Physical Activity and Risk of Small-for-Gestational-Age Birth Among Predominantly Puerto Rican Women

To estimate the association between multiple domains of physical activity and risk of small-for-gestational-age (SGA) birth. We utilized data from 1,040 participants in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of predominantly Puerto Rican prenatal care patients in Massachusetts. Physical activity was assessed by bilingual interviewers using a modified version of the Kaiser physical activity survey in early (mean = 15 weeks) and mid pregnancy (mean = 28 weeks). Physical activity (i.e., sports/exercise, household, occupational, and active living) in pre, early and mid pregnancy was categorized in quartiles. SGA was classified as <10th percentile of birth weight for gestational age. Pre- and early-pregnancy physical activity were not associated with SGA. In multivariable analyses, women with high total activity in mid-pregnancy had a decreased risk of SGA [risk ratio (RR) = 0.42; 95% confidence interval (CI) 0.21–0.82; p _trend = 0.003] as compared to those with low total activity. Findings were similar for high household activity (RR = 0.69; 95% CI = 0.34–1.40; p _trend = 0.26), active living (RR = 0.63; 95% CI = 0.35–1.13; p _trend = 0.04), and occupational activity (RR = 0.79, 95% CI = 0.47–1.34; p _trend = 0.26). High levels of sports/exercise were associated with an increased SGA risk without a significant dose–response association (RR = 2.14, 95% CI 1.04–4.39; p _trend = 0.33). Results extend prior studies of physical activity and SGA to the Hispanic population.     

The effects of maternal body mass index on pregnancy outcome

The increasing prevalence of obesity is presenting a critical challenge to healthcare services. We examined the effect of Body Mass Index in early pregnancy on adverse pregnancy outcome. We performed a population register-based cohort study using data from the North Western Perinatal survey (N = 99,403 babies born during 2004–2006), based at The University of Manchester, UK. The main outcome measures were Caesarean section delivery, preterm birth, neonatal death, stillbirth, Macrosomia, small for gestational age and large for gestational age. The risk of preterm birth was reduced by almost 10% in overweight (RR = 0.89, [95% CI: 0.83, 0.95]) and obese women (RR = 0.90, [95% CI: 0.84, 0.97]) and was increased in underweight women (RR = 1.33, [95% CI: 1.16, 1.53]). Overweight (RR = 1.17, [95% CI: 1.09, 1.25]), obese (RR = 1.35, [95% CI: 1.25, 1.45]) and morbidly obese (RR = 1.24, [95% CI: 1.02, 1.52]) women had an elevated risk of post-term birth compared to normal women. The risk of fetal macrosomia and operative delivery increased with BMI such that morbidly obese women were at greatest risk of both (RR of macrosomia = 4.78 [95% CI: 3.86, 5.92] and RR of Caesarean section = 1.66 [95% CI: 1.61, 1.71] and a RR of emergency Caesarean section = 1.59 [95% CI: 1.45, 1.75]). Excessive leanness and obesity are associated with different adverse pregnancy outcomes with major maternal and fetal complications. Overweight and obese women have a higher risk of macrosomia and Caesarean delivery and lower risk of preterm delivery. The mechanism underlying this association is unclear and is worthy of further investigation.     

Short-term weight change and fluctuation as risk factors for type 2 diabetes in Finnish male smokers

Risk of weight change and fluctuation for type 2 diabetes was studied in a prospective study among 20,952 Finnish male smokers aged 50–69 years. Baseline data on lifestyle and medical history were collected, and height and weight measured. Weight was measured thrice after the baseline, 1 year apart. Weight change was defined as the slope of the regression line fitted to the four measurements and weight fluctuation as the root-mean-square-error deviation from this line. Incident cases of diabetes were identified from a national medication reimbursement register; 535 cases up to 9 years’ follow-up. The Cox proportional hazards model served to estimate relative risk [RR, 95% confidence interval (CI)]. Weight gain and fluctuation associated with higher risk for diabetes, multivariate RR = 1.77, 95% CI 1.44–2.17, for weight gain of at least 4 kg compared with those of weight change less than 4 kg, and RR = 1.64, 95% CI 1.24–2.17 in the highest weight fluctuation quintile compared to the lowest. These RRs remained similar when weight change and fluctuation were adjusted for each other. Large weight fluctuation increased the risk of diabetes both in men who gained weight (≥4 kg), had stable weight (± <4 kg), and lost weight (≥4 kg); RR = 2.17, 95% CI 1.60–2.94, RR = 1.47, 95% CI 1.14–1.91, and RR = 2.04, 95% CI 1.47–2.83, respectively, compared to those with stable weight and moderate fluctuation. Short-term weight gain and large weight fluctuation are independent risk factors for diabetes.     

Disparities in Self-Reported Postpartum Depression among Asian,Hawaiian, and Pacific Islander Women in Hawaii: Pregnancy Risk Assessment Monitoring System (PRAMS), 2004–2007

Postpartum depression affects 10–20% of women and causes significant morbidity and mortality among mothers, children, families, and society, but little is known about postpartum depression among the individual Asian and Pacific Islander racial/ethnic groups. This study sought to indentify the prevalence of postpartum depression among common Asian and Pacific Islander racial/ethnic groups. Data from the Hawaii Pregnancy Risk Assessment and Monitoring System (PRAMS), a population-based surveillance system on maternal behaviors and experiences before, during, and after the birth of a live infant, were analyzed from 2004 through 2007 and included 7,154 women. Questions on mood and interest in activities since giving birth were combined to create a measure of Self-reported Postpartum Depressive Symptoms (SRPDS). A series of generalized logit models with maternal race or ethnicity adjusted for other sociodemographic characteristics evaluated associations between SRPDS and an intermediate level of symptoms as possible indicators of possible SRPDS. Of all women in Hawaii with a recent live birth, 14.5% had SRPDS, and 30.1% had possible SRPDS. The following Asian and Pacific Islander racial or ethnic groups were studied and found to have higher odds of SRPDS compared with white women: Korean (adjusted odds ratio [AOR] = 2.8;95% confidence interval [CI]: 2.0–4.0), Filipino (AOR = 2.2;95% CI: 1.7–2.8), Chinese (AOR = 2.0;95% CI: 1.5–2.7), Samoan (AOR = 1.9;95% CI: 1.2–3.2), Japanese (AOR = 1.6;95% CI: 1.2–2.2), Hawaiian (AOR = 1.7;95% CI: 1.3–2.1), other Asian (AOR = 3.3;95% CI: 1.9–5.9), other Pacific Islander (AOR = 2.2;95% CI: 1.5–3.4), and Hispanic (AOR = 1.9;95% CI: 1.1–3.4). Women who had unintended pregnancies (AOR = 1.4;95% CI: 1.2–1.6), experienced intimate partner violence (AOR = 3.7;95% CI: 2.6–5.5), smoked (AOR = 1.5;95% CI: 1.2–2.0), used illicit drugs (AOR = 1.9;95% CI: 1.3–3.9), or received Women, Infant, and Children (WIC) benefits during pregnancy (AOR = 1.4;95% CI: 1.2–2.6) were more likely to have SRPDS. Several groups also were at increased risk for possible SRPDS, although this risk was not as prominent as seen with the risk for SRPDS. One in seven women reported SRPDS, and close to a third reported possible SRPDS. Messages about postpartum depression should be incorporated into current programs to improve screening, treatment, and prevention of SRPDS for women at risk.     

Risk Factors for Sub-Clinical and Major Postpartum Depression Among a Community Cohort of Canadian Women

Objectives To identify prenatal and perinatal factors that predict women at risk of sub-clinical and major postpartum depression among a cohort of low medical risk pregnant women in Canada. Methods Data from 1,403 women who completed a randomized controlled trial of supplementary support during pregnancy was analyzed to identify risk factors for sub-clinical and major postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS), completed at eight weeks postpartum, was used to classify each woman’s depression symptom severity. Demographic, obstetric, behavioral risk, mental health and psychosocial factors were considered. Multiple logistic regression analyses were used to identify risk factors most predictive of sub-clinical and major postpartum depression. Results After adjustment for other covariates, variables that increased the risk of sub-clinical postpartum depression included a history of depression (OR = 2.27, CI = 1.42–3.63), anxiety symptoms during pregnancy (OR = 2.12, CI = 1.09–4.11), being born outside Canada (OR = 1.87, CI = 1.17–3.00), and low parenting self-efficacy (OR = 1.65, CI = 1.06–2.55). Variables that increased the risk of major postpartum depression included a history of depression (OR = 2.78, CI = 1.56–4.97), being born outside Canada (OR = 2.97, CI = 1.70–5.17), depressive symptoms during pregnancy (OR = 2.83, CI = 1.29–6.19) and not breastfeeding at eight weeks postpartum (OR = 2.12, CI = 1.21–3.70). Conclusions A history of depression and being born outside Canada predicted women who were at an increased risk of sub-clinical and major postpartum depression. The remaining risk factors specific to sub-clinical and major postpartum depression suggest some differences between women vulnerable to sub-clinical compared to major depressive symptoms in the postpartum period, which may have implications for targeted screening and intervention strategies.     

Maternal Socio-Economic and Race/Ethnic Characteristics Associated with Early Intervention Participation

Objectives To evaluate whether Massachusetts Early Intervention (EI) serves children at risk of developmental delay due to social factors, we identified socio-demographic characteristics associated with program enrollment and examined predictors of participation at each stage from referral to enrollment. Methods The Pregnancy to Early Life Longitudinal (PELL) data system linked birth certificate, hospital discharge, and EI data for all Massachusetts births, 1998–2000. We identified predictors of enrollment among births and predictors of referral, eligibility evaluation among those referred, and enrollment among eligible children using multivariate modified Poisson models to adjust for medical risks. Results Overall, 29,950 children (13.7% of births) enrolled in EI. Most social risk indicators predicted enrollment, including maternal government insurance (RR = 1.32, 95% CI 1.29–1.36) and maternal education ≤10 years (RR = 1.36, 95% CI 1.30–1.42). Having a foreign-born (RR = 0.77, 95% CI 0.74–0.80), non-English speaking (RR = 0.93, 95% CI 0.89–0.97) or Asian (RR = 0.88, 95% CI 0.82–0.94) mother was negatively associated with enrollment. Of births, 18.6% were referred to EI. Similar socio-demographic variables predicted referral as predicted enrollment. Among referrals, 87.7% received an evaluation. Evaluation was negatively associated with young maternal age, black maternal race, and high poverty level. Of eligible children, 93.0% enrolled. Enrollment among eligible children was negatively associated with young maternal age and high poverty level. Conclusion In Massachusetts, children born with social risk factors have high EI participation. Nevertheless, children in immigrant communities may face barriers to initial contact with EI, while children from low socioeconomic environments may be at risk for not enrolling after EI referral.

Paternal exposure to Agent Orange and spina bifida: a meta-analysis

The objective of this study is to conduct a meta-analysis of published and unpublished studies that examine the association between Agent Orange (AO) exposure and the risk of spina bifida. Relevant studies were identified through a computerized literature search of Medline and Embase from 1966 to 2008; a review of the reference list of retrieved articles and conference proceedings; and by contacting researchers for unpublished studies. Both fixed-effects and random-effects models were used to pool the results of individual studies. The Cochrane Q test and index of heterogeneity (I ²) were used to evaluate heterogeneity, and a funnel plot and Egger’s test were used to evaluate publication bias. Seven studies, including two Vietnamese and five non-Vietnamese studies, involving 330 cases and 134,884 non-cases were included in the meta-analysis. The overall relative risk (RR) for spina bifida associated with paternal exposure to AO was 2.02 (95% confidence interval [CI]: 1.48–2.74), with no statistical evidence of heterogeneity across studies. Non-Vietnamese studies showed a slightly higher summary RR (RR = 2.22; 95% CI: 1.38–3.56) than Vietnamese studies (RR = 1.92 95% CI: 1.29–2.86). When analyzed separately, the overall association was statistically significant for the three case–control studies (Summary Odds Ratio = 2.25, 95% CI: 1.31–3.86) and the cross sectional study (RR = 1.97, 95% CI: 1.31–2.96), but not for the three cohort studies (RR: 2.11; 95% CI: 0.78–5.73). Paternal exposure to AO appears to be associated with a statistically increased risk of spina bifida.     

Life Course Racism and Depressive Symptoms among Young Black Women

The objective of this study is to evaluate the life course effects of racism on depressive symptoms in young Black women and to identify particularly sensitive periods. Guided by life-course theory and using logistic regression, we analyzed baseline data on racism frequency and stress from racism at two time periods (before age 20 and during the 20s) and follow-up data (at approximate 20-month intervals) on depressive symptoms (using a modified 11-item Center for Epidemiologic Studies Depression Scale, CES-D) among 1612 Black women participants aged 23–34 years living in Detroit, MI. Of the 1612 women, 65% reported experiencing some racism at baseline, and 36.5% had high depressive symptoms at follow-up. Those who experienced high frequency of racism before age 20 had an increased risk for high depressive symptoms (RR = 1.26, 95% CI:  1.07, 1.46) compared to participants in the low racism frequency group. We observed similar associations for high vs. low stress from racism (RR = 1.30, 95% CI : 1.06, 1.54) and high vs. low combination of racism frequency and stress (RR = 1.38, 95% CI: 1.13, 1.64). These findings did not hold or were weaker when assessing racism during the 20s. Among women who experienced high racism across the two time periods, the risk of high depressive symptoms was higher than those who experienced low racism during both periods (RR = 1.49, 95% CI:  1.14, 1.86). The slightly stronger associations between racism and depressive symptoms in childhood and adolescence than in young adulthood suggest that early life might be a sensitive period for experiencing racism.     

Diabetes and modifiable risk factors for cardiovascular disease: the prospective Million Women Study

To compare the effect of potentially modifiable lifestyle factors on the incidence of vascular disease in women with and without diabetes. In 1996–2001 over one million middle-aged women in the UK joined a prospective study, providing medical history, lifestyle and socio-demographic information. All participants were followed for hospital admissions and deaths using electronic record-linkage. Adjusted relative risks (RRs) and incidence rates were calculated to compare the incidence of coronary heart disease and stroke in women with and without diabetes and by lifestyle factors. At recruitment 25,915 women (2.1% of 1,242,338) reported current treatment for diabetes. During a mean follow-up of 6.1 years per woman, 21,928 had a first hospital admission or death from coronary heart disease (RR for women with versus without diabetes = 3.30, 95% CI 3.14–3.47) and 7,087 had a first stroke (RR = 2.47, 95% CI 2.24–2.74). Adjusted incidence rates of these conditions in women with diabetes increased with duration of diabetes, obesity, inactivity and smoking. The 5-year adjusted incidence rates for cardiovascular disease were 4.6 (95% CI 4.4–4.9) per 100 women aged 50–69 in non-smokers with diabetes, 5.9 (95% CI 4.6–7.6) in smokers with diabetes not using insulin and 11.0 (95% CI 8.3–14.7) in smokers with diabetes using insulin. Non-smoking women with diabetes who were not overweight or inactive still had threefold increased rate for coronary disease or stroke compared with women without diabetes. Of the modifiable factors examined in middle aged women with diabetes, smoking causes the greatest increase in cardiovascular disease, especially in those with insulin treated diabetes.     

Maternal Influences on Nausea and Vomiting in Early Pregnancy

Symptoms of nausea and vomiting in early pregnancy (NVP) are common among pregnant women, but whether some women are more likely than others to experience these symptoms has not been well established. We examined potential risk factors for NVP symptom severity, timing of onset, and duration. We included 2,407 newly pregnant women who participated in a prospective cohort study on early pregnancy health between 2000 and 2004 in three U.S. cities. Data on NVP and other health information were collected through telephone interviews, early gestation ultrasound, and medical record abstractions. Generalized linear models were used to model possible risk factors for each NVP characteristic. Eighty-nine percent of women had NVP; for 99% of these, symptoms started in the first trimester. None of the characteristics examined were associated with having NVP. Among those with NVP, increasing risk of delayed symptoms onset was associated with advancing maternal age; increased risks were also seen among non-Hispanic Black [Risk ratio (RR) = 4.3, 95% confidence interval (CI): 1.6,11.6] and Hispanic women (RR = 2.3, 95% CI:0.4,11.5). NVP symptoms for multigravidae were more likely to last beyond the first trimester with each additional pregnancy. Most pregnant women experienced NVP. Nearly all of them, regardless of characteristics examined, had symptoms beginning in the first trimester. Maternal age, race/ethnicity, and gravidity were associated with delayed onset and symptoms that persisted into the second trimester.     

Depressive symptoms and self-reported occupational injury in small and medium-sized companies

Objectives  This survey was designed to determine whether depressive symptoms had an effect on the risk of self-reported occupational injury in South Korea. Methods  We conducted a prospective follow-up survey of workers at 44 small- to medium-sized companies classified into manufacturing or service businesses; 1,350 questionnaires were used in the final analysis. The first survey requested information regarding personal characteristics, work characteristics, and depressive symptoms (CES-D); the second survey queried participants in the first survey about self-reported occupational injuries (including minor scratches or cuts) experienced in the previous 4 months. Risk ratios (RRs) were calculated through Poisson regression analysis. The number of occupational injuries during the previous 4 months served as the dependent variable, and depressive symptoms served as the independent variable. Results  After adjustment for demographic factors, the RRs were 1.75 (95% CI: 1.41–2.18) and 2.68 (95% CI: 1.98–3.64) in male and female, respectively. Additional adjustment for work-related variables did not alter the RR considerably in females (2.65; 95% CI: 1.95–3.59). Among the male workers, however, the RR was not significant (1.21; 95% CI: 0.95–1.55). On the other hand, when the analysis was limited to blue-collar workers, after adjustment for demographic and work-related factors, the RRs remained significant in both genders (male: 1.34; 95% CI: 1.03–1.74; female: 2.04; 95% CI: 1.41–2.95). Conclusions  We found that the risk of self-reported occupational injury experience was higher in workers who reported depressive symptoms. Additional study using objective data is required to confirm our results.     

Risk factors differ between recurrent and incident preeclampsia: a hospital-based cohort study

PurposeTo examine whether risk factors, including prepregnancy body mass index (BMI), differ between recurrent and incident preeclampsia.MethodsData included electronic medical records of nulliparas (n = 26,613) delivering 2 times or more in Utah (2002–2010). Modified Poisson regression models were used to examine (1) adjusted relative risks (RR) of preeclampsia and 95% confidence intervals (CI) associated with prepregnancy BMI; (2) maternal risk factor differences between incident and recurrent preeclampsia among primiparous women.ResultsIn the first pregnancy, compared with normal weight women (BMI: 18.5–24.9), preeclampsia risks for overweight (BMI: 25–29.9), obese class I (BMI: 30–34.9), and obese class II/III (BMI: ≥35) women were 1.82 (95% CI = 1.60–2.06), 2.10 (95% CI = 1.76–2.50), and 2.84 (95% CI = 2.32–3.47), respectively, whereas second pregnancy–incident preeclampsia risks were 1.66 (95% CI = 1.27–2.16), 2.31 (95% CI = 1.67–3.20), and 4.29 (95% CI = 3.16–5.82), respectively. Recurrent preeclampsia risks associated with BMI were highest among obese class I women (RR = 1.60; 95% CI = 1.06–2.42) without increasing in a dose-response manner. Nonwhite women had higher recurrence risk than white women (RR = 1.70; 95% CI = 1.16–2.50), whereas second pregnancy–incident preeclampsia risk did not differ by race.ConclusionPrepregnancy BMI appeared to have stronger associations with risk of incident preeclampsia either in the first or second pregnancy, than with recurrence risk. Nonwhite women had higher recurrence risk.     

Prevalence and Risk Factors for Female Sexual Dysfunction Among Turkish Women Attending a Maternity and Gynecology Outpatient Clinic

Female sexual dysfunction is a common health problem for many women all over the world. This study was constructed to determine risk factors and prevalence of female sexual dysfunction among Turkish women, in Ordu province of Turkey between May 2008 and December 2008. Four hundred and twenty-five married women, between 18 and 56 years of age, who consented to participate, were included in the study. Data was collected by using a questionnaire form and the Female Sexual Function Index. The prevalence of female sexual dysfunction was 52.2%. The risk factors for female sexual dysfunction were, low education level of the woman (odds ratio [OR] = 1.830, 95% confidence interval [CI] = 1.088–3.078), low education level of the husband (OR = 1.734, 95% CI = 1.094–2.750), being brought up by parents with restrictive attitudes (OR = 1.558, 95% CI = 1.001–2.424), and having genital infections or symptoms (OR = 1.925, 95% CI = 1.213–3.055).     

Predictors of Smoking Relapse After Delivery: Prospective Study in Central Poland

The objective of the study was to identify factors which predispose women to smoking relapse postpartum and the factors that prevent the relapse, in order to design effective interventions to reduce the rate of smoking relapse after delivery. A prospective cohort study was conducted in 2004 and 2005 in Lodz, Poland. One hundred thirty-eight women who quit smoking for the pregnancy period were enrolled into the study between 32 and 36 weeks of pregnancy and were followed up at 3 months after delivery. Self-reported non-smoking status at enrollment and postpartum was verified using saliva cotinine level analyzed by liquid chromatography with tandem mass spectrometry (LC–MS/MS). The cut-off point of 10 ng/ml was adopted for the saliva cotinine level. About half of the study population relapsed into smoking within 3 months after delivery. Most (49%) relapses occurred in the first 4 weeks postpartum. Three factors were identified as directly influencing smoking relapse after delivery: need to cope with stressful situations (OR = 4.7; 95% CI 1.7–14.3), type of quitting attempt (OR = 4.0; 95% CI 1.1–16.1), and smoking environment at home (OR = 7.2; 95% CI 2.2–28.3). These three factors accounted for 84.0% (95% CI 52.7–96.1) of relapses. The profile of women who relapse to smoking after delivery can be described as quitting smoking only for pregnancy and postpartum period, resorting to smoking in response to stressful situations, and living with smokers. Those factors should be taken into account while conducting antismoking intervention for pregnant and postpartum women.     

Differential Mortality Patterns Between Nicaraguan Immigrants and Native-born Residents of Costa Rica

Background This study describes the all-cause and cause-specific mortality of Nicaraguan-born and native-born inhabitants of Costa Rica and examines the influence of socioeconomic and demographic factors on differential mortality risks. Methods We analyzed Costa Rican vital records for the years 1996–2005 with negative binomial regression models to determine the relative mortality risks of Nicaraguan immigrants versus Costa Rican natives with adjustments for age, urbanization, unemployment, poverty, education, and residential segregation. Results Nicaraguan-born men and women had reduced mortality risks of 32% and 34% relative to their Costa Rican-born counterparts. Excess homicide mortality was found among Nicaraguan-born men [rate ratio (RR) = 1.35, 95% CI: 1.19–1.53] and women (RR = 1.41, 95% CI: 1.02–1.95). Discussion The Nicaraguan-born population had a reduced all-cause mortality risk versus Costa Rican-born people over the years 1996–2005, due to markedly lower disease mortality. Homicide is a major source of excess mortality among Nicaraguan-born immigrants versus Costa Rican natives.     

Physical Abuse Around the Time of Pregnancy Among Women With Disabilities

Women with disabilities are at greater risk for physical abuse than women without disabilities. However, no previous population-based studies have examined physical abuse against women with disabilities around the time of pregnancy, a critical period for mother and child. The objective of this study was to describe the prevalence of physical abuse before and during pregnancy among a representative sample of Massachusetts women with and without disabilities. Data from the 2007–2008 Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed in 2010. Disability prevalence was 4.9% (95% CI = 3.9–6.2) among Massachusetts women giving birth during 2007–2008. The prevalence of physical abuse during the 12-months before pregnancy among women with disabilities was 13.6% (95% CI = 7.2–24.0) compared to 2.8% for women without disabilities (95% CI = 2.1–3.7). Similarly, 8.1% (95% CI = 4.0–15.7) of women with disabilities compared to 2.3% (95% CI = 1.7–3.1) of women without disabilities experienced physical abuse during pregnancy. Multivariate analyses indicated that women with disabilities were more likely to report physical abuse before pregnancy (OR = 4.3, 95% CI = 1.9–9.7), during pregnancy (OR = 2.8, 95% CI = 1.1–7.1), or during either time period (OR = 3.2, 95% CI = 1.4–7.1) than women without disabilities while controlling for maternal age, education, race/Hispanic ethnicity, marital status and household poverty status. No difference was observed by disability status in the likelihood of prenatal-care providers talking to women about physical abuse. These analyses reveal disproportionate prevalence of physical abuse before and during pregnancy among women with disabilities. Screening for physical abuse and timely referral of women in need of assistance are critical to optimize health outcomes for both mother and child.     

Adverse Birth Outcomes Among Korean Women Compared to White Women in the United States

To evaluate the risk of adverse birth outcomes among US- and foreign-born Korean women compared to US-born white women, we used the 2004 US natality file to assess the risk of low birth weight (LBW), preterm delivery (PTD), and cesarean delivery (CD) among US-born (N = 943) and foreign-born Koreans (N = 11,974) compared to white women (N = 25,834). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using regression models to assess the risk of these outcomes. US-born (aOR = 0.66, 95% CI 0.43–1.02) and foreign-born Korean women (aOR 0.86, 95% CI 0.70–1.06) exhibited a lowered risk of LBW than white women, although not statistically significant. The risks of PTD and CD among Korean women were similar to white women, regardless of Korean women’s nativity status. Future research should focus on identifying the cultural factors and practices associated with decreased risk of LBW among Korean women.     

Cancer mortality and oil production in the Amazon Region of Ecuador, 1990–2005

Objectives  To compare cancer mortality rates in Amazon cantons (counties) with and without long-term oil exploration and extraction activities. Methods  Mortality (1990 through 2005) and population census (1990 and 2001) data for cantons in the provinces of the northern Amazon Region (Napo, Orellana, Sucumbios, and Pastaza), as well as the province with the capital city of Quito (Pichincha province) were obtained from the National Statistical Office of Ecuador, Instituto Nacional del Estadistica y Censos (INEC). Age- and sex-adjusted mortality rate ratios (RR) and 95% confidence intervals (CI) were estimated to evaluate total and cause-specific mortality in the study regions. Results  Among Amazon cantons with long-term oil extraction, activities there was no evidence of increased rates of death from all causes (RR = 0.98; 95% CI = 0.95–1.01) or from overall cancer (RR = 0.82; 95% CI = 0.73–0.92), and relative risk estimates were also lower for most individual site-specific cancer deaths. Mortality rates in the Amazon provinces overall were significantly lower than those observed in Pichincha for all causes (RR = 0.82; 95% CI = 0.81–0.83), overall cancer (RR = 0.46; 95% CI = 0.43–0.49), and for all site-specific cancers. Conclusions  In regions with incomplete cancer registration, mortality data are one of the few sources of information for epidemiologic assessments. However, epidemiologic assessments in this region of Ecuador are limited by underreporting, exposure and disease misclassification, and study design limitations. Recognizing these limitations, our analyses of national mortality data of the Amazon Region in Ecuador does not provide evidence for an excess cancer risk in regions of the Amazon with long-term oil production. These findings were not consistent or supportive of earlier studies in this region that suggested increased cancer risks.     

Birth Outcomes,Postpartum Health and Primary Care Contacts of Immigrant Mothers in an Australian Nulliparous Pregnancy Cohort Study

To investigate differences and similarities in birth outcomes, postpartum health and primary care contacts of mothers born overseas of non-English speaking background (NESB) compared with Australian-born mothers. Nulliparous women were recruited in early pregnancy (≤24 weeks gestation) to a prospective pregnancy cohort study from six metropolitan public hospitals in Victoria, Australia. Analyses are based on questionnaires completed in pregnancy and at 3 months postpartum. Of the 1,507 women recruited in the study, 1,431 women (95%) were followed up at 3 months postpartum. Immigrant mothers of NESB (n = 212) and Australian born mothers (n = 1,074) had similar obstetric outcomes and postpartum physical health outcomes. Immigrant women were more likely to say they had been depressed for 2 weeks or longer since the birth (Adj OR = 1.92, 95% CI 1.3–2.8); to report relationship problems (Adj OR = 1.39, 95% CI 0.9–2.1) and to report lower emotional satisfaction with their relationship with the partner (Adj OR = 1.69, 95% CI 1.1–2.6) after adjusting for age, education status, income, method of birth and genital tract trauma. Immigrant mothers were less likely to be asked about feeling low or depressed by general practitioners (OR = 0.79, 95% CI 0.5–0.9) and about relationship problems by maternal and child health nurses (OR = 0.68, 95% CI 0.5–0.9). Immigrant women of NESB reported greater psychological distress, less emotional satisfaction with their partner and more relationship problems in the first 3 months postpartum than Australian born women. Although immigrant mothers had an equivalent level of contact with primary care practitioners in the first 3 months postpartum, they were less likely to be asked about their emotional well-being or about relationship problems by health professionals.     

<Emphasis Type="Italic">HFE</Emphasis> gene mutations increase the risk of coronary heart disease in women

The purpose of the present study is to examine HFE gene mutations in relation to newly diagnosed (incident) coronary heart disease (CHD). In a population-based follow-up study of 7,983 individuals aged 55 years and older, we compared the risk of incident CHD between HFE carriers and non-carriers, overall and stratified by sex and smoking status. HFE mutations were significantly associated with an increased risk of incident CHD in women but not in men (hazard ratio [HR] for women = 1.7, 95% confidence interval [CI] 1.2–2.4 versus HR for men = 0.9, 95% CI 0.7–1.2). This increased CHD risk associated with HFE mutations in women was statistically significant in never smokers (HR = 1.8, 95% CI 1.1–2.8) and current smokers (HR = 3.1, 95% CI 1.4–7.1), but not in former smokers (HR = 1.3, 95% CI 0.7–2.4). HFE mutations are associated with increased risk of incident CHD in women.