Extreme obesity and risk of stillbirth among black and white gravidas

OBJECTIVE: To estimate the risk for stillbirth among three generally accepted obesity subtypes based on severity. METHODS: We used the Missouri maternally linked cohort data containing births from 1978 to 1997. Using prepregnancy weight and height, mothers were classified on the basis of calculated body mass index (BMI) above 30 into three subsets: class I (30-34.9), class II (35-39.9), and extreme obesity (greater than or equal to 40). Using normal-weight, white women (18.5-24.9) as a reference, we applied Cox proportional hazard regression models to estimate risks for stillbirth. RESULTS: The prevalence of obesity in pregnant women was 9.5% (12.8% among blacks and 8.9% among whites). Overall, obese mothers were about 40% more likely to experience stillbirth compared with nonobese gravidas (adjusted hazard ratio 1.4; 95% confidence interval [CI] 1.3-1.5). The risk for stillbirth increased in a dose-dependent fashion with increase in BMI: class I (adjusted hazard ratio 1.3; 95% CI 1.2-1.4); class II (adjusted hazard ratio 1.4; 95% CI 1.3-1.6) and extreme obesity (adjusted hazard ratio 1.9; 95% CI 1.6-2.1; P for trend <.01). Obese black mothers experienced more stillbirths than their white counterparts (adjusted hazard ratio 1.9; 95% CI 1.7-2.1 compared with adjusted hazard ratio 1.4; 95% CI 1.3-1.5). The black disadvantage in stillbirth widened with increase in BMI, with the greatest difference observed among extremely obese black mothers (adjusted hazard ratio 2.3; 95% CI 1.8-2.9). CONCLUSION: Obesity is a risk factor for stillbirth, particularly among extremely obese, black mothers. Strategies to reduce black-white disparities in birth outcomes should consider targeting obese, black women. LEVEL OF EVIDENCE: II.     

A report on 158 cases of transcervical chorionic villus sampling

Between 1989 and 1994 first trimester transcervical chorionic villus sampling was offered to 158 patients after proper counselling. The gestational age range was 9–12 weeks. The most important indication was advanced maternal age (75.4%). Adequate sampling after two, and a maximum of three attempts, was achieved in 98% and 99.3% of patients respectively. After the first year of the study karyotyping using the direct method alone was successful in 96% of cases. The success of karyotyping cultures was 98%. Excluding one false positive result the rate of fetal karyotypic abnormalities was 4.8%. 5 spontaneous abortions occurred (3.2%), all in patients of advanced maternal age. Moderate or severe vaginal bleeding occured in 6.7% of the patients. There was no case of chorioamnionitis.     

Weekly chloroquine prophylaxis and the effect on maternal haemoglobin status at delivery

Our aim was to determine the effectiveness of chloroquine prophylaxis in reducing the frequency of malaria-induced anaemia at delivery. We estimated the haemoglobin levels of 207 parturients; 82 (39.6%) had been on chloroquine prophylaxis [treatment group (TG)] while 125 (60.4%) did not take any malaria preventive medication antenatally [control group (CG)]. The proportion of women with malaria parasitaemia was significantly higher in CG than TG [risk ratio (RR=1.57, CI=1.05-2.34)]. The dose-response relationship between the severity of parasitaemia and the risk of being anaemic (P < 0.001) confirms a strong correlation between gestational malaria and maternal anaemia. There was a 35% reduction in risk for anaemia in the TG compared with the CG (RR=0.65, 0.40-1.06). The difference in risk was more pronounced after adjusting for disparity in place of residence, educational status and obstetric history (adjusted RR=0.54, CI=0.21-0.98). Primiparous mothers appeared to have benefited more from the antianaemic effects of malaria chemoprevention than mothers of higher parity (protective effectiveness 43% compared with 33%, respectively). In conclusion, despite reports of widespread Plasmodium falciparum resistance to chloroquine on the African continent, malaria chemosuppression with the drug was found beneficial in reducing the risk of anaemia at delivery among Cameroonian women.     

Are Gestational Diabetes Mellitus and Preconception Diabetes Mellitus Less Common in Non-Hispanic Black Women than in Non-Hispanic White Women?

Based on their higher risk of type 2 diabetes, non-Hispanic blacks (NHBs) would be expected to have higher gestational diabetes mellitus (GDM) risk compared to non-Hispanic whites (NHWs). However, previous studies have reported lower GDM risk in NHBs versus NHWs. We examined whether GDM risk was lower in NHBs and NHWs, and whether this disparity differed by age group. The cohort consisted of 462,296 live singleton births linked by birth certificate and hospital discharge data from 2004 to 2007 in Florida. Using multivariable regression models, we examined GDM risk stratified by age and adjusted for body mass index (BMI) and other covariates. Overall, NHBs had a lower prevalence of GDM (2.5 vs. 3.1 %, p < 0.01) and a higher proportion of preconception DM births (0.5 vs. 0.3 %, p ≤ 0.01) than NHWs. Among women in their teens (risk ratio 0.56, p < 0.01) and 20–29 years of age (risk ratio 0.85, p < 0.01), GDM risk was lower in NHBs than NHWs. These patterns did not change with adjustment for BMI and other covariates. Among women 30–39 years (risk ratio 1.18, p < 0.01) and ≥40 years (risk ratio 1.22, p < 0.01), GDM risk was higher in NHBs than NHWs, but risk was higher in NHWs after adjustment for BMI. Associations between BMI and GDM risk did not vary by race/ethnicity or age group. NHBs have lower risk of GDM than NHWs at younger ages, regardless of BMI. NHBs had higher risk than NHWs at older ages, largely due to racial/ethnic disparities in overweight/obesity at older ages.     

Feto-infant Health and Survival: Does Paternal Involvement Matter?

Lack of paternal involvement during pregnancy and infancy may account for a significant burden of the adverse pregnancy outcomes among black women and could therefore, represent an important avenue providing the opportunity to improve feto-infant health and survival. This study aimed to review the literature on paternal involvement during the perinatal period and its influence on feto-infant health and survival. Literature for this review was identified by searching the PubMed database from the National Center for Biotechnology Information at the US National Library of Medicine as well as the ISI Web of Knowledge Databases, OVID, and CINAHL. A total of seven papers were identified and included in this review. There is paucity of data in this domain. Overall findings suggest that paternal involvement during pregnancy may have important implications for maternal prenatal health behaviors and feto-infant health. Although results are limited, results suggest that paternal involvement has a positive influence on prenatal care usage, abstinence from alcohol and smoking, and a reduction in low birth weight and small for gestational age infants. None of the papers examined the relationship between stillbirth and paternal involvement. Additional studies with enhanced measures of paternal involvement are needed to better assess the role of fathers in enhancing prenatal health behaviors and pregnancy outcomes. Efforts should be made to include fathers in future studies and reduce reliance on maternal report and to investigate paternal roles across different racial groups so that appropriate interventions can be developed.     

Racial Disparities in Perinatal Outcomes and Pregnancy Spacing Among Women Delaying Initiation of Childbearing

Introduction Reducing racial/ethnic disparities is a key objective of the Healthy People 2010 initiative. Unfortunately, racial disparities among women delaying initiation of childbearing have received limited attention. As more women in the US are delaying initiation of childbearing, it is important to examine racial disparities in reproductive health outcomes for this subgroup of women. Objective To examine racial disparities in perinatal outcomes, interpregnancy interval, and to assess the risk for adverse outcomes in subsequent pregnancy for women delaying initiation of childbearing until age 30 or older compared to those initiating childbearing at age 20–29. Methods We conducted a retrospective cohort study using the Missouri maternally linked cohort files 1978–1997. Final study sample included 239,930 singleton sibling pairs (Whites and African Americans). Outcome variables included first and second pregnancy outcomes (fetal death, low birth weight, preterm delivery and small-for-gestational age) and interpregnancy interval between first and second pregnancy. Independent variables included maternal age at first pregnancy and race. Analysis strategies used involved stratified analyses and multivariable unconditional logistic regression; interactions between maternal race, age and interpregnancy interval were examined in the regression models. Results Compared to Whites, African American mothers initiating childbearing at age 30 or older had significantly higher rates of adverse outcomes in the first and second pregnancy (P < 0.0001). Generally, African Americans had significantly higher rates of second pregnancy following intervals <6 months compared to Whites; however, no significant racial differences were noted in interpregnancy interval distribution pattern after controlling for maternal age at first pregnancy. African Americans delaying initiation of childbearing had significantly higher risk for adverse perinatal outcomes in the second pregnancy compared to Whites after controlling for potential confounders, however there were no significant interactions between maternal age at first pregnancy, race and short interpregnancy interval. Conclusion Although African Americans were less likely to delay initiation of childbearing than were White women, their risk for adverse perinatal outcomes was much greater. As health care providers strive to address racial disparities in birth outcomes, there is need to pay attention to this unique group of women as their population continues to increase. Greg R. Alexander—Deceased.     

Healthy Start Program and Feto-Infant Morbidity Outcomes: Evaluation of Program Effectiveness

Objective We evaluate the impact of the Healthy Start intervention program on feto-infant morbidity within a community setting. Methods Prospective data from 2002 to 2007 within the ongoing Federally funded Healthy Start intervention project in Central Hillsborough County were merged with corresponding birth outcomes data from the Florida Department of Health. The impact of the project on the following feto-infant morbidity indices was assessed among service recipients: low birth weight (LBW), very low birth weight (VLBW), preterm, very preterm, small for gestational age (SGA) and a composite feto-infant morbidity outcome. Program effectiveness and impact were measured using odds ratios from logistic regression models and number needed to treat (NNT). Results The risk for low birth weight (OR = 0.7; 95% CI = 0.5–1.0), preterm (OR = 0.7; 95% CI = 0.5–0.9) and the composite feto-infant morbidity outcome (OR = 0.8; 95% CI = 0.6–0.9) was reduced among service recipients (N = 536) as compared to non-recipients (N = 2,815). A clinically important level of risk reduction was also noted for very low birth weight (OR = 0.5; 95% CI = 0.2–1.1) and very preterm (OR = 0.6; 95% CI = 0.3–1.2) although these did not reach statistical significance. The adjusted NNT was lowest for the composite feto-infant morbidity outcome (18), preterm birth (21) and low birth weight (24), and highest for very preterm (86) and very low birth weight (74) events. Conclusions In a disadvantaged community setting, the Healthy Start intervention program was found to reduce the risk for very low birth weight and preterm births by about one-third.