Sociodemographic factors associated with weekend birth and increased risk of neonatal mortality

OBJECTIVE: To learn whether weekend risk of neonatal mortality is related to selected sociodemographic factors. DESIGN: A retrospective cohort design. Logistic regression was used to obtain odds ratios, and analysis of variance and chi-square to identify differences in values and incidence of key variables. SAMPLES: The data were derived from matched Texas birth and infant death certificates from 1999 through 2001. MAIN OUTCOME MEASURES: A subset of deaths up to 28 days of life attributable to conditions originating in the perinatal period. These deaths were called neonatal mortality-p. RESULTS: Women who were White, married, had Medicaid assistance, and had private prenatal care were less likely to deliver on weekends. Odds of neonatal mortality-p increased 36.5% when a birth took place on the weekend. The weekend crude odds of neonatal mortality-p increased for all racial/ethnic groups, but the differences were not statistically significant. CONCLUSIONS: The likelihood of delivering on the weekend increases with certain sociodemographic factors. This fact is important because the risk of neonatal mortality is higher among weekend births.     

Preterm at birth is not associated with greater cardiovascular risk in adolescence

Objective: To determine the effects of preterm birth and gender on subsequent cardiovascular risk factors among urban adolescents in a capital in the Brazilian northeast and to compare them with a group of adolescents term at birth.

Methods: In a retrospective double cohort, data of birth weight were extracted from hospital registers of children born in a same day of birth, between 1992 and 2002. We classified the preterm as a unique group born before 37 weeks of gestation. A total of 134 adolescents, aged 10–20 years were found and investigated. We measured anthropometric and clinical data, blood lipid profile and glucose after overnight fasting.

Results: Preterm subjects had less years of scholar education, especially between females (p?=?0.01). Preterm females also had lower height (p?=?0.00) and waist-hip circumference ratio (p?=?0.01). Preterm males had lower cesarean delivery (p?=?0.05) and greater family history of cardiovascular disease (p?=?0.05). Although the differences on clinical or laboratorial measurements were small and non-significant for cardiovascular risk factors, systolic blood pressure (SBP) and diastolic blood pressure (DBP) tended to be higher in preterm groups, especially for females (SBP?=?4.1?mmHg and DBP?=?1.6?mmHg, p?=?0.12 and p?=?0.38, respectively).

Conclusion: Premature did not increase cardiovascular risk adolescents in this sample. The lower association between premature and poor health outcomes among adolescents in a low average socioeconomic status population from a capital in the Brazilian northeast corroborates previous findings in other countries.     

Sexually transmitted infection is associated with increased risk of preterm birth in South Carolina women insured by Medicaid

Objective.?We investigated the association between diagnosed maternal sexually transmitted infections (STIs) and very preterm or late preterm birth in 108,346 South Carolina women receiving medical care purchased by Medicaid from 1996 through 2002, and delivering singleton infants.

Methods.?ICD9 codes in South Carolina Medicaid data were used to identify maternal infections. Gestational age was obtained from birth certificates.

Results.?Trichomoniasis, gonorrhea, and/or Chlamydia/non-gonococcal urethritis (NGU) were diagnosed in 4,208 women. Preterm birth occurred in just over 9% of pregnancies. Women diagnosed with one of the infections in the first 7 months of pregnancy were significantly more likely to deliver very preterm infants (adjusted HR?=?1.73, p?<?0.0001). Women with infection in the first 8 months were significantly more likely to deliver between 33 and 36 weeks (adjusted HR?=?1.39, p?<?0.0001). Of the three infections, Chlamydia/NGU was most strongly associated with preterm birth and infections occurring later in pregnancy (months 6, 7, and 8).

Conclusion.?STIs appear to be preventable risk factors for very and late preterm birth.     

Preterm birth risk assessment

Preterm birth is a leading cause of peripheral morbidity and mortality. The national rate of prematurity approaches 11%. In spite of widespread tocolytic use, the preterm birth rate has actually increased over the past 30 years in the United States. Preterm birth appears to have a multifactorial etiology. Leading theories include infectious, inflammatory or ischemic insult to the uteroplacental barrier, activation of the fetal hypothalamic-pituitary pathway, decreased cervical competence, and pathologic uterine distention. Multiple biochemical and biophysical markers have been studied for their potential to correctly identify women at risk of preterm delivery. Of these, fetal fibronectin and endovaginal ultrasound examination of the cervix have proven effective in predicting which symptomatic women are actually at low risk of preterm birth. Salivary estriol is being studied as a marker for preterm labor and delivery and it too will likely be found to be a reliable risk identifier in a high risk population. However, home uterine activity monitoring has not been shown to decrease the frequency of preterm birth or its neonatal complications.     

Young maternal age associated with increased risk of postneonatal death

OBJECTIVE: To determine whether full-term, healthy infants born to early adolescent mothers (15 years old and younger) are at higher risk of postneonatal death compared with infants of adult mothers. METHODS: We combined the comprehensive 1996 and 1997 United States birth cohorts to compare postneonatal mortality rates among maternal age groups. With postneonatal death as our main outcome measure, we used multivariable logistic regression to model adjusted odds ratios. RESULTS: The postneonatal mortality rate for infants born to mothers 15 years old and younger was substantially higher (3.2 per 1000) than that of infants born to mothers 23-29 years old (0.8 per 1000) and remained substantially higher after adjusting for maternal race or ethnicity. Even after adjusting for maternal race or ethnicity, prenatal care utilization, and marital status, infants born to early adolescent mothers had a three-fold higher risk (odds ratio 3.0, 95% confidence interval 2.5, 3.6) of postneonatal death compared with adult mothers. CONCLUSION: Healthy infants born to early adolescent mothers are at increased risk of postneonatal death. Many of these deaths are potentially preventable; therefore, developing targeted postnatal support services specifically designed to address the needs of healthy infants born to adolescent mothers might have a positive effect on the lives of these children.     

Cancer risk associated with early and late maternal age at first birth

OBJECTIVE: This paper provides a review of the literature associating maternal age at first birth and cancer. Potential mechanisms explaining associations between maternal age at first birth and cancer are also discussed. METHOD: Systematic review of English language literature using searches on established databases (e.g., Medline, Popline) and the references of materials identified in these databases. RESULTS: Older age (typically defined as 35 years or older) at first birth is associated with increased risk of breast and brain cancers. Conversely, younger age (typically defined as 19 years or younger) at first birth is associated with an increased risk of cervical and endometrial cancers. There is an unclear correlation between maternal age at first birth and site-specific malignancies such as ovarian, colorectal, thyroid, pancreatic, and kidney cancers. Causal mechanisms linking age at first birth and cancer were identified and reported for breast, brain, cervical, and endometrial cancers. CONCLUSION: Older age at first birth increases the risk for breast and brain cancers but decreases the risk of cervical and endometrial cancers.     

Referral for fetal echocardiography is associated with increased maternal anxiety

Background.?Referral for fetal echocardiography (fECHO) is an acute stressor that may induce significant maternal anxiety. To promote good clinical management of expectant mothers in this situation, including adequate screening for possible psychiatric interventions, data are needed regarding the psychosocial functioning of women scheduled for fECHO procedures.

Objective.?To investigate the association between fECHO and maternal anxiety.

Methods.?Pregnant women answered two questionnaires before first fECHO. The Spielberger State-Trait Anxiety Inventory (STAI) assessed how subjects feel “now” (state) versus how they “usually feel” (trait). Separate state and trait anxiety scores were calculated; scores were compared between the study cohort and a gestational age-matched historical cohort of 31 pregnant women who did not undergo fECHO. A second questionnaire developed by the investigators ascertained pregnancy specific concerns and characteristics.

Results.?Forty subjects were enrolled. The mean state score of the fECHO cohort (42.1?±?15.1) differed from the historical cohort (32.8?±?11.3; p?=?0.006); however there was no difference between trait scores (34.7?±?10.8 vs. 35.4?±?12.8; p?=?0.8). A multivariate linear regression model controlling for race and maternal age demonstrated that fECHO was a strong independent predictor of maternal state anxiety score (p?=?0.004, β?=?10.4).

Conclusions.?Pregnant women presenting for fECHO report high anxiety levels compared with women not presenting for fECHO. Clinician awareness and sensitivity are recommended and further investigation of modifiers of anxiety in this high risk group should be explored.     

Preterm birth and maternal country of birth in a French district with a multiethnic population

OBJECTIVES: This analysis explores the association between preterm birth and maternal country of birth in a French district with a multiethnic population. DESIGN: Prospective observational study. SETTING: District of Seine-Saint-Denis in France POPULATION: 48,746 singleton live births from a population-based birth register between October 1998 and December 2000. METHODS: We compare preterm birth rates by mother's country of birth controlling for demographic and obstetric factors as well as insurance coverage and timing of initiation of antenatal care. MAIN OUTCOME MEASURES: Overall preterm birth rates and preterm birth rates by timing of delivery (<33 weeks versus 33-36 weeks of gestation), mode of onset (spontaneous or indicated preterm birth) and the presence of hypertension in pregnancy. RESULTS: Women born in Northern Africa, Southern Europe and South/East Asia did not have higher preterm birth rates than women born in continental France. Rates were significantly higher for women born in the overseas French districts in the Caribbean and Indian Ocean and Sub-Saharan Africa. Excess risk was greatest for early preterm births, medically indicated births and preterm births associated with hypertension. CONCLUSIONS: Patterns of preterm birth with relation to timing, mode of onset and medical complications among of Afro-Caribbean origin should be confirmed in future research.     

Preterm birth unrelated to maternal height in Asian women with singleton gestations.

OBJECTIVE: To determine whether maternal height has a significant effect on the length of gestation or the incidence of preterm birth in Asian women with singleton gestations. METHODS: We retrospectively studied a cohort of consecutive adult Asian women with singleton gestations who delivered in a 2-year period, to determine the relationship between maternal height, expressed in quartiles, and the mean gestational age and incidence of preterm birth. RESULTS: Of the 9819 deliveries during that period, 449 were excluded from analysis because of multiple gestation, maternal age less than 20 years, or incomplete data because of no antenatal care in our hospital. The 25th, 50th, and 75th percentile values of maternal height were 152, 156, and 160 cm, respectively. Significant differences were found in the maternal age, weight and body mass index (BMI), birth weight, and birth weight as a percentage of maternal weight, among the four quartiles, but the trend for age, BMI, and birth weight percentage was opposite to that of maternal weight and birth weight. However, there was no significant difference in the mean gestational age or incidence of preterm birth at less than 28, 28-31, or 32-36 weeks' gestation. There was no difference in the incidence of pregnancies beyond 41 weeks' gestation. CONCLUSION: Maternal stature does not have a significant influence on the mean gestational age or incidence of preterm birth in adult Asian women with singleton gestations.     

Mid-trimester maternal heart rate is related to neonatal birth weight

Abstract

Objective(s): We sought to establish the relationship between maternal mid-trimester heart rate (HR) and neonatal birth weight in women at high a priori risk of preeclampsia.

Study Design: Ninety-nine women were recruited following second trimester uterine artery Doppler assessment. Maternal blood pressure (BP) and HR were measured between 23⁺⁴ and 30⁺⁵ weeks gestation and neonatal birth weight was expressed as a z-score. The relationship between the parameters was investigated using Pearson’s correlation coefficient.

Results: There was a significant positive correlation between maternal HR and neonatal birth weight z-score, r?=?0.22 (95% CI: 0.02–0.40), p?=?0.03. An inverse correlation was found between uterine artery Doppler pulsatility index (PI) and maternal HR, r?=??0.43 (95% CI: 0.01–0.40), p?=?0.0001, and neonatal birth weight, r?=??0.3 (95% CI: ?0.47 to ?0.10), p?=?0.004. For neonatal birth weight z-score <?1.65, r?=?0.69 (95% CI: 0.15–0.91), p?=?0.02. There was no relationship between BP and uterine artery Doppler or neonatal birth weight.

Conclusion: The finding of a continuous relationship between maternal HR and neonatal birth weight prior to the onset of fetal growth restriction is novel, suggesting that maternal cardiovascular adaptation is reflected by neonatal birth weight. Lower maternal HR is associated with lower neonatal birth weight and vice versa. Further, we confirm the reported associations between uterine artery Doppler PI and both maternal HR and neonatal birth weight.     

Exchange of peripherally inserted central catheters is associated with an increased risk for bloodstream infection

It is not uncommon that the peripherally inserted central catheter (PICC) needs to be replaced either due to blockage or migration to a peripheral position. In such circumstances, there are two methods of PICC placement: new-site insertion and exchange by using the old PICC as a guide wire. Our objective was to investigate risk of infection associated with the exchange method. In this retrospective study, data on all PICC insertions in the neonatal intensive care unit in 2004 to 2008 were obtained. In the population who needed removal of existing PICC and insertion of a new one, we compared central line-associated bloodstream infection (CLABSI) within 1 week of insertion between the two insertion methods. Of 1148 PICC insertions reviewed, 164 (103 new-site and 61 exchange insertions) were performed after removal of a blocked/malpositioned PICC and therefore comprised the study population. The rate of CLABSI was higher in the exchange method (9.8% versus 1%, P < 0.007). After adjusting for the confounders, the odds for CLABSI within 7 days of PICC insertion was higher with the exchange method (odds ratio 25.2, 95% confidence interval: 2.17 to 292.98; P = 0.01). In infants, insertion of PICCs using the exchange method carries an increased risk of bloodstream infection.     

Preterm birth and neonatal mortality in China in 2011

Objective

To determine the incidence of preterm birth, its regional distribution, and associated neonatal mortality in mainland China.

Methods

In a multicenter, hospital-based investigation of preterm birth, 2011 data were obtained from the seven administrative regions of mainland China. Between one and three subcenters were randomly selected for each administrative region, followed by secondary and tertiary hospitals within the chosen subcenters. Data were obtained from women’s medical records, and obstetric and perinatal events were summarized.

Results

Data for 107 905 deliveries were analyzed, which included 7769 (7.1%) preterm births (occurring between 28 and 37 weeks of pregnancy). The incidence varied among regions. Late preterm birth (between 34 and 37 weeks) accounted for 5495 (70.7%) of preterm births. The neonatal mortality rate was 33 deaths per 1000 live preterm births. Of the 254 neonatal deaths, 147 (57.9%) occurred after very preterm birth (between 28 and 32 weeks). Overall, 4519 (58.2%) preterm births occurred by cesarean.

Conclusion

The distribution of preterm birth across China is unbalanced, and neonatal mortality associated with preterm birth is high.     

Obstetric and neonatal outcomes associated with maternal hypothyroid disease.

OBJECTIVE: We sought to determine whether women with treated hypothyroid disease were more likely than women without thyroid disease to suffer adverse obstetric or neonatal outcomes or to deliver a child with a congenital anomaly. METHODS: Using an institutional database, we identified women with treated hypothyroid disease (n = 482) who delivered a baby at our institution during a 33-month period. We compared the occurrence of adverse obstetric or neonatal outcomes among these women to the occurrence among women without thyroid disease (n = 19,487). RESULTS: Women with treated hypothyroid disease were not at increased risk for delivering a baby with low birth- weight,fetal demise, or congenital anomaly compared to the control group. Women with treated hypothyroid disease were more likely to have chronic hypertension (2.3% vs. 1.2%, p = 0.03) and had an increased risk of pre-eclampsia (4.3% vs. 2.6%,p= 0.03) compared to women without thyroid disease. CONCLUSION: Women with treated hypothyroid disease are not at higher risk than the general population for adverse neonatal outcomes, but may be at increased risk for pre-eclampsia.     

Increased fetal DNA in the maternal circulation in early pregnancy is associated with an increased risk of preeclampsia

OBJECTIVE: The aim of our study was to determine if fetal DNA is present in the maternal circulation in early pregnancy before the clinical manifestation of preeclampsia, and if this could be predictive of the development of preeclampsia. STUDY DESIGN: Blood were obtained from patients attending for a first antenatal visit. Cases were asymptomatic women who subsequently developed preeclampsia matched to control women for parity and gestational age. Real-time polymerase chain reaction (PCR) using TaqMan primers and probes directed against SRY gene sequences quantified fetal DNA in the maternal circulation. RESULTS: There were 88 cases of women with preeclampsia and 176 control women, both sampled at a mean gestation (+/-SD) of 15.7 +/- 3.6 weeks. The presence of fetal DNA in the maternal circulation in early pregnancy is associated with an 8-fold increased risk of developing preeclampsia. CONCLUSION: Increased fetal DNA is present in the maternal circulation in early pregnancy in women who subsequently develop pre-eclampsia and there appears to be a graded response between the quantity of fetal DNA and the risk of developing pre-eclampsia.