Consecutive Live Births Research Articles

Birth defects in a rural province in Papua New Guinea

BackgroundGlobally, birth defects are the fourth most common cause of neonatal mortality. They cause substantial morbidity, and often long-term disability. Despite this, the impact of birth defects on public health...

IJCM_94A: Risk Factors for Short Birth Intervals in women: A Case-Control Study from a Tertiary Health Care facility in Central India

Background: The interval between successive pregnancies, commonly referred to as the birth interval, plays a crucial role in maternal and child health outcomes. Optimal birth spacing is associated with improved maternal nutritional status, reduced risks of adverse pregnancy outcomes, and enhanced child survival. Conversely, short birth intervals, defined as intervals less than 24 months between two consecutive live births, have been linked to an increased likelihood of adverse maternal and child health consequences. Through a comprehensive examination of the contextualized risk factors, we aim to provide evidence that can guide healthcare practitioners, policymakers, and public health professionals in their efforts to improve maternal and child health outcomes in Central India. Objective: To determine risk factors for short birth interval among women in the tertiary health care centre of Central India. Methodology: A hospital-based unmatched case-control study was employed on 45 cases and 45 controls. Cases were women who gave birth within the last 6 months and with at least two consecutive alive births with a birth interval of less than 33 months. Controls were women who gave birth within the last 6 months and had a birth interval between 33 to 59 months between two successive live births. The data was collected by predesigned and pretested semi structured questionnaire from selected respondents. Results: Some important risk factors identified in the present study were age less than 30 years, use of contraception and shorter duration of breastfeeding. Conclusion: Encouraging postpartum family planning and effective breastfeeding will go a long way to reduce the prevalence of short birth interval and its consequences on maternal, neonatal and child health

Changes in Residential Greenspace and Birth Outcomes among Siblings: Differences by Maternal Race.

Growing research investigates the perinatal health benefits of greenspace in a mother's prenatal environment. However, evidence of associations between residential greenspace and birth outcomes remains mixed, limiting the relevance this work holds for urban policy and greening interventions. Past research relies predominantly on cross-sectional designs that are vulnerable to residential selection bias, and rarely tests effect modification by maternal race/ethnicity, which may contribute to heterogeneous findings. This study uses a rigorous, longitudinal sibling comparison design and maternal fixed effect analyses to test whether increases in maternal exposure to residential greenspace between pregnancies precede improved birth outcomes among non-Hispanic (NH) white (n = 247,285) and Black (n = 54,995) mothers (mean age = 28 years) who had at least two consecutive live births in California between 2005 and 2015. Results show that increases in residential greenspace correspond with higher birthweight (coef. = 75.49, 95% CI: 23.48, 127.50) among Black, but not white (coef. = -0.51, 95% CI: -22.90, 21.90), infants. Additional analyses suggest that prior evidence of perinatal benefits associated with residential greenspace among white mothers may arise from residential selection; no such bias is observed for Black mothers. Taken together, these findings support urban greening initiatives in historically under-resourced neighborhoods. Efforts to evenly distribute residential greenspace may reduce persistent racial disparities in birth outcomes, an important step towards promoting health equity across the life course.

A STUDY ON ASSOCIATION OF MATERNAL AND CHILD HEALTH VARIABLES WITH BIRTH SPACING IN INDIA

Introduction- Birth spacing is an important element of the population growth of any country and has a strong relationship with maternal and child health. It is dened as the time interval between two consecutive live births of children. Methodology- The present study used secondary data from NFHS-4 that was conducted in 2015-2016. We restricted our sample to those reproductive women age 15-49 years who had reported at least two pregnancies in the reproductive calendar, with the most recent of those births having occurred in ve years preceding the survey. If women had more than two children then birth spacing of last two was taken for analysis. This study included, a total of 104907 women in the nal analysis sample. Majority 82027 Results- (78.2%) women were residing in rural areas of India while 228880 (21.8%) were residence of urban area. 44376 (42.3%) of the women had age group of 25-29 years. Approximately three fourth 76591(73.0%) mothers have given birth to 2-3 children. Male child preponderance was seen in this analysis. Caesarean section was done in 11198 (10.7%) mothers. The authors suggest that authorities from union and state governments, hea Conclusion- lth ofcials, other stakeholders and policymakers should contribute towards improving birth spacing practices through various educational campaigns, family planning activities and benets to the couples having 2 children at the prescribed birth interval promoting good health of mothers as well as child.

Are preterm birth and very low birth weight rates altered in the early COVID (2020) SARS-CoV-2 era?

We evaluated the prevalence of preterm birth (PTB) and very low birth weight (VLBW) during Jan-Dec 2,020 (early COVID era) at 5 hospitals (2 in West Virginia, 3 in California) compared to Jan 2017-Dec 2019 (pre-COVID) inclusive of 2 regional perinatal centers (1 in Huntington, WV and 1 in San Jose, CA) and 3 community hospitals (1 each in Cabell, Los Angeles and Santa Clara counties). We examined PTB and VLBW rates of live births at 5 US hospitals from Jan 2017-Dec 2020. We compared PTB and VLBW rates in 2020 to 2017-2019 using Poisson regression and rate ratio with a 95% confidence interval. We stratified live births by gestational age (GA) (<37, 33-36, and <33 weeks) and birth weight (≤1,500 g, >1,001 g to ≤1,500 g, ≤1,000 g). We examined PTB rates at 4 of the hospitals during Jan-Dec 2020 and compared them to the prior period of Jan 2017-Dec 2019 using Statistical Process Control (SPC) for quarterly data. We examined PTB and VLBW rates in 34,599 consecutive live births born Jan 2017-Dec 2019 to rates of 9,691 consecutive live births in 2020. There was no significant change in PTB (<37 weeks GA) rate, 10.6% in 2017-2019 vs. 11.0% in 2020 (p = 0.222). Additionally, there was no significant change when comparing VLBW rates in 2017-2019 to 2020, 1.4% in 2017-2019 vs. 1.5% in 2020 (p = 0.832). We found no significant change in the rates of PTB or VLBW when combining the live birth data of 5 US hospitals in 3 different counties.

Breech Presentation in Twins as a Risk Factor for Developmental Dysplasia of the Hip.

Introduction:Identifying risk factors associated with developmental dysplasia of the hip (DDH) is essential for early diagnosis and treatment. Breech presentation is a major DDH risk factor, possibly because of crowding of the fetus within the uterus. In multifetal pregnancy, fetuses are generally smaller than singletons, which may obscure the effect of breech presentation on fetal hips. Only a few studies have investigated the occurrence of DDH in multifetal pregnancies. In this study, we aimed to evaluate whether the breech presentation is a major risk factor of DDH in twin pregnancies.Methods:This retrospective study included 491 consecutive live births (after 23+0 weeks gestation) delivered through cesarean section with at least 1 baby with noncephalic presentation in single or twin pregnancies from April 2013 to October 2018. We analyzed the incidence of DDH and its associated factors, including sex, breech, and multifetal pregnancy, with a generalized linear mixed model.Results:The incidence of DDH was 12.5% in singleton with breech presentation, 9.8% in twin-breech presentation, and 0.7% in twin-cephalic presentation. Multivariate analysis showed that singleton-breech presentation (P=0.003), twin-breech presentation (P=0.003), and female sex (P=0.008) were independent risk factors for DDH.Conclusion:Breech presentation is an independent risk factor for DDH in twin pregnancies, although twin pregnancy itself is not an independent risk factor for DDH.

Timely Birth Dose Vaccine to Prevent Vertical Transmission of Hepatitis B: A Single Center Experience on the Road to the WHO Elimination Goals in Italy.

Italy was one of the first industrialized countries to implement a program of routine vaccination against hepatitis B virus (HBV) infection. However, currently, no HBV vaccine is administered at birth if the screened mother is HBsAg negative, whilst babies born to HBsAg positive mothers are given vaccine and hepatitis B immunoglobulin, within 12–24 post-delivery hours. A single center retrospective analysis of policies and practices to prevent mother-to-child transmission of HBV was carried out, to evaluate their adherence to HBV care guidelines. Paired maternal-infant medical records for consecutive live births, between January 2015 and December 2019, were reviewed at the AOU Città della Salute e Scienza di Torino, where a total of 235/35,506 babies (0.7%) were born to HBsAg positive mothers. Markers of active viral replication, i.e., HBV DNA level and/or HBeAg, were reported in only 66/235 (28%) of the mothers’ medical records. All newborns had immunoprophylaxis at birth: 61% at <12 h, 31% between 12 and 24 h, 7% between 24 and 36 h and 1% at >36 h. In 2019, two cases of vertical HBV transmission occurred, despite timely immunoprophylaxis, as their mothers’ viral load was detected too late for antiviral prophylaxis. Missed early identification of pregnant women with high viremia levels or late vaccinations may contribute to perinatal HBV infection. Immunoprophylaxis should be given to babies born to HBsAg positive mothers at the latest within 12 h. In Italy, policies aimed at achieving the WHO 2030 goal of eliminating viral hepatitis should be further implemented.

Determinants of Short Birth Interval Among Married Women of Child Bearing Age in Becho Woreda, South West Showa Zone, Oromia Region, Ethiopia

Background: Short Birth interval is the time duration less than 33 months between two consecutive live births. Short birth interval is one of the concerns of different countries of the world, because it can affect the overall economic, political and social aspects of a given country by increasing their fertility. Women in the developing world who have many children in quick succession place themselves and their children at enormous risks.Child bearing patterns-maternal age, birth order, and the interval between births-have an important influence upon the probability that a child will survive infancy and early childhood. Thus the study area has short birth interval below the national and WHO recommendation. Objective: To identify determinants of short birth interval among married women of child bearing age in Becho Woreda. Methods and materials : Community based case control study was conducted from July to October 2019. Cases (n=231) were women with short birth intervals less than 33 months), whereas controls (n=462) were women having history of birth intervals (33 to 59 Months) selected by systematic random sampling. Data were collected using structured interviewer administered questionnaires then cleaned, coded, entered and analyzed by using SPSS version 22. Frequency distributions, measures of central tendency and logistic regression were calculated and interpreted accordingly. Result: Result of this study revealed that 60.3% of respondents had information about short birth interval and 65.4% of respondents have utilized previous pregnancy plan. Age of mother at first child birth, the number of children, her educational level, wealth index, occupation of the mother, and duration of breast feeding and use of modern contraceptive were the determinant of optimum birth interval. Having no formal education [(AOR= 2.04, 95% CI; (1.49-2.78)], duration of breastfeeding for less than 24 months[(AOR=0.62, 95% CI; (0.45-0.84)], preceding child being female [(AOR=7.69, 95% CI; (5.24-11.30)], modern contraceptive use [(AOR=7.07, 95% CI: (5.03-9.94)], poor wealth index [(AOR=3.08, 95% CI; (1.85-5.14)] and Previous pregnancy plan [(AOR= 8.59, 95% CI; (6.02-12.18)] of respondents were independent predictors of short birth interval. Conclusion and recommendation : Educational status, duration of breast feeding, sex of the preceding child, modern contraceptive use and wealth index were markers of unequal distribution of inter birth intervals. Ministry of Health should work on women and their partner on creating awareness about the importance of modern contraceptive utilization, breast-feeding, and optimal birth interval. Keywords : Birth interval; Child bearing age; Determinants; South West Shoa DOI: 10.7176/JHMN/87-01 Publication date: March 31 st 2021

Duration of birth interval and its predictors among reproductive-age women in Ethiopia: Gompertz gamma shared frailty modeling.

The World Health Organization recommended a minimum of 33 months between consecutive live births to reduce the incidence of adverse pregnancy outcomes. Poorly spaced pregnancies are associated with poor maternal and child health outcomes such as low birth weight, stillbirth, uterine rupture, neonatal mortality, maternal mortality, child malnutrition, and maternal hemorrhage. However, there was limited evidence on the duration of birth interval and its predictors among reproductive-age women in Ethiopia. Therefore, this study aimed to investigate the duration of birth interval and its predictors among reproductive-age women in Ethiopia. A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 11022 reproductive-age women who gave birth within five years preceding the survey was included for analysis. To identify the predictors, the Gompertz gamma shared frailty model was fitted. The theta value, Akakie Information Criteria (AIC), Bayesian Information Criteria (BIC), and deviance was used for model selection. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable Gompertz gamma shared frailty analysis, the Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to show the strength and statistical significance of the association. The median inter-birth interval in Ethiopia was 38 months (95% CI: 37.58, 38.42). Being living in Addis Ababa (AHR = 0.15, 95% CI: 0.03, 0.70), being rural resident (AHR = 1.13, 95% CI: 1.01, 1.23), being Muslim religious follower (AHR = 6.53, 95% CI: 2.35, 18.18), having three birth (AHR = 0.51, 95% CI: 0.10, 0.83), having four birth (AHR = 0.30, 95% CI: 0.09, 0.74), five and above births (AHR = 0.10, 95% CI: 0.02, 0.41), and using contraceptive (AHR = 2.35, 95% CI: 1.16, 4.77) were found significant predictors of duration of birth interval. The length of the inter-birth interval was consistent with the World Health Organization recommendation. Therefore, health care interventions that enhance modern contraceptive utilization among women in rural areas and Muslim religious followers would be helpful to optimize birth interval.

Pathologic examination of placenta: a study on 500 live births to assess conformity to College of American Pathologists (CAP) guidelines and clinicopathologic correlation

Purpose Pathological examination of placenta is vital to understand the pathophysiology of adverse perinatal outcomes, prevention of recurring conditions in subsequent pregnancies and medico-legal risk assessment. The College of American Pathologists (CAP) has published a set of guidelines to help guide the submission of placentas to pathology. However, awareness and conformity to these guidelines are not well established and vary from one institution to the other. We aimed to examine the appropriateness of placental pathologic examination at our institution and their conformity to guidelines in this audit type study to help improve our practices. Materials and methods Detailed retrospective review of obstetrical records was performed including history and delivery reports for a total of 500 consecutive live births noting whether the placenta was sent for pathologic evaluation according to CAP guidelines. Sensitivity and specificity of placental examination were calculated based on the 2 × 2 contingency table. Results The sensitivity and specificity of pathologic examination of placenta in conformity to CAP guidelines were 63.4% and 91.6%, respectively. The most common indications for submission were maternal followed by fetal and placental indications. Concordant clinico-pathologic correlation was found in 87/135 placentas submitted. Conclusions Placenta has long been ignored with limited understanding of the value of its examination. More awareness of CAP guidelines is needed to appropriately submit placentas for pathologic examination. Each institution needs to develop their own set of guidelines taking guidance from CAP guidelines and tailored to its population. Meaningful communication between obstetricians, neonatologists, and pathologists is key to improving the utility of pathologic examination of placenta and the application of results for better patient care.

Interpregnancy and interbirth intervals and all-cause, cardiovascular-related and cancer-related maternal mortality: findings from a large population-based cohort study

IntroductionScarce research is available regarding the association between interbirth intervals (IBI) and long-term maternal health outcomes, particularly cardiovascular disease (CVD) mortality. We aimed to assess whether IBIs were associated with...

Individual and community level determinants of short birth interval in Ethiopia: A multilevel analysis.

The World Health Organization recommends a minimum of 33 months between two consecutive live births to reduce the risk of adverse maternal and child health outcomes. However, determinants of short birth interval have not been well understood in Ethiopia. The aim of this study was to assess individual- and community-level determinants of short birth interval among women in Ethiopia. A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was performed. A total of 8,448 women were included in the analysis. A two-level multilevel logistic regression analysis was used to identify associated individual- and community-level factors and estimate between-community variance. At the individual-level, women aged between 20 and 24 years at first marriage (AOR = 1.37; 95% CI: 1.18-1.60), women aged between 25 and 29 years at first marriage (AOR = 1.65; 95% CI: 1.20-2.25), having a husband who attended higher education (AOR = 1.32; 95% CI: 1.01-1.73), being unemployed (AOR = 1.16; 95% CI: 1.03-1.31), having an unemployed husband (AOR = 1.23; 95% CI: 1.04-1.45), being in the poorest wealth quintile (AOR = 1.82; 95% CI: 1.39-2.39), being in the poorer wealth quintile (AOR = 1.58; 95% CI: 1.21-2.06), being in the middle wealth quintile (AOR = 1.61; 95% CI: 1.24-2.10), being in the richer wealth quintile (AOR = 1.54; 95% CI: 1.19-2.00), increased total number of children born before the index child (AOR = 1.07; 95% CI: 1.03-1.10) and death of the preceding child (AOR = 1.97; 95% CI: 1.59-2.45) were associated with increased odds of short birth interval. At the community-level, living in a pastoralist region (AOR = 2.01; 95% CI: 1.68-2.39), being a city dweller (AOR = 1.75; 95% CI: 1.38-2.22), high community-level female illiteracy (AOR = 1.23; 95% CI: 1.05-1.45) and increased distance to health facilities (AOR = 1.32; 95% CI: 1.11-1.56) were associated with higher odds of experiencing short birth interval. Random effects showed significant variation in short birth interval between communities. Determinants of short birth interval are varied and complex. Multifaceted intervention approaches supported by policy initiatives are required to prevent short birth interval.

Neonatal birth fractures: a retrospective tertiary maternity hospital review

We aimed to identify the incidence and types of neonatal birth fractures in a single tertiary maternity hospital in the United Kingdom and to find possible associated factors, including all live births born between 2000 and 2016. We reviewed hospital records and imaging of all neonates who had any imaging done to identify birth fractures. We identified 87,461 consecutive live births. Sixty-six sustained a fracture during delivery: 46 clavicle-, 13 humerus-, four skull-, one femoral-, one rib- and one tibial fracture. Five neonates with a clavicle or humeral fracture had an Erb’s palsy. Sixty-five fractures were in singletons. Twenty-five fractures were diagnosed after discharge. Binary logistic regression analysis with R-Studio showed a significant association between ‘Fracture’ and ‘Birthweight’ (p < .0005), ‘Delivery Mode’ (Forceps: p < .001, Ventouse: p < .0004) and ‘Gestation’ (p < .0005) but not with ‘Sex’, ‘Day’ and ‘Time’ of delivery, ‘Number of deliveries per day’, ‘Singleton/Multiple Births’ and ‘Breech’. The incidence of birth fractures (0.075%) was low with 24 hours obstetrician support on site in comparison to published data. We recommend to include data on neonatal birth injuries in addition to the existing clinical safety markers for delivery units.Impact statementWhat is already known on this subject? Most birth fractures affect the clavicle with a large variation in published incidences from 0.035% to 3.2%. High birthweight is the most frequently identified risk factor. An increased risk for out of hours deliveries (16.00–8.00) and inverse association between fracture rate and level of experience and academic qualification have also been reported. Between 14% and 39% of fractures are diagnosed after discharge but many studies are based on birth certificate and discharge diagnoses coding only.What the results of this study add? This is the first study on neonatal birth fractures from the United Kingdom and the only study for which radiological investigations of all neonates were reviewed. Our fracture rate of 0.075% for all fractures is therefore most likely the most accurate, showing no significant difference in the fracture risk between our six defined time intervals and days of the week, with experienced midwifes managing many high risk pregnancies and an obstetrician being present on site all the time.What the implications are of these findings for clinical practice and/or further research? Our findings support to use data on neonatal birth injuries as one indicator to assess the quality and safety of maternity units.

Factors associated with low birthweight among newborns delivered at public health facilities of Nekemte town, West Ethiopia: a case control study

BackgroundLow birthweight (LBW) remains the most important risk factor which attributed to mortality of 15–20% of newborns across the globe. An infant with low birthweight is more likely to have stunting in childhood and develop markers of metabolic risk factors at his later age. Furthermore, LBW is a risk for inter-generational assaults of malnutrition as it is the risk for sub optimal growth until adulthood, affecting women’s and male’s reproductive capabilities. Thus, there is enough concern to study the determinants of LBW across different settings. Accordingly, this study was conducted to assess the determinants of low birthweight s in public health facilities of Nekemte town, West Ethiopia.MethodsFacility based unmatched case control study was employed from February to April 2017. The data were collected using structured, pretested interviewer administered questionnaire in all public health facilities of Nekemte town. Consecutive live births of less than 2500 g in each of the hospitals and health centres were selected as cases and succeeding babies with weights of at least 2500 g as controls. Data were entered in to Epi-data software version 3.1 and exported to SPSS Version 21 and analyzed using frequency, cross-tabs and percentage. Factors with p-value < 0.25 in Bivariate analysis were entered in to multivariable logistic regression and statistical significance was considered at p-value < 0.05.ResultA total 279 (93 cases &186 controls) were included in the study with a mean birthweight of 2138.3 g ± SD 206.87 for cases and 3145.95 g ± SD 415.98 for controls. No iron-folate supplementation (AOR = 2.84, 95% CI, 1.15–7.03), no nutritional counselling (AOR = 4.05, 95%CI, 1.95–8.38), not taking snacks (AOR =3.25, 95%CI, 1.64–6.44), maternal under nutrition (AOR =5.62, 95%CI, 2.64–11.97), anemia (AOR = 3.54, 95%CI, 1.46–8.61) and inadequate minimum dietary diversity score of women MDDS-W (AOR = 6.65, 95%CI, 2.31–19.16) were factors associated with low birthweight .ConclusionLacking nutrition counselling during pregnancy, lacking iron/folic acid supplementation during pregnancy, not taking snacks during pregnancy, maternal under-nutrition, maternal anemia and inadequate minimum dietary diversity score of women (MDDS-W) were independently associated with LBW. Thus, public health intervention in the field of maternal and child health should address these determinants.

The duration of the interpregnancy interval in multiparous women and maternal weight gain between pregnancies: findings from a UK population-based cohort

Maternal obesity in pregnancy increases the risk of adverse long-term health outcomes in both mother and offspring. A population-based cohort of prospectively collected routine antenatal healthcare data collected between January 2003 and September 2017 at University Hospital Southampton, UK was utilised to investigate the association between duration of interpregnancy interval between successive pregnancies and gain in maternal body mass index by the start of the next pregnancy. Records of 19362 women with two or more consecutive singleton live births were analysed. Two-thirds had gained weight when presenting to antenatal care for their subsequent pregnancy with 20% becoming overweight/obese. Compared to an interval of 24–35 months, an interval of 12–23 months was associated with lowest risk of weight gain (adjusted RR 0.91, 99% CI 0.87 to 0.95, p < 0.001) and ≥36 months with greatest risk (adjusted RR 1.11, 99% CI 1.07 to 1.15, p < 0.001) for the first to second pregnancy. This study shows that most multiparous women start their pregnancy with a higher weight than their previous one. An interval of 12–23 months is associated with the lowest risk of starting the second pregnancy with a higher body weight accounting for age. In countries with high prevalence of maternal obesity, birth spacing may merit exploration as a factor impacting on perinatal morbidity.

Birthweight and gestational age centiles in South Indian newborns

Background: India has recently gone through a vast technological and economic revolution which has influenced all sections of society. The study was undertaken to determine any changes in the pattern of intrauterine growth in South Indian babies over three decades compared with national and international studies. Objectives: To construct new 2015-2017 centile charts for birthweight in babies born from 28 to 42 gestational weeks in the metropolitan city of Bangalore, South India compared with an earlier South Indian centile chart constructed in 1983 at Christian Medical College and Hospital (CMCH), Vellore, India and other national and international studies. Design, setting and method: This is a retrospective study of two cohorts. The first cohort consisted of 4,426 consecutive live births from January to December 1983, at CMCH, a tertiary referral hospital in South India. The second cohort consisted of 2,708 consecutive live births from January 2015 to May 2017 at Shifaa Hospital, a multispecialty centre, in the metropolitan city of Bangalore, South India, about 300 km from CMCH. The chief outcome measure was birthweight centiles according to gestational age. The two cohorts of singleton live births were analysed to determine the mean birth weights, gestation and centile growth patterns. Data were obtained from labour room records. Results: Among a total of 4,426 live births during 1983, the mean birthweight was 2881g and among 2,708 live births during 2015-2017, the mean birth weight was 2873g, a difference of 8g. The mean gestation was 38.8 weeks in the former and 38.2 weeks in the latter study respectively. The centile growth curves among the two cohorts revealed almost similar percentile weight distribution except for preterm 31-36 weeks gestation, where birthweights in the 2015-2017 cohort were 200-300g higher compared to the 1983 cohort. However, the 90thcentile curve, at term 38-40 weeks revealed an increase of 200-300g weight gain in 1983 cohort which thereafter plateaued, with 300g weight gain at 40-41 weeks in the 2015-2017 cohort. Comparison was also made with both national and international centile intrauterine growth curves. Conclusions: The 2015-2017 centile charts for birthweight in babies born from 28 to 42 gestational weeks in the metropolitan city of Bangalore, South India had almost similar growth curves and mean birthweights compared to the 1983 South Indian centile chart indicating an inherent genetic predisposition for the small Indian baby. The updated centiles for births during 2015-2017 provide a more valid tool to assess South Indian fetal growth. Sri Lanka Journal of Child Health, 2019; 48(2): 140-145

A health facility based case-control study on determinants of low birth weight in Dassie town, Northeast Ethiopia: the role of nutritional factors

BackgroundLow birth weight remains a major public health problem affecting developing countries. Evidence shows that low birth weight has long lasting negative health consequences through its contribution to stunting, mental impairment and non-communicable chronic diseases in later life. Thus, it is worth investigating the role of nutritional factors as determinants of low birth weight to suggest nutritional interventions to curb its negative health outcomes. This study aimed to investigate the determinants of low birth weight with main focus on the role of nutritional factors in Ethiopia.MethodsA facility-based case-control study was conducted from 3 February to 29 April, 2017. The data were collected using structured, pretested interviewer-administered questionnaire in all public health facilities of Dessie Town. Anthropometric measurements were made following standard procedures for both mothers and their newborns. Consecutive live births of < 2500 g and two succeeding normal weight babies were selected as cases and controls, respectively. Data were entered in to Epi-data software version 3.1, and exported to SPSS version 21, and analyzed using frequency, mean and percentage. Factors with p < 0.25 during bivariate analyses were entered into a multivariable logistic regression model to determine significant determinants of LBW. Statistical significance was considered at p < 0.05. Results were reported with odds ratio and 95% CI.ResultsMean ± SD of birth weight (g) was 2138 ± 207 for cases and 3145 ± 415 for controls. After adjusting for potential confounders using multivariable logistic regression analysis, the absence of iron and folate supplementation, receiving no nutritional counseling and consuming no additional meal, maternal undernutrition, maternal anemia and inadequate dietary diversity during the current pregnancy were found to be significant determinants of low birth weight in our study.ConclusionLack of nutritional counseling, absence of additional meal intake and iron and folate supplementation during pregnancy, and maternal undernutrition, maternal anemia and inadequate maternal dietary diversity were significant determinants of low birth weight. The importance of nutritional counseling, improving iron and folate supplementation during pregnancy, and nutritional status of pregnant women need to be strengthened to reduce the incidence of LBW in Ethiopia. In addition, behavioral change communications targeting pregnant women to improve women dietary diversity and their extra meal intake practice need to be enhanced in Ethiopia.

Linking midwives and hospital morbidity data to investigate the effect of interpregnancy interval on gestational diabetes: a 35-year cohort study in Western Australia

IntroductionInterpregnancy interval (IPI) is a potentially modifiable risk factor for preganncy outcomes, and short and long IPI may be associated with increased rik of pregnancy complications. Record linkage provides the only practiacble means to investigate IPI effects, which requires large generalisable sample sizes and long follow-up time.&#x0D; Objectives and ApproachThis study examines the effect of IPI on gestational diabetes in Western Australia, with the aim to inform the evidence-base for IPI recommendations in high-income countries. A longitudinal population-based retrospective cohort study was conducted using de-identified, probabilistically-linked records for all births in Western Australia from 1980 to 2015 (inclusive) from the state’s Midwives Notification System and the WA Hospital Morbidity Data Collection. Logistic regression model was used to estimate the odds of gestational diabetes by IPI category. Analyses included all women with at least two consecutive singleton live births at 20-44 weeks of gestation.&#x0D; ResultsA cohort of 320,616 women were included in the study. Of these, 13,680 (4\%) had an IPI &gt; 120 months (AOR:1.53, 95\% CI 1.38-1.70) as compared to 18-23 months.&#x0D; Conclusion/ImplicationsOur findings show that both short and long IPIs may be associated with increased risk of gestational diabetes in a high-income setting. In this study, data linkage improved ascertainment of the outcome measure. Results suggest 18-23 months following a previous livebirth may be optimal for avoiding complications in future pregnancies.

Interpregnancy Intervals in a Contemporary Manitoba Cohort: Prevalence of So-Called Suboptimal Intervals and Associated Maternal Characteristics

ObjectiveShort and long interpregnancy intervals (IPIs) have been associated with various adverse outcomes, and a 2016 American College of Obstetricians and Gynecologists' Committee Opinion recommends an optimal IPI of 18 months to 5 years. Descriptive data on the IPI in Canada are lacking. The objective of this study was to examine IPIs in a Manitoba cohort. MethodsWe analyzed a subset of records from a larger dataset used to examine the IPI and adverse perinatal outcomes. For that study, Manitoba's Hospital Abstracts data were searched to identify births from 1985 to 2014. Each two consecutive live births to the same mother formed a sibling pair. The IPI was calculated as the interval between the two siblings' births, minus the younger sibling's GA. Information on maternal characteristics was extracted from various datasets housed in the Manitoba Population Research Data Repository. The current analysis examined second and higher-order births between 2010 and 2014. The proportion of suboptimal IPIs was determined and IPIs were cross-tabulated with birth year and maternal subgroups. ResultsMore than half of pregnancies were conceived following a suboptimal interval. IPIs of less than 6 months – which have been associated with the highest risk of adverse outcomes – were more prevalent among certain subgroups. These included younger women as well as women who received inadequate prenatal care, smoked or drank alcohol during pregnancy, were low income, or did not graduate from high school. ConclusionSuboptimal IPIs were common in this Manitoba cohort. Stakeholders should consider whether greater efforts to promote appropriate birth spacing are warranted.

Risk factors for stillbirths: how much can a responsive health system prevent?

BackgroundThe stillbirth rate is an indicator of quality of care during pregnancy and delivery. Good quality care is supported by a functional heath system. The objective of this study was to explore the risk factors for stillbirths, particularly those related to a health system.MethodsThis case-control study was conducted in two districts of Bihar, India. Information on cases (stillbirths) were obtained from facilities as reported by Health Management Information System; controls were consecutive live births from the same population as cases. Data were collected from 400 cases and 800 controls. The risk factors were compared using a hierarchical approach and expressed as odds ratio, attributable fractions and population attributable fractions.ResultsOf all the factors studied, 22 risk factors were independently associated with stillbirths. Health system-related factors were: administration of two or more doses of oxytocics to augment labour before reaching the facilities (OR 1.6; 95% CI 1.2–2.1), any complications during labour (OR 2.3;1.7–3.1), >30 min to reach a facility from home (OR 1.4;1.05–1.8), >10 min to attend to the pregnant woman after reaching the facility (OR 2.8;1.7–4.5). In the final regression model, modifiable health system-related risk factors included: >10 min taken to attend to women after they reach the facilities (AOR 3.6; 95% CI 2.5–5.1), untreated hypertension during pregnancy (AOR 2.9; 95% CI 1.5–5.6) and presence of any complication during labour, warranting treatment (AOR 1.7; 95% CI 1.2–2.4). Among mothers who reported complications during labour, time taken to reach the facility was significantly different between stillbirths and live births (2nd delay; 33.5 min v/s 25 min; p < 0.001). Attributable fraction for any complication during labour was 0.56 (95% CI 0.42–0.67), >30 min to reach the facility 0.48 (95% CI 0.31–0.60) and institution of management 10 min after reaching the facility 0.68 (95% CI 0.58–0.75). Reaching a facility within 30 min, initiation of management within 10 min of reaching the facility and timely management of complications during labour could have prevented 17%, 37% and 20% of stillbirths respectively.ConclusionA pro-active health system with accessible, timely and quality obstetric services can prevent a considerable proportion of stillbirths in low and middle income countries.