孕妇被动吸烟与小于胎龄儿关系的Meta分析

目的 探讨孕妇孕期被动吸烟与小于胎龄儿之间的关系,分析不同孕期和不同地点被动吸烟的效应.方法 利用Meta分析方法综合分析国内外8篇关于孕妇孕期被动吸烟与小于胎龄儿关系的回顾性研究文献.结果 孕妇孕期被动吸烟与小于胎龄儿之间的粗合并效应值OR=1.45(95%CI:1.05～2.01),调整合并效应值OR=1.76(95%CI:1.15～2.69);孕妇孕早期被动吸烟的合并效应值OR=1.85(95%CI:1.25～2.72),孕中晚期被动吸烟的合并效应值OR=2.12(95%CI:1.43～3.13);家庭和工作中被动吸烟与小于胎龄儿之间的关系均没有统计学意义.结论 孕妇孕期被动吸烟可增加发生小于胎龄儿的危险性.除了家庭和工作环境外,还应注意其他环境的被动吸烟.     

Risk factors for urothelial carcinoma: drinking measures, smoking and other life style-related risk factors--results of the Berlin Urothelial Study (BUS)

With the exception of smoking and several occupational exposures there is little knowledge about risk factors for urothelial cancer. A case control study in the area of former West Berlin was performed from 1990-1995 to investigate the role of several lifestyle risk factors, such as smoking, drinking behaviour and regular intake of analgesics and laxatives. The study includes 647 hospital-based incident cases with bladder cancer (n = 571), renal pelvis cancer (n = 51), and ureter cancer (n = 25), and 647 population-based controls which were matched individually by sex and age. Data analyses were carried out using standard methods for case control studies (conditional multiple logistic regression analysis). Odds ratios (OR) and 95% confidence intervals (CI) were applied as effect parameter. Statistically significantly increased odds ratios were observed for current smoking (OR: 3.46, 95% CI: 2.50-4.78), previous but now abandoned smoking (OR: 1.51, 95% CI: 1.09-2.81), and for regular intake of laxatives (OR: 2.52, 95% CI: 1.56-4.09). Furthermore, an increased risk for urothelial cancer was observed for daily consumption of three and more litres of cold drinks (OR: 2.65 95% CI: 1.12-6.24). The results underline that lifestyle factors other than smoking may contribute to a higher risk of urothelial cancer.     

孕期被动吸烟对妊娠并发症及妊娠结局的影响

目的了解孕期被动吸烟发生情况,并探讨其对妊娠并发症及结局的影响。方法选取2012年4月―2013年3月在我国15家医疗保健机构分娩的8926例单胎活产产妇作为研究对象,使用自制调查问卷收集孕期被动吸烟发生情况、妊娠并发症和结局等信息,采用单因素和多因素Logistic回归分析模型分析孕期被动吸烟对妊娠并发症及结局的影响。结果共1801例产妇在孕期经历被动吸烟。控制混杂因素后,孕期经历被动吸烟的产妇妊娠期糖尿病(gestational diabetes mellitus,GDM)的发生风险是非被动吸烟者的1.359倍(95%CI:1.146~1.612,P<0.001),胎膜早破的风险为1.290倍(95%CI:1.095~1.520,P=0.002),早产的风险为1.367倍(95%CI:1.155~1.619,P<0.001),娩出低出生体重儿的风险为1.341倍(95%CI:1.079~1.668,P=0.008)。与非被动吸烟者相比,平均每周被动吸烟天数≥4天者胎膜早破、早产和低出生体重儿的发生风险分别为非被动吸烟者的1.402倍(95%CI:1.104~1.780,P=0.006)、1.690倍(95%CI:1.339~2.132,P<0.001)和1.584倍(95%CI:1.172~2.141,P=0.023)。结论被调查产妇孕期被动吸烟率较高,孕期经历被动吸烟能够增加妊娠期糖尿病、胎膜早破、早产和低出生体重儿的发生风险。     

The impact of maternal education on intrauterine growth: a comparison of former West and East Germany

BACKGROUND: Objective of this re-analysis of datasets from former East and West Germany was to examine the influence of maternal education on intrauterine growth in two different political and social systems. METHODS: Information on socio-demographic or lifestyle factors and pregnancy outcome was available for 3374 liveborn singletons from West Germany (1987/88) and 3070 from East Germany (1990/91). Multiple logistic regression was used to estimate the association between maternal education and the risk of delivering a small-for-gestational-age (SGA) newborn below the 10th percentile of birthweight. RESULTS: Women with the lowest education had a significantly elevated risk of SGA newborns compared to women with the highest education in West (odds ratio [OR] = 2.58, 95% CI : 1.17-5.67) and East Germany (OR = 2.77, 95% CI : 1.54- 5.00). The distribution of factors known to influence intrauterine growth varied with education in both states. After adjusting for these factors, women with the lowest educational level still had a higher risk of SGA birth: OR (West) = 2.02, 95% CI : 0.87-4.72; OR (East) = 1.95, 95% CI : 1.02-3.74. CONCLUSIONS: Our findings support the assumption that in former socialist countries health inequalities as a result of social inequalities existed.     

Maternal occupation and adverse pregnancy outcomes: a Finnish population-based study

BACKGROUND: There is accumulating evidence that the type of work and environmental exposures in the working environment may have adverse effects on foetal development. AIM: To compare the risk of low birth weight (LBW), small-for-gestational age (SGA) and pre-term delivery (PD) in broad categories of maternal occupation including farming and forestry; factory, mining and construction; office, non-manual and service work and housewives. METHODS: The study population consisted of 2568 singleton newborns of women who participated in The Finnish Prenatal Environment and Health Study after the delivery (response rate 94%). Information on maternal occupation and work during pregnancy was collected after the delivery. The health outcomes were LBW (<2500 g), SGA and PD (<37 weeks). RESULTS: In newborns of women working in factories, mining and construction, the risk of LBW (adjusted odds ratio [OR] 3.66, 95% confidence interval [CI] 1.15-11.62), SGA (adjusted OR 1.53, 95% CI 0.73-3.21), but not the risk of PD (adjusted OR 0.64, 95% CI 0.19-2.22), was higher compared with newborns of housewives. In newborns of farmers and forestry workers, the risks of PD (adjusted OR 2.38, 95% CI 1.01-5.65), LBW (adjusted OR 2.86, 95% CI 0.78-11.58) and SGA (adjusted OR 1.51, 95% CI 0.62-3.65) were all elevated. In office, non-manual and service workers, the corresponding estimates were lower (LBW: 1.62, 0.67-3.95; SGA: 1.45, 0.92-2.28; PD: 1.18, 0.69-2.01). CONCLUSIONS: There were substantial differences in the risk of adverse pregnancy outcomes between the main branches of industry.     

Intergenerational and environmental factors influencing pregnancy outcomes

PURPOSE: Factors that relate to the mother's own course of growth and development might influence later reproductive performances. This study examines the effect of maternal birth weight and maternal height and maternal weight gain, on term-small for gestational age (SGA) and preterm delivery.METHODS: Data used for this study were from the South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) and birth certificate files for 1993-1995. Since PRAMS data were weighted to adjust for sampling probabilities, non-response and survey design, Survey Data Analysis (SUDAAN) software was used in all analyses.RESULTS: Maternal birth weight was strongly associated with term SGA (OR = 3.65; 95% CI = 1.83-7.29), but not preterm delivery among black mothers; it was associated with preterm delivery (OR = 1.86; 95% CI = 1.09-3.17), but not term-SGA for white mothers. Maternal birth weight was associated with term SGA among nonsmokers only (OR = 2.34; 95% CI = 1.33-4.11). Maternal weight gain modified the effect of height on birth outcomes. Among women with inadequate weight gain, there was a 3-fold increase in risk for term-SGA (OR = 3.06; 95% CI = 2.41-3.89) for short maternal height, but not for preterm delivery. Among women with adequate plus weight gain, the association between short maternal height and term-SGA was 2.7 (95% CI = 0.55-9.43) compared to 3.67 (95% CI = 0.1.41-9.56) between short maternal height and preterm delivery. Maternal weight gain also modified the effect of maternal height on both outcomes for black mothers and for nonsmokers only.CONCLUSIONS: Findings indicate the need for interventions directed to those women who can benefit most from appropriate targeted weight gain recommendations. Therefore, prevention methods should be implemented to encourage short stature women to gain adequate weight during pregnancy.     

Parental occupational exposure to pesticides and childhood germ-cell tumors

In a recently completed US case-control study (Children's Oncology Group, 1993-2001) with 253 cases and 394 controls, the authors investigated the association between parental occupational exposure to pesticides and risk of childhood germ-cell tumors. Information on occupational pesticide exposure was collected using job-specific module questionnaires and assessed by an experienced industrial hygienist. Odds ratios for childhood germ-cell tumors associated with maternal exposures before pregnancy, during pregnancy, and after the birth of the index child were 1.0 (95% confidence interval (CI): 0.8, 1.4), 1.1 (95% CI: 0.7, 1.6), and 1.3 (95% CI: 0.9, 1.8), respectively. Paternal exposures before pregnancy, during pregnancy, and after the birth of the index child were not related to germ-cell tumors (odds ratios (ORs) were 0.9 (95% CI: 0.7, 1.2), 0.8 (95% CI: 0.5, 1.2), and 0.8 (95% CI: 0.5, 1.3), respectively). When both parents had ever been occupationally exposed to pesticides before the index pregnancy, the odds ratio was 0.8 (95% CI: 0.4, 1.3). Subgroup analyses showed a positive association between maternal exposure to herbicides during the postnatal period and risk of germ-cell tumors in girls (OR = 2.3, 95% CI: 1.0, 5.2) and an inverse association between paternal exposure to pesticides during the index pregnancy and germ-cell tumors in boys (OR = 0.2, 95% CI: 0.1, 1.0). This study did not provide strong evidence supporting a relation between parental pesticide exposure in the workplace and risk of germ-cell tumors among offspring.     

Correlates of smoking in pregnant women in six Brazilian cities

OBJECTIVE: To evaluate sociodemographic and lifestyle correlates of smoking in pregnant women sampled from hospitals. METHODS: A cross-sectional study was conducted in 5,539 pregnant women aged 20 or more who sought medical attention in prenatal clinics of affiliate hospitals of the Brazilian National Health System in the cities of Manaus, Fortaleza, Salvador, Rio de Janeiro, S?o Paulo, and Porto Alegre from 1991 to 1995. Interviews were conducted using a standardized questionnaire that covered sociodemographics and smoking habits before and during pregnancy. Current smoking was defined as smoking at least one cigarette/day, former smoking as reporting having smoked at least one cigarette/day but having quit, and never smoking as never having smoked one cigarette/day. RESULTS: Smoking during pregnancy was associated with lower education (OR=2.13; CI 95%: 1.76-2.57) and greater parity (OR=1.84; CI 95%: 1.53-2.21). Positive associations were also found with increased gestational age and alcohol consumption. No significant association was found with skin color or occupation status. A protective effect was observed for women married or living with a partner (OR=0.55 CI 95%: 0.42-0.72). Having Manaus' women as a reference, Porto Alegre's women showed the greatest risk for smoking in pregnancy (OR=5.00; CI 95%: 3.35-7.38), followed by S?o Paulo's (OR=3.42; CI 95%: 2.25-5.20), Rio de Janeiro (OR=2.53; CI 95%: 1.65-3.88) and Fortaleza's (OR=2.56; CI 95%: 1.74-3.78). CONCLUSIONS: The study findings are similar to those described in the literature regarding education, parity, and marital status. However, no association with skin color was seen in the multivariate analysis. Former smokers had sociodemographic characteristics more similar to non-smokers than former smokers.     

Risk factors for early infant mortality in Sarlahi district, Nepal

OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies. METHODS: Over the period 1994-97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR = 1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). CONCLUSION: Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy.     

Tobacco and alcohol use during pregnancy and risk of oral clefts. Occupational Exposure and Congenital Malformation Working Group

OBJECTIVES: This study examined the relationship between maternal tobacco and alcohol consumption during the first trimester of pregnancy and oral clefts. METHODS: Data were derived from a European multicenter case-control study including 161 infants with oral clefts and 1134 control infants. RESULTS: Multivariate analyses showed an increased risk of cleft lip with or without cleft palate associated with smoking (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.07, 3.04) and an increased risk of cleft palate associated with alcohol consumption (OR = 2.28, 95% CI = 1.02, 5.09). The former risk increased with the number of cigarettes smoked. CONCLUSIONS: This study provides further evidence of the possible role of prevalent environmental exposures such as tobacco and alcohol in the etiology of oral clefts.     

Maternal smoking during pregnancy and the risk of congenital urinary tract anomalies.

To study maternal smoking during pregnancy and the risk of congenital urinary tract anomalies, we interviewed mothers of 118 affected infants born to residents of western Washington State during 1990 and 1991 and mothers of 369 control infants randomly selected from those without birth defects delivered during those years in five hospitals in King County, Washington. Maternal smoking was associated with an increased risk of congenital urinary tract anomalies in offspring (adjusted odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.2, 4.5). This risk was higher among light smokers (1-1000 cigarettes during the pregnancy) (OR = 3.7; 95% CI = 1.7, 8.6) than among heavy smokers (OR = 1.4; 95% CI = 0.6, 3.3). Our results corroborate previous findings and support the hypothesis of a causal relation.     

Early intrauterine exposure to tobacco-inhaled products and obesity

An association between maternal smoking during pregnancy and offspring obesity has been reported. This study assessed the impact of maternal smoking during the first trimester. Data on 4,974 German children aged 5-6 years were obtained at school entry health examinations in 2001-2002 in Bavaria. Obesity was defined by body mass index using International Obesity Task Force cutpoints. Prevalence of obesity was 1.9% (95% confidence interval (CI): 1.5, 2.4) in offspring of never smokers, 4.5% (95% CI: 2.9, 6.7) for maternal smoking during the first trimester only, and 5.9% (95% CI: 3.8, 8.7) for maternal smoking throughout pregnancy. Unadjusted odds ratios were higher for maternal smoking throughout pregnancy (odds ratio = 3.23, 95% CI: 2.00, 5.21) compared with the first trimester only (odds ratio = 2.41, 95% CI: 1.49, 3.91). Adjusted odds ratios were similar: 1.70 (95% CI: 1.02, 2.87) for maternal smoking throughout pregnancy and 2.22 (95% CI: 1.33, 3.69) for maternal smoking in the first trimester only. When modeled together, no statistically significant difference in obesity risk was found between maternal smoking in the first trimester compared with throughout pregnancy. The effect of intrauterine tobacco exposure on childhood obesity may depend largely on cigarette smoking during the first trimester, whereas the additional impact of smoking throughout pregnancy might be due to confounding by sociodemographics. Women should be encouraged to quit smoking prior to conception.     

孕期HBV感染及肝内胆汁淤积症对小于胎龄儿与低出生体重的交互影响

  目的  探讨妊娠期乙型肝炎病毒（hepatitis B virus，HBV）感染及肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）对小于胎龄儿（small for gestational age infant，SGA）与低出生体重儿（low birth weight infant，LBW）发生风险的影响，并分析其交互效应。  方法  以2017年1月~2018年4月在某三甲医院建卡就诊并在本院分娩的孕妇为研究对象，采用化学发光法测定孕妇外周血乙型肝炎表面抗原（hepatitis B surface antigen，HBsAg）及总胆汁酸。以Logistic回归模型分析HBV感染及ICP孕妇发生不良妊娠结局的风险，用相乘与相加模型分析其交互作用。  结果  在控制混杂因素后，与正常孕妇相比，孕期仅感染HBV或仅患有ICP均不增加SGA与LBW的发生风险，但孕期HBV感染合并ICP使未足月SGA和LBW的发生风险分别增加了76%（OR=1.76，95%CI:1.16~2.65，P=0.007）与85%（OR=1.85，95%CI:1.44~2.38，P<0.001）；孕期HBV感染与ICP对未足月SGA[RERI（95%CI）=6.54（0.14~12.94），AP（95% CI）=0.90%（0.68%~1.13%），S（95% CI）=7.03（1.38~42.64）]和LBW[RERI（95%CI）=5.69（0.48~10.90），AP（95%CI）=0.76%（0.55%~0.97%），S（95%CI）=8.02（1.92~33.43）]存在相乘与相加的交互作用，其发生风险分别是两因素单独存在风险之和的7.03倍和8.02倍。  结论  妊娠期HBV感染合并ICP增加了未足月SGA和LBW的发生风险，怀孕后积极防治HBV感染与ICP可降低SGA和LBW的出生。     

A case-control study of maternal smoking and congenital malformations

We conducted a population-based case-control study to assess the association between maternal smoking during pregnancy and the risk of giving birth to a child with a congenital malformation. Cases were all singleton livebirths with a congenital malformation recorded on the 1984-1986 Washington State Birth Records (n = 3284). The smoking histories of these mothers were compared to a randomly selected group of mothers with a singleton livebirth of a child without a malformation during these same years (n = 4500). When all malformations were taken as a group, there was no association with maternal smoking (relative risk (RR) = 1.0, 95% CI 0.9-1.1). However, increased risks were observed for a number of specific malformations, including microcephalus (RR = 2.0, 95% CI 1.0-4.0), cleft defects (RR = 1.4, 95% CI 1.0-2.0), and club foot (RR = 1.4, 95% CI 1.0-2.0). We did not find any association with Down's syndrome (RR = 0.8 95% CI 0.5-1.3) or any other malformation. We conclude that maternal smoking during pregnancy may be associated with an increased risk for some malformations.     

Determinants of developmental delay in infants aged 12 months

The aim of this study was to determine which demographic, maternal, obstetric and postnatal variables were associated with achievement of developmental milestones at the age of 12 months in term infants. Mothers and babies were enrolled in the Auckland Birthweight Collaborative Study shortly after birth. All infants were full term (gestation >or= 37 weeks). Approximately half of the sample were small for gestational age (SGA = birthweight 10th percentile). A maternal interview was conducted soon after birth. Phase 2 of the study occurred 12 months later when mothers were sent a postal questionnaire requesting information about the child's health and development during the first year of life using the Denver Prescreening Developmental Questionnaire. Seven hundred and forty-four (85.4%) European mothers returned the postal questionnaire. SGA children were not at increased risk of developmental delay at 12 months of age. In a sample representative of New Zealand European children, after adjustment for the effects of potential confounders, maternal smoking during pregnancy (OR = 2.1 [95% CI 1.1, 4.0]), maternal smoking during the first year of life (OR = 1.9 [95% CI 1.0, 3.8]) and low levels of satisfaction with parenting (OR = 2.4 [95% CI 1.1, 5.2]) were associated with significantly increased risk of developmental delay. In the subgroup of SGA children, maternal smoking during pregnancy (OR = 2.9 [95% CI 1.4, 6.2]), high levels of stress associated with parenting (OR = 2.2 [95% CI 1.2, 4.0]), and low levels of satisfaction with parenting (OR = 4.3 [95% CI 1.3, 13.5]) were significantly associated with developmental delay after adjustment for the effects of potential confounders. In conclusion, maternal and postnatal factors were better predictors of developmental delay than demographic variables.     

孕妇被动吸烟与低出生体重关系的Meta分析

目的分析孕妇孕早期和不同孕期被动吸烟对新生儿低出生体重的影响。方法通过Meta分析方法分析孕妇被动吸烟与新生儿低出生体重之间的关系。对NCBI、OVID-MEDLINE、CNKI、VIP以及CBM数据库进行检索(截止日期为2008年4月),结果报告合并OR值及95%CI。结果共获得26篇文献,其中队列研究20篇,病例对照研究6篇。总体分析,孕妇被动吸烟的合并效应值OR=1.65(95%CI:1.39～1.97);调整合并效应值OR=1.60(95%CI:1.25～2.05);最低和最高暴露量的合并效应值分别为OR=1.53(95%CI:1.14～2.04)和OR=2.53(95%CI:1.46～4.36);孕早期暴露的合并效应值OR=1.12(95%CI:0.82～1.55),没有统计学意义。结论孕妇被动吸烟增加新生儿低出生体重的危险性;孕中晚期可能是被动吸烟效应的敏感期;被动吸烟的阈值是否存在尚不明确。     

Parental occupational exposure to pesticides and the risk of childhood leukemia in Costa Rica

OBJECTIVES: Parental exposure to pesticides and the risk of leukemia in offspring were examined in a population-based case-control study in Costa Rica. METHODS: All cases of childhood leukemia (N=334), in 1995-2000, were identified at the Cancer Registry and the Children's Hospital. Population controls (N=579) were drawn from the National Birth Registry. Interviews of parents were conducted using conventional and icon-based calendar forms. An exposure model was constructed for 25 pesticides in five time periods. RESULTS: Mothers' exposures to any pesticides during the year before conception and during the first and second trimesters were associated with the risk [odds ratio (OR) 2.4, 95% confidence interval (95% CI) 1.0-5.9; OR 22, 95% CI 2.8-171.5; OR 4.5, 95% CI 1.4-14.7, respectively] and during anytime (OR 2.2, 95% CI 1.0-4.8). An association was found for fathers' exposures to any pesticides during the second trimester (OR 1.5, 95% CI 1.0-2.3). An increased risk with respect to organophosphates was found for mothers during the first trimester (OR 3.5, 95% CI 1.0-12.2) and for fathers during the year before conception and the first trimester (OR 1.5, 95% CI 1.0-2.2 and OR 1.6, 95% CI 1.0-2.6, respectively), and benzimidazoles during the first, second, and third trimesters of pregnancy (OR 2.2, 95% CI 1.0-4.4; OR 2.2, 95% CI 1.0-5.0; OR 2.2, 95% CI 1.0-5.2, respectively). There was a suggestion of an exposure-response gradient for fathers as regards picloram, benomyl, and paraquat. Age at diagnosis was positively associated with fathers' exposures and inversely associated with mothers' exposures. CONCLUSIONS: The results suggest that parental exposure to certain pesticides may increase the risk of leukemia in offspring.     

Prediction of perinatal mortality at an early stage of pregnancy

AIM: To define the probability of foetal and neonatal death (PFND) in Lithuania by means of the Medical Birth registry. METHODS: The Medical Birth registry for the year 2002 (29,619 pregnancies resulting in delivery) was used, covering social, environmental, health behaviour factors, obstetric history, health status of pregnant women, and delivery. RESULTS: A statistically significant model has been obtained in which 12 out of 45 analysed factors were significant for the risk of perinatal mortality (PM). In the case of previous neonatal pathology, e.g. damage to CNS, the risk of PM (OR 5.2; 95% CI = 2.1-13.3) was similar to the reported manual work or harmful working conditions during pregnancy (OR 4.8; 95% CI = 1.9-12.1 and OR 4.5; 95% CI = 1.3-15.2, respectively). The influence of father's alcohol abuse (OR 2.6; 95% CI = 1.4-4.7) was comparable to that of the stillborns or premature deliveries. The combination of several factors increased PFND significantly: maternal smoking during pregnancy and paternal smoking and alcohol abuse raised PFND to 0.03 (OR 6.8), mother's hard manual work in combination with harmful conditions during pregnancy increased OR more than 10 times (PFND 0.32) as compared with the situation when only one of those factors was present. CONCLUSIONS: The influence of social, environmental, and behavioural factors on the risk of PM was comparable to that of some of the complications during a previous pregnancy. The combination of risk factors significantly increased PFND. Using modelling, the individual prognosis may be presented to every pregnant woman at an early stage of pregnancy to potentially decrease the impact of unfavourable risk factors on PM.     

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.     

Country of origin, social support and the risk of small for gestational age birth

AIMS: This study investigates the risk of small for gestational age (SGA) in relation to country of origin of the mother. The role of psychosocial resources, socioeconomic and lifestyle factors was examined in different causal models. METHODS: Among all pregnant nulliparous women in the city of Malm?, Sweden, who gave birth in 1991--92, 872 (87.7%) women completed a questionnaire during their first antenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n = 826); 22% (n = 182) of these women were foreign-born. RESULTS: Fifty-five (6.7%) of the infants were classified as SGA, 37 (5.7%) of mothers of Swedish origin and 18 (9.7%) of foreign origin. SGA deliveries were much more prevalent among Middle East- and North Africa-born women (22%) and sub-Saharan-born women (15%). In all, women of foreign origin had increased odds for delivering SGA babies (OR = 1.8, 95% CI = 1.0,3.2). In a multivariate analysis psychosocial and socioeconomic factors explained 30% and 40%, respectively, of the increased SGA risk. Psychosocial factors seemed to be more prominent risk factors for SGA among mothers of foreign origin. A possible synergistic relation was demonstrated between foreign origin of the mother and low social anchorage. CONCLUSIONS: This study showed that psychosocial factors, most probably linked to a disadvantaged social situation, could be the theoretically most important focus for preventing SGA in immigrant women. This could also further support a hypothesis of a link between psychosocial stress and SGA in general. However, this should not exclude the need for intervention in the antenatal care system in terms of specially tailored support and education.