Risk factors for small-for-gestational-age babies: The Auckland Birthweight Collaborative Study

OBJECTIVE: This case-control study determined whether internationally recognized risk factors for small-for-gestational-age (SGA) term babies were applicable in New Zealand. METHODOLOGY: All babies were born at 37 or more completed weeks of gestation in one of three hospitals in Auckland. Cases weighed less than the sex specific 10th percentile for gestational age at birth, and controls (appropriate-for-gestational-age (AGA)) were a random selection of heavier babies. Information was collected by maternal interview and from obstetric databases. RESULTS: Information from 1714 completed interviews (844 SGA and 870 AGA) was available for analysis. Computerized obstetric records were available for 1691 of the 1701 women who consented to such access. In a multivariate analysis allowing for sex, gestational age at birth, social class and other potential confounders, mothers who smoked had a significantly increased risk of an SGA baby (adjusted OR 2.41; 95% CI 1.78-3.28), as did primiparous mothers (adjusted OR 1.34; 95% CI 1.03-1.73), mothers of Indian ethnicity (adjusted OR 3.22; 95% CI 1.95-5.30), women with pre-eclamptic toxaemia (adjusted OR 2.42; 95% CI 1.08-5.40) and those with pre-existing hypertension toxaemia (adjusted OR 5.49; 95% CI 1.81-16.71). Mothers of SGA infants were shorter (P < 0.001) and reported lower prepregnancy body weights (P < 0.001) than mothers of AGA infants. The population attributable fraction for smoking suggests that up to 18% of SGA infants born in the ABC Study could be related to maternal smoking. CONCLUSIONS: Risk factors associated with SGA births in other countries are also important in New Zealand. Smoking in pregnancy is an important and potentially modifiable behaviour, and efforts to decrease the number of women who smoke during pregnancy should be encouraged.     

Does rural or urban residence make a difference to neonatal outcome in premature birth? A regional study in Australia

BACKGROUND: Patients living in rural areas may be at a disadvantage in accessing tertiary health care. AIM: To test the hypothesis that very premature infants born to mothers residing in rural areas have poorer outcomes than those residing in urban areas in the state of New South Wales (NSW) and the Australian Capital Territory (ACT) despite a coordinated referral and transport system. METHODS: "Rural" or "urban" status was based on the location of maternal residence. Perinatal characteristics, major morbidity and case mix adjusted mortality were compared between 1879 rural and 6775 urban infants <32 weeks gestational age, born in 1992-2002 and admitted to all 10 neonatal intensive care units in NSW and ACT. RESULTS: Rural mothers were more likely to be teenaged, indigenous, and to have had a previous premature birth, prolonged ruptured membrane, and antenatal corticosteroid. Urban mothers were more likely to have had assisted conception and a caesarean section. More urban (93% v 83%) infants were born in a tertiary obstetric hospital. Infants of rural residence had a higher mortality (adjusted odds ratio (OR) 1.26, 95% confidence interval (CI) 1.07 to 1.48, p = 0.005). This trend was consistently seen in all subgroups and significantly for the tertiary hospital born population and the 30-31 weeks gestation subgroup. Regional birth data in this gestational age range also showed a higher stillbirth rate among rural infants (OR 1.20, 95% CI 1.09 to 1.32, p<0.001). CONCLUSIONS: Premature births from rural mothers have a higher risk of stillbirth and mortality in neonatal intensive care than urban infants.     

Factors relating to the infant's last sleep environment in sudden infant death syndrome in the Republic of Ireland.

AIM: To identify risk factors for sudden infant death syndrome (SIDS) in the sleeping environment of Irish infants. METHODS: A five year population based case-control study with parental interviews conducted for each case and three controls matched for age, place of birth, and last sleep period. A total of 203 SIDS cases and 622 control infants born 1994-98 were studied. RESULTS: In a multivariate analysis, co-sleeping significantly increased the risk of SIDS both as a usual practice (adjusted OR 4.31; 95% CI 1.07 to 17.37) and during the last sleep period (adjusted OR 16.47; 95% CI 3.73 to 72.75). The associated risk was dependent on maternal smoking (OR 21.84; 95% CI 2.27 to 209.89), and was not significant for infants who were > or =20 weeks of age (OR 2.63; 95% CI 0.49 to 70.10) or placed back in their own cot/bed to sleep (OR 1.07; 95% CI 0.21 to 5.41). The use of pillows, duvets, and bedding with tog value > or =10 were not significant risk factors when adjusted for the effects of confounding variables, including maternal smoking and social disadvantage. However, the prone sleeping position remains a significant SIDS risk factor, and among infants using soothers, the absence of soother use during the last sleep period also significantly increased the SIDS risk (OR 5.83; CI 2.37 to 14.36). CONCLUSION: Co-sleeping should be avoided in infants who are <20 weeks of age, or whose mothers smoked during pregnancy. The prone position remains a factor in some SIDS deaths, and the relation between soother use and SIDS is a complex variable requiring further study.     

Exposure to tobacco smoke and infant crying

AIM: To examine the association of excessive infant crying with maternal smoking during and after pregnancy, paternal smoking, and smoking by other people in the living environment of the infant. METHODS: We collected data on infant crying and smoking in a Dutch national sample of 5845 infants aged 0-3 mo (response 62.8%). We defined excessive crying as crying over 3 h a day on more than 3 d of the preceding week. RESULTS: The prevalence rate of excessive crying was 4.0% (95% CI 3.5 to 4.5%). Excessive crying occurred more frequently among infants of fathers smoking 15 + cigarettes/d (odds ratio (OR) 1.99, 95% CI 1.38 to 2.86) and of mothers smoking 10 + cigarettes/d during pregnancy (OR 1.86, 95% CI 1.02 to 3.42). Infants whose parents were heavy current smokers or whose mothers had been so during pregnancy had a 69% higher prevalence of excessive crying than infants of non-smoking parents (rates: 6.3% and 3.7%, respectively; odds ratio 1.80; 95% CI 1.26 to 2.57). CONCLUSION: Parents stopping smoking may prevent excessive infant crying.     

Socio-economic determinants, maternal smoking and coffee consumption, and exclusive breastfeeding in 10205 children

AIM: To examine socio-economic factors, smoking, coffee consumption and exclusive breastfeeding duration. METHODS: This study was part of a prospective cohort study of children born between 1 October 1997 and 1 October 1999 (the All Babies in Southeast Sweden (ABIS) study). Eleven socio-economic characteristics (parental employment, civil status, whether parents were born in Sweden, parental education, residence at birth and during child's first year, crowded living), maternal smoking, coffee consumption, infant sex, siblings, parental age, and maternal alcohol consumption during pregnancy were analysed using logistic regression and Cox's proportional hazards method. All data were obtained through questionnaires distributed at infant birth and at 1 y of age. Exclusive breastfeeding duration<4 mo and actual breastfeeding duration were our main outcome measures. RESULTS: Out of 10205 infants, 2206 (21.6%) were exclusively breastfed for less than 4 mo ("short exclusive breastfeeding"; SEBF). Backward stepwise regression analysis identified the following risk factors for SEBF: maternal smoking (95% confidence interval for adjusted odds ratio, 95% CI AOR 2.00-2.82), low maternal education (95% CI AOR 1.45-2.19), maternal employment less than 3 mo during pregnancy (95% CI AOR 1.17-1.54), paternal age相似文献   

Risk factors for small for gestational age

BACKGROUND: The purpose of the paper was to determine the risk factors for small-for-gestational-age (SGA) infants at full term, in Japan. METHODS: The study was conducted at four hospitals and clinics in the Tokyo metropolitan area. A retrospective review of 2972 mothers and their infants born from singleton pregnancies at any time during the years 2002 and 2003 was conducted. RESULTS: Of these women, 8.4% gave birth to SGA infants. The proportion of SGA infants was significantly higher among heavy smokers (>10 cigarettes/day; 13.7%, P < 0.01). The odds ratio (OR) for SGA decreased significantly in proportion to the pregnancy body mass index (OR, 0.89; 95% confidence interval [CI]: 0.84-0.94, P < 0.001). The OR of SGA for stratified maternal weight gain was 1.79 (95%CI: 1.24-2.58, P 12 kg. CONCLUSION: The present study clearly confirms the detrimental effect of a low prepregnancy body mass index, low maternal weight gain and maternal smoking during pregnancy on the incidence of SGA infants.     

Differences in the epidemiology of prematurity and intrauterine growth retardation

Although both preterm (PT) and intrauterine growth retarded (IUGR) infants can have similar birth weights, they are known to show different neonatal and post-neonatal features. Newborns (n = 623) from the Guatemalan longitudinal study of nutritional supplementation during pregnancy were studied. There were 61 PT (less than or equal to 37 wk) and 173 IUGR (less than or equal to 10th percentile) infants. Simultaneous adjustment using the long-linear model showed that calorie and/or protein supplementation during pregnancy lowered the risk of PT (adjusted odd ratios (OR) = 0.52, 95%, CI = 0.40-0.77, and 0.43 CI = 0.36-0.59, respectively), but did not affect the incidence of IUGR. Low maternal head circumference and weight increased the risk of IUGR only (OR = 1.4, CI = 1.02-1.8 and 2.3 CI = 1.8-2.7, respectively). Male fetuses were at higher risk of both PT and IUGR. These data confirm the differential effect of maternal characteristics and nutritional supplementation during pregnancy on both PT and IUGR, and strongly suggest the need to include both gestational age and birth weight as outcome measures in epidemiological studies, thus avoiding the exclusive use of LBW (less than or equal to 2500 g).     

Factors relating to the infant's last sleep environment in sudden infant death syndrome in the Republic of Ireland

Aim: To identify risk factors for sudden infant death syndrome (SIDS) in the sleeping environment of Irish infants. Methods: A five year population based case-control study with parental interviews conducted for each case and three controls matched for age, place of birth, and last sleep period. A total of 203 SIDS cases and 622 control infants born 1994–98 were studied. Results: In a multivariate analysis, co-sleeping significantly increased the risk of SIDS both as a usual practice (adjusted OR 4.31; 95% CI 1.07 to 17.37) and during the last sleep period (adjusted OR 16.47; 95% CI 3.73 to 72.75). The associated risk was dependent on maternal smoking (OR 21.84; 95% CI 2.27 to 209.89), and was not significant for infants who were ⩾20 weeks of age (OR 2.63; 95% CI 0.49 to 70.10) or placed back in their own cot/bed to sleep (OR 1.07; 95% CI 0.21 to 5.41). The use of pillows, duvets, and bedding with tog value ⩾10 were not significant risk factors when adjusted for the effects of confounding variables, including maternal smoking and social disadvantage. However, the prone sleeping position remains a significant SIDS risk factor, and among infants using soothers, the absence of soother use during the last sleep period also significantly increased the SIDS risk (OR 5.83; CI 2.37 to 14.36). Conclusion: Co-sleeping should be avoided in infants who are <20 weeks of age, or whose mothers smoked during pregnancy. The prone position remains a factor in some SIDS deaths, and the relation between soother use and SIDS is a complex variable requiring further study.     

Sudden infant death and maternal cigarette smoking: Results from the Lower Saxony Perinatal Working Group

Maternal smoking has long been identified as a risk factor for sudden infant death (SID). However, only few studies analysed the biological plausibility of the relationship between maternal smoking and SID. In Lower Saxony (North Germany), detailed information concerning the perinatal period is routinely obtained for almost all infants born in this region. The perinatal data sets from 190 SID cases who had died between 1986 and 1990 and in whom a full autopsy had been performed were identified and compared to data sets from 5920 random controls, frequency matched to cases on year of birth. After adjusting for potential confounders (socio-economic status, birth weight, maternal age and nationality), smoking during pregnancy was still associated with a significantly increased risk of SID (odds ratio (OR) 2.7, 95% confidence interval (CI) 1.7–4.5). There was a clear dose-effect relationship between the number of cigarettes smoked and the risk of SID: adjusted ORs were 2.6 (1.5–4.4) for 1–10 cigarettes/day, 2.8 (1.8–6.0) for 11–20 cigarettes/day, and 6.9 (1.9–25.5) for >20 cigarettes/day. There also appeared to be an interaction between smoking during pregnancy and maternal anaemia: the risk of SID almost doubled if mothers not only smoked, but were also anaemic (haemoglobin <100 g/l). These results support the concept that smoking during pregnancy has direct biological effects on the fetus which are associated with an increased risk of SID later in life. The exact mechanism(s) whereby smoking increases the risk of SID, however, remains to be determined. The detrimental effects of smoking on SID should be strongly addressed in any national or local campaign aiming to reduce the incidence of SID in a community.Conclusion Maternal smoking during pregnancy is an important modifiable risk factor for SID.     

Smoking,nicotine and tar and risk of small for gestational age babies

AIMS: To assess the effect of maternal smoking and environmental tobacco smoke (ETS) on risk of small for gestational age infants (SGA). METHODS: Case-control study of 844 cases and 870 controls. RESULTS: Maternal smoking in pregnancy was associated with an increased risk of SGA (adjusted odds ratio (OR)= 2.41; 95% confidence interval (CI) = 1.78, 3.28). We could not detect an increased risk of SGA with paternal smoking, or with other household smokers when the mother was a non-smoker, but did find an increased risk with exposure to ETS in the workplace or while socializing. Infants of mothers who ceased smoking during pregnancy were not at increased risk of SGA, but those who decreased but did not stop remained at risk of SGA. There was no evidence that the concentration of nicotine and tar in the cigarettes influenced the risk of SGA. CONCLUSIONS: Maternal smoking in pregnancy is a major risk factor for SGA. This study suggests that mothers should be advised to cease smoking completely during pregnancy, and that a reduction in the number of cigarettes smoked or smoking low tar or nicotine concentration cigarettes does not reduce the risk of SGA.     

Maternal and paternal recreational drug use and sudden infant death syndrome.

OBJECTIVE: To determine whether maternal or paternal use of cocaine, opiates, or marijuana during conception and pregnancy and postnatally increases the risk of sudden infant death syndrome (SIDS) during the first year of the infant's life. This is an important issue and may prove useful in further decreasing the rate of SIDS. METHODS: A case-control study was conducted consisting of 239 infants who died of SIDS in southern California between 1989 and 1992, and 239 healthy infants who were matched on the basis of birth hospital, date of birth, age, and sex. Specific drug use at the period of conception, during pregnancy and breastfeeding, and in the presence or vicinity of the infant was ascertained by telephone for the white, African American, Hispanic, Asian American, and Pacific Islander case and control fathers and mothers. RESULTS: Maternal recreational drug use during pregnancy was not associated with the risk of SIDS after adjusting for maternal smoking during pregnancy (adjusted odds ratio [OR] = 2.0; 95% confidence interval [CI], 0.6-6.5). There were statistically significant differences between case and control fathers' use of marijuana during conception (OR = 2.2; 95% CI, 1.2-4.2; P =.01), during pregnancy (OR = 2.0; 95% CI, 1.0-4.1; P =.05), and postnatally (OR = 2.8; 95% CI, 1.1-7.3; P =.04) and the risk of SIDS, while adjusting for paternal smoking and alcohol use. CONCLUSIONS: There was no association between maternal recreational drug use and SIDS. Paternal marijuana use during the periods of conception and pregnancy and postnatally were significantly associated with SIDS. The role of paternal psychoactive drug use, especially the relationship between marijuana and SIDS, is an understudied area; however, before any definitive role for the father can be confirmed, these findings should be investigated and replicated in future studies.     

Females born large for gestational age have a doubled risk of giving birth to large for gestational age infants

AIM: To analyse if females born large for gestational age (LGA) have an increased risk to give birth to LGA infants and to study anthropometric characteristics in macrosomic infants of females born LGA. METHODS: The investigation was performed as an intergenerational retrospective study of women born between 1973 and 1983, who delivered their first infant between 1989 and 1999. Birth characteristics of 47,783 females, included in the Swedish Birth Register both as newborns and mothers were analysed. LGA was defined as >2 SD in either birth weight or length for gestational age. The infants were divided into three subgroups: born tall only, born heavy only and born both tall and heavy for gestational age. Multiple logistic and linear regression analyses were performed. RESULTS: Females, born LGA with regard to length or weight, had a two-fold (adjusted OR 1.96, 95% Cl 1.54-2.48) increased risk to give birth to an LGA infant. Females, born LGA concerning weight only, had a 2.6 (adjusted OR 2.63, 95%, 1.85-3.75) fold increased risk of having an LGA offspring heavy only and no elevated risk of giving birth to an offspring that was tall only, compared to females born not LGA. In addition, maternal obesity was associated with a 2.5 (adjusted OR 2.56, 95%, 2.20-2.98) fold increased risk of having an LGA newborn, compared to mothers with normal weight. CONCLUSION: Females, born LGA, have an increased risk to give birth to LGA infants, compared to mothers born not LGA. Maternal overweight increases this risk even further.     

胎龄≤32周早产儿低血糖的危险因素分析

目的 探讨胎龄≤32周早产儿出生后发生低血糖的危险因素。方法 回顾性纳入2017年1月至2020年6月入住新生儿重症监护病房的86例胎龄≤32周低血糖早产儿作为低血糖组,随机选取同期住院监测血糖正常的早产儿172例为对照组。采用单因素分析与多因素logistic回归分析筛选早产儿低血糖的危险因素。结果 研究期间早产儿共计515例,其中低血糖86例（16.7%）。低血糖组小于胎龄儿（SGA）、剖宫产出生、孕母高血压、产前使用激素的比例均高于对照组（P < 0.05）,而出生体重及血糖检测前已静脉使用葡萄糖的比例均低于对照组（P < 0.05）。SGA（OR=4.311,95% CI：1.285~14.462）、孕母高血压（OR=2.469,95% CI：1.310~4.652）和产前使用激素（OR=6.337,95% CI：1.430~28.095）为早产儿低血糖的危险因素（P < 0.05）,静脉使用葡萄糖（OR=0.318,95% CI：0.171~0.591）为早产儿低血糖的保护因素（P < 0.05）。结论 SGA、孕母高血压和产前使用激素可增加胎龄≤32周早产儿早期发生低血糖的风险;对胎龄≤32周早产儿,建议生后尽早静脉使用葡萄糖,以减少低血糖的发生。     

Preterm delivery but not intrauterine growth retardation is associated with young maternal age among primiparae in rural Nepal

Pregnancy during adolescence is associated with adverse birth outcomes, including preterm delivery and low birthweight. The nutrient availability to the fetus may be limited if the mother is still growing. This research aims to study the effects of pregnancy during adolescence in a nutritionally poor environment in rural Nepal. This study utilized data from a randomized controlled trial of micronutrient supplementation during pregnancy in south-eastern Nepal. Women of parity 0 or 1 and of age 相似文献   

Prenatal exposure to polychlorinated biphenyls: effects on birth size and gestational age

Polychlorinated biphenyls (PCBs), environmental pollutants that concentrate in the fatty tissue of predatory sports fish, cross the placenta in women exposed to ordinary dietary levels. Two hundred forty-two newborn infants whose mothers consumed moderate quantities of contaminated lake fish and 71 infants whose mothers did not each such fish were examined during the immediate postpartum period. PCB exposure, measured by both contaminated fish consumption and cord serum PCB levels, predicted lower birth weight and smaller head circumference. Exposed infants were 160 to 190 gm lighter than controls, and their heads were 0.6 to 0.7 cm smaller. Head circumference was disproportionately small in relation to both birth weight and gestational age. Control analyses showed that none of these effects was attributable to any of 37 potential confounding variables, including socioeconomic status, maternal age, smoking during pregnancy, and exposure to polybrominated biphenyls. These findings are consistent with earlier reports from studies in laboratory animals.     

Infants of diabetic mothers are at increased risk for the oculo-auriculo-vertebral sequence: A case-based and case-control approach

OBJECTIVES: To determine if infants of diabetic mothers (IDM) are at increased risk for dysplastic ears and the oculoauriculo-vertebral spectrum (OAVS). STUDY DESIGN: Cases of IDM with dysplastic external ears seen at Cedars-Sinai Medical Center were combined with case series in medical literature describing similar patients. Data from a large congenital birth defects registry in Spain were analyzed, and odds ratios (OR) for infants born to either a gestational or preconceptionally diabetic mother to have one of the studied malformations were calculated with 95% confidence intervals. RESULTS: Among the 30 patients in the case series, 50.0% (15) had hemifacial microsomia; 46.7% (14) had hearing loss; 33.3% (10) had facial nerve palsy; 33.3% (10) had vertebral anomalies; 36.7% (11) had cardiovascular defects, of which 45% (5) were conotruncal defects; 26.7% (8) had renal anomalies; 13.3% (4) had limb defects (all radial ray hypoplasia); 10% (3) had DiGeorge sequence; 6.7% (2) had laterality defects; and 6.7% (2) had imperforate anus. Within the cases from the birth defects registry, the odds ratio for OAVS in infants of mothers with gestational diabetes mellitus was 2.28 (95% CI, 1.03-4.82, P =.03), and the OR for ear anomalies in these infants was 1.21 (95% CI, 0.94-1.56, P =.13). When infants of mothers with preconceptionally diagnosed type 1 or 2 diabetes were considered, the OR for OAVS was 1.50 (95% CI, 0.08-9.99, P =.49), and the OR for dysplastic ears was 0.94 (95% CI, 0.48-1.81, P =.85). CONCLUSIONS: Our data indicate that OAVS occurs with a higher incidence in IDM than in the general population. Associated problems include hearing loss, athymia, and cardiac, renal, and limb malformations. Therefore, we recommend that an IDM with features consistent with OAVS undergo a workup including hearing evaluation, skeletal survey, echocardiogram, renal ultrasonogram, and immunodeficiency workup if clinically indicated. Furthermore, noting that most of these defects occur in structures of neural crest origin, we hypothesize that poorly controlled maternal diabetes interferes with cephalic neural crest cell migration.     

Impact of maternal drug dependency on birth weight and head circumference of offspring

The impact of maternal opiate dependency on birth weight and head circumference of offspring was studied in 150 mother-infant pairs and 150 controls. Mean birth weight and head circumference of drug-dependent offspring were reduced symmetrically compared with drug-free controls of similar socioeconomic status. Although mean gestational ages and rates of prematurity were similar, intrauterine growth retardation occurred in 20% of passively addicted infants vs 4% of controls. A longer period of methadone maintenance was associated with longer gestation and increased birth weight, while higher methadone dosages were associated with higher birth weights and larger head circumferences. Smoking was associated with reduced birth weight by an average of 160 g per pack of cigarettes smoked per day; longer duration of smoking was associated with reductions in both birth weight and head circumference. These data suggest therapeutic strategies to improve these fetal growth characteristics and perhaps improve neurobehavioral outcome of drug-dependent newborns.     

Short duration of skin-to-skin contact: effects on growth and breastfeeding

AIM: To compare weight gain and head growth in very-low-birthweight (VLBW, <1501 g) infants with or without exposure to short duration of skin-to-skin contact (STSC) during their stay in a neonatal intensive care unit. METHODS: Stable VLBW infants were randomised into either STSC or control group. Parents of the STSC group were encouraged to provide STSC for at least 1 h daily. RESULTS: One hundred and forty-six infants were randomised, but only 126 were enrolled (STSC group: n = 64; Controls: n = 62). Infants in the STSC group had better mean weekly increase in head circumference (1.0 cm (SD = 0.3) vs. 0.7 cm (SD = 0.3); P < 0.0001) and higher breastfeeding rate at discharge (29.7% vs. 14.5%; P = 0.04). Although the mean duration of maternal education was longer in STSC (13.0 vs. 12.1 years; P = 0.04) than in controls, linear regression analysis showed that the significant predictors associated with weekly head growth were exposure to STSC (unstandardised coefficient: 0.2; 95% confidence intervals (CI): 0.1, 0.3; P < 0.0001) and head circumference of infants at the time of enrollment (unstandardised coefficient: -0.05; 95% CI: -08, -0.03; P < 0.0001); the number of years of maternal education was not a significant predictor. Logistic regression analysis showed that the only significant predictors of successful breastfeeding at discharge were receiving expressed breast milk at enrollment (adjusted OR: 4.1; 95% CI: 1.4, 11.7; P = 0.009) and receiving expressed breast milk during intervention period (adjusted OR: 8.3; 95% CI: 2.8, 24.4; P < 0.0001); exposure to STSC and maternal education were not significant predictors. CONCLUSION: Exposure to short duration of STSC may promote head growth in VLBW infants.     

Smoking and smoking cessation during early pregnancy and its effect on adverse pregnancy outcomes and fetal growth

Maternal smoking during pregnancy is a significant threat to the fetus. We examined the association between active maternal smoking and smoking cessation during early pregnancy with newborn somatometrics and adverse pregnancy outcomes including preterm delivery, low birth weight, and fetal growth restriction. One thousand four hundred mother–child pairs with extensive questionnaire data were followed up until delivery, within the context of a population-based mother–child cohort study (Rhea study), in Crete, Greece, 2007–2008. Comparing smokers to nonsmokers, the adjusted odds ratio (OR) was 2.8 [95% confidence interval (CI), 1.7, 4.6] for low birth weight and 2.6 (95%CI: 1.6, 4.2) for fetal growth restriction. This corresponded to a 119-g reduction in birth weight, a 0.53-cm reduction in length, and a 0.35-cm reduction in head circumference. Smoking cessation early during pregnancy modified significantly these pregnancy outcomes indicating the necessity for primary smoking prevention.     

Factors associated with discontinuation of breastfeeding before 1 month of age

Background:  Breastfeeding is associated with many benefits for both mother and child. Initiation rates are high in Sweden. Recently a slight decline is seen. Aim: The aim of this study was to assess factors associated with discontinuation of breastfeeding during the first 4 weeks. Method: A population‐based longitudinal birth cohort study recruiting from 2007 to 2008 in south‐western Sweden. At the first visit to the child health centre, parents were asked to complete a questionnaire. Also, the infants’ height, weight, head and waist circumference were collected. Response rate was 69.2%. Results: Twenty‐seven per cent of mothers had breastfeeding problems. In a multivariate analysis, there was a negative correlation between breastfeeding and use of pacifier (OR 3.72; CI 2.09–6.63), maternal smoking (OR 2.09; CI 1.08–4.05) and breastfeeding problems (OR 2.54; CI 1.73–3.71). Breastfeeding problems were correlated with poor sucking technique (OR 2.96; CI 2.14–4.07), support from maternity ward (OR 2.56; CI 2.05–3.19) and perceived poor weight gain (OR 1.37; CI 1.00–1.86). Conclusion: Many mothers reported breastfeeding problems that are associated with an early cessation. This is preventable with support, but the timing is crucial. To promote breastfeeding, the support from the child health centres must be tailored with the maternal perspective in mind.