Maternal Risk Factors (maternal + risk_factor)

Distribution by Scientific Domains


Selected Abstracts


The Asian birth outcome gap

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2006
Cheng Qin
Summary Asians are often considered a single group in epidemiological research. This study examines the extent of differences in maternal risks and birth outcomes for six Asian subgroups. Using linked birth/infant death certificate data from the State of California for the years 1992,97, we assessed maternal socio-economic risks and their effect on birthweight, preterm delivery (PTD), neonatal, post-neonatal and infant mortality for Filipino (87 120), Chinese (67 228), Vietnamese (45 237), Korean (23 431), Cambodian/Laotian (21 239) and Japanese (18 276) live singleton births. The analysis also included information about non-Hispanic whites and non-Hispanic blacks in order to give a sense of the magnitude of risks among Asians. Logistic regression models explored the effect of maternal risk factors and PTD on Asian subgroup differences in neonatal and post-neonatal mortality, using Japanese as the reference group. Across Asian subgroups, the differences ranged from 2.5- to 135-fold for maternal risks, and 2.2-fold for infant mortality rate. PTD was an important contributor to neonatal mortality differences. Maternal risk factors contributed to the disparities in post-neonatal mortality. Significant differences in perinatal health across Asian subgroups deserve ethnicity-specific interventions addressing PTD, teen pregnancy, maternal education, parity and access to prenatal care. [source]


A common variant in MTHFD1L is associated with neural tube defects and mRNA splicing efficiency,

HUMAN MUTATION, Issue 12 2009
Anne Parle-McDermott
Abstract Polymorphisms in folate-related genes have emerged as important risk factors in a range of diseases including neural tube defects (NTDs), cancer, and coronary artery disease (CAD). Having previously identified a polymorphism within the cytoplasmic folate enzyme, MTHFD1, as a maternal risk factor for NTDs, we considered the more recently identified mitochondrial paralogue, MTHFD1L, as a candidate gene for NTD association. We identified a common deletion/insertion polymorphism, rs3832406, c.781-6823ATT(7,9), which influences splicing efficiency and is strongly associated with NTD risk. Three alleles of rs3832406 were detected in the Irish population with varying numbers of ATT repeats: Allele 1 consists of ATT7, whereas Alleles 2 and 3 consist of ATT8 and ATT9, respectively. Allele 2 of this triallelic polymorphism showed a decreased case risk as demonstrated by case,control logistic regression (P=0.002) and by transmission disequilibrium test (TDT) (P=0.001), whereas Allele 1 showed an increased case risk. Allele 3 showed no influence on NTD risk and represents the lowest frequency allele (0.15). Additional single nucleotide polymorphism (SNP) genotyping in the same genomic region provides additional supportive evidence of an association. We demonstrate that two of the three alleles of rs3832406 are functionally different and influence the splicing efficiency of the alternate MTHFD1L mRNA transcripts. Hum Mutat 30:1,7, 2009. 2009 Wiley-Liss, Inc. [source]


Care and Outcome of Out-of-hospital Deliveries

ACADEMIC EMERGENCY MEDICINE, Issue 7 2000
Harry C Moscovitz MD
Abstract. Objectives: To identify interventions by paramedics in out-of-hospital deliveries and predictors of neonatal outcome. Methods: A prospective case series of consecutive out-of-hospital deliveries at Yale-New Haven Hospital from January 1991 to January 1994. Data describing out-of-hospital interventions, demographics, maternal risk factors, and neonatal outcomes were collected from out-of-hospital, emergency department (ED), and hospital records. Subgroups defined by source of prenatal care were compared using a multiple logistic regression model to determine predictors of poor neonatal outcome. Results: Ninety-one patients presented to the hospital after delivery. Paramedics attended 78 (86%) of the cases. Paramedics performed endotracheal intubation in one neonate and supported ventilation in four others. Suctioning and warming of the neonate were documented in 58% and 76%, respectively, and hypothermia was common (47%) in the paramedicattended deliveries. There were 9 neonatal deaths. Eight (89%) of the neonatal deaths were in the group with no prenatal care (p < 0.0001). Lack of prenatal care (RR 304, 95% CI = 5.0 to 18,472) and history of poor prenatal care (RR 22.5, 95% CI = 1.19 to 427) were significant predictors of poor neonatal outcome. Sixteen percent of all study patients and 43% of those with no prenatal care were treated in the ED during their pregnancies. Eighteen percent of the patients had had no prenatal care during previous pregnancies. Conclusions: Paramedics manage labor and delivery of a high-risk population. Fundamental aspects of care were not universally documented. Lack of prenatal care was associated with high neonatal morbidity and mortality. Nearly half of the mothers who went on to deliver without prenatal obstetric care saw emergency physicians during their pregnancies. [source]


The Asian birth outcome gap

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2006
Cheng Qin
Summary Asians are often considered a single group in epidemiological research. This study examines the extent of differences in maternal risks and birth outcomes for six Asian subgroups. Using linked birth/infant death certificate data from the State of California for the years 1992,97, we assessed maternal socio-economic risks and their effect on birthweight, preterm delivery (PTD), neonatal, post-neonatal and infant mortality for Filipino (87 120), Chinese (67 228), Vietnamese (45 237), Korean (23 431), Cambodian/Laotian (21 239) and Japanese (18 276) live singleton births. The analysis also included information about non-Hispanic whites and non-Hispanic blacks in order to give a sense of the magnitude of risks among Asians. Logistic regression models explored the effect of maternal risk factors and PTD on Asian subgroup differences in neonatal and post-neonatal mortality, using Japanese as the reference group. Across Asian subgroups, the differences ranged from 2.5- to 135-fold for maternal risks, and 2.2-fold for infant mortality rate. PTD was an important contributor to neonatal mortality differences. Maternal risk factors contributed to the disparities in post-neonatal mortality. Significant differences in perinatal health across Asian subgroups deserve ethnicity-specific interventions addressing PTD, teen pregnancy, maternal education, parity and access to prenatal care. [source]


Changing patterns of inequality in birthweight and its determinants: a population-based study, Scotland 1980,2000

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2005
Lesley Fairley
Summary Birthweight is used as an indicator of individual and population health and is known to be strongly correlated with adult cardiovascular disease. This paper uses routinely collected maternity discharge data from Scotland between 1980 and 2000 to look at birthweight trends and the changes in the distribution of maternal risk factors for birthweight. We also examine the contributions of each of the risk factors to birthweight trends and investigate whether there has been a reduction in inequality in birthweight over time. Data from 1 282 172 singleton live births were used in the analysis. Both mean birthweight and low birthweight (LBW: <,2500 g) were used as outcomes. The risk factors studied were maternal age, parity, maternal height, marital status and occupational social class of the father. The slope and relative indices of inequality were used to measure the change in inequalities over time. Mean birthweight increased from 3320 g in 1980 to 3410 g in 2000, while the percentage LBW decreased slightly from 5.7% in 1980 to 5.4% in 2000. The prevalence of many risk factors changed; there has been an increase in the proportion of older mothers, single mothers, taller mothers and mothers with undetermined social class. Although most risk factors had a significant change in effect over time, the inequalities in birthweight between groups did not appear to diminish over time. Both the slope and relative index of inequality had a quadratic relationship over time, with the inequalities in birthweight being greatest in the early 1980s and late 1990s. [source]


Maternal factors associated with the duration of breast feeding in Jeddah, Saudi Arabia

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2003
Sherine Shawky
Summary Recently, there has been increasing concern about the decline in breast-feeding pattern in developing countries. The objectives of this study were to document the recent breast-feeding trends in Jeddah during the first year of an infant's life and identify the probable maternal risk factors implicated in breast-feeding cessation. Data were collected from six randomly selected primary health care centres in Jeddah City. All married women with an infant , 12 completed months of age were interviewed, and information on socio-demographic characteristics, breast feeding and contraceptive use were collected. Cox proportional hazard regression model was used to calculate the adjusted odds ratios for the various maternal risk factors related to breast-feeding cessation. A total of 400 women were enrolled in the study. Their mean age at delivery was 28.0 years (SD = 4.1 years). Approximately 40.0% had never attended school, 43.0% had at least five children and 13.8% were smokers. Deliveries by caesarean section were reported by 13.0% of women and contraceptive use by 44.7%, among whom oral contraceptives were the commonest method. Around 94.0% of women ever initially breast fed their infants, and this proportion dropped to 40.0% by the infant's 12th month. Women who delivered by caesarean section (OR = 1.9 [95% CI 1.3, 2.8]P = 0.001) and those who used oral contraceptives (OR = 1.5 [95% CI 1.1, 2.2]P = 0.031) were at higher risk of stopping breast feeding and lower probability of maintaining breast feeding to the 12th month post partum than those who delivered vaginally and did not use oral contraceptives. Breast-feeding practice seems to decline rapidly during the first year of the infant's life. Health care professionals should promote breast-feeding practice as early as the antenatal period. They should also take into consideration the impact of caesarean section deliveries and early oral contraceptive use to avoid their negative impact on breast-feeding practice. [source]


Cutaneous manifestations of neonatal lupus and risk of subsequent congenital heart block

ARTHRITIS & RHEUMATISM, Issue 4 2010
Peter M. Izmirly
Objective Cutaneous disease associated with placental transport of maternal anti-SSA/Ro or anti-SSB/La antibodies is transient, and children often appear to be otherwise healthy. However, the impact of this manifestation of neonatal lupus (NL) on the risk of cardiac disease occurring in a future pregnancy is critical for family counseling and for powering preventive trials. The purpose of this study was to determine the recurrence rates of NL, with specific focus on cardiac NL following cutaneous NL in a child enrolled in the Research Registry for Neonatal Lupus (RRNL). Methods Fifty-eight families who were enrolled in the RRNL met the following inclusion criteria for our study: maternal anti-SSA/Ro or anti-SSB/La antibodies, a child with cutaneous NL, and a pregnancy subsequent to the child with cutaneous NL. Results The majority of the 58 mothers (78%) were Caucasian. Of 77 pregnancies that occurred following the birth of a child with cutaneous NL, the overall recurrence rate for any manifestation of NL was 49% (95% confidence interval [95% CI] 37,62%); 14 pregnancies (18.2%) were complicated by cardiac NL, 23 (29.9%) by cutaneous NL, and 1 (1.3%) by hematologic/hepatic NL. A subset analysis was restricted to the 39 children who were born after the initial child with cutaneous NL had been enrolled in the RRNL. The overall recurrence rate for NL was 36% (95% CI 20,52%); 5 pregnancies (12.8%) were complicated by cardiac NL and 9 (23.1%) by cutaneous NL. There were no significant differences in the following maternal risk factors for having a subsequent child with cardiac or cutaneous NL: age, race/ethnicity, anti-SSB/La status, diagnosis, use of nonfluorinated steroids, or breastfeeding. The sex of the subsequent fetus did not influence the development of cardiac or cutaneous NL. Conclusion Based on data from this large cohort, the identification of cutaneous NL in an anti-SSA/Ro antibody,exposed infant is particularly important, since it predicts a 6,10-fold risk of a subsequent child developing cardiac NL. [source]


Fetal macrosomia and pregnancy outcomes

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Hong JU
Background:, Pregnancies with a macrosomic fetus comprise a subgroup of high-risk pregnancies. There is uncertainty in the clinical management and outcomes of such pregnancies. Aim:, We sought to examine clinical management and maternal and fetal outcomes in pregnancies with macrosomic infants at Royal Brisbane and Women's Hospital (RBWH). Methods:, Data from 276 macrosomic births (weighing , 4500 g) and 294 controls (weighing 3250,3750 g) delivered during 2002,2004 at RBWH were collected from the hospital database. Univariate and logistic regression analyses were performed for maternal risk factors and maternal and neonatal outcomes that were associated with fetal macrosomia. Results:, Macrosomia was more than two times likely in women with body mass index (BMI) of > 30 kg/m2 (odds ratio (OR) 2.41, 95% confidence interval (CI) 1.26,4.61) and in male infant sex (OR 2.05, 95% CI 1.35,3.12), and four times more likely in gestation of > 40 weeks (OR 3.93, 95% CI 1.99,7.74). Maternal smoking reduced the risk of fetal macrosomia (OR 0.27, 95% CI 0.14,0.51). Macrosomia was associated with nearly two times higher risk of emergency caesarean section (OR 1.75, 95% CI 1.02,2.97) and maternal hospital stay of > 3 days (OR 1.66, 95% CI 1.11,2.50), and four times higher risk of shoulder dystocia (OR 4.08, 95% CI 1.62,10.29). Macrosomic infants were twice as likely to have resuscitation (OR 2.21, 95% CI 1.46,3.34) and intensive care nursery admission (OR 1.89, 95% CI 1.03,3.46). Conclusion:, Macrosomia was associated with an increased risk of adverse maternal and neonatal health outcomes. Optimal management strategies of macrosomic pregnancies need evaluation. [source]


Avoidable risk factors in perinatal deaths: A perinatal audit in South Australia

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2008
Titia E. DE LANGE
Objectives: To analyse risk factors of perinatal death, with an emphasis on potentially avoidable risk factors, and differences in the frequency of suboptimal care factors between maternity units with different levels of care. Methods: Six hundred and eight pregnancies (2001,2005) in South Australia resulting in perinatal death were described and compared to 86 623 live birth pregnancies. Results: Two hundred and seventy cases (44.4%) were found to have one or more avoidable maternal risk factors, 31 cases (5.1%) had a risk factor relating access to care, while 68 cases (11.2%) were associated with deficiencies in professional care. One hundred and four women (17.1% of cases) presented too late for timely medical care: 85% of these did have a sufficient number of antenatal visits. The following independent maternal risk factors for perinatal death were found: assisted reproductive technology (adjusted odds ratio (AOR) 3.16), preterm labour (AOR 22.05), antepartum haemorrhage (APH) abruption (AOR 6.40), APH other/unknown cause (AOR 2.19), intrauterine growth restriction (AOR 3.94), cervical incompetence (AOR 8.89), threatened miscarriage (AOR 1.89), pre-existing hypertension (AOR 1.72), psychiatric disorder (AOR 1.85) and minimal antenatal care (AOR 2.89). The most commonly found professional care deficiency in cases was the failure to act on or recognise high-risk pregnancies/complications, found in 49 cases (8.1%). Conclusion: Further improvements in perinatal mortality may be achieved by greater emphasis on the importance of antenatal care and educating women to recognise signs and symptoms that require professional assessment. Education of maternity care providers may benefit from a further focus on how to recognise and/or manage high-risk pregnancies. [source]


Marriage still protects pregnancy

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2005
Kaisa Raatikainen
Objective To assess the risk factors and outcome of pregnancy outside marriage in the 1990s, in conditions of a high percentage of extramarital pregnancies and high standard maternity care, used by the entire pregnant population. Design Hospital-based cohort study. Setting A university-teaching hospital in Finland. Population The 25,373 singleton pregnancies of known marital and cohabiting status. Methods Odds ratios (ORs) with 95% confidence intervals were calculated to estimate the effect of extramarital childbearing on pregnancy outcome. Multiple logistic regression analyses were conducted to control for confounding maternal risk factors. Main outcome measures Small-for-gestational age (SGA) infants, preterm birth (less than 37 completed weeks), low birthweight (LBW; under 2500 g). Results Of the study population, 67.5% were married and 32.5% were unmarried; 24.2% of all mothers were cohabiting. Unmarried status was strongly associated with social disadvantage and particular risk factors, specifically unemployment, smoking and previous pregnancy terminations, which in turn had an impact on obstetric outcome. There were significantly more SGA infants among unmarried mothers (P < 0.001), with an absolute difference of 45%; more preterm deliveries (P= 0.001), with an absolute difference of 17.5%; and more LBW infants (P < 0.001), with an absolute difference of 26%. The differences in adverse pregnancy outcomes between study groups (i) all unmarried women, (ii) cohabiting women and (iii) single women, remained significant after multivariate analysis at adjusted ORs of 1.11, 1.11 and 1.07 for SGA, 1.17, 1.15 and 1.21 for LBW and 1.15, 1.15 and 1.29 for the preterm births, respectively. Conclusion Even in the 1990s when cohabitation was already common, pregnancy outside marriage was associated with an overall 20% increase of adverse outcomes, and free maternity care did not overcome the difference. [source]


Early-onset neonatal group B streptococcal infection in London: 1990,1999

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2004
on behalf of the Health Protection Agency Group B Streptococcus Working Group
Objective To identify the incidence of early-onset group B streptococcal infection and to describe the antecedent maternal risk factors, in order to provide data to inform the design of interventional strategies that could be introduced in the UK to reduce the burden of this infection. Design A retrospective study with review of case notes of mothers and babies. Setting Seven maternity units in London during 1990,1999. Population All cases of proven early-onset neonatal group B streptococcal infection. Methods Identification of presence of risk factors that could be used to select women for the offer of intrapartum antibiotic prophylaxis. Main outcome measures Incidence and case-fatality rate of invasive early-onset group B infection. Results One hundred and forty cases were identified among a birth cohort of 198,388 live births, an incidence of 0.71 per 1000 live births. Twenty-two babies died, a case-fatality rate of 15.6% or 1.1 per 100,000 live births. Women of black ethnic origin, and those who had had a previously affected infant, multiple pregnancy, preterm delivery, prolonged rupture of membranes or intrapartum fever all had a significantly increased risk of delivering an infected infant. Conclusions These data suggest that the incidence of early-onset group B streptococcal infection in these London centres is sufficiently high to warrant administration of intrapartum antibiotics to at-risk women. [source]