Births, gestation and birthweights in South Tees 1990-1996

BACKGROUND: The UK government has specified that all health authorities are to develop local health improvement programmes. Birthweight and gestational age are important health determinants, and therefore indicators of the health status of children in a community. They also have important resource implications for health and social services. Data regarding birthweight and its relationship to gestational age are not routinely available. This paper describes the results of the measurement of the birthweights and gestational ages of children born to residents in a UK health district, and their relationship with deprivation. METHODS: Routinely collected birthweight and gestational age data for children born to parents resident in the South Tees district during the period 1990-1996 inclusive were downloaded from the community child health department mainframe computer. The data were analysed and compared with national standards. RESULTS: The analysis showed that, despite the high levels of deprivation, birthweights were close to or slightly above average for most gestational ages. However, when compared with the average district in England and Wales, 8 per cent more low-birthweight children, of which 42 per cent were less than 28 weeks gestation, were born in the area. Materially deprived mothers were more likely to give birth to pre-term and light for gestational age infants. CONCLUSIONS: This study has shown that it is now possible to use routine sources of information to monitor local trends in birthweight and gestation, and their relationship with deprivation.     

Duration of gestation, size at birth and later childhood behaviour

Although many previous studies have reported an association between preterm birth or small size at birth and later behaviour, multiple methodological limitations threaten the validity of causal inferences from reported associations. The authors have examined the association between gestational age and gestational age-specific size at birth (weight, length and head circumference) and behaviour in a large sample of children born healthy at term. The data were from the 6.5-year follow-up of 13,889 Belarusian children who participated in the Promotion of Breastfeeding Intervention Trial, a cluster-randomised trial of a breast-feeding promotion intervention. Child behaviour was measured using the parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ). Differences in SDQ scores by gestational age and by birthweight, birth length and birth head circumference standardised for gestational age and sex (z-scores) were analysed after controlling for potentially confounding maternal and family factors. There was no association between gestational age and child behaviour after adjusting for potential confounding factors. Lower birthweight-for-gestational age was associated with higher scores in problem behaviours including total difficulties, conduct problems, hyperactivity, emotional symptoms and peer problems. Similar but smaller differences were observed with birth length and birth head circumference, but those differences were attenuated with adjustment for birthweight. The patterns of association were consistent in both parent and teacher assessments. Among school-age children born at term within normal range of birthweight, fetal growth, but not gestational age, was associated with behavioural problem scores.     

Adolescent girls and their babies: achieving optimal birthweight. Gestational weight gain and pregnancy outcome in terms of gestation at delivery and infant birth weight: a comparison between adolescents under 16 and adult women

AIMS: Pregnancy amongst under 16s has been reported to result in worse outcomes for the baby, including low birthweight. This study aimed to find out whether the under 16s need to gain more weight during pregnancy to avoid this outcome. METHOD: A retrospective case control study of pregnancy outcomes in girls delivering before the age of 16 and women delivering aged 25-30. Data was collected from medical case notes, including maternal age, pregnancy weight gain and infant birth weight. RESULTS: Although weight gain amongst under 16s was similar to that in the control group, average birthweight of babies born to under 16s was less than in the older group. For both girls and older women greater weight gain in pregnancy did result in higher birth weights. DISCUSSION: As younger girls are still growing it may be necessary for them to achieve a greater pregnancy weight gain in order to achieve a satisfactory birth weight.     

Intrauterine growth standards in a developing country: a study of singleton livebirths at 28-42 weeks' gestation

This study aimed to develop fetal growth charts for the population of Greater Beirut, Lebanon, and compare them with previously established references. A survey of consecutive singleton livebirths admitted to normal nurseries and neonatal intensive care units of major hospitals, through the database project of the National Collaborative Perinatal Neonatal Network was used as a design. The study was conducted in nine major healthcare institutions serving the population of Beirut and its suburbs. A total of 24 767 singleton livebirths delivered between 28 and 42 weeks' gestation, with known data on gender, gestational age and anthropometric characteristics were recorded between 1 April 1999 and 31 March 2002. Growth charts were developed by plotting birthweight, length and head circumference percentiles against gestational age for male and female infants separately. Overall, 1348 (5.4%) pregnancies were delivered before 37 weeks' gestation and 1227 (4.9%) were low birthweight. Male infants were delivered slightly earlier than their female counterparts and the mean birthweight, length and head circumference were consistently higher in males. A total of 2247 (9.1%) infants were small-for-gestational-age, with a male-to-female sex ratio of 1.03. Using previously established growth references that overestimated small-for-gestational-age prevalence resulted in a greater proportion of false positives. The opposite was true for growth references that underestimated small-for-gestational-age prevalence. The current growth charts present useful tools for assessing the general health status of newborn infants delivered at sea level in the urban areas of Lebanon and other East Mediterranean countries.     

Births and abortions among Amsterdam teenagers according to ethnicity, 1996-1998

OBJECTIVE: To determine the number of teenage births and abortions in Amsterdam, the Netherlands, in total and according to age and ethnic origin. DESIGN: Retrospective analysis of routinely collected data. METHOD: Based on data collected from the municipal population register and the abortion clinics in Amsterdam, birth rates, abortion rates and abortion ratios were calculated for the period 1996-1998. The birth rate was the number of live births and the abortion rate the number of abortions per 1000 teenage girls. The abortion ratio was the number of abortions per 100 pregnancies. RESULTS: The average birth rate and abortion rate for the period 1996-1998 were 3.2 and 7.6 for 14- to 16-year-old girls respectively, and 25.0 and 29.5 for 17- to 19-year-old girls respectively. Among 14- to 16-year-old girls 70 pregnancies out of 100 ended in an abortion and among 17- to 19-year-old girls 54 pregnancies out of 100. In both age groups the birth rate for Surinamese, Antillian, Moroccan, Turkish and Ghanian girls was higher than for Dutch girls. There was one exception: Moroccan girls aged 14-16 years did not have a higher birth rate than Dutch girls of the same age. Surinamese, Antillian and Ghanian girls aged 14-16 years and 17-19 years also had a higher abortion rate compared with Dutch girls of the same age. The Turkish and Moroccan girls did not have (much) higher abortion rates. In both age groups the abortion ratio was lowest for Turkish teenagers and highest for Ghanian teenagers. The figures for second-generation immigrant teenagers were more akin to those of the native Dutch girls than those of first-generation immigrants. CONCLUSION: In Amsterdam unwanted pregnancies were most frequent in Surinamese, Antillian and Ghanian teenage girls. To prevent these pregnancies further research into the (cultural) determinants of sexual behaviour is necessary.     

Stillbirth and infant mortality in singletons by cause of death,birthweight, gestational age and birthweight‐for‐gestation,Newcastle upon Tyne 1961–2000

Glinianaia SV, Rankin J, Pearce MS, Parker L, Pless‐Mulloli T. Stillbirth and infant mortality in singletons by cause of death, birthweight, gestational age and birthweight‐for‐gestation, Newcastle upon Tyne 1961–2000. Paediatric and Perinatal Epidemiology 2010. The dramatic reduction observed in stillbirth and infant mortality over the last few decades has not been assessed by both birthweight and gestation. We have explored temporal changes in stillbirth and infant mortality in Newcastle upon Tyne, UK, by cause of death, birthweight, gestational age, birthweight standardised for gestation and infant sex during 1961–2000. We included 131 044 singleton births to mothers resident in Newcastle, including 1342 stillbirths and 1620 infant deaths. Cause‐, birthweight‐, gestational age‐ and birthweight‐for‐gestation‐specific stillbirth (per 1000 total births) and infant mortality (per 1000 livebirths) rates were compared between 1961–80 and 1981–2000 and between individual consecutive decades. Between 1961 and 2000, total stillbirth and infant mortality rates declined dramatically from 23.4 to 4.7 per 1000 total births and from 25.7 to 5.9 per 1000 livebirths, respectively. Rates fell continuously during the first two study decades; however, from 1981–90 to 1991–2000 the decline was not statistically significant. Between 1961–80 and 1981–2000, both stillbirth and infant mortality significantly declined in all birthweight and gestational age categories and for most leading causes of death. Although the population mean birthweight during 1981–2000 [3304 g (SD ± 569)] was significantly higher than during 1961–80 [3255 g (SD ± 572)] (P < 0.0001), the lowest stillbirth and infant mortality rates in 1981–2000 were consistently at about 1 SD above the mean birthweight, with mortality rates increasing for babies with lower or higher weight‐for‐gestation. Declines in stillbirth and infant mortality in Newcastle were associated with reductions in birthweight‐ and gestational age‐specific mortality rates and occurred in most cause‐specific groups of death.     

Adverse perinatal and neonatal outcomes and their determinants in rural Vietnam 1999-2005

Population-based estimations of perinatal and neonatal outcomes are sparse in Vietnam. There are no previously published data on small for gestational age (SGA) infants. A rural population in northern Vietnam was investigated from 1999 to 2005 (n=5521). Based on the birthweight distributions within the population under study, reference curves for intrauterine growth for Vietnamese infants were constructed and the prevalence and distribution of SGA was calculated for each sex. Neonatal mortality was estimated as 11.6 per 1000 live births and the perinatal mortality as 25.0 per 1000 births during the study period. The mean birthweight was 3112 g and the prevalence of low birthweight was 5.0%. The overall prevalence of SGA was 6.4%. SGA increased with gestational age and was 2.2%, 4.5% and 27.1% for preterm, term and post-term infants, respectively. Risk factors for SGA were post-term birth: adjusted odds ratio (AOR) 7.75 [95% CI 6.02, 9.98], mothers in farming occupations AOR 1.72 [95% CI 1.21, 2.45] and female infant AOR 1.61 [95% CI 1.27, 2.03]. There was a pronounced decrease in neonatal mortality after 33 weeks of gestation. Suggested interventions are improved prenatal identification of SGA infants by ultrasound investigation for fetal growth among infants who do not follow their expected clinical growth curve at the antenatal clinic. Other suggestions include allocating a higher proportion of preterm deliveries to health facilities with surgical capacity and neonatal care.     

Cigar smoking in California: 1990-1996

BACKGROUND: Cigars have been heavily promoted in recent years. The nature and extent of the resultant increase in cigar smoking needs to be understood before the public health implications can be assessed. METHODS: Data are from population-based surveys conducted in California adults (> or = 18 years) in 1990 (n = 24,296) and 1996 (n = 24,266). Trends in current (every day or some days) cigar use are described for demographic subgroups and by cigarette smoking status. RESULTS: Current cigar use has doubled in California, from 2.5% in 1990 to 4.9% in 1996. In 1996, fewer than 5% of cigar smokers smoked cigars daily; essentially all of the increase was from nondaily use in those under 45 years of age of both genders, particularly in 18- to 24-year-olds. Among males, increased cigar use was observed in all racial/ethnic groups except Asians, and was observed in those with higher educational attainment and higher incomes. In both years, current and former cigarette smokers had higher rates of cigar use than never smokers, but the increase in current cigar smoking was observed regardless of cigarette smoking status. In 1996, daily cigar smokers were more likely to be former cigarette smokers than nondaily cigar smokers. CONCLUSION: If more people begin to smoke cigars daily, or if cigar use leads young people to initiate cigarette smoking or leads former cigarette smokers to relapse to cigarette smoking, the recent trends in cigar use may have public health implications.     

Arbovirus surveillance in South Carolina, 1996-98

Arboviruses isolated and identified from mosquitoes in South Carolina (USA) are described, including new state records for eastern equine encephalitis virus (EEE), St. Louis encephalitis virus (SLE), Flanders virus, Tensaw virus (TEN), and a variant of Jamestown Canyon virus (JC). Mosquitoes were collected at 52 locations in 30 of 46 South Carolina counties beginning in June 1996, and ending in October 1998, and tested for arboviruses. Of 1,329 mosquito pools tested by virus isolation (85,806 mosquitoes representing 34 mosquito species or complexes), 15 pools were positive. Virus isolations included EEE from 1 pool each of Anopheles crucians complex and Culex erraticus; a variant of JC from 1 pool of An. crucians complex; a California serogroup virus from 1 pool of Aedes atlanticus/tormentor; TEN from 5 pools of An. crucians complex and 1 pool each of Culex salinarius and Psorophora ciliata; Flanders virus from 1 pool of Culiseta melanura; and Potosi virus from 1 pool each of Aedes vexans, Coquillettidia perturbans, and Psorophora columbiae. Of 300 mosquito pools tested by antigen-capture assay for EEE and SLE (14,303 mosquitoes representing 16 mosquito species or complexes), 21 were positive for EEE and I was positive for SLE. Positive EEE mosquito pools by antigen-capture assay included An. crucians complex (14 pools), Anopheles punctipennis (1 pool), Anopheles quadrimaculatus (1 pool), Cq. perturbans (4 pools), and Cs. melanura (1 pool). One pool of Cx. salinarius was positive for SLE by antigen-capture assay. Arbovirus-positive mosquito pools were identified from 12 South Carolina counties, all located in the Atlantic Coastal Plain, and from 4 of 8 Carolina bays surveyed.     

Trends in antimicrobial utilization in a university hospital, 1990-1996

OBJECTIVE: There is a worldwide concern about rational drug use, more specifically related to antimicrobial utilization. In developing countries, few resources are intended for monitoring on rational drug use. Moreover, there are limited data on the use of antimicrobial agents in hospitals. A study was carried out to describe patterns of use of antimicrobial agents over a 7-year period (1990 to 1996). METHODS: The study was conducted in a 690-bed tertiary care university hospital in Porto Alegre, Brazil. Hospital records were reviewed to identify inpatient antibiotics use. Results were expressed in defined daily dose per 100-beds/day. Cluster analysis was performed to determine the trends in use of individual agents. RESULTS: Antimicrobials use increased year after year, from 83.8 DDD per 100 beds-day in 1990 to 124.58 DDD per 100 beds-day in 1996. Penicillins were the drug group mostly used (39.6%), followed by cephalosporins (15.0%), aminoglycosides (14.4%), sulfonamides (12.8%), glycopeptides (3.6%), and lincosamides (3.1%). These groups were responsible for around 90% of all agents used. The use of antimicrobial agents was divided into thirteen groups based on cluster analysis. CONCLUSIONS: Antimicrobial use increased dramatically in the study period, and this increase was significantly higher when compared to other studies. When newer alternative agents became available in the hospital, the use of already existing drugs decreased and in some cases remained relatively stable. After implementing specific interventions, such as an effort for the correct use of cefoxitin, the expected changes in use were observed.     

Pedestrian fatalities by race/ethnicity in Arizona, 1990-1996

PURPOSE: To explore rates of pedestrian fatalities in Arizona, and how rates and circumstances of pedestrian deaths differ by race/ethnicity, urban or rural residence, age, and gender. METHODS: Using the Fatality Analysis Reporting System and the National Center for Health Statistics' Multiple Cause of Death file, pedestrian fatalities in Arizona from 1990 through 1996 were classified by gender, race/ethnicity, and urban or rural residence. Age-adjusted rates were calculated and adjusted for the proportion of rural residence. Age analyses compared pedestrian fatality rates in 10-year age groups by race/ethnicity. Conditions associated with pedestrian deaths were examined, including the time and day of occurrence, alcohol involvement, and degree of pedestrian contribution to the crash. RESULTS: American Indians had rates of pedestrian deaths 6 to 13 times those of non-Hispanic whites. Elevated rates for American Indians were found in urban and rural areas, in both genders, in all age groups in men, and in five of nine age groups in women. American-Indian pedestrian death rates and relative risks (RRs) were higher in rural areas than in urban areas. Compared to non-Hispanic whites, urban Hispanic males had an elevated RR of 1.56, rural Hispanic females had an RR of 2.45, and urban African-American (AA) females had an RR of 2.33. However, significantly elevated rates, compared to non-Hispanic whites, were limited to Hispanic males aged <5 years and African-American females aged 65 to 74 years. In all race/ethnic groups, except rural Hispanics, men had higher rates than women, although American-Indian women had higher rates than non-Hispanic whites, African Americans, and Hispanic men.Rural residence accounted for 27% of the excess American-Indian pedestrian mortality. Sixty-one percent of urban, American-Indian pedestrian deaths occurred on weekends, compared to 29% among non-Hispanic whites and 46% among Hispanics. American Indians had six times the rate of alcohol-related pedestrian deaths as non-Hispanic whites in urban areas and 16 times that respective rate in rural areas. Hispanics had an alcohol- involvement RR of 1.82 in urban areas, but the RR was not elevated in rural areas. When blood alcohol was measured, the blood alcohol concentration was >0.20 g/dL in 64.4% of American Indians, 35% of Hispanics, and 29% of non-Hispanic whites. CONCLUSION: A major disparity in pedestrian fatalities exists for both American-Indian men and women in urban and rural areas. Other racial/ethnic groups have elevated pedestrian fatality rates that are gender and residence specific, and are limited to specific age groups. Much of the American-Indian excess mortality is alcohol related and associated with residence in rural areas.     

The association between neighbourhoods and adverse birth outcomes: a systematic review and meta-analysis of multi-level studies

Many studies have examined the role of neighbourhood environment on birth outcomes but, because of differences in study design and modelling techniques, have found conflicting results. Seven databases were searched (1900-2010) for multi-level observational studies related to neighbourhood and pregnancy/birth. We identified 1502 articles of which 28 met all inclusion criteria. Meta-analysis was used to examine the association between neighbourhood income and low birthweight. Most studies showed a significant association between neighbourhood factors and birth outcomes. A significant pooled association was found for the relationship between neighbourhood income and low birthweight [odds ratio = 1.11, 95% confidence interval: 1.02, 1.20] whereby women who lived in low income neighbourhoods had significantly higher odds of having a low birthweight infant. This body of literature was found to consistently document significant associations between neighbourhood factors and birth outcomes. The consistency of findings from observational studies in this area indicates a need for causal studies to determine the mechanisms by which neighbourhoods influence birth outcomes.     

Nutrition and length of gestation

This paper examines whether a food supplementation program carried out in Guatemala affected the length of gestation (n=830 singleton births). Women who consumed more of a protein-energy or an energy supplement had significantly longer lengths of gestation. Regression slopes of energy on length of gestation were statistically significant and similar for both types of supplements, suggesting a role for energy but not for protein. The earlier calories were provided in pregnancy the greater their effect on gestation length. Women in the upper tercile of the distribution of energy intakes in the first trimester of pregnancy had a mean length of gestation 1.42 weeks longer than women in the lower tercile of the distribution. The percent of preterm deliveries (<37 weeks) was 5 percent in the upper group and 20 percent in the lower group.     

Trait anxiety in pregnant women predicts offspring birth outcomes

The goal of our study was to characterise the relationships between trait anxiety symptoms of women during their pregnancies and birth outcomes of their offspring using a longitudinal cohort from the Maternal Health Practices and Child Development Project. We used the State-Trait Personality Index anxiety measure that is based on Spielberger's State-Trait Anxiety Inventory to measure self-reported trait anxiety at two gestational assessments (fourth and seventh months, representing the first and second trimesters, respectively) and at a third assessment shortly after delivery (representing the third trimester). Demographic, social, psychological, substance use and medical factors were assessed prenatally, and outcomes of the 763 live, singleton births were determined at delivery.
In regression models, trait anxiety at the second and third trimesters predicted lower birthweight and shorter birth length, controlling for confounders. Anxiety reported at the third trimester predicted shortened gestational age, controlling for confounders. At the first and second trimesters, the relationship of birthweight and birth length to maternal trait anxiety was only significant for severe anxiety. Women whose anxiety reached severe levels for at least two trimesters were significantly more likely to deliver offspring of lower birthweight and shorter birth length than those women who reported severe anxiety at none or only one of the trimesters. Additionally, offspring of women who experienced severe anxiety during all three trimesters had shorter mean gestational age than offspring of women who did not report severe anxiety at any trimester. Women who report chronic, severe trait anxiety are at the highest risk of having shorter gestations and delivering smaller babies.     

Secular Trends in Uncertain-Sex Births and Proportion of Male Births in Norway, 1967-1998

It has been hypothesized that environmental factors influence sex differentiation in the fetus, thus causing a reduced sex ratio (male/female) at birth, an increase in the prevalence of ambiguous-sex infants, and possibly an increase in spontaneous abortion rates. In Norway, subsequent to 1967, all deliveries, including late abortions after 16 wk of gestation, have been reported to the Medical Birth Registry of Norway. The authors used these data to assess birth-weight-specific secular trends of uncertain-sex infants and the proportion of male births, from 1967 through 1998. Total rates of uncertain-sex infants increased from 2.3/10,000 births in 1967 to 8.0/10,000 births in 1998 in the birth weight strata of less than 600 gm. The total proportion of male births was stable; however, there was a reduction in the proportion of male births among births weighing less than 400 gm—from 58.4% to 53.4%. Incomplete ascertainment of abortions may have biased the results, but it would not have accounted for the increased occurrence of uncertain-sex infants and the decreased proportion of males observed among late-term abortions.     

Maternal dental history, child's birth outcome and early cognitive development

Prenatal exposure to high levels of mercury, radiation and inflammation have been associated with adverse reproductive outcomes such as increases in preterm delivery, low birthweight and delayed neurodevelopment. Few data are available to evaluate the potential effects of prenatal low-level exposure to these factors as may occur during dental care. We evaluated maternal dental history prior to and during pregnancy in relation to birth outcomes and early communicative development among offspring in a large cohort (n = 7375) of British children born in 1991-92. Dental history was assessed by questionnaire. The child's communicative development was assessed using the MacArthur Communicative Development Inventory at 15 months of age. Total mercury was measured in umbilical cord tissue for a subset of the children. Overall, dental care, including amalgam fillings, was not associated with birth outcomes or language development. Having X-rays taken during pregnancy was not associated with birthweight measured continuously (b = 14.7, P = 0.4), but was associated with slightly increased odds of having a term, low-birthweight baby (OR 1.9, [95% confidence interval 1.0, 3.4]). More detailed evaluation of the potential adverse effects of elective dental treatment during pregnancy, particularly dental X-rays, may be warranted.     

All-cause mortality trends in Dikgale, rural South Africa, 1996-2003

AIMS: The Dikgale Demographic Surveillance System (DDSS) site, established in 1995, is one of three rural surveillance sites in South Africa. This paper describes detailed mortality patterns of a rural African population in the central region of Limpopo Province. METHODS: These data were based on yearly household visits to collect data on vital events, covering 63, 873 person-years of observation over eight years. RESULTS: Crude mortality was 7.5 per 1,000 person-years (females: 6.9, males: 8.1). Under-1 year and under-5 years mortality was 15.1 and 5.8 per 1,000 person-years, respectively. Life expectancy at birth was 64.3 years (females: 68.1, males: 60.0). For the two four-year periods (1996-9 and 2000-3) under-20 years mortality risk decreased (rate ratio=0.45, 95% CI: 0.25 to 0.80) while 20-49 years mortality risk increased (rate ratio=1.55, 95% CI: 1.10 to 2.20). Multivariate mortality risk for migrants remained relatively constant (0.71, 95% CI: 0.54 to 0.94) across the two four-year periods, but has increased 2.5-fold in all DDSS +50 year-old adults across the two four-year periods. CONCLUSIONS: The DDSS mortality estimates appear to have remained relatively constant while recent mortality estimates for the Agincourt Demographic and Health Surveillance System (ADHSS) site suggest that mortality risk is higher and life expectancy is lower in ADHSS residents. Moreover, DDSS mortality estimates are substantially more favourable compared with provincial and national mortality estimates.