Teenage pregnancy in type 1 diabetes mellitus

Carmody D, Doyle A, Firth RGR, Byrne MM, Daly S, Mc Auliffe F, Foley M, Coulter‐Smith S, Kinsley BT. Teenage pregnancy in type 1 diabetes mellitus Younger maternal age at delivery has been linked to adverse reproductive outcomes. Pregnancy complicated by type 1 diabetes mellitus (T1DM) is also associated with adverse pregnancy outcomes. Optimising diabetic glycaemic control prior to pregnancy is known to reduce the rate of congenital abnormalities and improve pregnancy outcomes. Teenage pregnancies are not usually planned and little data exist on teenage pregnancy complicated by T1DM. We sought to identify the glycemic control achieved in teenage pregnancy with T1DM and to clarify if there is an associated increase in adverse pregnancy outcomes compared to those seen in older women with T1DM. We compared outcomes in 18 teenagers (TG) with 582 older women with T1DM (CON) from 1995–2007. TG booked to the combined diabetes‐obstetrical service at a median gestational age of 11 weeks (range 6–22) compared to 7 weeks in CON (range 4–40, p < 0.02). Glycaemic was worse in TG compared to CON at 13, 26 and 35 weeks gestation, despite higher insulin doses. First trimester miscarriage rate did not differ between groups. Major congenital anomaly rate was 6.2% (1/16) compared to 3.2% in CON. This preliminary study has demonstrated that pregnant teenage women with T1DM book later to specialised care and have worse glycaemic control in pregnancy compared to older women with T1DM. This group also appear to be more insulin resistant than older women in early pregnancy. Our data would suggest that teenagers with type 1 diabetes mellitus may constitute a high‐risk group for adverse pregnancy outcomes.     

Characteristics of the mother and child in teenage pregnancy

As shown in 11,464 black and white pregnant teenagers and 28,477 older pregnant women, teenage mothers tend to be of small stature and weight, consistent with age and early maturation. The small size of their infants is in proportion to their smaller size and not to their early age at conception. Although the progeny of teenage mothers show a higher incidence of prematurity and diminished birth size, in the extent of fetal loss, low Apgar and Bayley scores, and in the frequency of medical abnormalities, they are not at a disadvantage compared with infants of third-decade mothers of comparable size.     

Socio-cultural, obstetric and anthropometric characteristics of newborn children of mothers who smoke in Spain

IntroductionOne in every four women smoke at the beginning of the pregnancy in Spain; of these, 25-50% give up smoking during gestation and most of them smoke again after childbirth. Maternal smoking has harmful effects on babies, such as low birth-weight with its resulting morbidity. The objective of this study is to compare the anthropometric and socio-cultural characteristics between newborns from smoking mothe?s and those from non- smoking ones.Materials and methodsSmoking habits and the socio-cultural characteristics were assessed from a sample of 1499 pregnant women, as well as their newborn anthropometric variables of their newborn babies during 2009 in the Aragon region of Spain.ResultsIn the sample of 1499 pregnant women the prevalence of smoking during pregnancy was 19.6%; among the Spanish women, 23% of them smoked during the gestation compared with only 11% in women from other countries. The smoker mothers were younger and they had a lower educational level than the non smoker ones; however, there were no statistical differences between their anthropometric characteristics. Newborns from smoker women in Aragon had a lower weigh at delivery (3155 vs. 3295 grams: p < .001) and a relative risk of low weight at birth for their gestational age of 2.1 (95% CI: 1.35 – 2.97). The length and the rest of newborn anthropometric variables were also affected.ConclusionThe prevalence of smoking during gestation is high in Aragon. The mothers who smoke are younger and have different socio-cultural characteristics compared with non-smoker mothers. Maternal smoking habits have a harmful effect on newborn nutritional status, representing an avoidable risk of low weight at birth.     

Exclusive breastfeeding and nutritional status in Bangladesh

Objective : The purposes of the study were to assess exclusive breastfeeding practice and examine the factors effect on nutritional status of children from 0 to 24 months age.Method : Data from a national survey entitled “Surveillance on Breastfeeding and Weaning Situation and Child and Maternal Health in Bangladesh were used to investigate the exclusive breastfeeding practice and to examine the factors having influence on child nutrition. Information was collected from mothers of 2781 children between 0 and 24 months of age.Results : It was that 16% of women still exclusively breastfed their children for less than 6 months. Of the children 38.1% were stunted and 38% were under weight for their age. Overall, 46% of children were suffering from diseases. Bivariate analysis showed that maternal education and family income were important correlates of exclusive breastfeeding (Chi-square p<0.001). Exclusively breastfed children were nutritionally better off (p<0.001). Logistic regression analysis showed that the children of illiterate women were nutritionally more vulnerable than children of women who had secondary and higher education (OR=1.69, 95% Cl=1.33–2.15). The children of older age women were less likely to be stunted than children of younger age women (OR=0.78, 95% CI=0.64–0.96).Conclusion : Despite efforts of different government agencies and NGOs, exclusive breastfeeding rate was still low in Bangladesh. Traditional cultural barriers still exist. In order to remove the harmful cultural beliefs and to spread the messages of the benefit of exclusive breastfeeding for survival and nutritional status of the children more behaviour change communication should be made to promote, protect and support breastfeeding.     

Changes in women's dietary diversity before and during pregnancy in Southern Benin

Dietary diversity before and during pregnancy is crucial to ensure optimal foetal health and development. We carried out a cohort study of women of reproductive age living in the Sô‐Ava and Abomey‐Calavi districts (Southern Benin) to investigate women's changes in dietary diversity and identify their determinants both before and during pregnancy. Nonpregnant women were enrolled (n = 1214) and followed up monthly until they became pregnant (n = 316), then every 3 months during pregnancy. One 24‐hr dietary recall was administered before conception and during each trimester of pregnancy. Women's dietary diversity scores (WDDS) were computed, defined as the number of food groups out of a list of 10 consumed by the women during the past 24 hr. The analysis included 234 women who had complete data. Mixed‐effects linear regression models were used to examine changes in the WDDS over the entire follow‐up, while controlling for the season, subdistrict, socio‐demographic, and economic factors. At preconception, the mean WDDS was low (4.3 ± 1.1 food groups), and the diet was mainly composed of cereals, oils, vegetables, and fish. The mean WDDS did not change during pregnancy and was equally low at all trimesters. Parity and household wealth index were positively associated with the WDDS before and during pregnancy in the multivariate analysis. Additional research is needed to better understand perceptions of food consumption among populations, and more importantly, efforts must be made to encourage women and communities in Benin to improve the diversity of their diets before and during pregnancy.     

Las Dos Cosas Versus Exclusive Breastfeeding: A Culturally and Linguistically Exploratory Intervention Study in Hispanic Mothers Living in Kentucky

IntroductionFormula supplementation among infants of breastfeeding Hispanic immigrants is common practice known as las dos cosas. The purpose of this study was to assess the feasibility, effectiveness, and acceptability of a culturally and linguistically diverse intervention to promote exclusive breastfeeding (EBF) for the first 6 months.MethodsA sample of 39 Hispanic pregnant women was recruited and randomly assigned to intervention (n = 20) and control groups (n = 19). The intervention included a peer counselor and professional support, and mothers were followed from pregnancy to 6 months after birth.ResultsAfter the study, women assigned to the intervention group were over three times more likely to EBF their baby through all four postpartum assessed time points (odds ratio = 3.1, 95% confidence interval: 1.1–8.7).DiscussionThis culturally and linguistically diverse intervention contributed to increased EBF duration and decreased formula supplementation in Hispanic mothers up to 6 months postpartum.     

To be rather than not to be--that is the problem with the questions we ask adolescents about their childbearing intentions.

OBJECTIVE: To demonstrate that rephrasing the questions used to assess childbearing intentions to quantify the strength of the intent to remain nonpregnant, rather than the strength of the intent to become pregnant, would make teenagers' responses more useful to health care providers, family planning counselors, and health policy makers. METHODS: Examples from the teen pregnancy prevention literature are used to support the recommendations for change. RESULTS: Teenagers rarely plan their pregnancies. However, because those who are having sexual intercourse must actively try not to become pregnant or they will likely conceive, teenagers often become pregnant because they lack a firm commitment not to do so. Thus, to accurately profile the antecedents of adolescent pregnancy, (1) the questions used to assess childbearing intentions must be rephrased so that teenagers who intend to remain nonpregnant can be distinguished from those who do not and (2) separate differential diagnoses must be developed for inconsistent contraceptive use within these 2 groups of teenagers who are at risk for unintended pregnancy. CONCLUSION: Asking sexually active teenagers about the strength of their intent to remain nonpregnant will make the results of office interviews and national surveys more useful because the responses such questions elicit will enable health care providers and policy makers to target common, modifiable antecedents of inconsistent contraceptive use for interventions.     

Maternal nutrition practices in Uttar Pradesh,India: Role of key influential demand and supply factors

Despite strong policy and program commitment, essential maternal nutrition services are not reaching enough women in many countries. This paper examined multifactorial determinants (personal, family, community, and health services) associated with maternal nutrition practices in Uttar Pradesh, India. Data were from a household survey of pregnant (n = 667) and recently delivered women (n = 1,835). Multivariable regression analyses were conducted to examine the determinants of four outcomes: consumption of diverse diets, consumption of iron folic acid (IFA) and calcium tablets, and weight monitoring during pregnancy. Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal program implementation. During pregnancy, women consumed 28 IFA and 8 calcium tablets, 18% consumed diverse diet, and 17% were weighed ≥3 times. Nutrition knowledge was associated with consumption of diverse diet (odds ratio [OR] = 2.2 times), IFA (2.3 times), calcium (11.7 times), and weight monitoring (1.3 times). Beliefs and self‐efficacy were associated with IFA (OR = 2.0) and calcium consumption (OR = 4.6). Family support and adequate health services were also associated with better nutrition practices. Under optimal program implementation, we estimate that 51% of women would have adequate diet diversity, an average consumption of 98 IFA, and 106 calcium tablets, and women would be weighed 4.9 times during pregnancy. Strengthening existing program operations and increasing demand for services has the potential to result in large improvements in maternal nutrition practices from current baseline levels but may not be sufficient to meet World Health Organization‐recommended levels without creating an enabling environment including improvements in education and income levels to support behaviour change.     

Outcome of teenage pregnancy

Objective The objective of the study was to evaluate the obstetric, fetal and neonatal outcomes of teenage pregnancy in a tertiary care teaching hospital. Methods A retrospective case control study was performed over a period of 5 years. Data were retrieved from hospital records. All teenage mothers (aged 13–19 completed years at delivery) delivering in the University Hospital were taken as cases. Next 3 consecutive deliveries in the age group of 20–30 year were selected as controls for each case. For statistical analysis the cases were further subdivided into 2 groups, ≤17 years (Group A) and 18–19 years (Group B). Groups were compared for obstetric complications and neonatal outcome. Statistical analysis was done by software package SPSS 10. Results The incidence of teenage deliveries in hospital over last 5 years was 4.1%. Majority of the teenagers were primigravida (83.2% vs. 41.4%, p<0.01). Complications like pregnancy induced hypertension (PIH) (11.4% vs 2.2%, p<0.01), pre-eclamptic toxemia (PET) (4.3% vs 0.6%, p<0.01) eclampsia (4.9% vs 0.6%, p<0.01) and premature onset of labor (26.1% vs 14.6%, p<0.01) occurred more commonly in teenagers compared to controls. Teenage mothers also had increased incidence of low birth weight (LBW) (50.4% vs 32.3%, p<0.01), premature delivery (51.8% vs 17.5%, p<0.01) and neonatal morbidities like perinatal asphyxia (11.7% vs 1.9%, p<0.01), jaundice (5.7% vs 1.2%, p<0.01) and respiratory distress syndrome (1.9% vs 0.3%, p<0.05). Teenage pregnancy was also associated with higher fetal (1.9% vs 0.3%, p<0.05) and neonatal mortality (3.8% vs 0.5%, p<0.05). Conclusion Teenage pregnancy was associated with a significantly higher risk of PIH, PET, eclampsia, premature onset of labor, fetal deaths and premature delivery. Increased neonatal morbidity and mortality were also seen in babies delivered to teenage mothers. Younger teenager group (≤17 years) was most vulnerable to adverse obstetric and neonatal outcomes.     

The post-partum mid-upper arm circumference of adolescents is reduced by pregnancy in rural Nepal

The purpose of this study was to examine whether changes in the mid‐upper arm circumference (MUAC) in pregnancy and early post‐partum varied by maternal age. The MUAC of 3359 nulliparous pregnant women ≤25 years of age in rural Nepal was measured in early pregnancy and at 3 months post‐delivery of a live‐born infant. Regression was used to model the change in MUAC and prevalence of MUAC < 20 cm by maternal age, adjusted for confounders. A total of 5.2% of the pregnant women were under 16 years of age. The prevalence of MUAC measurements <20 cm was 11.3% in early pregnancy and did not differ by maternal age. The prevalence of low MUAC was 17.7% at post‐partum, but those <16 years of age had a significantly higher prevalence of low post‐partum MUAC [odds ratio: 2.47, 95% confidence interval (CI) 1.49, 4.10] compared with women 20–25 years of age, adjusted for maternal literacy, caste, meat consumption in early pregnancy and timing of measurements. All women reduced their MUAC from early pregnancy through post‐partum. The adjusted loss of the MUAC among those under 16 years of age was 0.97 cm (95% CI: ?1.33, ?0.60), compared with 0.40 cm (95% CI: ?0.70, ?0.10) among women 20–25 years of age. In an energy‐restricted environment, girls under 16 years contributed to a half centimetre more loss of MUAC than older women of the same parity. Such a loss of fat, muscle or both may put younger women and their breastfed offspring at greater risk of other adverse health and nutritional outcomes.     

Inadequate status of iodine nutrition among pregnant women residing in three districts of Niamey,the Niger Republic's capital

Universal dietary salt iodisation (UDSI) programme was implemented in Niger in 1996. However, since 2000, there has been a slowdown in progress against iodine deficiency. The aim of our study was to assess the iodine status among pregnant women in a context where national controls are not effective at ensuring universal availability of adequately iodised salt. This is mainly to assess the impact of the slowdown in the fight against iodine deficiency in this vulnerable group. The study was centred on 240 healthy pregnant women volunteers recruited in three districts primary health centres. A control group of 60 non‐pregnant, non‐lactating healthy women was also studied and compared. Median urinary iodine concentration (UIC) of all pregnant women was 119 μg L^?1, and 61.67% had UIC below 150 μg L^?1. Median UIC for the first, second and third trimester were 144, 108 and 92 μg L^?1, respectively. The percentage of pregnant women with UIC below 150 μg L^?1 increased from 52% in the first trimester to 66% in the third trimester. The median UIC of the control group was 166 μg L^?1, and 28.33% had UIC below 100 μg L^?1. No significant relationship was found between nutritional iodine status and provenance, age and parity. However, significant relationship was found between iodine status and stage of pregnancy, gestational age and educational level (P < 0.05). Iodine nutrition status thus observed was inadequate in 61.67% of all the pregnant women. It is therefore urgent to revitalise implementation of the UDSI programme, and in the short term to consider iodine supplementation for pregnant women.     

Scholastic performance of adolescents

Objective : To find out the factors affecting scholastic performance of adolescents belonging to various groups and the determinants for poor scholastic performance.Methods : 1892 adolescents of 13 to 19 years age group belonging to different category of schools were interviewed and assessed by a team consisting of pediatrician, psychologist and PG-DCCD* students using Teenage Screening Questionnaire — Trivandrum and Study Habit Rating Scale. Daily study pattern, Family environment, Education status of parents, Personal distractions, and Attitude towards studies were observed as factors affecting scholastic performance.Result : On multivariate analysis the predictor variables for poor scholastic performance were; lower studying daily lessons, poor concentration in studies, lower education status of father and unhappy family.Conclusion : It is feasible to identify determinants of scholstic performance and plan intervention strategies at school level.     

Overweight increases risk of first trimester hypothyroxinaemia in iodine‐deficient pregnant women

Hypothyroxinaemia early in pregnancy may impair fetal brain development. Increased body weight has been associated with low thyroxine concentrations in non‐pregnant women. In pregnant women, morbid maternal obesity is a risk factor for thyroid dysfunction. But whether lesser degrees of overweight that are much more common could be a risk factor for hypothyroxinaemia in pregnancy is unclear. The objective of this study was to investigate if overweight increases risk for thyroid dysfunction, and specifically hypothyroxinaemia, in iodine‐deficient pregnant women. We performed a cross‐sectional study at first hospital visit among healthy Thai pregnant women. We measured weight and height, urinary iodine concentration (UIC), serum thyroid hormones and thyroglobulin. Pre‐pregnancy weight and relevant dietary factors were determined by questionnaire, and body mass index (BMI) was used to classify weight status. Among 514 women (mean gestational age, 11 weeks) with a median UIC of 111 μg dL^–1, indicating mild iodine deficiency, 12% had low free thyroxine (fT4) concentrations: 3% had overt hypothyroidism; 7% had subclinical hypothyroidism; and 8% had isolated hypothyroxinaemia. Based on pre‐pregnancy BMI, 26% of women were overweight or obese. In a multiple regression model, BMI was a negative predictor of fT4 (β = ?0.20, P < 0.001). Compared to normal weight women, the prevalence ratio (95% CI) of a low fT4 in overweight women was 3.64 (2.08–6.37) (P < 0.01). Iodine‐deficient pregnant Thai women who are overweight have a 3.6‐fold higher risk of hypothyroxinaemia in the first trimester compared to normal weight women. Targeted screening should consider overweight a potential risk factor for thyroid dysfunction in pregnant women in iodine‐deficient areas.     

Teenage relationships and sex education.

Most of the consequences of early intercourse affect the woman and much research has focused upon her. As part of a study on teenage pregnancy, where 137 women were interviewed, 46 men were also interviewed. They were less likely to have had teaching about sex from parents and were subject to less parental supervision than the women. Both sexes had had similar experience of school sex education. Just under half of the men started having intercourse before 16 years. Over half of both sexes were initiated by an experienced partner and for 15/25 (60%) of the men this was within the first month of a relationship. Most men had had several partners and 27/99 (27%) of teenage women at least three, most in the context of stable relationships. ''Serial monogamy'' exposes each partner indirectly to their partners previous partners (with the associated medical risks). Education must help teenagers make decisions about sexual involvement that take account of these facts and the implications for their own future health and happiness.     

Prepregnancy health status and the risk of preterm delivery

BACKGROUND: Despite extensive evaluation, our understanding of risk factors for premature delivery is incomplete. OBJECTIVE: To examine whether a woman's health status and risk factors before pregnancy are associated with a woman's risk of preterm delivery, independent of risk factors that occur during pregnancy. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of pregnant women in the San Francisco Bay area who delivered a singleton infant (n = 1619). MAIN OUTCOME MEASURE: Preterm delivery (<37 weeks' gestational age). RESULTS: Sociodemographic characteristics alone explained 13.0% of the risk of preterm delivery, whereas risk factors that occurred before pregnancy explained 39.8% and risk factors that occurred during pregnancy explained 47.1%. After we adjusted for sociodemographic characteristics, prepregnancy risk factors, and pregnancy risk factors, women who reported poor physical function during the month before conception were nearly twice as likely to experience a preterm delivery (odds ratio, 1.97; 95% confidence interval, 1.18-3.30) as women with better physical function. CONCLUSION: A broader focus on the health of women prior to pregnancy may improve rates of preterm delivery.     

辅助生殖技术与妊娠期糖尿病孕产妇肠道菌群的特异表达

目的 通过检测和比较不同受孕方式及是否并发妊娠期糖尿病(gestational diabetes mellitus,GDM)孕产妇的肠道菌群,明确辅助生殖技术(assisted reproductive technology,ART)及GDM孕产妇肠道菌群的特异性表达,分析其机制,为今后预防干预、促进ART妊娠母婴健康...     

The relationship of serum vitamin D with pre‐eclampsia in the Iranian women

Vitamin D deficiency may be a risk factor for negative outcome in pregnancy, such as pre‐term labour, low birthweight, intrauterine growth retardation and gestational diabetes. This study aimed to evaluate the relationship between vitamin D and pre‐eclampsia. This was a case–control study of 59 pre‐eclamptic women and 59 healthy pregnant women selected in two hospitals in Ahvaz, Iran. Women with term singleton pregnancy, nulliparous and of reproductive age were selected. Venous blood samples (2 mL) were taken and the level of 25‐dihydroxy vitamin D (25‐OH‐D) was measured. If the levels of 25‐OH‐D were less than 10 ng mL^?1, between 10 ng mL^?1 and 29 ng mL^?1 and more than 30 ng mL^?1, they were considered as indicating deficient, insufficient and normal 25‐OH‐D concentrations, respectively. The independent t‐test, Mann–Whitney U‐test, chi‐square and logistic regression were used for analysing the data. Vitamin D deficiency was significantly higher in the pre‐eclampsia group [odds ratio (OR) = 24.04, confidence interval (CI) = 2.10–274.8, P = 0.01]. Older women (30–35 years) were more likely to develop pre‐eclampsia compared with the control group (OR = 10.36, CI = 2.18–49.09, P = 0.003). The results showed that women with body mass index (BMI) <20 were more likely to develop pre‐eclampsia. The ages between 20 years and 30 years and normal BMI were not the risk factors for pre‐eclampsia. Vitamin D deficiency has a statistically significant relationship with pre‐eclampsia. It seems that the serum vitamin D levels are low in Iranian women because of their particular lifestyle and they may need more than 400 IU day^?1 vitamin D supplement during pregnancy.     

The pregnant adolescent prostitute

The issue of teenage pregnancy is one of paramount concern and has been covered extensively in the professional literature. Teenage prostitution, as well, has drawn attention from medical and social science researchers. An increasing number of teenage prostitutes are becoming pregnant and delivering infants. These young women constitute a high-risk group that merits professional investigation and requires sensitive clinical approaches. We describe the pregnancy and early postpartum outcomes of 61 teenage prostitutes (age range, 13 to 18 years) in Seattle, Wash, during the period from January 1987 to February 1988. The subjects' environment, prenatal care, drug use, contraceptive practices, repeated pregnancies, and risk for sexually transmitted diseases (including acquired immunodeficiency syndrome) are discussed. Two case examples are used for illustration.     

Relationships Among Family Participation,Team Support,and Intensity of Early Intervention Services

ABSTRACT

Aims: In America, children with disabilities and their families may receive early intervention (EI) services under the Individuals with Disabilities Education Improvement Act (IDEA). The IDEA mandates that decisions on service delivery are based on the needs of the child and family. It is unclear how decisions on intensity of services are made in EI. The purpose of this study was to determine whether parent participation and team support are determinants of the recommendation for intensity of service at the initial Individualized Family Service Planning (IFSP) meeting. Methods: The participants were 63 parents of children 2–33 months of age and 74 professionals. The first author observed all IFSP meetings and completed the Parent Participation Measure. Following the meeting, parents completed a demographic form, the Ages and Stages Questionnaire, and the Family Needs Survey. The recommended intensity of service was recorded. Results and Conclusions: Parent participation and team support were not significant determinants of intensity of EI service after controlling for child development and family needs (R² = 0.145, p = .14). The recommended intensity of service was 240 min per month for 57% of the families suggesting that factors other than parent participation and team support influenced the decision on intensity of service.