Changing pregnancy outcomes of Samoan women in Hawaii

In the state of Hawaii, Samoan mothers are known for the large average birthweight and low percentage of low birthweight (< 2500 g) of their infants, in spite of the relatively low socio-economic status of the population. This paper reports the findings of a temporal trend analysis of birth outcomes of Samoan women and identifies worrying changes. Data were obtained from Hawaii birth certificates. Single live births to Hawaii-resident Samoan and Caucasian women from 1979 to 1994 were included in the study. Infants of Samoan women experienced a 75 g decline in mean birthweight and an increase in the percentage of low (< 2500 g) and very low (< 1500 g) birthweight from 2.6 and 0.4 to 3.8 and 0.8 respectively. During the same time, infants of Caucasian mothers experienced an increase in mean birthweight and a decline in low birthweight, while very low birthweight did not change. Maternal socio-demographic characteristics explained only part of the findings and use of prenatal care did not appear to be associated with any birth outcome indicators. Multiple regression analyses identified an adjusted loss of 50.8 g in birthweight and a 1.48 increase in the odds ratio of small-for-gestational-age associated with birth at the end (1991-4) compared with the beginning (1979-82) of the study period. Further studies focusing on maternal health status and psycho-social variables, including the effect of acculturation-related stress, are warranted to identify at least some of the determinants of the changes identified by this analysis.     

Birth outcomes across ethnic groups of women in Nepal

This study was conducted at the Western Regional Hospital (WRH), Pokhara, Nepal. We investigated the relationship between selected socioeconomic variables, pregnancy indices, birth weight, and maternal health in women of different ethnic origins. In our cross-sectional data set, 29.8% of infants were born with a low birth weight. Our data analysis showed Indo-Aryan and lower caste ethnic groups had significantly lower weight babies than Tibeto-Burman and Newar groups. Further analysis showed that the Tibeto-Burman group received better care during pregnancy. Similarly, the Newar groups had significantly better nutritional intake than the Indo-Aryan and lower caste groups. The outcome of food restriction and antenatal care during pregnancy in specific ethnic groups has important implications for the health care delivery system. Health policymakers should target those ethnic groups and develop culturally based policies to reduce the incidence of low birth weight in Nepal.     

Birth outcomes among women with congenital neuromuscular disabilities

BackgroundWomen with disabilities are at an increased risk for adverse birth outcomes; however, research among women with congenital neuromuscular disabilities (cNMD) is limited.ObjectiveTo describe characteristics and compare birth outcomes among women with and without cNMD.MethodsData were from the Slone Birth Defects Study (case-control, conducted from 1976 to 2015), which collected information on demographic, reproductive, and lifestyle characteristics. cNMD included spina bifida, cerebral palsy, muscular dystrophy, contractures, or arthrogryposis and were identified by participant report. Those with cNMD were matched to participants without cNMD by interview year and study site. We use modified Poisson regression to estimate relative risks (RR) for low birthweight, macrosomia, preterm birth, and small/large-for-gestational age (SGA/LGA). Given the case-control design and overrepresentation of infants with congenital anomalies, data were weighted to reflect a 3% national prevalence of infants with congenital anomalies.ResultsWomen with cNMD (n = 125) were more likely to be white, nulliparous, have a cesarean section, have an unplanned pregnancy, report a pre-pregnancy BMI ≥25 kg/m², smoke during pregnancy, and report genitourinary infections. Women with cNMD had infants with shorter gestational length (mean difference: ?7.44 days, 95% CI: ?13.94, ?0.95) compared to women without cNMD. cNMD was associated with higher risk of preterm birth (RR = 3.98, 95% CI: 1.33, 11.95) and SGA (RR = 2.14, 95% CI: 0.74, 6.15).ConclusionWomen with cNMD were more likely to deliver preterm and have an SGA infant. These findings highlight disparities faced by women with cNMD and stress the need to provide optimal perinatal and reproductive care.     

Birth outcomes of prostituting adolescents.

In 1989, researchers at the University of Washington, Division of Adolescent Medicine, described the multifactorial risks of pregnancy for adolescents engaged in prostitution activities. Factors identified as placing this population at particular risk were transience, substance abuse, violence, sexually transmitted diseases, inadequate (or no) medical care, and poor nutrition. The relationship between such risks in the pregnant adolescent and poor birth outcome has been widely demonstrated. In this follow-up study, we describe the birth outcomes of 54 of the original sample of 61 prostituting adolescents who delivered infants between November 1987 and November 1989 in Seattle, Washington. The data were collected by retrospective chart review. Maternal factors evaluated were 1) age 2) ethnic group 3) substance abuse history 4) number of prenatal visits 5) maternal complications and 6) parity. The infant inpatient charts were reviewed for the following characteristics: 1) birth weight 2) occipitofrontal head circumference 3) length 4) Apgar scores and 5) neonatal complications. Results indicated high rates of maternal and infant complications with respect to: preterm birth (22%), precipitous delivery (15%), pregnancy-induced hypertension (16%), positive toxicology screens (28%), meconium staining (30%), infant hypertonicity (30%), and small for gestational age infants (14.5%).     

Birth outcomes and the effectiveness of prenatal care.

OBJECTIVE: To investigate pregnant women's self-selection effects on the estimation of birthweight production function. A particular emphasis is placed on assessing the effectiveness of prenatal care as a major medical input in the birthweight production function. DATA SOURCES: Primary data compiled from birth and abortion certificates for the Commonwealth of Virginia in 1984. Several area-specific socioeconomic variables were also employed from the Area Resource File 1984; Supplemental Food Program for Women, Infants, and Children (WIC) Local Agency Directory; and the family planning clinics data by the Alan Guttmacher Institute (AGI). STUDY DESIGN: Two types of self-selection effects are defined: selection effect due to sample censoring from the resolution of pregnancies as live births or induced abortions; and selection effect due to the use of prenatal care as an endogenous variable. Race- and location-specific birthweight production functions are estimated using models with and without correction for self-selection effects. PRINCIPAL FINDINGS: The self-selection effect in the resolution of pregnancies is race-specific, being significant for African American women. The effectiveness of prenatal care in birthweight production is underestimated substantially by the selection bias from the use of prenatal care, and overestimated by the selection bias from pregnancy resolutions. On average, the overall estimated effectiveness of prenatal care is over five times higher after controlling for the selection effects. CONCLUSIONS: Self-selection effects could be a very serious problem in measuring the effectiveness of birthweight determinants in general. The overall effectiveness of prenatal care, in particular, tends to be significantly biased downward without controlling for selection effects. The significance and scale of the bias depends crucially on specific data and cohorts of the population investigated.     

Birth outcomes in Colorado's undocumented immigrant population

Background  

The birth outcomes of undocumented women have not been systematically studied on a large scale. The growing number of undocumented women giving birth in the United States has important implications for clinical care and public health policy. The objective of this study was to describe birth outcomes of undocumented immigrants in Colorado.     

Pregnancy outcomes among Spanish-surname women in California.

We compared pregnancy outcomes among United States-born and Mexican-born women having Spanish surnames with US-born Whites and Blacks using California's 1981 matched birth-death cohort file. Maternal risk characteristics between US-born Black women and US-born women with Spanish surnames were similar. In contrast, Latino women, regardless of national origin, delivered small proportions of low weight infants as compared to Blacks. Birthweight-specific mortality rates during the fetal and neonatal periods for the offspring of Mexican-born Spanish surname women were generally higher than those for other ethnic groups. Our findings are consistent with the underreporting of postneonatal deaths among Mexican-born Latinos, yet suggest that their relatively low reported infant mortality rates compared to Blacks can be explained by a more favorable birthweight distribution.     

Birth outcomes among urban African-American women: a multilevel analysis of the role of racial residential segregation

Residential segregation is a common aspect of the urban experiences of African-Americans in the United States (US), yet few studies have considered how segregation might influence perinatal health. Here, we develop a conceptual model of relationships between segregation and birth outcomes and test the implications of the model in a sample of 434,376 singleton births to African-American women living in 225 US Metropolitan Statistical Areas (MSAs). Data from the National Center for Health Statistics 2002 birth files were linked to data from the 2000 US Census and two distinct measures of segregation: an index of isolation (the probability that an African-American resident will encounter another African-American resident in any random neighborhood encounter) and an index of clustering (the extent to which African-Americans live in contiguous neighborhoods). Using multilevel regression models, controlling for individual- and MSA-level socioeconomic status and other covariates, we found higher isolation was associated with lower birthweight, higher rates of prematurity and higher rates of fetal growth restriction. In contrast, higher clustering was associated with more optimal outcomes. We propose that isolation reflects factors associated with segregation that are deleterious to health including poor neighborhood quality, persistent discrimination and the intra-group diffusion of harmful health behaviors. Associations with clustering may reflect factors associated with segregation that are health-promoting such as African-American political power empowerment, social support and cohesion. Declines in isolation could represent positive steps toward improving birth outcomes among African-American infants while aspects of racial contiguity appear to be mitigating or indeed beneficial. Segregation is a complex multidimensional construct with both deleterious and protective influences on birth outcomes, depending on the dimensions under consideration. Further research to understand racial/ethnic and economic health disparities could benefit from a focus on the contributory role of neighborhood attributes associated with the dimensions segregation and other social geographies.     

Anthropometric indicators of breast cancer risk in postmenopausal women in Hawaii

As part of a case-control study of breast cancer in Hawaii, self-reported data on height, weight at various ages, breast size, shoe size, and triceps skinfold thickness were collected from 138 Japanese postmenopausal cases, 134 Caucasian postmenopausal cases, 154 Japanese neighborhood controls, and 142 Caucasian neighborhood controls. In a multiple covariance analysis, cases of both ethnic groups were slightly heavier (at all ages) and more obese (based on a weight-corrected-for-height index) than were controls, although none of the differences was statistically significant. Among the Japanese only, cases were also taller, had a greater body surface area (computed from the height and weight data), and had a larger shoe size than did the controls. The latter finding was statistically significant (p less than 0.05). Odds ratios were computed by multiple logistic regression analysis and revealed no additional relationships; however, there were suggested dose-response gradients for height, weight at age 20, and body surface area in the Japanese women and for breast size in the Caucasian women. A further analysis of risks based on changes in relative body weight between young adult life (age 20) and current age was also negative. Overall, these findings offer only weak support for an association between weight or obesity and breast cancer risk and suggest that anthropometric indices are at best very indirect indicators of true etiologic factors for breast cancer.     

Birth malformations and other adverse perinatal outcomes in four U.S. Wheat-producing states

Chlorophenoxy herbicides are widely used in the United States and Western Europe for broadleaf weed control in grain farming and park maintenance. Most of the spring and durum wheat produced in the United States is grown in Minnesota, Montana, North Dakota, and South Dakota, with more than 85% of the acreage treated with chlorophenoxy herbicides such as 2,4-dichlorophenoxyacetic acid (2,4-D) and 4-chloro-2-methylphenoxyacetic acid (MCPA). Rates of adverse birth outcomes in rural, agricultural counties of these states during 1995-1997 were studied by comparing counties with a high proportion of wheat acreage and those with a lower proportion. Information routinely collected and made available by federal agencies was used for this ecologic study. Significant increases in birth malformations were observed for the circulatory/respiratory category for combined sexes [odds ratio (OR) = 1.65; 95% confidence interval (CI), 1.07-2.55]. A stronger effect was observed for the subcategory, which excluded heart malformations (OR = 2.03; 95% CI, 1.14-3.59). In addition, infants conceived during April-June--the time of herbicide application--had an increased chance of being diagnosed with circulatory/respiratory (excluding heart) malformations compared with births conceived during other months of the year (OR = 1.75; 95% CI, 1.09-2.80). Musculoskeletal/integumental anomalies increased for combined sexes in the high-wheat counties (OR = 1.50; 95% CI, 1.06-2.12). Infant death from congenital anomalies significantly increased in high-wheat counties for males (OR = 2.66; 95% CI, 1.52-4.65) but not for females (OR = 0.48; 95% CI, 0.20-1.15). These results are especially of concern because of widespread use of chlorophenoxy herbicides.     

Determinants of infant-feeding choice among young women in Hilo, Hawaii

Our multicultural island community is unique in that many young mothers live in multigenerational households. In this qualitative study, we examined the factors that influenced young mothers' infant-feeding practices in Hilo, a small rural town in the Hawaiian Islands. The study participants consisted of young mothers, health care professionals, and educators. Our findings suggest that both the young mother's mother and her partner are very influential in the infant-feeding decision. Many young women in our study bottle fed to obtain assistance in caretaking, and to facilitate public breastfeeding. Additionally, we explored young mother's views of sexuality and breastfeeding, and their health promotion implications.     

Birth weight outcomes for repeat teenage pregnancy

To investigate the outcomes for repeat teenage pregnancy and the effect of interpregnancy interval on birth weight, birth certificate data were reviewed from all mothers under 26 years delivering their second baby during 1981–1983 at an urban teaching hospital. Initially, 409 mothers who had delivered their first baby at the same hospital were identified. Mothers were divided into three groups: mothers under 20 years for both births; mothers under 20 years for the first birth, with the second birth delayed until 20 to 25 years; and mothers 20–25 years for both births. Group 1 mothers had high but identical rates of low birth weight (17.5%) for both parities, high rates of very low birth weight infants (<1501 g), and no change in mean birth weight between the two pregnancies. Group 2 mothers were older at first birth and had better outcomes for first and second births than group 1 mothers. For group 1 mothers, the initiation of prenatal care was delayed at second pregnancy compared to first pregnancy (46% receiving first trimester care versus 59% at first delivery). In contrast, groups 2 and 3 showed improvement in accessing prenatal care for the second pregnancy. Interpregnancy interval had no influence on the birth weight of the second infant in any group.     

Pregnancy planning in Hawaii.

Figures from the 1970 National Fertility Study indicate an improvement in preventing unwanted fertility during the previous decade. A 1970-1971 study of fertility in Hawaii revealed that only 46% of conceptions and 56% of eventual live births had been planned. Married women over 35 and teen-agers, both married and unmarried, had the greatest proportion of unplanned conceptions. The figures revealed a great unmet need for family planning among unmarried women and teen-agers generally. There exists a differential access to abortion, with younger women having less access. In Hawaii unmarried women terminated unwanted pregnancies more often than married women. Most unwanted pregnancies were found to result from nonuse or inconsistent use of birth control rather than from contraceptive failure. Timing failures, especially for the 1st birth, should receive more attention from family planners.     

Adiposity and blood pressure in a multiethnic population of women in Hawaii

Objective. To compare the amount and distribution of fat among White, Japanese, Filipino and Hawaiian women and to investigate associations between measures of adiposity and serum cholesterol and blood pressure.

Design. Cross‐sectional survey of adiposity, serum cholesterol and blood pressure of 421 volunteer women of White (N = 137), Japanese (N = 144), Filipino (N = 74) and Hawaiian (N = 66) ethnicities, age 25–35 years. Anthropométrie measures (weight; height; subscapular, bicep, tricep, suprailiac and calf skinfold thickness; waist, hip and mid‐upper arm circumferences), grip strength, serum cholesterol and blood pressure.

Results. Hawaiian women had the highest levels of adiposity by all measures. Asian women (especially Filipinos) had higher subscapular skinfold thicknesses than did Whites and, for the same value of body mass index (BMI), had a greater percentage of body fat. BMI was the strongest correlate of systolic blood pressure, while subscapular skinfold thickness was the strongest correlate of diastolic blood pressure. Blood pressure varied by adiposity but not ethnicity. No measures of body fat were associated with serum cholesterol.

Conclusion. Higher body fat measures, especially BMI, were associated with higher systolic blood pressure. However, higher subscapular skinfold (upper body) thickness was also associated with higher diastolic blood pressure. Subscapular fatness appears to be especially important among women of Asian ethnicity, Filipino women in particular.     

An epidemiologic study on differences in health status between employed men and women in Hawaii.

Differences in health status between employed men and employed women were examined. 56,203 participants in a stratified random sample of Hawaii's adult population were interviewed during 1981-1986 in the Hawaii Health Surveillance Program. Multiple regression analysis controlling for sociodemographic and occupational variables showed that although the differences were small, employed women reported more health problems than employed men, especially acute conditions and those requiring more hospital services. The findings of this study indicate a need for further study to understand the nature of the observed differences and to develop relevant preventive programs.