Higher Birth Research Articles

Rural-urban differences on the rates and factors associated with early initiation of breastfeeding in Nigeria: further analysis of the Nigeria demographic and health survey, 2013

BackgroundThis study investigates and compares the rates and factors associated with early initiation of breastfeeding (EIBF) within one hour of birth in rural and urban Nigeria.MethodsData from the 2013 Nigeria Demographic and Health Survey (NDHS) were analyzed. The rates of EIBF were reported using frequency tabulation. Associated factors were examined using Chi-Square test and further assessed on multivariable logistic regression analysis.ResultsThe rates of EIBF were 30.8% (95% confidence interval [CI] 29.0, 32.6) and 41.9% (95% CI 39.6, 44.3) in rural and urban residences, respectively (p < 0.001). The North-Central region had the highest EIBF rates both in rural (43.5%) and urban (63.5%) residences. Greater odds of EIBF in rural residence were significantly associated with higher birth order (Adjusted Odds Ratio [AOR] 1.29, 95% CI 1.10, 1.60), large birth size (AOR 1.33, 95% CI 1.10, 1.60), and health facility delivery (AOR 1.46, 95% CI 1.23, 1.72). Rural mothers in the rich wealth index, not working and whose husbands obtained at least a secondary school education had significantly higher odds of early initiation of breastfeeding. Regardless of residence, greater odds of EIBF were significantly associated with non-cesarean delivery (Rural AOR 3.50, 95% CI 1.84, 6.62; Urban AOR 2.48, 95% CI 1.60, 3.80) and living in North-Central (Rural AOR 1.84, 95% CI 1.34, 2.52; Urban AOR 4.40, 95% CI 3.15, 6.15) region. Also, higher odds of EIBF were significantly associated with living in North-East (Rural AOR 1.48, 95% CI 1.05, 2.08; Urban AOR 3.50, 95% CI 2.55, 4.83), South-South (Rural AOR 1.51, 95% CI 1.11, 2.10; Urban AOR 2.84, 95% CI 2.03, 3.97) and North-West (Urban residence only AOR 2.08, 95% CI 1.54, 2.80) regions.ConclusionsRural-urban differences in the rates and factors associated with EIBF exist in Nigeria with rural residence having significantly lower rates. Intervention efforts which address the risk factors identified in this study may contribute to improved EIBF rates. Efforts need to prioritize rural mothers generally, (particularly, those in rural North-West region) as well as mothers in urban South-West region of Nigeria.

Predicting high risk births with contraceptive prevalence and contraceptive method-mix in an ecologic analysis

BackgroundIncreased contraceptive use has been associated with a decrease in high parity births, births that occur close together in time, and births to very young or to older women. These types of births are also associated with high risk of under-five mortality. Previous studies have looked at the change in the level of contraception use and the average change in these types of high-risk births. We aim to predict the distribution of births in a specific country when there is a change in the level and method of modern contraception.MethodsWe used data from full birth histories and modern contraceptive use from 207 nationally representative Demographic and Health Surveys covering 71 countries to describe the distribution of births in each survey based on birth order, preceding birth space, and mother’s age at birth. We estimated the ecologic associations between the prevalence and method-mix of modern contraceptives and the proportion of births in each category. Hierarchical modelling was applied to these aggregated cross sectional proportions, so that random effects were estimated for countries with multiple surveys. We use these results to predict the change in type of births associated with scaling up modern contraception in three different scenarios.ResultsWe observed marked differences between regions, in the absolute rates of contraception, the types of contraceptives in use, and in the distribution of type of birth. Contraceptive method-mix was a significant determinant of proportion of high-risk births, especially for birth spacing, but also for mother’s age and parity. Increased use of modern contraceptives is especially predictive of reduced parity and more births with longer preceding space. However, increased contraception alone is not associated with fewer births to women younger than 18 years or a decrease in short-spaced births.ConclusionsBoth the level and the type of contraception are important factors in determining the effects of family planning on changes in distribution of high-risk births. The best predictions for how birth risk changes with increased modern contraception and for different contraception methods allow for more nuanced predictions specific to each country and can aid better planning for the scaling up of modern contraception.

Determinants of Third or Higher Births in Korea: Focusing on the Effects of Cash Grants

Determinants of Third or Higher Births in Korea: Focusing on the Effects of Cash Grants

Higher Birth Weight Linked to Osteosarcoma Severity

Higher Birth Weight Linked to Osteosarcoma Severity

Factors contributing to regional inequalities in acute respiratory infections symptoms among under-five children in Nigeria: a decomposition analysis

BackgroundAcute respiratory infections (ARI) are major causes of morbidity and mortality in many low-income countries. Although factors associated with ARI symptoms in children under 5 years of age have been identified; however, variation in their prevalence resulting from regional-specific proximate determinants has received little attention. Therefore, we aim to investigate the specific regional determinants of overall and wealth-related inequality in children having ARI in Nigeria over a decade.MethodsWe analyzed trends in development of ARI symptoms among children under 5 years of age in Nigeria using nationally representative cross sectional surveys carried out in 2003, 2008 and 2013. Overall- and household wealth index based- inequality in the distribution of prevalence of ARI symptoms were estimated by region using Gini index and Concentration Index, respectively. Multivariate logistic regressions for complex survey and decomposition analysis for both indexes were used to calculate percentual contribution.ResultsWe found a decreasing trend in development of ARI symptoms over the decade between regions. Children in South Western region had reduced likelihood of developing the symptoms. Concentration index (CI) for the prevalence of ARI symptoms over the years and across regions had negative values (all p < 0.05). Gini index (GI) varies from 0.21 in North East to 0.62 in South Western region. Furthermore, the mapping showed that the extent at which both inequalities contribute to ARI symptoms prevalence in each region is different. The four major sources of wealth-related inequalities were poor households, no maternal education, biomass cooking, and rural area.The major contributors to overall inequalities were having a child aged 6 to 23 months, having no maternal education, having no vaccination card, and having a high birth order/short birth interval.ConclusionsAlthough ARI prevalence decreased over the decade, it has remained unequally distributed between regions and over the time. The sources of those inequalities are context sensitive. Thus, in future health promotion initiatives, it is imperative to account for regional variations in the distribution of ARI.

Assessment of Mental Health Literacy among Perinatal Hispanic Adolescents

ABSTRACT According to the United States (U.S.) Census Bureau, Hispanics are the fastest growing ethnic minority in the U.S. As such, Hispanic females have the highest birth rate (35 per 1000) among adolescents between the ages of 15 and 19 years. Despite high fertility rates, there is limited mental health information among Hispanic adolescents during the perinatal period. Perinatal depression is a major concern as it poses health risks for both the mother and infant. Adverse outcomes such as preterm birth, low infant birth weight, and poor maternal-infant attachment may result from perinatal depression. However, less than half of Hispanic adolescent mothers who experience perinatal depression receive treatment. Previous research identified low mental health literacy (MHL) as one of the primary reasons for the limited use of mental health services among ethnic minorities. This study assessed the MHL of pregnant and postpartum Hispanic adolescents (n = 30) using a modified MHL scale. Implications for nursing practice are discussed to help improve mental health outcomes among pregnant and postpartum Hispanic adolescents.

Cerebroplacental ratio in pregnancies complicated by gestational diabetes mellitus.

To assess the relationship between the cerebroplacental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). This was a retrospective cohort study of women with a non-anomalous singleton pregnancy diagnosed with GDM who delivered at Mater Mothers' Hospital between 2007 and 2015. CPR was measured in 1089 cases between 34 + 0 and 36 + 6 weeks' gestation. CPR values were compared between groups categorized according to GDM treatment (by diet, oral hypoglycemic agent (OHA) or insulin). The association between CPR and intrapartum and perinatal outcomes was evaluated. No difference in CPR was observed between treatment groups. Fetuses with CPR < 10th centile were significantly more likely to have adverse composite perinatal outcome (odds ratio (OR) = 2.93 (95% CI, 1.95-4.40)), preterm delivery and low birth weight than fetuses with CPR ≥ 10th centile (all P < 0.001). These associations were present regardless of the type of GDM treatment. Fetuses of women with insulin-controlled GDM had poorer neonatal outcomes than did fetuses of women treated with OHA or dietary control alone. The risk of adverse outcome was significantly increased in the insulin-treated group (OR = 1.75 (95% CI, 1.34-2.28); P < 0.001), which also had higher rates of preterm delivery and higher birth weight. Regardless of the type of treatment, a low CPR is associated with poorer neonatal outcome in women with GDM. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Impact of a rapid molecular test for positive blood cultures from neonatal intensive care patients on clinical management: a retrospective audit.

Both Staphylococcus aureus and coagulase negative Staphylococci are common causes of late-onset neonatal sepsis in the neonatal intensive care unit (NICU), usually relating to intravascular access device infections. This project aimed to review the impact on antimicrobial treatment and clinical outcome in the NICU setting, of the introduction of the Xpert MRSA/SA BC test (Cepheid, USA) for the identification of staphylococci in blood cultures. A retrospective audit was carried out of the pre- and post-intervention periods; the intervention was the introduction of the Xpert MRSA/SA BC test. In total, 88 neonates had positive blood cultures with Staphylococcus spp., comprising 42 neonates in the pre-intervention and 46 in the post-intervention groups. The pre-intervention group had a higher birth weight (1.541kg vs. 1.219kg, p=0.05) and higher platelet count (288 vs. 224×109/L, p=0.05). There was a trend towards a shorter duration of antimicrobial therapy in term infants and in the length of admission; however, this was not statistically significant (p=0.2). All of the nine infants post-intervention with significant bacteraemia (S. aureus =3, CoNS =6) were changed to the optimal antimicrobial at the time the result was available. This study shows that the introduction of the Xpert MRSA/SA BC test can lead to a reduction in the length of admission and duration of antimicrobials in term infants; however, the difference was not statistically significant. All nine infants with clinically significant bacteraemia were treated with the appropriate antimicrobial when the Xpert MRSA/SA BC test result was available.

OP 55 Associations between fetal HLA-G genotype and birth and placenta weight in pregnancies complicated by preeclampsia and in uncomplicated pregnancies possible implications for HLA diversity

Introduction During pregnancy, the maternal immune system must cope with the semi-allogeneic fetus in order to facilitate a successful pregnancy. The extra-villous trophoblast cells situated at the feto-maternal interface express high amounts of the immune regulatory non-classical human leukocyte antigen-G (HLA-G). A 14 base pair insertion/deletion polymorphism (14 bp ins/del) in the 3″-untranslated region of the HLA-G gene has an impact on the expression level of HLA-G and a low expression of HLA-G have been linked to pregnancy complications like preeclampsia. Objectives In the present study, we investigated the impact of the fetal HLA-G 14 bp ins/del genotype on the clinical outcome in normal pregnancies and pregnancies complicated by preeclampsia, in terms of birth weight and placental weight of children born by mothers heterozygous for the HLA-G 14 bp ins/del. Patients and methods Two independent cohorts of pregnant women were used for this nested case-control study. Analysis were made on pregnancies complicated by severe preeclampsia (n = 101), normal uncomplicated pregnancies (n = 185) and a combination of the two. Both Taqman analyses and DNA sequencing were applied to determine the HLA-G 14 bp ins/del genotype. Results Combining normal pregnancies and pregnancies complicated by preeclampsia and adjusting for gestational age at birth, the results show that newborns born by HLA-G 14 bp heterozygous mothers that are homozygous for the HLA-G 14 bp insertion, have a significantly lower birth weight (P = 0.008) and lower placental weight (P = 0.009) compared to newborns that are homozygous for the HLA-G 14 bp deletion. The results indicate that children with the HLA-G 14 bp ins/ins genotype born by mothers suffering from severe preeclampsia have a lower birthweight than children with the HLA-G 14 bp ins/del or del/del genotypes born by mothers suffering from severe preeclampsia, however not significantly (P = 0.08). Conclusion The highest mean birth weight and placenta weight was observed in newborns homozygous for the HLA-G 14 bp deletion and the lowest mean birth and placenta weight was observed in newborns homozygous for the HLA-G 14 bp insertion. It can be speculated that a compromise between intermediate birth and placenta weight, HLA heterozygosity and induction of maternal tolerance have evolved in humans.

Measuring the distribution of adolescent births among 15–19-year-olds in Chile: an ecological study

BackgroundAlthough within Latin America Chile has one of the lowest birth rates among adolescents, it has a high rate in comparison to other developed nations.AimTo explore trends in birth rates...

High or low birth weight may increase risk of liver disease

Children with a high or low birth weight may be at an increased risk of developing non-alcoholic fatty liver disease (NAFLD), according to researchers.

Impact of maternal nutritional supplementation in conjunction with a breastfeeding support program on breastfeeding performance, birth, and growth outcomes in a Vietnamese population

Purpose: This study aimed to evaluate the effects of maternal nutritional supplementation (MNS) in conjunction with a breastfeeding support program on birth outcomes and breastfeeding performance. Methods: A total of 228 singleton Vietnamese mothers aged 20–35 years at 26–29 weeks of gestation with pre-pregnancy body mass index (BMI) < 25.0 kg/m2 were randomized to the intervention (n = 114), receiving MNS (252 kcal/day) daily up to 12 weeks postpartum and four breastfeeding education and support sessions or to the control (n = 114), receiving standards of care. Results: The intervention was 2.09 times more likely to exclusively breastfeed over the 12 weeks than the control (95%CI: 1.05–4.13, p = .0358), after controlling for potential confounders. Infant’s breast milk intake was significantly higher in the intervention than the control among mothers with baseline mid-upper arm circumference (MUAC) < 50th (p = .0251). Infants in the intervention had significantly higher birth weight (p = .0312), birth weight-for-age (p = .0141) and birth head circumference-for-age (p = .0487), and higher head circumference-for-age z-score (p = .0183) development over the postnatal period, compared with the control. Conclusions: Use of MNS and breastfeeding support improve birth outcomes and exclusive breastfeeding (EBF) rate in Vietnamese mothers. Additionally, it promotes breast milk production among mothers with lower baseline MUAC.

Prenatal determinants of physical activity and cardiorespiratory fitness in adolescence \u2013 Northern Finland Birth Cohort 1986 study

BackgroundLower levels of physical activity and cardiorespiratory fitness are key risk factors of chronic adult diseases. Physical activity and cardiorespiratory fitness are predicted by birth weight, but the underlying parental and pregnancy-related factors remain largely unknown. We examined how prenatal determinants are associated with physical activity and cardiorespiratory fitness in adolescence.MethodsOf the 16-year-old members of the population-based Northern Finland Birth Cohort 1986 (NFBC 1986), 6682 singletons with no major physical disability reported their amount of physical activity outside school hours, and 4706 completed a submaximal cycle ergometer test assessing cardiorespiratory fitness. Physical activity was expressed as metabolic equivalent hours per week (METh/week) and cardiorespiratory fitness as peak oxygen uptake (ml·kg−1·min−1). Prenatal determinants included birth weight, length of gestation, mother’s and father’s body mass index (BMI), maternal gestational diabetes mellitus (GDM), and maternal hypertension and smoking during pregnancy. Data were analyzed by multiple linear regression.ResultsA higher birth weight and longer length of gestation predicted lower levels of physical activity and cardiorespiratory fitness at 16 years, although the association between length of gestation and physical activity was inverse U-shaped. Mother’s or father’s overweight or obesity before pregnancy were associated with lower levels of their offspring’s physical activity and fitness in adolescence. Adjusting for maternal pregnancy disorders and the adolescent’s own BMI attenuated the associations with the mother’s but not the father’s overweight/obesity. Furthermore, maternal GDM predicted lower cardiorespiratory fitness.ConclusionsA high birth weight and parental overweight/obesity are associated with lower levels of both physical activity and cardiorespiratory fitness in adolescence, while maternal GDM and longer length of gestation are associated with lower cardiorespiratory fitness. Both long and short lengths of gestation predict low physical activity.

A nutrition-based program for pregnant incarcerated women

ABSTRACTThe current study presents the findings from the William & Mary Healthy Beginnings Program (W&M HBP), a nutrition-based education program for incarcerated pregnant women. Participants included 116 pregnant women who participated in the W&M HBP (53% identified as a person of color), and 51 incarcerated women (43% identified as a person of color) who recently gave birth but did not participate in W&M HBP. Results show higher birth weights among offspring born to W&M HBP than women in the comparison group. W&M HBP participants significantly increased their pregnancy- and nutrition-related knowledge, and knowledge gains significantly predicted longer gestational periods.

Gestational weight gain among nutritionally treated GDM patients

Objective: We aimed to evaluate pregnancy outcome in diet-treated gestational diabetes mellitus (GDM) patients according to the 2009 Institute of Medicine (IOM) guidelines concerning gestational weight gain (GWG). Design and patients: This was a retrospective cohort study, limited to women with singleton pregnancies and diet-treated GDM. Women with preexisting diabetes or women with pharmaceutical treatment were excluded. We compared patients with adequate GWG with patients with excess GWG according to the 2009 IOM guidelines. Results: Overall, 142 women were evaluated, of which 99 (69.7%) had adequate GWG and 43 (30.3%) had excess GWG. All demonstrated good glycemic control. Patients in the excess GWG group had higher mean pre-pregnancy weight and body mass index (BMI). No other obstetrical or perinatal statistically significant differences were demonstrated, although there was a trend for higher birth weight percentile and higher rate of respiratory distress among the excess GWG group. Conclusions: Higher pre-pregnancy BMI is a risk factor for failing to comply with the 2009 IOM GWG guidelines. However, it seems that in pregnancies complicated by diet-treated GDM, GWG is not a reliable marker for adverse pregnancy outcome if glycemic control is adequate.

The impact of expected child-rearing expenses on childbirth based on the matching of two Korean panel data

In Korea, recent upward trends in age of marriage and downward trends in fertility rates have motivated the Korean government to provide childbirth grants and Early Childhood Education and Care (ECEC) subsidies. Through such provisions, the government hopes to lower parents’ concerns regarding child-rearing expenses and to promote higher birth rates. Using combined data from the Panel Study of Korean Children (PSKC) and the Korea Longitudinal Study of Women and Families (KLoWF), this study analyzes the relationship between birth rates and anticipated child-rearing expenses. The method of kernel matching was used to combine and analyze information on children from the KLoWF and the child care environment as well as on child-rearing expenses from the PSKC. The study’s findings suggest a significant but weak relationship between birth rates and the anticipated financial costs for raising a child. This relationship is more prominent in the low-education and low-income group than in economically well-situated and highly educated families. Based on the results, we suggest the following policy recommendations: firstly, further research needs to be conducted to determine the effects of governmental support on child-rearing. Secondly, customized support that considers family income and education should be provided to improve birth rates.

Potential exposure to endocrine disrupting chemicals and selected adverse pregnancy outcomes: a follow-up study of pregnant women referred for occupational counselling

BackgroundExperimental evidence indicates that fetal exposure to xenobiotics with the potential to interfere with the endogenous steroid hormone regulation of fetal development may reduce birth weight. However, epidemiological studies are limited. The aim of the study was to investigate whether potential occupational exposure to endocrine disrupting chemicals (EDC) of the mother during pregnancy is associated with preterm birth and low birth weight.MethodsPregnant women referred to an Occupational Health Clinic (OHC) in two Danish regions (Copenhagen or Aarhus) between 1984 and 2010, suspected of being exposed to occupational reproductive hazards were included in the study. A job exposure matrix enabled estimation of potential occupational exposure to EDC on the basis of job title. Births by women potentially exposed to EDC (n = 582) were compared to births by women referred to an OHC on the suspicion of other exposures than EDC (n = 620), and to a sample of births by all occupationally active women in the same geographical regions (n = 346,544), including 1,077 births of the referred women’s non-referred pregnancies.ResultsNo indications of reduced birth weight or increased risk of preterm birth were found among women potentially exposed to EDC. Women potentially exposed to EDC had children with a higher birth weight compared to the sample of occupationally active women but not compared to other women referred to an OHC.ConclusionsPotential maternal exposure to EDC at Danish workplaces is not related to low birth weight or preterm birth among women referred to occupational counselling. Occupational exposures might be too weak on the average to cause these adverse effects or counselling at the OHCs is effective in preventing them.

Prevalence of undiagnosed asymptomatic bacteriuria and associated risk factors during pregnancy: a cross-sectional study at two tertiary centres in Cairo, Egypt

BackgroundThe prevalence of asymptomatic bacteriuria (ASB) during pregnancy is poorly understood in Egypt—a country with a high birth rate.ObjectivesTo determine the prevalence of ASB among pregnant women booking at El...

Early life risk exposure and stunting in urban South African 2-year old children.

Stunting is a measure of overall nutritional status and is a major public health concern because of its association with child mortality and morbidity and later adult performance. This study examined the effects of pregnancy events, birth characteristics and infant risk exposure on stunting at age 2 years. The study, established in 1990 in Soweto, an urban South African township, included 1098 mother-infant pairs enroled in the Birth to Twenty Plus longitudinal birth cohort study. In total, 22% of children were stunted at age 2 years, with males at greater risk than females [24.8 v. 19.4%, odds ratio (OR)=1.38; 95% confidence interval (CI): 1.03, 1.83]. In unadjusted analysis, male sex, household socio-economic status (SES), overcrowding, maternal age, maternal education, single motherhood, ethnicity, birth weight, gestational age and duration of infant breastfeeding were all significantly associated with stunting. In multivariable analysis, higher birth weight was protective against stunting for both sexes. Higher maternal education was protective for females only (adjusted odds ratio (AOR)=0.35; 95% CI: 0.14, 0.87), whereas wealthier household SES protected males (AOR for richest SES group=0.39; 95% CI: 0.16, 0.92). In this and other similar settings, current stunting prevention efforts focussing on primarily providing targeted proximal interventions, such as food supplements, risk undermining the critical importance of addressing key distal determinants of stunting such as SES and maternal education.

Clinical outcome of assisted reproductive technologies in advanced aged men

Abstract Objective The purpose was to establish whether the advanced male age may influence the outcomes in a controlled assisted reproductive technology (ART) program. Design This is an experimental study. Setting Research and Clinical Center for Infertility of Yazd. Sample A total of 63 men undergoing ART cycles. Material In a retrospective study, the outcome of intracytoplasmic sperm injection (ICSI) in ART cycles in two groups of patients was studied. Patients regarding etiology of infertility were divided into two groups: (A) male factor infertility (n = 47), and (B) female factor infertility (n = 16). Sperm parameters, ART cycle characteristics and clinical outcomes were assessed between two groups. Main outcome measures Clinical outcomes of ART in advanced aged men. Results There were no significant differences in rates of sperm count and morphology between two groups, but the rate of spermatozoa with progressive motility were higher in group B in comparison with A ( P = 0.002). The rates of high quality embryos, pregnancy and live birth showed no significant differences between the groups ( P = 0.4, P = 0.4, P = 0.2, respectively). Conclusion It appears that the clinical outcome of ART in male and female factor infertility was not influenced by advanced paternal age.