Low Birth Weight Delivery Research Articles

Association of Rural and Frontier Residence with Very Preterm and Very Low Birth Weight Delivery in Nonlevel III NICUs.

Delivery of very preterm and very low birth weight neonates (VPT/VLBW) in a nonlevel III neonatal intensive care unit (NICU) increases risk of morbidity and mortality. Study objectives included the following: (1) Determine incidence of VPT/VLBW delivery (<32 weeks gestational age and/or birth weight <1,500 g), in nonlevel III units in Colorado; (2) Evaluate the independent association between residence and nonlevel III unit delivery; (3) Determine the incidence of and factors associated with postnatal transfer. This retrospective cohort study used 2007 to 2016 Colorado birth certificate data. Demographic and clinical characteristics by VPT/VLBW delivery in level III NICUs versus nonlevel III units were compared using Chi-square analyses. Multivariable logistic regression was used to estimate the independent association between residence and VPT/VLBW delivery. Among patients, 897 of 10,015 (8.96%) VPT/VLBW births occurred in nonlevel III units. Compared with infants born to pregnant persons in urban counties, infants born to those residing in rural (adjusted odds ratio [AOR] = 1.58, 95% confidence interval [CI]: 1.33, 1.88) or frontier (AOR = 3.19, 95% CI: 2.14, 4.75) counties were more likely to deliver in nonlevel III units and to experience postnatal transfer within 24 hours (rural AOR = 2.24, 95% CI: 1.60, 3.15; frontier AOR = 3.91, 95% CI: 1.76, 8.67). Compared with non-Hispanic Whites, Hispanics were more likely to deliver VPT/VLBW infants in nonlevel III units (AOR = 1.36, 95% CI: 1.15, 1.61). A significant number of VPT/VLBW neonates were born in nonlevel III units with associated disparities by race/ethnicity and nonurban residence. · Preterm delivery in a nonlevel III NICU increases risk of neonatal morbidity and mortality.. · A significant number of preterm deliveries in Colorado occur in hospitals with nonlevel III NICUs.. · Disparities in preterm delivery by race/ethnicity and nonurban residence exist..

Malaria Infection Is Common and Associated With Perinatal Mortality and Preterm Delivery Despite Widespread Use of Chemoprevention in Mali: An Observational Study 2010 to 2014.

In malaria-endemic areas, pregnant women and especially first-time mothers are more susceptible to Plasmodium falciparum. Malaria diagnosis is often missed during pregnancy, because many women with placental malaria remain asymptomatic or have submicroscopic parasitemia, masking the association between malaria and pregnancy outcomes. Severe maternal anemia and low birthweight deliveries are well-established sequelae, but few studies have confirmed the relationship between malaria infection and severe outcomes like perinatal mortality in high transmission zones. Pregnant women of any gestational age enrolled at antenatal clinic into a longitudinal cohort study in Ouelessebougou, Mali, an area of high seasonal malaria transmission. Follow-up visits included scheduled and unscheduled visits throughout pregnancy. Blood smear microscopy and polymerase chain reaction (PCR) analysis were employed to detect both microscopic and submicroscopic infections, respectively. Intermittent preventative treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) was documented and prompt treatment regardless of symptoms given upon malaria diagnosis. Of the 1850 women followed through delivery, 72.6% of women received 2 or more IPTp-SP doses, 67.2% of women experienced at least 1 infection between enrollment up to and including delivery. Malaria infection increased the risks of stillbirth (adjusted hazard ratio [aHR] 3.87, 95% confidence interval [CI]: 1.18-12.71) and preterm delivery (aHR 2.41, 95% CI: 1.35-4.29) in primigravidae, and early neonatal death (death within 7 days) in secundigravidae and multigravidae (aHR 6.30, 95% CI: 1.41-28.15). Malaria treatment after diagnosis, alongside IPTp-SP, is insufficient to prevent malaria-related stillbirth, early neonatal death and preterm delivery (PTD). Although IPTp-SP was beneficial in Mali during the study period, new tools are needed to improve pregnancy outcomes. NCT01168271.

Marginal cord insertion among singleton births at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

BackgroundUmbilical cord may insert abnormally i.e. marginal insertion to a placenta which can cause different birth and perinatal complications. Despite the increased effort taken by different responsible bodies, the prevalence of birth and perinatal complications are still high, possibly due to anomalous cord insertion. So far, anomalous cord insertion lacks proper attention in different medical settings. Hence, the present study aims to assess the magnitude, risk factors, and adverse birth outcomes of marginal cord insertion among singleton births.MethodsAn institution-based cross-sectional study design was conducted. A systematic random sampling technique was used to select study participants. Data were collected by using a structured questionnaire and it was entered into epi-data version 3.1 then exported to SPSS version 20 for data cleansing and analysis. Bi-variable and multivariable logistic regressions were employed to identify risk factors and adverse outcomes associated with marginal cord insertions. Crude and adjusted odds ratio (P-value < 0.05) with a 95% confidence interval were calculated.ResultThe magnitude of marginal cord insertion was 6.4% (95% CI = 4.4–8.8%) in singleton pregnancies. Independent risk factors for marginal cord insertion were advanced maternal age (AOR = 2.24, 95% CI: 1.35–11.08), primiparity (AOR = 1.98, 95% CI: 1.37–8.69), maternal chronic hypertension (AOR = 3.07, 95% CI: 1.66–9.76), previous cesarean delivery (AOR = 2.51, 95% CI: 1.43–10.21), and use of intrauterine contraceptive device before pregnancy (AOR = 2.22, 95% CI: 1.36–12.30). Pregnancies complicated by marginal cord insertion are at higher risk to develop low birth weight (AOR = 2.89, 95% CI: 1.23–6.80), preterm birth (AOR = 4.00, 95% CI: 1.44–11.14), and emergency cesarean delivery (AOR = 3.68, 95% CI: 1.03–13.81).Conclusion and recommendationMarginal cord insertion is a mistreated potential risk for low birth weight, preterm birth, and emergency cesarean delivery. Routine screening of marginal cord insertion should be considered in pregnancies with advanced age, nulliparity, hypertensive disorder, history of cesarean section, and intrauterine contraceptive device usage before pregnancy.

Maternal Urinary Tract Infection: Is It Associated With Neonatal Urinary Tract Infection?

Objective: Maternal urinary tract infection is associated with intrauterine growth restriction, preterm delivery and low birth weight. The purpose of this study was to evaluate whether maternal urinary tract infection is related to neonatal urinary tract infection. Materials and methods: The present prospective study included 230 singleton neonates. The participants were divided into two groups based on in utero exposure to maternal urinary tract infections. The study group (exposure to maternal urinary tract infection) included 115 neonates and the control group (without exposure to maternal urinary tract infection) included 115 healthy neonates. Physical examination, urinalysis, urine culture and urinary system ultrasonography were carried out for all neonates. Results: There were 153 deliveries by cesarean section and 77 vaginal births. There was no statistically significant difference between the groups in terms of gender distribution, maternal age, birth weight, mode of delivery, gravida and gestational age. Although the difference was not significant, the incidence of low birth weight and preterm delivery were higher in the study group in comparison to that in the control group. There was a statistically significant higher rate of neonatal urinary tract infection in the study group compared with control group (25.2% vs. 7.8%, p<0.001). The most commonly discovered pathogens were Escherichia coli, followed by Klebsiella spp., Proteus spp., and Serratia spp. in the study group. Conclusion: The results of this study showed that the presence of maternal urinary tract infection may contribute to increased urinary tract infection frequency in the neonatal period. Neonates at risk for a urinary tract infection should be regularly monitored due to nonspecific clinical presentation.

Frequency of cannabis use during pregnancy and adverse infant outcomes, by cigarette smoking status – 8 PRAMS states, 2017

BackgroundResearch on prenatal cannabis use and adverse infant outcomes is inconsistent, and findings vary by frequency of use or cigarette use. We assess (1) the prevalence of high frequency (≥once/week), low frequency (<once/week), and any cannabis use during pregnancy by maternal characteristics and adverse infant outcomes; (2) the prevalence of infant outcomes by cannabis use frequency, stratified by cigarette smoking; and (3) the association between cannabis use frequency and infant outcomes, stratified by cigarette smoking. MethodsCross-sectional data from 8 states’ 2017 Pregnancy Risk Assessment Monitoring System (n = 5548) were analyzed. We calculated adjusted prevalence ratios (aPR) between cannabis use frequency and infant outcomes with Modified Poisson regression. ResultsApproximately 1.7 % and 2.6 % of women reported low and high frequency prenatal cannabis use, respectively. Prevalence of use was higher among women with small-for-gestational age (SGA) (10.2 %) and low birthweight (9.7 %) deliveries, and cigarette use during pregnancy (21.2 %). Among cigarette smokers (aPR: 1.8; 95 % CI: 1.1−3.0) and non-smokers (aPR: 2.1; 95 % CI: 1.1−3.9), high frequency cannabis use doubled the risk of low birthweight delivery but did not increase preterm or SGA risk. Regardless of cigarette use, low frequency cannabis use did not significantly increase infant outcome risk. ConclusionsPrenatal cannabis use was more common among women who smoked cigarettes during pregnancy. High frequency cannabis use was associated with low birthweight delivery, regardless of cigarette use. Healthcare providers can implement recommended substance use screening and provide evidence-based counseling and cessation services to help pregnant women avoid tobacco and cannabis use.

Review of pregnancy in Crohn's disease and ulcerative colitis.

Inflammatory bowel disease (IBD) frequently affects women of childbearing age and can have implications in pregnancy. Most women with IBD have comparable fertility with women in the general population. Fertility is reduced in women with active disease or previous ileal-pouch–anal anastomosis (IPAA) surgery and is temporarily reduced in men taking sulfasalazine. Women with IBD have an increased risk of preterm delivery, low birth weight, small-for-gestational-age infants and Cesarean section (CS) delivery, however, no increased risk of congenital abnormalities. These adverse outcomes are particularly prevalent for women with active IBD compared with those with quiescent disease. Conception should occur during disease remission to optimize maternal and fetal outcomes and reduce the risk of disease exacerbations during pregnancy. Pre-conception counseling is therefore pertinent to provide patient education, medication review for risk of teratogenicity and objective disease assessment. Most medications are safe during pregnancy and breastfeeding, with the exception of methotrexate, ciclosporin, allopurinol and tofacitinib. Delivery modality should be guided by obstetric factors in most cases; however, CS is recommended for women with active perianal disease and can be considered for women with inactive perianal disease or IPAA. In conclusion, most women with IBD have uncomplicated pregnancies. Active IBD is the predominant predictor of poor outcomes and disease exacerbations; therefore, maintenance of disease remission during and before pregnancy is crucial.

COMPLICATIONS OF PREGNANCY AMONG ADOLESCENTS AND ADULT MOTHERS TREATED IN A PUBLIC HOSPITAL, THE REPUBLIC OF LIBERIA: A RETROSPECTIVE COMPARATIVE STUDY

Complications of pregnancy remain a serious threat in Sub-Saharan Africa despite efforts to minimise maternal mortality due to pregnancy complications, and achieve the Millennium Development Goal 5. This is a retrospective study to determine the most common pregnancy complications among adolescents compared to adults treated in a public hospital from 2015 to 2018. The researcher applied a convenience sampling method in selecting the medical records. The instrument used was adapted from previous studies and data were analysed with descriptive and chi-square test for the inferential statistics. A total of 1,265 patients met the eligibility criteria and 540 (42.7%) were adolescents. Low birth weight (n=478, 88.5%) and preterm delivery (n=496, 91.9%) were common among babies born to adolescent mothers. Pregnancy-related complications among adolescent mothers showing the prevalence of anaemia, hypertension, and malaria were 494 (84.9%), 149 (56.2%) and 193 (62.1%) respectively. Gestational diabetes was found to be high among adult mothers (n=98, 74.8%). Among adolescent mothers, the prevalence of eclampsia was 62 (78.5%) and hemorrhage 61 (53.0%). The prevalence of Intrauterine growth restriction (IUGR) was high among adolescent mothers (n=252, 80.5%). Comprehensive strategies are needed to keep girls in schools and to raise awareness and develop campaigns about using contraception properly to reduce the incidence of adolescent pregnancy as well as to minimise the incidence of pregnancy-related complications.

Risk Factors and Outcomes of Low Birth Weight Neonates Admitted In a Tertiary Care Center

Introduction: Birth weight &lt;2500 grams, &lt;1500 grams and &lt;1000 grams irrespective of gestational age is low birth weight, very low birth weight and extremely low birth weight respectively. Low birth weight is associated with high morbidity and mortality. Aims: To find out the possible maternal risk factors associated with low birth weight babies, morbidities and mortalities seen in them during their hospital stay. Methods: Hospital based cross sectional observational study was performed in 200 newborns &lt;2500 grams in Nepalgunj Medical College, Kohalpur, Banke, Nepal. Results: Out of 200 neonates 8 (4%), 40 (20%) and 152 (76%) were extremely low birth weight, very low birth weight and low birth weight respectively with Male:Female ratio of 1.12:1. Most common maternal risk factors for low birth weight was Illiterate mothers (88%) followed by preterm delivery (68%). Inadequate antenatal visit was associated with low birth weight (P&lt;0.05). Most common morbidity seen in low birth weight was neonatal sepsis (96%) followed by neonatal jaundice (87%). 44 (22.0%) neonates expired and 156 (78.0%) survived. Neonatal sepsis was most common (36.4%) cause of mortality followed by respiratory distress syndrome (22.7%). Conclusion: Certain measures could be taken to prevent low birth weight deliveries: discouraging delivery at teenage, adequate antenatal visits, avoiding smoking and alcohol during pregnancy. Well trained staffs and better facilities in neonatal intensive care unit could improve the survival and minimize the morbidities in low birth neonates.

Maternal proximity to petrochemical industrial parks and risk of premature rupture of membranes

BackgroundLiving near petrochemical industries has been reported to increase the risks of adverse birth outcomes, such as low birth weight and preterm delivery. However, evidence regarding the role of petrochemical exposure in pregnancy complications remains limited. This study evaluated the association between maternal proximity to petrochemical industrial parks (PIPs) during pregnancy and the occurrence of premature rupture of membranes (PROM). MethodsWe performed a population-based 1:3 case–control study by using the 2004–2014 Taiwanese Birth Certificate Database. Birth records reported as stillbirth or bearing congenital anomalies were excluded. Cases were newborns reported to have PROM, whereas controls were randomly sampled from those without any pregnancy complications by matching birth year and urbanization index of the residential township. The proximity to PIPs was evaluated by calculating the distance to the nearest PIP of the maternal residential township during pregnancy. Furthermore, petrochemical exposure opportunity, accounting for monthly prevailing wind direction, was quantified during the entire gestational period. We applied conditional logistic regression models to evaluate the associations. ResultsIn total, 29371 PROM cases were reported during the study period, with a corresponding 88113 healthy controls sampled. The results revealed that living within a 3-km radius of PIPs during pregnancy would increase the risk of PROM (odds ratio [OR] = 1.76, 95% CI: 1.66–1.87). Furthermore, compared with the lowest exposed group, those with high petrochemical exposure opportunity had a significantly increased risk of PROM occurrence (OR = 1.69–1.75). The adverse effects remained robust in the subgroup analysis for both term- and preterm-PROM. ConclusionsThe results of the present work provide evidence that living near PIPs during pregnancy would increase the risk of PROM, and additional studies are warranted to confirm our findings.

Perinatal Mortality and Associated Factors Among Antenatal Care Attended Pregnant Mothers at Public Hospitals in Gamo Zone, Southern Ethiopia.

Introduction: Perinatal mortality is the death of a baby between 28 weeks of gestation onwards and before the first 7 days of life. According to WHO, Ethiopia is one of the most commonly noticed country in the world in considering perinatal mortality rate. The overall perinatal mortality rate in Ethiopia was around 66–124 per 1,000 births.Objective: To determine the magnitude of perinatal mortality and associated factors among mothers who attended antenatal care at public hospitals in Gamo Zone, Southern Ethiopia.Methods: A cross-sectional study was conducted at Arba Minch General Hospital and Chencha District Hospital antenatal care attended by pregnant mothers from the 1st of February to the 28th of March 2019, among the mothers enrolled at ANC clinic from the 1st of January to the 30th of December 2018 using a simple random sampling method for the pre-determined 1,820 records. Both bivariate and multivariable logistic regression analysis was conducted. Variables which had a p-value <0.25 in bivariate analysis were considered as a candidate variable for multivariable analysis and variables which had a P-value <0.05 in multivariable analysis were declared as statically significant.Results: The prevalence of perinatal mortality was 12.6% (95% CI: 11.80, 13.40) and grand multiparity (AOR: 7.40; 95% CI: 2.77, 20.26), having one antenatal visit (AOR: 4.40; 95% CI: 1.64, 11.91), spontaneous vaginal delivery (AOR: 0.36; 95% CI: 0.16, 0.82), being pre-term (AOR: 6.78; 95% CI: 2.41, 19.09), birth weight <2,500 gram (AOR: 3.10; 95% CI: 1.48, 6.46), maternal ever hemoglobin level <10 gm/dl (AOR: 4.04; 95% CI: 1.91, 8.57), and pre-partum onset of pregnancy induced hypertension (AOR: 4.01; 95% CI: 2.01, 6.08) were statistically significant in the multivariable logistic regression model.Conclusion: The magnitude of perinatal mortality was high as compared with the Ethiopian Health and Demographic Survey report 2016 and high parity, low in number of antenatal care visits, low gestational age, low birth weight, low maternal hemoglobin level, and pre-partum onset of pregnancy induced hypertension were independent factors which increase the perinatal mortality while spontaneous vaginal delivery reduces the mortality risk. Therefore; the community should be educated to reduce the number of instance of births. In addition; the health care professionals should emphasize on the care provided for the newborns having low birth weight and use spontaneous vaginal delivery as much as possible.

Foetal and maternal outcomes in hyperuricaemia pre-eclampsia patients in Hospital Universiti Sains Malaysia

Preeclampsia patients have frequently been found to experience hyperuricaemia and this may result in poor outcomes compared to those with normal uric acid levels. This study aimed to determine the relationship of hyperuricaemia in pre-eclampsia patients with foetal and maternal outcomes. This prospective cohort study involved 79 patients in a tertiary centre from year 2016 to 2018. Blood samples were taken antenatally and at the 6th week, post-delivery for renal function including serum uric acid level. Our findings indicate that there was a higher incidence of poor maternal and foetal outcomes in the hyperuricaemia group than the normal uric acid group. Serum uric acid has been shown to be a significant predictor for low birth weight and premature delivery in preeclampsia patients. It was also found that there was a significant negative correlation between uric acid level and antenatal creatinine clearance (r s = −0.338, p = .002). The assessment of the serum uric acid level seems to be important to ensure better outcomes in patients with preeclampsia. Impact statement What is already known on this subject? Preeclampsia is a serious pregnancy-related complication and remains as one of the most important cause of maternal and foetal morbidity and mortality, affecting 2–8% in all pregnancy. Many studies have established the association between hyperuricaemia and preeclampsia. Besides, numerous studies have found that hyperuricaemia contributed to adverse maternal and foetal outcomes. What the results of this study add? There was a significant increase in adverse foetal and maternal outcomes in the hyperuricaemia group compared to the normal uric acid group. This study revealed that serum uric acid remains a significant predictor for low birth weight and premature delivery in preeclampsia patients. What the implications are of these findings for clinical practice and/or further research? Hyperuricaemia does not merely become an indicator for the severity of disease in preeclampsia patients but also indicates adverse foetal outcomes. Large population-based studies are required to establish the absolute maternal and foetal outcomes in patients with hyperuricaemia. Besides, further studies are recommended on long-term implication of hyperuricaemia which is not limited to only during antenatal period.

The association between intimate partner violence and low birth weight and preterm delivery in eastern Ethiopia: Findings from a facility-based study

ObjectiveTo determine the associations between intimate partner violence during pregnancy and low birth weight and preterm birth among women who gave birth in public hospitals in Harari region, eastern Ethiopia. DesignA cross-sectional study was conducted among women who gave birth in public hospitals in Harari region. ParticipantsWomen aged 16–45 years who gave birth in hospitals from November 2018 to April 2019. SettingTwo public hospitals in Harari regional state, eastern Ethiopia MeasurementIntimate partner violence was measured using a questionnaire adapted from the World Health Organization Multi-Country Study on Women's Health and Domestic Violence against Women. Binary and multiple logistic regression was performed to establish the association between intimate partner violence and low birth weight and preterm birth. Both crude and adjusted odds ratios with 95% confidence intervals were calculated. The level of significance was set at a p-value of <0.05. ResultsIn this study, 39% of women reported experiencing partner violence during their most recent pregnancy. The prevalence of preterm birth and low birth weight were found to be 18.9% and 12.01%, respectively. After adjusting for potential confounders, women who experienced any intimate partner violence during pregnancy were 1.62 times (AOR = 1.62, 95%CI= 1.22, 2.78) more likely to give birth prematurely and 1.37 times (AOR= 1.37, 95%CI=1.73, 2.57) more likely to have a low birth weight infant relative to women who did not experience intimate partner violence during pregnancy. Conclusion and implications for practiceThe results underscore the need for including intimate partner violence prevention as an important strategy to reduce child mortality and morbidity. Screening pregnant women for intimate partner violence and providing support for women who have experienced violence might be helpful in tackling prematurity and low birth weight.

Impact of maternal HIV–HBV coinfection on pregnancy outcomes in an underdeveloped rural area of southwest China

ObjectivesOur objective was to determine the impact of maternal HIV–hepatitis B virus (HBV) coinfection on pregnancy outcomes.MethodsThe current study was conducted in a county of Yi Autonomous Prefecture in southwest...

A correlative study between maternal hemoglobin concentration during third trimester and fetal birth weight of babies born at Kathmandu Medical College and Teaching Hospital

Background: Anemia is one of the commonest health problems faced by pregnant women in both developing and developed countries. Maternal anemia is a potential risk factor for fatal outcomes like low birth weight and preterm delivery. This study intended at comparing the birth weight of the babies who were born to mothers with and without anemia during the third trimesters.&#x0D; Materials and methods: This study is a descriptive, cross-sectional study conducted at Kathmandu Medical College, Teaching Hospital from July 2019 to June 2020. The third-trimester hemoglobin of mothers was recorded along with the birth weight of their respective babies. Mothers with regular antenatal care visits at this hospital were included and the known causes for anemia like renal disorders, twin pregnancies, and others were excluded from the study. The third-trimester hemoglobin level of all pregnant females was correlated with the birth weight of the babies.&#x0D; Results: Out of a total of 2417 pregnant women, 317 (13%) had anemia. The overall prevalence of low birth weight was 12%. Out of 317 anemic mothers, 99 (31%) delivered low birth weight babies. Among those 99 low birth weight babies, 30 (30%) were preterm and 69 (70%) were term babies with the prevalence of low birth weight in anemic mothers being 31%. The correlation between maternal hemoglobin and birth weight was found to be statistically significant.&#x0D; Conclusions: Despite regular antenatal care, maternal anemia still prevails, affecting neonatal birth weight. There was a statistically significant correlation between maternal hemoglobin and birth weight (p-value &lt;0.0001).

Protective Effects of Maternal Education against Low Birth Weight Deliveries: Blacks' Diminished Returns.

Racial and economic disparities in low birth weight (LBW) deliveries is among the most well-established differences between Blacks and Whites. As LBW is an established risk factor for chronic diseases such as asthma and diabetes, it is particularly important to understand drivers of racial and economic disparities in LBW deliveries in urban areas. Built on the Minorities' Diminished Returns framework, which argues that educational attainment generates fewer positive health outcomes for Black than White Americans, we conducted this study with three aims: 1) to test the association between mothers' educational attainment and LBW of babies born in urban areas, 2) to compare Blacks and Whites for the effect of mothers' educational attainment on LBW, and 3) to test whether LBW is predictive of future chronic diseases 15 years later. Data came from the Fragile Families and Child Well-being / included a random sample of births in cities larger than 200,000 population. For the aims 1 and 2, we analyzed data of 2,922 births to Black (n = 2,146) or White (n = 776) mothers. For aim 3, we analyzed data of a subsample of 1,604 Black or White newborns who were followed to age 15. The presence or absence of chronic diseases was determined at age 15. Logistic regression was used for data analysis. Maternal educational attainment was inversely associated with LBW overall. We, however, found a significant interaction between maternal educational attainment and race, suggesting that the inverse association between maternal education and LBW is weaker for Black than White babies. At the same time, LBW increased the odds of chronic disease 15 years later. Diminished returns of maternal educational attainment contribute to racial disparities in LBW, which in turn contributes to future racial inequalities in chronic diseases in urban settings. That is, smaller protective effects of maternal education on reducing LBW for Black than White children contribute to the high prevalence of chronic diseases among adolescents in urban settings. Health disparities are not just due to racial differences in socioeconomic status but also diminishing returns of socioeconomic status indicators such as education for racial and ethnic minorities. Research should study contextual factors that reduce Blacks' ability to translate their human capital to health outcomes in urban settings.

Unculturable and culturable periodontal-related bacteria are associated with periodontal inflammation during pregnancy and with preterm low birth weight delivery

Recent studies revealed culturable periodontal keystone pathogens are associated with preterm low birth weight (PLBW). However, the oral microbiome is also comprised of hundreds of ‘culture-difficult’ or ‘not-yet-culturable’ bacterial species. To explore the potential role of unculturable and culturable periodontitis-related bacteria in preterm low birth weight (PLBW) delivery, we recruited 90 pregnant women in this prospective study. Periodontal parameters, including pocket probing depth, bleeding on probing, and clinical attachment level were recorded during the second trimester and following interviews on oral hygiene and lifestyle habits. Saliva and serum samples were also collected. After delivery, birth results were recorded. Real-time PCR analyses were performed to quantify the levels of periodontitis-related unculturable bacteria (Eubacterium saphenum, Fretibacterium sp. human oral taxon(HOT) 360, TM7 sp. HOT 356, and Rothia dentocariosa), and cultivable bacteria (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum and Prevotella intermedia) in saliva samples. In addition, ELISA analyses were used to determine the IgG titres against periodontal pathogens in serum samples. Subjects were categorized into a Healthy group (H, n = 20) and periodontitis/gingivitis group (PG, n = 70) according to their periodontal status. The brushing duration was significantly lower in the PG group compared to the H group. Twenty-two of 90 subjects delivered PLBW infants. There was no significant difference in periodontal parameters and serum IgG levels for periodontal pathogens between PLBW and healthy delivery (HD) groups. However, ordinal logistic regression analysis revealed that a higher abundance of Treponema denticola, Prevotella intermedia, Fretibacterium sp. HOT360 and lower levels of Rothia dentocariosa were significantly associated with the presence of periodontal disease during pregnancy. Moreover, the amount of Eubacterium saphenum in saliva and serum IgG against Aggregatibacter actinomycetemcomitans were negatively correlated with PLBW. Taken together, unculturable periodontitis-associated bacteria may play an important role both in the presence of periodontal inflammation during pregnancy and subsequent PLBW.

Association of smoke-free laws with preterm or low birth weight deliveries-A multistate analysis.

To assess the association between the change in statewide smoke-free laws and the rate of preterm or low birth weight delivery hospitalizations. 2002-2013 Healthcare Cost and Utilization Project State Inpatient Databases. Quasi-experimental difference-in-differences design. We used multivariate logistic models to estimate the association between the change in state smoke-free laws and preterm or low birth weight delivery hospitalizations. The analyses were also stratified by maternal race/ethnicity to examine the differential effects by racial/ethnic groups. Delivery hospitalizations among women aged 15-49years were extracted using the International Classification of Diseases, Ninth Revision, and Diagnosis-Related Group codes. Non-Hispanic black mothers had a higher rate of preterm or low birth weight delivery hospitalization than other racial/ethnic groups. Overall, there was no association between the change in smoke-free laws and preterm or low birth weight delivery rate. Among non-Hispanic black mothers, the change in statewide smoke-free laws was associated with a 0.9-1.9 percentage point (P<.05) reduction in preterm or low birth weight delivery rate beginning in the third year after the laws took effect. There was no association among non-Hispanic white mothers. A decline in the black-white disparity of 0.6-1.6 percentage points (P<.05) in preterm or low birth weight delivery rates was associated with the change in state smoke-free laws. The change in state smoke-free laws was associated with a reduction in racial/ethnic disparities in preterm or low birth weight delivery hospitalizations in selected US states.

Self-reported physical health status of donor sperm-conceived adults.

Donor-conceived neonates have poorer birth outcomes, including low birth weight and preterm delivery that are associated with poorer long-term health in adulthood through the developmental origins of health and disease (DOHaD) theory. The aim of this study was to conduct the first investigation of the adult health outcomes of donor-conceived people. An online health survey was completed by 272 donor sperm-conceived adults and 877 spontaneously conceived adults from around the world. Donor and spontaneously conceived groups were matched for age, sex, height, smoking, alcohol consumption, exercise, own fertility and maternal smoking. Donor sperm-conceived adults had significantly higher reports of being diagnosed with type 1 diabetes (P = 0.031), thyroid disease (P = 0.031), acute bronchitis (P = 0.008), environmental allergies (P = 0.046), sleep apnoea (P = 0.037) and having ear tubes/grommets surgically implanted (P = 0.046). This is the first study to investigate the health outcomes of adult donor sperm-conceived people. Donor sperm-conceived adults self-reported elevated frequencies of various health conditions. The outcomes are consistent with birth defect data from donor sperm treatment and are consistent with the DOHaD linking perturbed early growth and chronic disease in adulthood.

Perfil e resultados perinatais de gestantes com sí­ndrome hipertensiva do Sul do Brasil

Objetivou-se analisar o perfil e resultados perinatais de gestantes de alto risco com Sí­ndrome Hipertensiva. Trata-se de um estudo epidemiológico, observacional e retrospectivo, com abordagem quantitativa. Foram utilizados dados secundários de 471 gestantes de alto risco e com Sí­ndrome Hipertensiva da cidade de Sarandi/PR e posteriormente acompanhadas pelo ambulatório e realização do parto no hospital de referência, no perí­odo de 2012 a 2016, com partos realizados até 2017. As variáveis independentes foram constituí­das pela Sí­ndrome Hipertensiva, classificada em: hipertensão crônica, pré-eclâmpsia/eclâmpsia, pré-eclâmpsia sobreposta í hipertensão crônica, também conhecida como doença hipertensiva especí­fica da gestação (DHEG). As variáveis desfechos foram: prematuridade, baixo peso ao nascer, Apgar &lt;7 no 1º e 5º minutos, óbito fetal, óbito neonatal e parto cesárea. Os dados foram submetidos aos testes Qui-quadrado e Teste Exato de Fisher. Todas as discussões foram realizadas em ní­vel de 5% de significância (p&lt;0,05) e intervalo de confiança de 95%. A Sí­ndrome hipertensiva gestacional associa-se diretamente a prematuridade, o desenvolvimento de Apgar inferior a sete no quinto minuto de vida, o baixo peso ao nascer, a morte fetal e ao parto cesárea.

Unplanned out-of-hospital deliveries in Finland: A national register study on incidence, characteristics and maternal and infant outcomes.

Unplanned out-of-hospital deliveries (UOHDs) have earlier been related to higher perinatal mortality and morbidity, but recent research has not paid much attention to them. Our aim was to evaluate the incidence, characteristics, risk factors, and maternal and perinatal mortality and morbidity in UOHDs in Finland. We conducted a national register study on births, causes of death and congenital anomalies for all live and stillbirths during 1996-2013. The study group included 1420 infants delivered by mothers with UOHDs. The 1 051 139 infants born in hospitals during the study period were the reference group. Data on maternal and delivery characteristics, obstetric procedures, infants' characteristics, neonatal care unit admissions, diagnoses, congenital anomalies and causes of death were collected. The annual rate of UOHDs increased in 1996-2013 from 46 to 260 per 100 000 deliveries, whereas the number of delivery units decreased from 44 to 29. UOHD infants had five times higher perinatal mortality rates than those delivered in hospitals. The perinatal mortality rate did not change by time in the UOHDs, whereas it diminished among in-hospital deliveries. Maternal morbidity in UOHDs was low. The predictors for UOHDs were delivery after the year 2001, delivery in sparsely populated areas, alcohol, drug abuse and/or smoking during pregnancy, being single, fewer prenatal visits, having delivered earlier and birthweight <2500g. UOHD was one of the predictors of perinatal morbidity and mortality. Among the UOHD cases, the predictors of perinatal morbidity or mortality included low birthweight and preterm delivery. Time period seemed not to predict morbidity or mortality. The UOHD rate increased, probably due to multifactorial causes, including living in area with low population density and short duration of labor. UOHD was a significant predictor of perinatal morbidity or mortality, but the numbers were very small. Neonatal morbidity and mortality in UOHDs did not seem to be related to the area or time period of birth.