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.     

Interpregnancy BMI change and risk of primary caesarean delivery

We conducted a retrospective study using Missouri maternally linked cohort files (1989-2005). We examined the association between interpregnancy body mass index (BMI) change and risk of primary caesarean delivery. BMI was classified as normal (18.5-24.9 kg/m(2)) or obese (≥30.0 kg/m(2)). Interpregnancy BMI change was defined using the following categories: normal-normal, normal-obese, obese-normal and obese-obese. Logistic regression models were used to generate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the risk of primary caesarean delivery in the second pregnancy. Elevated risks for caesarean delivery in the second pregnancy were noted for normal weight mothers becoming obese (OR = 1.41, 95% CI 1.26-1.57) and obese mothers maintaining their obese status across both pregnancies (OR = 1.75, 95% CI 1.65-1.87). Women with a reduction in BMI (obese-normal) had a risk level for primary caesarean section that was comparable with that of women with normal BMI status in both pregnancies.     

Younger maternal age (at initiation of childbearing) and recurrent perinatal mortality

Objective

To assess whether young maternal age at initiation of childbearing is associated with recurrence of perinatal mortality (PM), as well as its components: stillbirth and neonatal death.

Study design

We conducted a population-based, retrospective cohort study on the Missouri maternally linked longitudinal data files comprising adolescent (10-19 years; n = 73,533) or mature (20-24 years; n = 78,618) mothers in their first pregnancy with follow-up in their second pregnancy to document the occurrence of PM or its components. The study covered the period 1989-2005. We used unconditional logistic regression modeling to generate odds ratios and to control for confounding.

Results

A history of perinatal mortality, stillbirth, or neonatal mortality increased the risk of a recurrence by 4-5 times. Among women with a history of PM or stillbirth in the first pregnancy, maternal age at initiation of pregnancy was not a risk factor for subsequent PM or its components. However, adolescent mothers with a history of neonatal mortality in the first pregnancy were about 5 times as likely to experience stillbirth in the second pregnancy, as compared to their mature counterparts.

Conclusions

Young maternal age at the initiation of childbearing is not associated with an overall increased risk of recurrent perinatal loss. However, prior history of neonatal mortality among teen mothers is strongly predictive of subsequent stillbirth.     

Stillbirth as a risk factor for subsequent infant mortality

Background

Infant mortality is an important indicator of the health and wellness of a society. Multiple risk factors for infant mortality have been identified and investigated; however, the influence of prior pregnancy experience on subsequent infant mortality is under-researched.

Aims

To examine the association between stillbirth in the first pregnancy and risk for infant mortality in the second pregnancy in a large population-based dataset.

Study design

Population-based, retrospective cohort study

Subjects

Missouri maternally linked cohort data files were utilized from 1989 through 2005. Analyses were restricted to women who had two singleton pregnancies during the study period.

Outcome measures

The exposure was stillbirth in the first pregnancy, while the primary outcome was infant mortality in the second pregnancy.

Results

Women who experienced stillbirth in their first pregnancy were more likely to be of advanced age, black, and obese and had higher rates of pregnancy-related complications (p < 0.01). Previous stillbirth was associated with an elevated risk for subsequent infant mortality (AHR = 2.51, 95% CI: 1.73-3.65) and neonatal mortality (AHR = 3.04, 95% CI: 1.99-4.65), after adjustment for socio-demographic variables and pregnancy complications. Risk estimates for mortality in the second pregnancy were most profound among black mothers with a history of stillbirth in the first pregnancy [risk for infant mortality: (AHR = 2.68, 95% CI: 1.41-5.09) and neonatal death: (AHR = 4.25, 95% CI: 2.34-7.60)].

Conclusions

Women with prior stillbirth bear elevated risks for subsequent infant mortality. Women's previous childbearing experiences could serve as important criteria in determining appropriate interconception strategies to improve subsequent feto-infant health and survival.     

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.     

Maternal HIV/AIDS Status and Neurological Outcomes in Neonates: A Population-Based Study

This study sought to examine the association between maternal HIV/AIDS infection and neonatal neurologic conditions in the state of Florida. We analyzed all births in the state of Florida from 1998 to 2007 using hospital discharge data linked to birth certificate records. The main outcomes of interest included selected neonatal neurologic complications, namely: fetal distress, cephalohematoma, intracranial hemorrhage, seizure, feeding difficulties, and other central nervous system complications. The sample size for this study was 1,645,515 records. All forms of substance abuse as well as cesarean section deliveries were more frequent in mothers with HIV/AIDS. Infants born to HIV-infected mothers showed higher proportions of feeding difficulties and seizures whereas HIV-negative mothers had a greater proportion of cases of fetal distress and cephalohematoma. Seizures and feeding difficulties are common among infants born to HIV/AIDS infected mothers. This population-based retrospective cohort study provides further understanding of the association between maternal HIV/AIDS status and neonatal neurological outcomes.     

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.