which definition was also used to separate atopic and non-atopic asthma. There was a significant association between high birth weight (>4510 g) and asthma among the atopic subjects (OR 2.40, 95% CI 1.33–4.32). When looking at atopy, the highest risk was observed among the subjects with highest birth weight category (>4510 g) (OR 1.44, 95% CI 1.05–1.97) and the adjacent (4200–4500 g) birth weight category (OR 1.24, 95% CI 1.01–1.53), when compared with the reference category (2500–3340 g). Our results support the notion that high birth weight is associated with an increased risk of asthma and suggest that the association is mostly explained by an increased risk of atopy. The biological mechanisms behind the associations are unknown, but they could be related to obesity.     

Birth Data for Patients Who Later Develop Growth Hormone Deficiency: Preliminary Analysis of a National Register

ABSTRACT. This study analyses gestational age, mode of delivery and size at birth in children who later developed idiopathic or organic growth hormone deficiency (GHD). A data register of children on growth hormone (GH) treatment in Sweden was compared with the Swedish Medical Birth Register during a 14-year period (1973-1986) comprising 1.4 million newborn children. Size at birth was evaluated using a new Swedish reference standard based on data from around 500,000 newborn children. It was found that the children who later develop idiopathic GHD (IGHD) were born with a normal distribution of gestational age. They were more often born with breech delivery (7.1% versus 2.8%) or caesarean section (16.6% versus 10.4%) compared with normal children. The children's condition at birth was poorer than normal, as shown by the frequency of Apgar scores below 7 at 5 minutes (5.2% versus 1.2%). Finally, it was found that children who later develop IGHD (n = 220) had a median birth length of 0.87 SDS below the mean and a median birth weight of 0.60 SDS below the mean of the standard. In contrast, both the birth length and weight of the children who later develop organic GHD (OGHD) (n = 92) did not differ from that of the reference.     

Low birth weight in Tasmania 1975-1983: The effect of socioeconomic status

An analysis of all births in Tasmania from 1975 to 1983 showed that social class differences in low birth weights were almost entirely restricted to infants between 1500 and 2500 g weight at birth. There was a marginal increase in very low birth weight infants (<1500 g) among women whose partners were unemployed or in unskilled work but extremely low birth weight infants (<1000 g) were evenly distributed across the whole social spectrum.     

出生体重与5至8岁儿童超重和肥胖关联的队列研究

目的以回顾性队列研究探讨出生体重与5~8岁儿童超重和肥胖的关系。方法利用上海市闵行区所辖的13家社区卫生服务中心3~12岁儿童的体格检查数据库,截取5~8岁儿童的身高和体重数据进行分析。体检时行问卷调查生育史、出生体重、妊娠情况和出生后喂养史。按照出生体重分为:2 500 g(低出生体重儿)、~3 000 g、~3 500 g、~4 000 g和≥4 000 g组(巨大儿)。采用多元logistics分析评估出生体重与5~8岁儿童超重和肥胖的关系,并调整相关因素的影响。结果 99 897名5~8岁儿童进入分析,超重发生率为10.1%,肥胖发生率为5.0%。11.4%的儿童为低出生体重,7.3%为巨大儿;出生体重2 500 g、~3 000 g、~3 500 g、~3 500 g、~4 000 g和≥4 000 g组超重检出率分别为8.4%、7.6%、9.2%、11.5%和14.5%;肥胖检出率分别为4.7%、3.9%、4.4%、5.9%和7.9%。2简单相关分析发现,~3 500 g、~4 000 g和≥4 000 g组出生体重与儿童体重呈正相关(P0.000 1),在调整了性别、年龄、身高、分娩史、孕周、喂养史和身高后,仍具有显著相关性。3与出生体重~3 500 g组相比,~4 000 g组超重和肥胖的发生率增加31%和43%,~4 500 g组超重和肥胖的发生率增加76%和103%;~3 000 g组发生超重和肥胖的风险最低(RR=0.80,95%CI:0.73~0.88,P0.000 1;RR=0.87,95%CI:0.77~0.98,P0.000 1),调整了年龄、性别、孕周和产式等因素后,仍具有相关性;5、6、7和8岁儿童~4 000 g和≥4 000 g组发生超重和肥胖的风险相近;2 500 g组肥胖的风险RR为1.07(95%CI:0.79~1.43),P=0.27。结论出生体重对5~8岁儿童超重和肥胖的影响呈非线性关系。出生体重3 500 g儿童5~8岁超重和肥胖的风险显著增高。     

Mortality in 504 infants weighing less than 1501 g at birth and treated in four neonatal intensive care units of South-Belgium between 1976 and 1980

Mortality was studied in 504 infants weighing less than 1501 g at birth and treated in four neonatal intensive care units of South-Belgium between 1976 and 1980. Two hundred and twenty-one babies died during their stay at the hospital, a mortality rate of 438 per 1000 live births. The neonatal mortality rate (mortality during the first 28 days of life) was 373 per 1000 live-births. Thirty-three infants died after the neonatal period, which is 15% of the total number of deaths. Twothirds of these post-neonatal deaths were related to complications of diseases associated with pre-term delivery. Mortality rates were higher in infants of less than 1001 g than in those of 1001–1250 g or 1251–1500 birth weight. In each birth weight category, patients born in their own obstetrical departments and referred infants had similar mortality rates. Longitudinal analysis showed improving mortality rates between 1976 and 1977 in the total population of VLBW infants, between 1977 and 1978 in infants of <1001 g and in 1980 compared to 1976 in the 1251–1500 g group. There were higher incidences of need for ventilatory assistance, patent ductus arteriosus, necrotising enterocolitis and septicaemia in referred patients of <1001 g than in patients born in their own obstetrical departments with comparable birth weight. Artification ventilation was more often required in referred infants of 1251–1500 g. This study confirms the importance of considering at least the complete hospital stay when analysing mortality in VLBW infants. Infants of <1001 g had high mortality, particularly after the neonatal period. This phenomenon was asscciated with complications of morbid conditions related to extreme prematurity.Abbreviations VLBW very low birth weight - PDA patent ductus areeriosus - NEC necrotising enterocolitis