Maternal health during pregnancy and perinatal mortality in Bangladesh: evidence from a large-scale community-based clinical trial

Perinatal mortality is very high in Bangladesh. In this setting, few community-level studies have assessed the influence of underlying maternal health factors on perinatal outcomes. We used the data from a community-based clinical controlled trial conducted between 1994 and 1997 in the catchment areas of a large MCH/FP hospital located in Mirpur, a suburban area of Dhaka in Bangladesh, to investigate the levels of perinatal mortality and its associated maternal health factors during pregnancy. A total of 2007 women were followed after recruitment up to delivery, maternal death, or until they dropped out of the study. Of these, 1584 who gave birth formed our study subjects. The stillbirth rate was 39.1 per 1000 births [95% confidence interval (CI) 39.0, 39.3] and the perinatal mortality rate (up to 3 days) was 54.3 per 1000 births [95% CI 54.0, 54.6] among the study population. In the fully adjusted logistic regression model, the risk of perinatal mortality was as high as 2.7 times [95% CI 1.5, 4.9] more likely for women with hypertensive disorders, 5.0 times [95% CI 2.3, 10.8] as high for women who had antepartum haemorrhage and 2.6 times [95% CI 1.2, 5.8] as high for women who had higher haemoglobin levels in pregnancy when compared with their counterparts. The inclusion of potential confounding variables such as poor obstetric history, sociodemographic characteristics and preterm delivery influenced only marginally the net effect of important maternal health factors associated with perinatal mortality. Perinatal mortality in the study setting was significantly associated with poor maternal health conditions during pregnancy. The results of this study point towards the urgent need for monitoring complications in high-risk pregnancies, calling for the specific components of the safe motherhood programme interventions that are designed to manage these complications of pregnancy.     

中国3省市21家医院早产发生的相关因素及结局研究

目的 分析早产发生的影响因素与结局,为早产的防治工作提供依据. 方法 对3省市21家医院完成分娩的全部产妇13 322例进行调查,计算早产发生率,分析早产发生的相关因素,比较早产儿与足月儿的新生儿结局. 结果 早产发生率为6.0％,其中晚期早产（孕周34～36周）占77.3％;导致早产发生危险增加的因素有年龄＜20岁、年龄＞35岁、在校读书年数＞12年、多胎、发生妊娠合并症;早产导致死胎或死产,低、极低出生体重,Apgar得分≤7分,进入新生儿重症监护室,出院前或生后7d内死亡的危险增加. 结论 早产是威胁胎儿及新生儿健康的重要因素,应尽早识别具备早产危险因素的孕妇,以便及时开展针对性的治疗工作.     

Modelling prior reproductive history to improve prediction of risk for very preterm birth

Watson LF, Rayner J‐A, King J, Jolley D, Forster D, Lumley J. Modelling prior reproductive history to improve prediction of risk for very preterm birth. Paediatric and Perinatal Epidemiology 2010. In published studies of preterm birth, analyses have usually been centred on individual reproductive events and do not account for the joint distributions of these events. In particular, spontaneous and induced abortions have often been studied separately and have been variously reported as having no increased risk, increased risk or different risks for subsequent preterm birth. In order to address this inconsistency, we categorised women into mutually exclusive groups according to their reproductive history, and explored the range of risks associated with different reproductive histories and assessed similarities of risks between different pregnancy histories. The data were from a population‐based case–control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. Detailed reproductive histories were collected by interview a few weeks after the birth. The cases were 603 women who had had a singleton birth between 20 and less than 32 weeks gestation (very preterm births including terminations of pregnancy) and the controls were 796 randomly selected women from the population who had had a singleton birth of at least 37 completed weeks gestation. All birth outcomes were included. Unconditional logistic regression was used to assess the association of very preterm birth with type and number of prior abortions, prior preterm births and sociodemographic factors. Using the complex combinations of prior pregnancy experiences of women (including nulligravidity), we showed that a history of prior childbirth (at term) with no preterm births gave the lowest risk of very preterm birth. With this group as the reference category, odds ratios of more than two were associated with all other prior reproductive histories. There was no evidence of difference in risk between types of abortion (i.e. spontaneous or induced) although the risk increased if a prior preterm birth had also occurred. There was an increasing risk of very preterm birth associated with increasing numbers of abortions. This method of data analysis reveals consistent and similar risks for very preterm birth following spontaneous or induced abortions. The findings point to the need to explore commonalities rather than differences in regard to the impact of abortion on subsequent births.     

Modelling sequence of prior pregnancies on subsequent risk of very preterm birth

Watson LF, Rayner J‐A, King J, Jolley D, Forster D, Lumley J. Modelling sequence of prior pregnancies on subsequent risk of very preterm birth. Paediatric and Perinatal Epidemiology 2010. The prevalence and intractability of preterm birth is known as is its association with reproductive history, but the relationship with sequence of pregnancies is not well studied. The data were from a population‐based case–control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. Detailed reproductive histories were collected by interview a few weeks after the birth. The cases were 603 women having a singleton birth between 20 and <32 weeks gestation (very preterm births including terminations of pregnancy). The controls were 796 randomly selected women from the population having a singleton birth of at least 37 completed weeks gestation. Unconditional logistic regression was used to assess the association of very preterm birth with sequence of pregnancies defined by their outcome (prior abortion – spontaneous or induced, and prior preterm or term birth) with adjustment for sociodemographic factors. The outcomes of each prior pregnancy, stratified by pregnancy order, and starting with the pregnancy immediately before the index or control pregnancy, were categorised as one of abortion, preterm birth or term birth. We showed that each of these prior pregnancy events was an independent risk of very preterm birth. This finding does not support the hypothesis of a neutralising effect of a term birth after an abortion on the subsequent risk for very preterm birth and is further evidence for the cumulative or increasing risk associated with increasing numbers of prior abortions or preterm births.     

Assessing Weight Gain by the 2009 Institute of Medicine Guidelines and Perinatal Outcomes in Twin Pregnancy

Objective The objective is to estimate the impact of maternal weight gain outside the 2009 Institute of Medicine recommendations on perinatal outcomes in twin pregnancies. Study Design Twin pregnancies with two live births between January 1, 2004 and December 31, 2014 delivered after 23 weeks Finger Lakes Region Perinatal Data System (FLRPDS) and Central New York Region Perinatal Data System were included. Women were classified into three groups using pre-pregnancy body mass index (BMI). Perinatal outcomes in women with low or excessive weekly maternal weight gain were assessed using normal weekly weight gain as the referent in each BMI group. Results Low weight gain increased the risk of preterm delivery, birth weight less than the 10th percentile for one or both twins and decreased risk of macrosomia across all BMI groups. There was a decreased risk of hypertensive disorders in women with normal pre-pregnancy weight and an increased risk of gestational diabetes with low weight gain in obese women. Excessive weight gain increased the risk of hypertensive disorders and macrosomia across all BMI groups and decreased the risk of birth weight less than 10th percentile one twin in normal pre-pregnancy BMI group. Conclusion Among twin pregnancies, low weight gain is associated with low birth weight and preterm delivery in all BMI groups and increased risk of gestational diabetes in obese women. Our study did not reveal any benefit from excessive weekly weight gain with potential harm of an increase in risk of hypertensive disorders of pregnancy. Normal weight gain per 2009 IOM guidelines should be encouraged to improve pregnancy outcome in all pre-pregnancy BMI groups.     

The determinants of the high Dutch perinatal mortality in a complete regional cohort, 1990-1994

OBJECTIVE: Analysis of the effects of population-based determinants (maternal age, parity, multiple pregnancy and ethnicity) and of professional and organisational factors (conservative management in case of early preterm birth, the policy on prenatal screening and the Dutch obstetric-care system in general) on perinatal mortality. DESIGN: Population-based prospective cohort study. METHOD: In a regional cohort (Zaanstreek) of 8031 pregnancies in the period 1990-1994 data were prospectively collected in an electronic database by deliverers of primary and secondary care. Analysis focussed on the effect on perinatal mortality of maternal age, parity, multiple pregnancy, ethnicity and professional and organisational factors (the policy in case of early preterm birth, the policy on prenatal screening and the Dutch obstetric-care system in general). Perinatal mortality was defined as mortality from a gestational age of 22 weeks until 28 days post partum. RESULTS: The perinatal mortality in the Zaanstreek was 12.6/1000. Increasing the gestational age to 28 weeks decreased the perinatal mortality by 29%. The perinatal mortality in this cohort was significantly affected by parity, multiple pregnancy and maternal age (relative risk: 2.8), but not by ethnicity if corrected for the previous factors. Conservative management in case of early preterm birth and a restrictive screening policy for lethal birth defects were associated with an increase in perinatal mortality. In 31 of 92 singleton pregnancies followed by perinatal mortality, a relationship to substandard care was established. In 7 cases this relationship was probable and in 1 case the midwife was responsible. CONCLUSION: Given the magnitude of their effects, both independently and via interaction, stratification for maternal age, parity, multiple pregnancy and ethnicity must precede any interpretation and comparison of perinatal mortality rates. Although clinical policy played a modest role, a negative role of the organisation of obstetric care was unlikely in this cohort. A definitive judgement as to the quality of perinatal care would require extension of the evaluation to at least the entire first year of life in connection with the morbidity. The most favourable effects can be expected from stimulatory measures directed at lowering the age at first pregnancy.     

The interrelationship of maternal smoking and increased perinatal mortality with other risk factors. Further analysis of the Ontario Perinatal Mortality Study, 1960-1961

Increased perinatal mortality among smokers' babies has been observed in many but not in all studies, with a statistically significant difference in some. This paper explores the hypothesis that maternal smoking may interact with other risk factors, so that a dose-related increase in perinatal mortality may be enhance or masked depending upon the presence or absence of these factors. Data are from the Ontario Perinatal Mortality Study of all single b irths in 10 teaching hospitals in Ontario in 1960-1961 a total of 51,490 births, including 701 fetal deaths and 655 early neonatal deaths. Perinatal mortality increased significantly with smoking, and was also affected by such factors as maternal age, parity, hospital status, previous pregnancy history, hemoglobin level, and others. Smoking frequencies also varied by many of these characteristics. Perinatal mortality was therefore analyzed by the amount smoked during pregnancy within subgroups of these antecedent risk factors. When smoking and other risk factors were cross-tabulated among 52 data subgroups, only the light smokers (less than 1 pack per day) under age 20 had lower perinatal mortality rates than their nonsmoking counterparts. In almost all subgroups the mortality increase with smoking was dose-related, but not in a simple, linear way. The increased risk of perinatal mortality associated with light smoking among young, low-parity, non-anemic mothers was less than 10 percent. At the other extreme, mothers of high parity, public hospital status, with previous low birthweight births, or with hemoglobin less than 11 gm had increased perinatal mortality risks of 70-100 percent when they were heavy smokers. The failure of some studies to find a significant increase in perinatal mortality with maternal smoking may be due to selection of study populations from the end of the spectrum where light smoking is associated with only a slight increase in perinatal risk. Other studies may select higher risk populations, where the influence of smoking on mortality is stronger. Depending on the magnitude of the difference, the amount smoked, and the size of the study, results might or might not be statistically significant.     

Placental abruption and perinatal mortality in the United States

Placental abruption is an uncommon obstetric complication associated with high perinatal mortality rates. The authors explored the associations of abruption with fetal growth restriction, preterm delivery, and perinatal survival. The study was based on 7,508,655 singleton births delivered in 1995 and 1996 in the United States. Abruption was recorded in 6.5 per 1,000 births. Perinatal mortality was 119 per 1,000 births with abruption compared with 8.2 per 1,000 among all other births. The high mortality with abruption was due, in part, to its strong association with preterm delivery; 55% of the excess perinatal deaths with abruption were due to early delivery. Furthermore, babies in the lowest centile of weight (<1% adjusted for gestational age) were almost nine times as likely to be born with abruption than those in the heaviest (> or =90%) birth weight centiles. This relative risk progressively declined with higher birth weight centiles. After controlling for fetal growth restriction and early delivery, the high risk of perinatal death associated with abruption persisted. Even babies born at 40 weeks of gestation and birth weight of 3,500-3,999 g (where mortality was lowest) had a 25-fold higher mortality with abruption. The link between fetal growth restriction and abruption suggests that the origins of abruption lie at least in midpregnancy and perhaps even earlier.     

Perinatal Care in Canada

HEALTH ISSUE: Canada's standard of perinatal care ranks among the highest in the world, but there is still room for improvement, both in terms of regional differences in care and global comparisons of approaches to care in Canada and elsewhere. Data from the Canadian Perinatal Surveillance System (CPSS) was used to evaluate morbidity and mortality among mothers and infants. KEY FINDINGS: Maternal mortality rates in Canada dropped to 4.4 per 100,000 live births in 1993-1997 and are among the lowest in the world. Rates of Caesarean section increased from 15.3 per 100 deliveries in 1994 to 19.1 in 1997. Although the infant mortality rate in Canada is among the lowest in the world (5.3-8.8 per 1,000 live births 1990-2000), there are unacceptable disparities between subpopulations. In Aboriginal populations, rates of stillbirth and perinatal mortality are 2-2.5 times the Canadian average. There has been a steady increase in the proportion of births among older women who have the highest risk of preterm births and pregnancy complications.The increasing rate of multiple births has accelerated recently and is of concern as these carry a higher risk of complications and are associated with an increased risk of preterm birth. The costs to the health care system are likely to be high. DATA GAPS AND RECOMMENDATIONS: CPSS data, including economic indicators, needs to be collected in a more timely and uniform manner across Canada. The CPSS should provide an evaluation of how well Canada fares in relation to international standards of perinatal care.     

Perinatal death in ethnic minorities in The Netherlands.

OBJECTIVES: To investigate differences in perinatal death rate and associated obstetric risk factors between ethnic groups in the Netherlands. DESIGN: Retrospective cohort study based on the 1990-1993 birth cohorts in the National Obstetric Registry. SUBJECTS: 569,743 births of which 85,527 were for women belonging to ethnic minorities. MAIN OUTCOME MEASURES: Perinatal death occurring between 16th week of pregnancy and 24 hours after birth. METHOD: Bivariate and multivariate analysis of perinatal death rate per ethnic group. A total of 42,282 women living in the three main cities of the Netherlands were classified on the basis of postal code districts into four socioeconomic (SES) classes for analysis of the relation between SES, perinatal death, and preterm birth. RESULTS: Black mothers had the highest perinatal death rate compared with indigenous Dutch (odds ratio 2.2, 95% CI 1.9, 2.4) followed by a group "others", consisting of women of mixed or unknown ethnicity (odds ratio 1.8, 95% CI 1.5, 2.0), Hindustani (odds ratio 1.4, 95% CI 1.2, 1.6), and Mediterraneans (odds ratio 1.3, 95% CI 1.2, 1.4). Asians (excluding West Indian Asians) and non-Dutch Europeans did not have higher rates than Dutch women. The increased rates of black and Hindustani women could be explained fully and that of the group "others" partially by higher rates of preterm birth. Controlling for age and parity lowered the odds ratio of the Mediterraneans slightly. The risk of ethnicity was independent of SES. CONCLUSION: Ethnic minorities in the Netherlands except immigrants from Asia and other European countries have higher rates of perinatal death than indigenous Dutch women. With a twofold increase, black women had the highest rate, which was related to an equally large increased rate of preterm birth.     

Determinants of perinatal and infant mortality in Italy.

Determinants of stillbirths, perinatal and infant mortality in Italy have been analyzed using information collected routinely by the Italian Central Institute of Statistics on more than 2,400,000 births and 33,000 infant deaths in the period 1980-1983. Individual records included data on maternal (i.e. age, education, obstetric history) and fetal characteristics (sex, birth weight, gestational week at birth). The Italian stillbirth, perinatal and infant (1st-365th day of life) mortality rates in the period considered were respectively 7.7/1000 births, 16.4/1000 births and 13.5/1000 livebirths. Perinatal and infant mortality was extremely elevated in the very-low-birth-weight category. About 90% of liverbirths weighing less than 1000 g died within the first year of life, but this fell to about 45% in babies weighing 1000-1499 g. Among other factors, stillbirth, perinatal and infant mortality rates were elevated among males, born to older women and in higher birth rank and multiple pregnancies. These findings persisted, although less markedly, after adjustment for weight. Mortality rates were about 50-70% higher in less educated women. This finding was not markedly changed after adjustment for birth weight and maternal age, suggesting that socio-economic factors are per se important determinants of perinatal and infant mortality in Italy.     

The importance of preterm births for peri- and neonatal mortality in rural Malawi

Peri- and neonatal mortality remain high in developing countries, especially in sub-Saharan Africa. In the present study, we quantified and identified the most important predictors of early mortality in rural Malawi. Data were obtained from a community-based cohort of 795 pregnant women and their 813 fetuses, followed prospectively from mid-pregnancy. In this group, peri- and neonatal mortality rates were 65.3 deaths per 1000 births and 37.0 deaths per 1000 live births respectively. When controlled for month of birth, maternal age and selected socio-economic variables, preterm birth was the strongest independent predictor of both peri- and neonatal mortality (adjusted odds ratios 9.6 for perinatal and 11.0 for neonatal mortality; 95% confidence intervals: [4.4, 21.0] and [3.7, 32.7] respectively). Weaker risk factors for mortality included a maternal history of stillbirth and abnormal delivery. Preterm delivery was associated with primiparity and peripheral malaria parasitaemia of the mother, and it accounted for 65% of the population-attributable risk for perinatal and 68% of the neonatal mortality. Successful intervention programmes to reduce peri- and neonatal mortality in Malawi have to include strategies to predict and prevent prematurity.     

Obstetric profiles and perinatal mortality among Pacific Island immigrants in New South Wales, 1990-93

OBJECTIVES: To describe the obstetric profile and perinatal mortality of Pacific Island-born women giving birth in New South Wales (NSW) and assess risk factors associated with the high perinatal death rate previously noted in this immigrant group. METHOD: Retrospective cohort study based on the Midwives Data Collection in NSW from 1990 to 1993. Births to 5,034 Pacific Island-born women were compared with births to 256,843 Australian-born women. RESULTS: Pacific Island-born women had fewer teenage pregnancies and were of an older age and higher parity. They were more likely to be married or in a de facto relationship and to present for antenatal care later in the pregnancy. The proportion of low birthweight and preterm birth was similar in the two groups but Pacific Islanders had a higher perinatal mortality rate (14.6/1,000 vs. 10.3/1,000, RR = 1.42, 95% CI = 1.13-1.54). Even at normal and high birthweights, infants of Pacific Island-born women were at greater risk of perinatal death. After adjusting for maternal factors (marital status, insurance status, parity and maternal age) Pacific Islanders were 30% more likely to have a perinatal death (OR = 1.30, 95% CI 1.07-1.54). CONCLUSIONS: Further analyses of the causes of perinatal death in Pacific Island-born women are needed so appropriate interventions can be implemented. IMPLICATIONS: The need for the design and evaluation of culturally specific services aimed at improving antenatal care attendance in Pacific Islanders is emphasised. Conventional risk assessment may not adequately predict adverse perinatal outcomes in all populations.     

兰州地区早产影响因素的研究

目的 探讨早产、自发性早产和医源性早产的相关高危因素.方法 回顾性调查2010年1月至2012年12月在甘肃省妇幼保健院住院分娩足月儿和早产儿的孕妇的住院资料,分娩足月活产儿5639例、早产儿540例,分为足月产组(≥37周孕龄)和早产组(<37周孕龄),比较早产组和足月产组发生早产的相关危险因素,以及自发性早产和医源性早产的相关高危因素.结果 ①Logistic回归分析发现教育年限(≥16年)(OR=0.61,95%CI:0.48~0.78)、家庭平均月收入(>3000元)(OR=0.62,95%CI:0.50~0.78)是早产发生的保护因素,而母亲妊娠合并症,比如妊娠期糖尿病(GDM)(OR=3.97,95%CI:1.70~9.25)、妊娠期高血压疾病(HDP)(OR=4.43,95%CI:3.35~5.87)、妊娠期胆汁淤积症(ICP)(OR=4.88,95%CI:3.25~7.32)是早产发生的独立高危因素.②按早产的病因分类,本研究中340例为自发性早产儿,余200例为医源性早产.经分层多因素非条件Logistic回归分析表明,与足月产相比,经产妇(OR=2.66,95%CI:1.87~3.76)、GDM(OR=4.52,95%CI:1.42~14.38),尤其是HDP孕妇(OR=14.19,95%CI:10.10~19.93)更易发生医源性早产,而ICP孕妇更多出现自发性流产(OR=12.875,95%CI:12.75~13.00).结论 应及早识别早产潜在的高危因素,加强围生期管理,以减少早产的发生,改善围生儿结局.     

The influence of maternal age on very preterm birth of twins: differential effects by parity

For singleton births, parity can modify the effect of maternal age on birth outcomes such as low birthweight and preterm birth; however, it is unknown whether this relationship exists for twin births. As the rate of twin births increases among older women, it is important to understand how parity may influence the relationship between maternal age and adverse birth outcomes. The NCHS Matched Multiple Birth Data Set, which contains all twin births in the USA from 1995 to 1998, was analysed. Parity was grouped into two levels (primiparous--no prior live births, and multiparous--at least one prior live birth), and maternal age was divided into the following groups: 20-24, 25-29, 30-34, 35-39, and 40 years or more. Very preterm birth was defined as births occurring before 33 weeks. Logistic regression was used to obtain odds ratios (OR) to estimate the risk of very preterm birth, and to determine the relationships between parity, maternal age, and very preterm birth. Among primiparae, women 40 years and older had a reduced risk of very preterm birth compared with women of 25-29 years (OR 0.74 [95% CI=0.66, 0.84]). Among multiparae, women 40 years and older had the same risk of very preterm birth compared with women of 25-29 years (OR 1.00 [95% CI=0.90, 1.12]). However, stratification by education revealed that the age gradient was limited to women with >12 years education among primiparae. The effect of maternal age on very preterm birth of twins differs according to parity. To some extent, that effect is further modified by education. Therefore, future analyses of maternal age and twin birth outcomes should account for measures of obstetric history and other factors, which may influence these results.     

Social differences of very preterm birth in Europe: interaction with obstetric history. Europop Group.

Social differences of very preterm birth (22-32 completed weeks of amenorrhea) were studied using data from a large case-control survey in Europe between 1994 and 1997; 1,675 very preterm births and 7,965 full-term births were included. The relation between social factors and very preterm birth was studied according to obstetric history and the mode of delivery onset. Very preterm birth was significantly related to low educational level among women with no previous adverse pregnancy outcome (odds ratio (OR) = 2.67, 95 percent confidence interval (CI) 1.66-4.28) and among primigravid women and those with previous first-trimester abortion (OR = 2.01, 95 percent CI 1.56-2.58). In this group, unemployment of all household members was associated with a double risk of very preterm birth. No significant association between very preterm birth and socioeconomic status was observed among women with previous second-trimester abortion or preterm birth. Socioeconomic indicators remained significantly associated with both spontaneous and induced very preterm births among women with no previous late fetal loss or preterm birth. The results are consistent with social factors affecting the risk of very preterm birth, but the relation differs according to obstetric history.     

Induced abortion: not an independent risk factor for pregnancy outcome, but a challenge for health counseling

PURPOSE: Low birth weight (LBW), preterm births, abnormal placentation, and miscarriages have been associated with prior induced abortions. An incidence-related effect has been suggested. The objective of this study is to assess the effects of prior induced abortions on obstetric risk factors and pregnancy outcome in conditions of free high-standard maternity care used by almost the entire pregnant population in Finland. METHODS: We analyzed a population-based database including 26,976 singleton pregnancies from 1989 to 2001, of which 2364 were among women with one prior induced abortion and 355 women had had at least two prior induced abortions. Data included maternal risk factors, pregnancy characteristics, and obstetric outcome measures and were based on results of a self-administered questionnaire at 20 weeks of pregnancy and clinical records. Odds ratios (ORs) concerning pregnancy outcomes were calculated in multiple logistic regression analysis. RESULTS: Induced abortions were associated with several known pregnancy risk factors; specifically, maternal age older than 35 years, unemployment, unmarried status, low educational level, smoking, alcohol consumption, overweight condition, and chronic illnesses. Preterm birth (OR, 1.19; 95% confidence interval, 1.01-1.41) in women with one prior abortion (7.3% versus 6.2%) and LBW (OR, 1.54; 95% confidence interval, 1.02-2.32) in women with two or more prior abortions (7.0% versus 4.7%) appeared to be more common, but after logistic regression analysis, we found no evidence of adverse pregnancy outcomes. CONCLUSIONS: Induced abortion is not an independent risk factor for adverse obstetric outcome. Marked health behavioral pregnancy risks are associated with prior induced abortions. Health counseling of these women is a challenge, but this objective has not yet been achieved.     

Jail incarceration and birth outcomes

This study examined the relationships between jail incarceration during pregnancy and infant birth weight, preterm birth, and fetal growth restriction. We used multivariate regression analyses to compare outcomes for 496 births to women who were in jail for part of pregnancy with 4,960 Medicaid-funded births as matched community controls. After adjusting for potential confounding variables, the relationship between jail incarceration and birth outcomes was modified by maternal age. Relative to controls, women incarcerated during pregnancy had progressively higher odds of low birth weight and preterm birth through age 39 years; conversely, jail detainees older than 39 years were less likely than controls to experience low birth weight or preterm birth. For women in jail at all ages, postrelease maternity case management was associated with decreased odds of low birth weight, whereas prenatal care was associated with decreased odds of preterm birth. Local jails are important sites for public health intervention. Efforts to ensure that all pregnant women released from jail have access to enhanced prenatal health services may improve perinatal outcomes for this group of particularly vulnerable women and infants.     

Infant Mortality Among Arab-Americans: Findings from the Arab-American Birth Outcomes Study

Arab-Americans (AAs) have lower risk of preterm birth relative to Non-Arab Whites. This has been attributed to lower likelihood of birth out of wedlock, maternal tobacco use during pregnancy, and foreign maternal birthplace among AAs. We were interested in understanding the roles of these and other demographic factors in the etiology of infant mortality among this group. Using data about all live, singleton births between 1989 and 2005 in the state with the highest proportion of AAs in the US, we calculated infant mortality (death prior to 1 year of life) for AAs and Non-Arab Whites. To clarify the etiology of potential differences in infant mortality, we also assessed infant mortality sub-categories, including neonatal mortality (death prior to 28 days of life) and post-neonatal mortality (death between 28 and 365 days of life). We fit trivariable and multivariable logistic regression models adjusted for explanatory covariates to assess each covariate’s contributions to the relation between ethnicity and infant mortality. AAs had a lower infant mortality rate (4.7 per 1,000 live births) than non-Arab Whites (5.6 per 1,000 live births), overall (odds ratio = 0.84, 95 % confidence interval: 0.74–0.96). In trivariable models, adjusting for marital status, maternal tobacco consumption during pregnancy, and maternal birthplace each separately attenuated the bivariate ethnicity-mortality relation to non-significance. Our findings suggest that lower risk of infant mortality among AAs relative to non-Arab Whites may be explained by differences in demographic characteristics and parental behavioral practices between them.     

Demographic survey of the level and determinants of perinatal mortality in Karachi, Pakistan

Summary. .A demographic survey was used to estimate the level and determinants of perinatal mortality in eight lower socio-economic squatter settlements of Karachi, Pakistan. The perinatal mortality rate was 54.1 per 1000 births, with a stillbirth to early neonatal mortality ratio of 1:1. About 65% of neonatal deaths occurred in the early neonatal period, and early neonatal mortality contributed 32% of all infant deaths. Risk factor assessment was conducted on 375 perinatal deaths and 6070 current survivors. Poorer socio-economic status variables such as maternal and paternal illiteracy, maternal work outside the home and fewer household assets were significantly associated with perinatal mortality as were biological factors of higher parental age, short birth intervals and poor obstetric history. Multivariable logistic analysis indicated that some socioeconomic factors retained their significance after adjusting for the more proximate biological factors. Population attributable risk estimates suggest that public health measures for screening of high-risk women and use of family planning to space births will not improve perinatal mortality substantially without improvement of socio-economic conditions, particularly maternal education. The results of this study indicate that an evaluation of perinatal mortality can be conducted using pregnancy histories derived from demographic surveys.