Teenage pregnancy and the influence of paternal involvement on fetal outcomes

Study Objective

We sought to assess the impact of paternal involvement on adverse birth outcomes in teenage mothers.

Design

Using vital records data, we generated odds ratios (OR) and 95% confidence intervals (CI) to assess the association between paternal involvement and fetal outcomes in 192,747 teenage mothers. Paternal involvement status was based on presence/absence of paternal first and/or last name on the birth certificate.

Setting

Data were obtained from vital records data from singleton births in Florida between 1998 and 2007.

Participants

The study population consisted of 192,747 teenage mothers ≤ 20 years old with live single births in the State of Florida.

Main Outcome Measures

Low birth weight, very low birth weight, preterm birth, very preterm birth, small for gestational age (SGA), neonatal death, post-neonatal death, and infant death.

Results

Risks of SGA (OR = 1.06; 95% CI: 1.03-1.10), low birth weight (OR = 1.19; 95% CI: 1.15-1.23), very low birth weight (OR = 1.53; 95% CI: 1.41-1.67), preterm birth (OR = 1.21; 95% CI: 1.17-1.25), and very preterm birth (OR = 1.49; 95% CI: 1.38-1.62) were elevated for mothers in the father-absent group. When results were stratified by race, black teenagers in the father-absent group had the highest risks of adverse birth outcomes when compared to white teenagers in the father-involved group.

Conclusions

Lack of paternal involvement is a risk factor for adverse birth outcomes among teenage mothers; risks are most pronounced among African-American teenagers. Our findings suggest that increased paternal involvement can have a positive impact on birth outcomes for teenage mothers, which may be important for decreasing the racial disparities in infant morbidities. More studies assessing the impact of greater paternal involvement on birth outcomes are needed.     

Association between intimate partner violence and induced abortion in Cameroon

Objective

To examine the association between intimate partner violence (IPV; physical, sexual, and emotional violence) and induced abortion in Cameroon.

Methods

We used data from the 2004 Cameroon Demographic Health Survey (DHS) and hierarchic multivariate modeling to compare the rates of induced abortion by IPV type.

Results

In 2004, 2570 women were administered the domestic violence module of the DHS. Of those women, 126 (4.9%) reported having had at least 1 induced abortion. Cameroonian women reported high rates of IPV: physical violence (995 [38.7%]); emotional violence (789 [30.7%]); and sexual violence (381 [14.8%]). After adjusting for covariates, physical and sexual IPV increased the risk for induced abortion, whereas the association between emotional violence and induced abortion was not significant in multivariate models.

Conclusion

Given the increased risk for maternal morbidity and mortality following unsafe induced abortions in Cameroon, the association between induced abortion and IPV is of interest in terms of public health. Programs targeted at preventing IPV might reduce the rate of maternal morbidity and mortality.     

Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes

Background and aims: To examine the association between maternal hepatitis B and C mono‐ and co‐infections with singleton pregnancy outcomes in the state of Florida. Methods: We analysed all Florida births from 1998 to 2007 using birth certificate records linked to hospital discharge data. The main outcomes of interest were selected pregnancy outcomes including preterm birth, low birth weight (LBW), small for gestational age (SGA), fetal distress, neonatal jaundice and congenital anomaly. Results: The study sample consisted of 1 670 369 records. Human immunodeficiency virus co‐infection and all forms of substance abuse were more frequent in mothers with hepatitis B and C infection. After using multivariable modelling to adjust for important socio‐demographical variables and obstetric complications, women with hepatitis C infection were more likely to have infants born preterm [odds ratio (OR), 1.40; 95% confidence intervals (CI), 1.15–1.72], with LBW (OR, 1.39; 95% CI, 1.11–1.74) and congenital anomaly (OR, 1.55; 95% CI, 1.14–2.11). In addition, women with hepatitis B infection were less likely to have infants born SGA (OR, 0.79; 95% CI, 0.66–0.95). Conclusions: Our findings provide further understanding of the association between maternal hepatitis B or C carrier status and perinatal outcomes. Infants born to women with hepatitis C infection appear to be at risk for poor birth outcomes, including preterm birth, LBW and congenital anomaly.     

MRI T2*技术对中、重型β地中海贫血患者心脏及肝脏铁沉积状态的评估

目的：了解中、重型β地中海贫血患者体内铁沉积状况。方法：对39例中、重型β地中海贫血患者的输血、排铁的情况进行统计,检测患者体内铁蛋白水平,并运用MRI T2*技术检测心脏及肝脏铁沉积状况。结果：患者血清铁蛋白水平最低为1500 ng/mL,最高达 11491 ng/mL。肝脏铁重度沉积者15例（38%）,中度沉积者15例（38%）,轻度沉积者7例（18%）,正常者 2例（5%）。 心脏铁重度沉积者7例（18%）,轻度沉积者5例（13%）,正常者27例（69%）。1例出现心律紊乱症状,4例年龄超过20岁者均呈现性腺功能发育不全。大多患者因家庭经济原因未能进行规律输血及排铁治疗,且开始排铁时间较晚。患者血清铁蛋白水平与开始排铁的时间、剂量密切相关。结论：未进行早期规律的输血和排铁治疗的地中海贫血患者,体内铁的沉积发生年龄早,易早期出现重要器官的功能损害而引发相关并发症,应引起临床医师和患者家属的高度重视并制定相应的诊疗措施提高患者的生活质量。     

Impact of prior bariatric surgery on maternal and fetal outcomes among obese and non-obese mothers

Purpose

To assess the association between bariatric surgery and pregnancy-related outcomes among obese and non-obese women in the state of Florida.

Methods

We conducted a population-based, retrospective cohort analysis using vital records and hospital discharge data in Florida during 2004–2007. Women were categorized based on prior bariatric surgery and pre-pregnancy obesity status. Maternal complications (i.e., anemia, pre-eclampsia, gestational diabetes, chronic hypertension, endocrine disorders, cesarean section, prolonged hospital stay) and fetal morbidities [macrosomia, preterm birth, small for gestational age (SGA)] were the outcomes of interest. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were computed.

Results

Mothers with a prior history of bariatric surgery, regardless of obesity status, were more likely to have anemia, chronic hypertension, endocrine disorders, and SGA infants. Classification based on prior history of bariatric surgery and obesity status showed that non-obese mothers with prior bariatric surgery were more likely to have anemia, chronic hypertension, endocrine disorders, and SGA infants, whereas obese mothers without prior bariatric surgery were at greater risk of having gestational diabetes, chronic hypertension, macrosomic infants (AOR = 1.69, 95% CI = 1.65–1.73), and prolonged hospital stay as compared to non-obese mother without prior bariatric surgery.

Conclusions

Although prior bariatric surgery is associated with multiple negative maternal and fetal outcomes, it is protective against infant macrosomia in obese mothers. Our findings support the need for preconception/interconception services tailored for former bariatric surgery patients to improve maternal and feto-infant health outcomes.

     

Pre-eclampsia in the first pregnancy and subsequent risk of stillbirth in black and white gravidas

Objective

To examine the association between prior pre-eclampsia and subsequent stillbirth in black women and white women.

Study design

This is a population-based retrospective study of Missouri maternally linked birth cohort files from 1989 to 2005. We analyzed singleton first and second births to mothers in the state of Missouri. The study population comprised women who experienced pre-eclampsia in their first pregnancy and a comparison group consisting of women who did not. The two groups were followed to their second pregnancy to document stillbirth occurrence. Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between prior pre-eclampsia and subsequent stillbirth were obtained from logistic regression models.

Results

Women who experienced prior pre-eclampsia had a 43% increased risk of subsequent stillbirth [OR = 1.43; 95% CI = 1.08–1.89]. Whereas women with a history of late-onset pre-eclampsia had no elevated risk for subsequent stillbirth, those whose first pregnancy resulted in early-onset pre-eclampsia had a more than 4-fold increased risk of stillbirth in their second pregnancy [OR = 4.07; 95% CI = 2.32–7.14]. When sub-analysis was performed on the two main racial groups in the State, we found that elevated risk for subsequent stillbirth in a second pregnancy was observed among black women with prior early-onset pre-eclampsia (OR = 8.21; 95% CI = 4.03–16.70) but not in whites (OR = 1.95; 95% CI = 0.72–5.26).

Conclusion

Initiation of pregnancy with pre-eclampsia elevates the risk for subsequent stillbirth. The risk elevation is most pronounced in black women with early-onset pre-eclampsia in their first pregnancy. This information is valuable for inter-pregnancy counseling of affected women.     

关于儿童死亡焦虑的初步探讨

利用斯皮尔伯格儿童状态焦虑的图示式、死亡刺激和脸谱对三组４９名儿童进行了死亡焦虑研究。结果表明，不同年龄组死亡焦虑得分存在明显差异，且焦虑水平随被试年龄的增加而升高。不同年龄的儿童对死亡对象的焦虑程度也不同。