Risk factors for neonatal seizures: a population-based study, Harris County, Texas, 1992-1994.

Risk factors for neonatal seizures were evaluated in 116,048 infants born between 1992 and 1994 to residents of Harris County, Texas; 207 of these infants were diagnosed with clinical neonatal seizures. Information was obtained from the infant's birth certificate to assess the relation between seizures and birth weight, gender, ethnicity, place of birth, mother's age, method of delivery, parity, and multiple births. These factors were evaluated by univariate and multivariate analysis using logistic regression. For preterm infants, a birth weight of <1,500 g was the strongest risk factor (relative risk (RR) = 9.1, 95% confidence interval (CI): 4.7, 17.5), followed by birth in a private/university hospital (RR = 2.8, 95% CI: 1.5, 5.0) and male gender (RR = 1.8, 95% CI: 1.0, 3.4). For term infants, significant risk factors included birth by cesarean section (RR = 2.2, 95% CI: 1.5, 3.2), small birth weight for gestational age (RR = 1.9, 95% CI: 1.2, 2.9), birth in a private/university hospital (RR = 1.8, 95% CI: 1.1, 3.0), and maternal age of 18-24 compared with 25-29 years (RR = 1.6, 95% CI: 1.1, 2.3). Birth by assisted vaginal delivery and primiparity were marginally significant for term infants. Birth weight is a significant risk factor for neonatal seizures. The role of perinatal complications warrants further evaluation.     

Pregnancy Intendedness,Maternal Psychosocial Factors and Preterm Birth

Objectives: This study examined associations between reported pregnancy intendedness and several maternal psychosocial factors in relation to preterm birth (<37 weeks' completed gestation). Methods: Women were recruited into a prospective cohort study between the 24th and 29th weeks of pregnancy in central North Carolina from 1996 to 2000. Prior to delivery, participants responded to questions about pregnancy intendedness, life events impacts, depressive symptoms, and coping style. Results: Women who reported not intending their pregnancy had increased odds of reporting low, medium and high levels of perceived stress during pregnancy (OR = 1.4 [95% CI: 1.1, 1.9], OR = 2.2 [95% CI: 1.7, 2.8], and OR = 3.4 [95% CI: 2.6, 4.5], respectively, relative to very low), medium and high levels of depressive symptoms (OR = 2.2 [95% CI: 1.8, 2.9] and OR = 3.1 [95% CI: 2.4, 3.9], respectively), and medium and high levels of several coping styles. Reporting not intending the pregnancy was not associated with increased risk of preterm birth (Risk Ratio [RR] = 1.0, 95% CI: 0.8, 1.1), but reporting the highest quartile of perceived stress (RR = 1.6, 95% CI: 1.1, 2.3) and the highest tertile of distancing coping style (compared with lowest quartile) was associated with preterm birth (RR = 1.4, 95% CI: 1.1, 1.9). Interactions between pregnancy intendedness and the psychosocial variables perceived stress, depression or coping style did not modify the psychosocial variable's associations with preterm birth. Conclusions: Pregnancy intendedness remains an important concept in the reproductive health literature integrally tied to indicators of maternal mental health, but not necessarily to pregnancy outcomes.     

Maternal stress and preterm birth

This study examined a comprehensive array of psychosocial factors, including life events, social support, depression, pregnancy-related anxiety, perceived discrimination, and neighborhood safety in relation to preterm birth (<37 weeks) in a prospective cohort study of 1,962 pregnant women in central North Carolina between 1996 and 2000, in which 12% delivered preterm. There was an increased risk of preterm birth among women with high counts of pregnancy-related anxiety (risk ratio (RR) = 2.1, 95% confidence interval (CI): 1.5, 3.0), with life events to which the respondent assigned a negative impact weight (RR = 1.8, 95% CI: 1.2, 2.7), and with a perception of racial discrimination (RR = 1.4, 95% CI: 1.0, 2.0). Different levels of social support or depression were not associated with preterm birth. Preterm birth initiated by labor or ruptured membranes was associated with pregnancy-related anxiety among women assigning a high level of negative impact weights (RR = 3.0, 95% CI: 1.7, 5.3). The association between high levels of pregnancy-related anxiety and preterm birth was reduced when restricted to women without medical comorbidities, but the association was not eliminated. The prospective collection of multiple psychosocial measures on a large population of women indicates that a subset of these factors is associated with preterm birth.     

Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy

AIMS: To evaluate the long-term clinical significance of intrauterine hematomas detected in the first trimester of pregnancy in a general obstetric population. METHODS: A prospective study was designed to compare the perinatal outcome in 187 pregnant women with intrauterine hematomas to 6488 controls in which hematomas were not detected at first trimester by ultrasound examination. RESULTS: The incidence of intrauterine hematoma in the first trimester in a general obstetric population was 3.1%. A retroplacental position of the hematoma was significantly correlated with an increased risk for adverse maternal and neonatal complications. The presence or absence of symptoms of threatened abortion did not affect these outcomes. The rates of operative vaginal delivery (RR: 1.9; CI: 1.1-3.2) and cesarean section (RR: 1.4; CI: 1.1-1.8) were significantly greater in the hematoma group as compared to the control group, as well as the rates of pregnancy induced hypertension (RR: 2.1; CI: 1.5-2.9) and preeclampsia (RR: 4.0; CI: 2.4-6.7). Placental abruption (RR: 5.6; CI: 2.8-11.1), and the incidence of placental separation abnormalities was also significantly more frequent in the hematoma group (RR: 3.2; CI: 2.2-4.7). Perinatal complications, including the rate of preterm delivery (RR: 2.3; CI: 1.6-3.2), intrauterine growth restriction (RR: 2.4; CI: 1.4-4.1), fetal distress (RR: 2.6; CI: 1.9-3.5), meconium stained amniotic fluid (RR: 2.2; CI: 1.7-2.9), and NICU admission (RR: 5.6; CI: 4.1-7.6) were also significantly increased in this group. Furthermore, the frequency of intrauterine demise and perinatal mortality was increased in the hematoma group, but this difference did not reach statistical significance (p = 0.6 and p = 0.2). CONCLUSION: The authors' study suggests that the presence of an intrauterine hematoma during the first trimester may identify a population of patients at increased risk for adverse pregnancy outcome.     

Gestational vaginal bleeding and pregnancy outcome

The relation between vaginal bleeding and pregnancy outcome was examined in a prospective study of 3,531 women seeking prenatal care in New York City from 1975 through 1985. Women were interviewed in the second trimester or later and were followed up at delivery. The frequency of vaginal bleeding during pregnancy was 22%. Few maternal characteristics or exposures were predictive of bleeding, and those that were associated with an increased risk of bleeding were only marginally so. Risk factors included advanced maternal age, previous spontaneous or induced abortion, working during pregnancy, and certain gynecologic conditions (fibroids, cervical inflammation, and ovarian cysts). Severity of bleeding was examined in relation to birth weight and length of gestation at delivery. Light bleeding during pregnancy was not associated with decreased birth weight or with shortened gestation at delivery. Heavy bleeding was associated with a decrease in mean birth weight of about 100 g (p less than 0.05) but was not significantly associated with the risk of low birth weight (odds ratio (OR) = 1.7, 95% confidence interval (CI) 0.9-3.3). Heavy bleeding was associated with preterm delivery among private patients (OR = 6.4, 95% Cl 1.7-23.5) but not public patients (OR = 0.3, 95% Cl 0.1-1.4). First trimester bleeding of any severity was marginally associated with congenital malformations in the offspring (OR = 1.7, 95% Cl 1.0-2.9); the effect was the same for major and minor abnormalities. There was no association between first trimester bleeding and placental complications of pregnancy or the delivery of a stillborn infant.     

Racial differences in the patterns of preterm delivery in central North Carolina, USA

Summary. In order to assess racial differences in rates of idiopathic preterm labour, preterm premature rupture of membranes, and medically indicated preterm delivery, the authors analysed data on 388 preterm (< 37 completed weeks of gestation) births (7.9% of all births) occurring between 1 September 1988 and 31 August 1989, in three central North Carolina counties. The crude relative risk (RR) of preterm birth among black women compared with white women was 2.6 [95% confidence interval (CI) 2.1, 3.1]. With adjustment for age, gravidity, marital status, education, and county of residence, the estimated relative risk for black women compared with white women was 2.1 (95% CI 1.1,4.1) for medically indicated preterm delivery, 1.6 (95% CI 1.1,2.3) for preterm birth as a result of preterm labour, and 1.9 (95% CI 1.2,3.1) for preterm premature rupture of membranes. Compared with white women, black women were at the highest risk of a preterm birth before 34 weeks of gestation (RR = 2.9; 95% CI 1.8, 4.7). The risk of medically indicated preterm delivery at 36 weeks was considerably higher for black women than for white women (RR = 3.4; 95% CI 1.1,10.2). For a better understanding and ultimately a reduction of the risk for preterm delivery among black women, investigation of specific aetiological pathways and gestational age groups may be required.     

Role of anxiety and depression in the onset of spontaneous preterm labor

The aim of this cohort study conducted in France in 1997-1998 was to investigate the effects of antenatal anxiety and depression on spontaneous preterm labor. A consecutive series of 634 pregnant women with singleton pregnancies was included. Anxiety and depression were assessed using self-administered questionnaires: Spielberger's State-Trait Anxiety Inventory and the Edinburgh depression scale. Depression scores were dichotomized with a cutoff value suggestive of major depression. The 75th percentile was used for anxiety scores. A logistic regression analysis, controlling for sociodemographic and biomedical factors and including interaction terms, revealed that depression was positively associated with the outcome among underweight women, defined as women with a prepregnancy body mass index below 19 (adjusted odds ratio (OR) = 6.9, 95% confidence interval (CI): 1.8, 26.2). A similar result was observed for trait anxiety in women with a history of preterm labor (adjusted OR = 4.8, 95% CI: 1.1, 20.4). The association was close to significance for state anxiety in women with vaginal bleeding (adjusted OR = 3.6, 95% CI: 0.9, 14.7). These findings show that anxiety and depression, when combined with specific biomedical factors, are associated with spontaneous preterm labor. A synergic action of psychological and biomedical factors on the secretion of placental corticotropin-releasing factor is hypothesized.     

Obesity, gestational weight gain and preterm birth: a study within the Danish National Birth Cohort

The aim of the present study was to assess the impact of obesity and gestational weight gain on the risk of subtypes of preterm birth, because little is known about these associations. The study included 62 167 women within the Danish National Birth Cohort for whom self-reported information about prepregnancy body mass index (BMI) and gestational weight gain was available. Information about spontaneous preterm birth with or without preterm premature rupture of membranes (PPROM) and about induced preterm deliveries was obtained from national registers. Cox regression analyses were used to examine associations of prepregnancy BMI and gestational weight gain with subtypes of preterm birth. The crude risks of PPROM and of induced preterm deliveries were higher in obese women (BMI > or = 30) than in normal-weight women (18.5 < or = BMI < 25), especially before 34 completed weeks of gestation, when obese women faced twice the risk. In the adjusted analysis, the hazard ratios and 95% confidence intervals for PPROM and for induced preterm delivery in obese women were 1.5 [1.2, 1.9] and 1.2 [1.0, 1.6] respectively. When obesity-related diseases were accounted for, no excess risk of induced preterm deliveries was seen in obese women, but the increased risk of PPROM was unchanged. Low weight gain was associated with an increased risk of all subtypes of preterm birth compared with normal weight gain, especially in early spontaneous preterm births, where the risk was doubled. We concluded that prepregnancy obesity was associated with a higher risk of PPROM and early induced preterm deliveries.     

Cigarettes, coffee, and preterm premature rupture of the membranes.

Premature (prior to 37 completed weeks of gestation) rupture of the membranes (preterm PROM) is one of the most common underlying causes of preterm delivery. However, there have been few epidemiologic studies of this obstetric complication. The authors studied the relation of maternal cigarette smoking and coffee consumption to both preterm PROM and spontaneous preterm labor not complicated by premature rupture of the membranes (preterm NONPROM) in a large cross-sectional data base. The 307 preterm PROM and 488 preterm NONPROM cases who delivered during 1977-1980 at the Boston Hospital for Women were compared with 2,252 randomly selected women who delivered at term at that institution. Multiple logistic regression techniques were used to derive maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). After confounders had been adjusted for, the relative risk of preterm PROM for women who reported ever having smoked during pregnancy, as compared with nonsmokers, was 1.6 (95% CI 1.1-2.4). However, no gradient between the number of cigarettes smoked per day and the risk of preterm PROM was observed. Similar results were observed for preterm NONPROM. Women who consumed three or more cups of coffee daily during the first trimester had a 2.2-fold greater risk of preterm PROM than did women who drank two or fewer cups (95% CI 1.5-3.3). Among coffee drinkers, there was some evidence of a linear trend in the risk of preterm PROM as coffee consumption increased. Consumption of three or more cups of coffee per day was less strongly associated with the occurrence of preterm NONPROM (adjusted OR = 1.4, 95% CI 1.0-1.9).     

Maternal, delivery, and perinatal characteristics associated with cryptorchidism: a population-based case-control study among births in Washington State

BACKGROUND: The etiology of cryptorchidism is largely unknown. To identify maternal, perinatal, and delivery characteristics associated with cryptorchidism at birth, we conducted a population-based case-control study using Washington State birth certificates linked to birth hospitalization records. METHODS: We identified 2,395 cases of cryptorchidism among male infants born in Washington State during 1986-1996, and, for comparison, we randomly selected four controls per case (N = 9,580), frequency-matched by year of birth. RESULTS: Infant characteristics associated with cryptorchidism included low birth weight (OR = 1.5; 95% CI = 1.3-1.8), small size for gestational age (OR = 1.9; 95% CI = 1.6-2.2), and breech presentation (OR = 1.7; 95% CI = 1.4-2.1). In addition to cryptorchidism, cases were more likely to have another type of congenital malformation (OR = 3.7; 95% CI = 3.2-4.2), particularly digestive (OR = 6.8; 95% CI = 3.7-12.7) or genitourinary (OR = 4.1; 95% CI = 3.0-5.6). Maternal and pregnancy characteristics associated with cryptorchidism included nulliparity (OR = 1.2; 95% CI = 1.1-1.3), maternal smoking during pregnancy (OR = 1.2; 95% CI = 1.1-1.4), and the following pregnancy complications: oligohydramnios (OR = 1.8; 95% CI = 1.3-2.6), placental abnormality (OR = 1.3; 95% CI = 1.0-1.8), and pregnancy-induced hypertension (OR = 1.6; 95% CI = 1.4-1.9). Odds ratios were similar when the analysis was restricted to term infants. CONCLUSIONS: These findings suggest that factors affecting fetal growth and development may increase the risk of cryptorchidism.     

Prepregnancy body mass index, vaginal inflammation, and the racial disparity in preterm birth

The authors sought to quantify the overall and race/ethnic-specific relations between prepregnancy body mass index and both preterm birth and vaginal inflammation. Data from a cohort of 11,392 women who enrolled in the multicenter Vaginal Infections and Prematurity Study (1984-1989) at 23-26 weeks' gestation were used. Compared with a prepregnancy body mass index of 22, a body mass index of 16 increased the risk of preterm birth by 90% (odds ratio = 1.9, 95% confidence interval (CI): 1.5, 2.6), and a body mass index of 18 increased the risk by 40% (odds ratio = 1.4, 95% CI: 1.2, 1.7). Ethnicity substantially modified the magnitude of the body mass index effect and the shape of the preterm birth risk curve, with underweight having a greater impact on preterm birth among Blacks and Hispanics than among Whites. Low body mass index increased the risk of a high level of neutrophils (> 5 per oil immersion field) and a high vaginal pH measurement (> or = 5.0) among Black women; for a body mass index of 16 versus 22, the odds ratio = 1.7 (95% CI: 1.1, 2.6). Compared with Black women with a body mass index of 22, Blacks with a body mass index of 16 had a 1.7-fold increased risk for a high level of neutrophils and a high vaginal pH measurement, while those with a body mass index of 18 had a 1.3-fold increased risk.     

Low birth weight in relation to multiple induced abortions.

BACKGROUND. Most studies report that a single induced abortion does not increase risk for delivering a low birth weight infant in a subsequent pregnancy. However, the effect of multiple abortions has not been adequately evaluated. METHODS. This relationship was studied in 6541 White women who delivered their first child between 1984 and 1987. We compared the frequencies of low birth weight (less than 2500 g) among infants born to 1999 women without prior induced abortion and 1999 women with one abortion with the frequencies of low birth weight among infants born to women with two (n = 1850), three (n = 520), and four or more (n = 173) prior induced abortions. RESULTS. After adjustment for confounding variables, we found no linear relationship in risk of low birth weight among women with one (relative risk [RR] = 1.2, 95% confidence interval [CI] = 0.9-1.5), two (RR = 1.5, 95% CI = 1.1-2.0), three (RR = 1.3, 95% CI = 0.8-1.9), or four or more (RR = 1.6, 95% CI = 0.9-2.9) prior induced abortions. CONCLUSIONS. These findings confirm earlier reports of little or no evidence of harmful effects on birth weight by one or by two or more induced abortions. We further report that risk is not significantly elevated even in women with three, four, or more prior terminations of pregnancy when compared with women with one or two abortions.     

An analysis of intra-uterine growth retardation in rural Malawi

OBJECTIVE: (1) To describe the sex-specific, birth weight distribution by gestational age of babies born in a malaria endemic, rural area with high maternal HIV prevalence; (2) to assess the contribution of maternal health, nutritional status and obstetric history on intra-uterine growth retardation (IUGR) and prematurity. METHODS: Information was collected on all women attending antenatal services in two hospitals in Chikwawa District, Malawi, and at delivery if at the hospital facilities. Newborns were weighed and gestational age was assessed through post-natal examination (modified Ballard). Sex-specific growth curves were calculated using the LMS method and compared with international reference curves. RESULTS: A total of 1423 live-born singleton babies were enrolled; 14.9% had a birth weight <2500 g, 17.3% were premature (<37 weeks) and 20.3% had IUGR. A fall-off in Malawian growth percentile values occurred between 34 and 37 weeks gestation. Significantly associated with increased IUGR risk were primiparity relative risk (RR) 1.9; 95% CI 1.4--2.6), short maternal stature (RR 1.6; 95% CI 1.0--2.4), anaemia (Hb<8 g/dl) at first antenatal visit (RR 1.6; 95% CI 1.2--2.2) and malaria at delivery (RR 1.4; 95% CI 1.0--1.9). Prematurity risk was associated with primiparity (RR 1.7; 95% CI 1.3--2.4), number of antenatal visits (RR 2.2; 95% CI 1.6--2.9) and arm circumference <23 cm (RR 1.9; 95% CI 1.4--2.5). HIV infection was not associated with IUGR or prematurity. CONCLUSION: The birth-weight-for-gestational-age, sex-specific growth curves should facilitate improved growth monitoring of newborns in African areas where low birth weight and IUGR are common. The prevention of IUGR requires improved malaria control, possibly until late in pregnancy, and reduction of anaemia.     

Antibiotic microbial resistance surveillance in invasive infections caused by Streptococcus pneumoniae and Staphylococcus aureus: the EARSS (European Antimicrobial Resistance Surveillance System) project in Italy (April 1999-April 2000)

This paper presents the results of an Italian multicentric study conducted in the period April 1999-April 2000 in 64 clinical microbiology laboratories, aimed at collecting antimicrobial resistance data using a standard European protocol (EARSS Project, European Antimicrobial Surveillance System). A total of 1701 strains of Staphylococcus aureus were isolated from blood and 367 strains of Streptococcus pneumoniae were isolated from blood (72.7%) or from CSF (27.3%). Methicillin resistance in S. aureus was found to be 42.1%; it was significantly higher in adults (RR = 6.6, CI 95% 2.5-17.0), in hospitals of Centre and North of Italy (respectively RR = 1.45, CI 95% 1.1-2.0; RR = 1.6, CI 95% 1.1-2.2), and in intensive care and surgery units (respectively RR = 1.8, IC 95% 1.6-2.0 and RR = 1.7, CI 95% 1.4-1.9). Penicillin resistance in S. pneumoniae was found to be 12.1%; it was higher in South Italy (RR = 3.5, CI 95% 1.9-6.6, in meningitis compared to sepsis (RR = 2.5, CI 95% 1.4-2.5) and in intensive care units compared to other departments (RR = 2.2, CI 95% 1.0-4.8). The level of erythromycin resistance in S. pneumoniae was of 28.2%, reaching 56.4% in penicillin resistant strains. These results suggest that a continued surveillance and effective control measures are required.     

Incidence of and socio-demographic risk factors for stillbirth, preterm birth and low birthweight among Zimbabwean women

Data on birth outcomes are important for planning maternal and child health care services in developing countries. Only a few studies have examined frequency of birth outcomes in Zimbabwe, none of which has jointly examined the spectrum of poor birth outcomes across important demographic subgroups. We assessed delivery patterns and birth outcomes in 17 174 births over a one-year period from October 1997 to September 1998 at Harare Hospital, Zimbabwe. The annual rate of stillbirth was 61 per 1000 live births, rate of preterm birth (<37 weeks) was 168 per 1000, and low birthweight (LBW) (<2500 g) was 199 per 1000. Not attending antenatal care (prenatal care) was associated with increased risks of stillbirth [relative risk (RR) = 2.54, 95% CI 2.21, 2.92], preterm delivery [RR = 2.43, 95% CI 2.26, 2.61] and LBW births [RR = 2.16, 95% CI 2.02, 2.31]. Preterm births and LBW births were more likely to be stillborn [RR = 7.26, 95% CI 6.28, 8.39 and RR = 6.85, 95% CI 5.94, 7.91]. In conclusion, the rate of stillbirth is high and is predominantly associated with preterm births and to a lesser extent LBW. Reducing the frequency of stillbirth will require a better understanding of the determinants of preterm births and strategies for addressing this particular subset of high-risk births.     

Chemical hair treatments and adverse pregnancy outcome among Black women in central North Carolina

Several studies suggest that toxic chemicals in hair products may be absorbed through the scalp in sufficient amounts to increase the risks of adverse health effects in women or their infants. This case-control study of 525 Black women from three counties in North Carolina who had delivered a singleton, liveborn infant examined whether exposure to chemicals used in hair straightening and curling increased the odds that the infant was preterm or low birth weight. Cases consisted of 188 preterm and 156 low birth weight births (for 123 women, their infant was both low birth weight and preterm). Controls were 304 women who delivered term and normal birth weight infants. Women who used a chemical hair straightener at any time during pregnancy or within 3 months prior to conception had an adjusted odds ratios (OR) of 0.7 (95% confidence interval (CI) 0.4-1.1) for preterm birth and 0.6 (95% CI 0.4-1.1) for low birth weight. Exposure to chemical curl products was also not associated with preterm delivery (adjusted OR = 0.9, 95% CI 0.5-1.8) or low birth weight (adjusted OR = 1.0, 95% CI 0.5-1.9). Despite this failure to find an association, continued search for risk factors to which Black women are uniquely exposed is warranted.     

妊娠晚期血红蛋白浓度与早产和低出生体重关系的研究

目的分析妊娠晚期血红蛋白(Hb)浓度与早产和低出生体重之间的关系。方法研究对象为江苏和浙江省4个县(市)在1995—2000年间分娩的102 489名妇女。按妊娠晚期Hb浓度分四组比较各组早产和低出生体重的发生率;采用logistic回归模型控制年龄、职业、文化程度、孕次、产检次数和妊高征等因素后,估计Hb与早产和低出生体重的关联程度。结果妊娠晚期贫血患病率为48.2%,以轻度和中度贫血为主。轻、中度贫血不增加早产和低出生体重的风险。当Hb为90～99 g/L时,早产和低出生体重的发生率最低;当Hb升高或降低时,早产和低出生体重的风险均呈增加趋势。Hb为70～119 g/L时,早产和低出生体重的风险变化不大,但重度贫血和高血红蛋白则显著增加早产和低出生体重的风险:Hb<70 g/L组早产和低出生体重的OR(95%CI)分别为1.8(1.0～3.3)和4.0(2.1～7.5);Hb≥130 g/L组的早产和低出生体重的OR(95%CI)为1.2(1.0～1.4)和1.5 (1.2～1.9)。结论妊娠晚期Hb水平与早产和低出生体重的风险之间均呈"U"形趋势,妊娠晚期重度贫血以及高血红蛋白均是早产和低出生体重的危险因素。     

Risk factors for early neonatal mortality

OBJECTIVE: To assess risk factors for early neonatal mortality. METHODS: A population-based case-control study was carried out with 146 early neonatal deaths and a sample of 313 controls obtained among survivals of the neonate period in the south region of the city of S?o Paulo, in the period of 8/1/2000 to 1/31/2001. Information was obtained through home interviews and hospital charts. Hierarchical assessment was performed in five groups with the following characteristics 1) socioeconomic conditions of mothers and families, 2) maternal psychosocial conditions, 3) obstetrical history and biological characteristics of mothers, 4) delivery conditions, 5) conditions of newborns RESULTS: Risk factors for early neonate mortality were: Group 1: poor education of household head (OR=1.6; 95% CI: 1.1;2.6), household located in a slum area (OR=2.0; 95% CI: 1.2;3.5) with up to one room (OR=2.2; 95% CI: 1.1;4.2); Group 2: mothers in recent union (OR=2.0; 95% CI: 1.0;4.2), unmarried mothers (OR=1.8; 95% CI: 1.1;3.0), and presence of domestic violence (OR=2.7; 95% CI: 1;6.5); Group 3: presence of complications in pregnancy (OR=8.2; 95% CI: 5.0;13.5), previous low birth weight (OR=2.4; 95% CI: 1.2;4.5), absence of pre-natal care (OR=16.1; 95% CI: 4.7;55.4), and inadequate pre-natal care (block 3) (OR=2.1; 95% CI: 2.0;3.5); Group 4: presence of clinical problems during delivery (OR=2.9; 95% CI: 1.4;5.1), mothers who went to hospital in ambulances (OR=3.8; 95% CI: 1.4;10.7); Group 5: low birth weight (OR=17.3; 95% CI: 8.4;35.6) and preterm live births (OR=8.8; 95% CI: 4.3;17.8). CONCLUSIONS: Additionally to proximal factors (low birth weight, preterm gestations, labor complications and unfavorable clinical conditions in gestation), the variables expressing social exclusion and presence of psychosocial factors were also identified. This context may affect the development of gestation and hinder the access of women to health services. Adequate prenatal care could minimize the effect of these variables.     

A Population-Based Study of Maternal and Perinatal Outcomes Associated with Assisted Reproductive Technology in Massachusetts

Objective: To assess associations between assisted reproductive technology (ART) and adverse maternal and infant outcomes, with an emphasis on singletons. Methods: We linked data from the US ART surveillance system with Massachusetts live birth-infant death records data for resident births in 1997–1998 and compared births conceived with ART (N = 3316) with births not conceived with ART or infertility medications (N = 157,066) on: maternal chronic conditions, pregnancy complications, labor and delivery complications, and perinatal and infant outcomes. Results: Overall, ART was strongly associated with numerous adverse outcomes. The magnitude was reduced for several outcomes when analyses were limited to singletons. After further exclusion of maternal subsets with rare ART births (maternal age <20; education <high school; unmarried, no or public health insurance; no or third trimester prenatal care initiation), and matching ART and non-ART singletons on birth hospital, birth month and year, maternal age, parity, and race/ethnicity, ART remained associated with pre-existing diabetes (Relative Risk [RR] = 2.2 95% confidence interval 1.02–4.9), incompetent cervix (RR = 6.0, [2.3–15.4]), pregnancy-induced hypertension (RR = 1.5, [1.04–2.2]), uterine bleeding (RR = 3.2, [1.5–6.8]), placental abruption (RR = 3.8 [1.6–9.4]), placenta previa (RR = 3.8, [1.6–9.4]), preterm delivery (RR = 2.4, [1.8–3.0]), very preterm delivery (RR = 2.5, [1.2–5.2]), low birth weight (RR = 2.1, [1.5–2.9]), and infant not discharged home (RR = 1.8, [1.2–2.6]). Conclusions: Women who conceive with ART are more likely than women who do not to enter pregnancy with a chronic condition and develop complications during pregnancy and labor and delivery. Additionally, infants born after ART are at increased risk for adverse health outcomes. The mechanisms underlying these associations require further study. The member clinics of MCARTER are listed in the Acknowledgments. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Association of sexual activity with colonization and vaginal acquisition of group B Streptococcus in nonpregnant women

In a longitudinal cohort study of 1,248 nonpregnant young women recruited from three Pittsburgh, Pennsylvania, health clinics in 1998-2000, the authors investigated risk factors associated with vaginal acquisition of group B Streptococcus (GBS). Rectal and vaginal swabs for GBS culture and demographic and behavioral interview data were obtained from the women at enrollment and at three 4-month intervals. Cox proportional hazards models were used to evaluate risk factors for GBS acquisition among the 1,089 women with follow-up data. At enrollment, 365 (29.2%) of the 1,248 study participants were vaginally colonized with GBS. Of 767 women who were GBS-negative at enrollment, 344 (44.9%) acquired vaginal GBS colonization during follow-up. The following factors were independently associated with vaginal acquisition of GBS at the 0.05 significance level: African-American race (hazard ratio (HR) = 1.5, 95% confidence interval (CI): 1.2, 1.9), having multiple sex partners during the past 4 months (HR = 1.7, 95% CI: 1.1, 2.5), having frequent sexual intercourse during the past 4 months (HR = 1.5, 95% CI: 1.1, 2.2), and having sexual intercourse within the 5 days prior to the follow-up visit (HR = 1.6, 95% CI: 1.3, 2.0). These results show that sexual activity is an important risk factor for vaginal acquisition of GBS.