Maternal Socioeconomic Characteristics Research Articles

Characteristics associated with non-initiation and non-completion of human papillomavirus vaccination among Danish girls: a nationwide register-based cohort study.

The aim was to identify maternal and paternal socioeconomic and demographic characteristics for non-initiation and non-completion of the human papillomavirus (HPV) vaccination among Danish girls including time-trends. This nationwide register-based cohort study included all girls residing in Denmark who were offered free-of-charge HPV vaccination as a part of the childhood vaccination program between 2009 and 2018 (birth cohorts 1996-2005). The study samples included 296,461 daughter-mother dyads and 291,025 daughter-father dyads. Data from the Danish Vaccination Register were linked with socioeconomic and demographic data from Statistics Denmark. HPV vaccination status was classified as 'non-initiation' for girls who received no HPV vaccine and as 'non-completion' for girls who initiated the HPV vaccination program but did not receive all the scheduled HPV vaccines. Data were analyzed using logistic regression models. Non-initiation of HPV vaccination was 13.7%, and non-completion was 24.2% among girls who initiated the HPV vaccination program. Girls of parents who were descendants of immigrants (adjusted odds ratio: 1.50; 95% confidence interval: 1.35-1.68), were at least 35-years old at time of birth, had basic or no education, had a low income, were not in the labor market, and were unmarried had the highest non-initiation and non-completion odds. The associations between socioeconomic and demographic characteristics and HPV vaccination uptake were similar for mothers and fathers. Despite free-of-charge availability to HPV vaccination in Denmark, we found disparities in non-initiation and non-completion of HPV vaccination among Danish girls by both mothers' and fathers' socioeconomic and demographic characteristics.

Maternal socio-economic and neonatal medical characteristics associated with survival of preterm neonates in Torit State Hospital, South Sudan: a descriptive cross-sectional study

Introduction: One in 10 babies is born preterm globally. Preterm birth is a major cause of mortality among children under 5 years old especially in sub-Saharan Africa. The socio-economic and clinical characteristics associated with survival of preterm babies admitted in Torit State Hospital are unknown. This study describes these characteristics to inform quality-of-care initiatives to improve preterm neonatal care.
 Method: A retrospective study was conducted of the medical records of 67 preterm neonates admitted from 1st January to 31st December 2021. Neonatal outcome at discharge was recorded as alive, dead, or absconded while neonatal clinical and maternal socio-economic characteristics were recorded as independent variables. The data were analysed using SPSS Statistics software version 21. Descriptive statistics including frequencies and proportions were calculated. Differences in the proportions were tested using the chi-squared statistic. All significance levels were set at p ≤ 0.05.
 Results: Of the 67 preterm babies admitted, 47 (70.1%) were discharged alive with a significant increase in body weight, 18 (26.9%) died and the outcomes of two patients were not recorded. The ability to suckle at the time of admission (p=0.01) and having a mother educated to at least primary level (p=0.035) were significantly associated with higher preterm survival.
 Conclusions: Premature mortality was common among preterm babies who were not able to suckle at the time of admission and lack of formal maternal education was associated with low survival rates. Educating girls to at least primary level can contribute significantly to preterm neonatal survival.

Maternal demographic, socioeconomic and environmental characteristics and adverse pregnancy outcomes, A structural equation model

Maternal demographic, socioeconomic and environmental characteristics and adverse pregnancy outcomes, A structural equation model

Abnormal birth weights for gestational age in relation to maternal characteristics in Sweden: a five year cross-sectional study

BackgroundAbnormal birth weight – small for gestational age (SGA) and large for gestational age (LGA) – are important indicators for newborn health. Due to changes in lifestyle in recent decades, it is essential to keep up-to-date with the latest information on maternal factors linked to abnormal birth weight. The aim of this study is to investigate SGA and LGA in relation to maternal individual, lifestyle and socioeconomic characteristics. .MethodsThis is a register-based cross-sectional study. Self-reported data from Sweden’s Salut Programme maternal questionnaires (2010–2014) were linked with records in the Swedish Medical Birth Register (MBR). The analytical sample comprised 5089 singleton live births. A Swedish standard method using ultrasound-based sex-specific reference curves defines the abnormality of birth weight in MBR. Univariable and multivariable logistic regressions were used to examine crude and adjusted associations between abnormal birth weights and maternal individual, lifestyle and socioeconomic characteristics. A sensitivity analysis, using alternative definitions of SGA and LGA under the percentile method, was undertaken.ResultsIn multivariable logistic regression, maternal age and parity were associated with LGA (aOR = 1.05, CI = 1.00, 1.09) and (aOR = 1.31, CI = 1.09, 1.58). Maternal overweight and obesity were strongly associated with LGA (aOR = 2.28, CI = 1.47, 3.54) and (aOR = 4.55, CI = 2.85, 7.26), respectively. As parity increased, the odds of delivering SGA babies decreased (aOR = 0.59, CI = 0.42, 0.81) and preterm deliveries were associated with SGA (aOR = 9.46, CI = 5.67, 15.79). The well-known maternal determinants of abnormal birthweight, such as unhealthy lifestyles and poor socioeconomic factors, were not statistically significant in this Swedish setting.ConclusionsThe main findings suggest that multiparity, maternal pre-pregnancy overweight and obesity are strong determinants for LGA babies. Public health interventions should address modifiable risk factors, especially maternal overweight and obesity. These findings suggest that overweight and obesity is an emerging public health threat for newborn health. This might also result in the intergenerational transfer of overweight and obesity. These are important messages for public health policy and decision making.

Association between maternal postpartum depressive symptoms, socioeconomic factors, and birth outcomes with infant growth in South Africa

This study aimed to investigate the association between maternal postpartum depressive symptoms, household demographic, socioeconomic, and infant characteristics with infant physical growth, and how these factors correlate to determine latent factors. This study was based on the baseline data of a 6-month randomised controlled trial aimed at providing an egg a day to infants aged 6 to 9-months from a low socioeconomic community in South Africa. Information collected on household demographic, socioeconomic, and infant characteristics was by face-to-face structured interviews, and trained assessors took anthropometric measurements. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal postpartum depressive symptoms. The analysis was based on 428 mother-infant pairs. Total EPDS score and its subscales score were not associated with stunting or underweight risk. However, a three- to four-fold increased risk of stunting and underweight, respectively was observed for premature birth. Low birthweight was associated with an estimated six-fold increased risk of underweight and stunting. Being female was associated with about 50% reduced risk of stunting and underweight. In conclusion, more robust studies are needed to substantiate these findings, with more awareness creation on the consequences of LBW and prematurity on the physical growth of infants from resource-limited settings.

Maternal Tobacco Smoking During Pregnancy and Children's Emotional and Behavioral Trajectories: The EDEN Mother-Child Birth Cohort Study.

The nature of the relationship between maternal tobacco smoking during pregnancy and the occurrence of children's behavioral problems is still a matter of controversy. We tested this association using data collected among a sample of pregnant women and their offspring followed up from birth to early adolescence (age 12 years), accounting for multiple parent, child, and family characteristics. Data come from 1424 mother-child pairs participating in the Étude des Déterminants pré et post-natals précoces du développement psychomoteur et de la santé de l'ENfant mother-child cohort in France. Using repeated measures (3, 5.5, 8, and 11.5 years) of the mother-reported Strengths and Difficulties Questionnaire, we estimated trajectories of children's emotional and behavioral difficulties. Two aspects of maternal smoking were studied: The timing (nonsmoker, smoking during the periconceptional period, or throughout pregnancy) and the level of use (cigarettes/day) during the first trimester of pregnancy. Robust Poisson regression models controlled for confounding factors including maternal mental health and socioeconomic characteristics using propensity scores with the overlap weighting technique. Contrary to bivariate analyses, in propensity score-controlled regression models, maternal smoking throughout pregnancy was no longer significantly associated with offspring emotional or behavioral difficulties. Maternal heavy smoking (≥10 cigarettes/day) remained significantly associated with intermediate levels of conduct problems (RR 1.25, 95% CI 1.19 to 1.31). The association between maternal smoking in pregnancy and offspring's emotional and behavioral difficulties appears to be largely explained by women's other characteristics. However, maternal heavy smoking appears to be related to offspring behavioral difficulties beyond the role of confounding characteristics. The relationship between maternal smoking during pregnancy (in two modalities: Timing and level of smoking) and behavioral difficulties in children is still a matter of debate. While the relationship between any maternal tobacco use and offspring behavioral difficulties appears to be largely explained by confounding factors, heavy maternal smoking in the first trimester of pregnancy seems to be associated with offspring behavioral difficulties beyond the socioeconomic and mental health characteristics transmitted across generations.

Preterm Birth and Total Health Care Use and Costs in the First 5 Years of Life: A Population-based Study

To investigate the relationship between preterm birth and hospital / out-of-hospital care and costs over the first five years of life. Birth data from a population-based cohort of 631,532 infants born between 2007 and 2013 were linked probabilistically with data on hospitalisations, primary and secondary care, and the use of medicines. We analysed the distribution of healthcare use and public healthcare costs for infants that survived at least five years, comparing the outcomes of extremely preterm (< 28 weeks' gestation), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term infants (at least 37 weeks). A linear regression model was used to investigate the effect of preterm birth on these outcomes, controlling for important confounders including pregnancy and birth complications, neonatal morbidity, survival, and maternal socioeconomic characteristics. Preterm birth has a statistically significant and economically relevant effect on healthcare use and costs in the first five years of life. Compared with a term infant, preterm infants born 32-36 weeks, 28-32 weeks, and < 28 weeks, respectively, had an average: 7.0 (std.err.=0.06), 41.6 (0.18), and 68.7 (0.35) days more hospital days; 3.1 (0.04), 11.0 (0.13) and 13.2 (0.25) more outpatient specialist physician visits; and five-year public healthcare costs which were 1.2 (<0.01), 6.8 (0.01), and 10.9 (0.02) times higher. Preterm infants also had statistically significant higher levels of GP visits and use of medicines. Higher levels of accessible care is needed for preterm infants across healthcare settings, and over a sustained period of time. As our understanding of the impact of preterm birth on long term clinical outcomes continues to improve, clinicians and policymakers should develop an accurate recognition of these needs for appropriate resource allocation towards research priorities and early intervention strategies.

The relationship between pre-pregnancy BMI and energy and macronutrients intakes during pregnancy in women from Yucatan, Mexico

In this observational study, our aim was to analyse the association between pre-pregnancy BMI and adequacy rates of energy and macronutrient intakes in a sample of pregnant women from Yucatan, Mexico. From September to December 2019, we collected data on socioeconomic, pregnancy, and dietary characteristics, and took anthropometric measurements of women during household visits. Pre-pregnancy BMI was calculated from measured height and self-reported body weight. Energy and macronutrient intakes (obtained from three 24-h dietary recalls) were compared with the estimated trimester-specific requirements to calculate adequacies (%). Multiple linear regression models showed that after accounting for maternal socioeconomic characteristics and perinatal variables, each unit increase in pre-pregnancy BMI was associated with decreases of 2%, 2%, and 2.6% in energy, carbohydrate, and total fat intakes, respectively. These results were significant when under- and over-reporters were excluded from the analyses. Women who enter pregnancy with higher BMI values may voluntarily or involuntarily reduce their food intake. IMPACT STATEMENT What is already know about this subject? Some studies have analysed the relationship between pre-pregnancy BMI categories (normal weight, overweight, and obesity) and diet quality during pregnancy, but few studies have focussed on quantitative energy and macronutrient intakes or their adequacies in relation to pre-pregnancy BMI. What do the results of this study contribute? In this sample of Mexican women belonging to a middle socioeconomic status, we found that after excluding under- and over-reporters from the analyses and accounting for maternal socioeconomic characteristics and perinatal variables, BMI was negatively associated with adequacy intake rates of energy, carbohydrates, and total fats during pregnancy. What are the implications of these findings for clinical practice and/or further research? Women who enter pregnancy with higher BMI values may voluntarily or involuntarily reduce their food intake. These results can be used to accordingly plan diet counselling during pregnancy.

Hierarchical modelling of factors associated with anaemia among under-five children in Nigeria.

This study used a nationally representative cross-sectional data from 2018 Nigeria Demographic Health Survey (NDHS) to investigate the prevalence and factors associated with anaemia in children aged less than five years in Nigeria. Anaemia was defined as haemoglobin level <11.0g/dl, while explanatory variables included parental profile, social and environmental factors. Descriptive analyses and multivariable Poisson regression models were fitted using Stata 15 software. Associated factors were quantified using Prevalence Ratio (PR) with 95% confidence interval (CI). Of the 5834 children aged 6-59 months, 51.9% were male. The prevalence of anaemia among under-five children was 71.6% (95% CI: 69.9-73.2). Childhood anaemia was associated with history of maternal anaemia (PR 1.06; CI 1.05-1.08); having underweight mothers (PR 1.02; CI 1.00-1.05); being a Muslim (PR 1.05; CI 1.02-1.08), Igbo (PR 1.07; CI 1.01-1.14) and Hausa (PR 1.04; CI 1.01-1.07) ethnic group. Further, children from South-South (PR 1.09; CI 1.06-1.13) and South-West (PR 1.06; CI 1.02-1.10) and those currently breastfeeding (PR 1.06; CI 1.04-1.07) had higher risk of anaemia. However, children from middle (PR 0.94; CI 0.91-0.97), or higher wealth indices were less likely to have anaemia. Maternal socio-economic and nutritional characteristics were identified as key predictors of under-five anaemia. Strategies are needed to mitigate the effect of poverty and tweak new and existing nutritional intervention programs to make them responsive to socio-cultural peculiarities across the various geo-political regions of Nigeria.

The LoCo (Lockdown Cohort)-effect: Socioeconomic differences in fertility during the pandemic

Abstract Background The economic and social disruptions caused by the COVID-19 pandemic and its mitigation measures may have affected fertility unequally across social strata. If a compositional change in maternal socioeconomic characteristics is confirmed, counterintuitive changes in future population health - the LoCo-effect - are likely. Methods We analysed data from maternal inpatient discharge records containing births between January 2018 and November 2021 by Scottish Index of Multiple Deprivation (SIMD) quintile. We used monthly number of births before November 2020 to estimate expected monthly births after November 2020 and compared against observed births in each SIMD quintile. Further, we estimated associations between monthly average stringency of national mitigation measures (Stringency Index (0-100)) and births 9 to 13 months later using distributed lag models. Results Between November 2020 and November 2021, there were 1301 (10.3%) fewer births than expected for the most deprived quintile (Q1; 953 (8.7%) and 375 (4.1%) less in Q2 and Q3). In the two least deprived quintiles, however, fertility remained mostly unchanged. A 10-point increase in monthly average Stringency Index in Q1 was associated with an average cumulative decrease of 8.5 births (95%CI: -14.1; -2.8, p = 0.006) 9 to 13 months later. Conversely, this estimate was a 4.4 increase (95%CI: 1.3; 7.5, p = 0.008) in Q5 and a 5.9 increase (95%CI: 1.4; 10.4, p = 0.013) in Q4. Conclusions Apart from their exposure to pandemic and lockdowns, it is likely that, due to compositional changes in births, the observed LoCo started life, on average, more socially advantaged than previous birth cohorts in Scotland. We show a substantial decrease in fertility in the most deprived areas, while fertility remained little changed in the least deprived areas. Increases in the stringency of lockdown measures were associated with a decrease in births in the most deprived but an increase in the least deprived areas 9 to 13 months later. Key messages • Between November 2020 and November 2021, there were substantial decreases in births among deprived areas in Scotland while fertility in the least deprived areas remained mostly unchanged. • For these births, the observed compositional shift in maternal socioeconomic characteristics may lead to changes in current and future health and health needs – the LoCo (Lockdown Cohort)-effect.

Smoking during pregnancy and children’s emotional and behavioural trajectories

Abstract Background The nature of the relationship between maternal tobacco smoking during pregnancy and the occurrence of children's behavioural problems is still a matter of controversy. We tested this association using data collected among a sample of children followed from pregnancy to early adolescence (age 11.5 years), accounting for multiple parents’, children's and family characteristics. Methods Data come from 1424 mother-child pairs participating in the EDEN mother-child cohort set up in France. Using repeated measures (3, 5.5, 8 and 11.5 years) of the mother-reported Strengths and Difficulties Questionnaire, we estimated trajectories of children's emotional and behavioural difficulties. Two aspects of maternal smoking were studied: the timing and the level of use (cigarettes/day) during the first trimester of pregnancy. Multinomial regression models controlled for confounding factors including maternal mental health and socioeconomic characteristics using propensity scores with the overlap weighting technique. Results Contrary to bivariate analyses, in propensity score-controlled regression models, maternal smoking throughout pregnancy was no longer significantly associated with offspring emotional or behavioural difficulties. Maternal heavy smoking (≥10cigarettes/day) remained significantly associated with intermediate levels of overall emotional and behavioural difficulties (OR 1.64, 95%CI 1.04-2.58) and conduct problems (OR 3.05 95%CI 1.22-7.61), as well as with high levels of conduct problems symptoms (OR 2.82 95%CI 0.88-9.06) - although the latter did not reach statistical significance. Conclusions The association between maternal smoking in pregnancy and offspring emotional and behavioural difficulties appears to be largely explained by women's other characteristics. However, maternal heavy smoking appears to be related to offspring behavioural difficulties beyond the role of confounding characteristics. Key messages • The association between maternal smoking in pregnancy and offspring emotional and behavioural difficulties seem largely explained by the family's socio-demographic and behavioural characteristics. • Maternal heavy smoking appears to be related to offspring behavioural difficulties beyond the role of confounding characteristics.

Impacts of the Affordable Care Act's Medicaid Expansion on Live Births.

We hypothesize that the Affordable Care Act's (ACA) Medicaid expansion, which extended health insurance coverage to preconception, between-conception, and postconception periods for women meeting income eligibility guidelines, impacted the number of live births in the United States by increasing access to contraception and financial well-being. These impacts may differ by maternal socioeconomic and demographic characteristics. Using data from birth certificates aggregated to the state-year level and a difference-in-differences design, we estimated the association between Medicaid expansion and count of live births. We also examined whether associations differed by socioeconomic and demographic characteristics. Overall, Medicaid expansion was not meaningfully associated with the count of births (difference-in-differences ß = 0.002; 95% confidence interval [CI] = -0.010, 0.015). However, among certain groups, Medicaid expansion was associated with meaningful changes in the count of live births, though all confidence intervals included the null value. The estimate of the relation between Medicaid expansion and the count of live births was -0.025 (95% CI = -0.052, 0.001) for those ages 18-24 years; -0.078 (95% CI = -0.231, 0.075) for those who were married, and -0.035 (95% CI = -0.104, 0.034) for those who were unmarried. Despite its potential to impact live births, our results indicate that the ACA's Medicaid expansion was not, in general, associated with live births of US residents of reproductive age. However, for younger, married, and unmarried women, the magnitude of estimates supports the hypothesis of a potentially meaningful effect of Medicaid expansions on live births.

Spatial analysis of economic predictors of under-five mortality in Nigeria

AbstractGlobally, under-five mortality rates declined from 93 deaths per 1,000 live births in 1990 to 38 in 2019. Despite the remarkable progress in reducing under-five mortality globally, it is still significantly high in Nigeria with 117 deaths per 1,000 live births, meaning that 1 in 8 children die before the age of 5. The extant literature on the risk factors of under-five mortality in Nigeria have been largely limited to maternal socio-economic characteristics and environmental factors, with little known about the macroeconomic predictors within a spatial context. As a result, this study examines the macroeconomic predictors of under-five mortality in Nigeria. The data were analysed using spatial statistics. Results show that some parts of northern Nigeria are hotspots of under-five mortality. The study also discovers that inflation rate is a risk factor of under-five mortality in southern Nigeria while internally generated revenue is the predictor in the northern region. The study recommends region-specific interventions such as controlling the high rate of inflation and improving internally generated revenue to reduce under-five mortality in the country.

Association between Hypertensive Disorders of Pregnancy and Long-Term Neurodevelopmental Outcomes in the Offspring.

The long-term impact of hypertensive disorders of pregnancy (HDP) exposure on offspring health is an emerging research area. The objective of this study was to evaluate the association between a maternal diagnosis of HDP (gestational hypertension and preeclampsia) and adverse neurodevelopmental outcomes in the offspring. This was a secondary analysis of two parallel multicenter clinical trials of thyroxine therapy for subclinical hypothyroid disorders in pregnancy. Women with singleton nonanomalous gestations diagnosed with subclinical hypothyroidism or hypothyroxinemia were randomized to thyroxine therapy or placebo. The primary outcome was child intelligence quotient (IQ) at 5 years of age. Secondary outcomes included several neurodevelopmental measures, including the Bayley-III cognitive, motor, and language scores at 12 and 24 months, Differential Ability Scales-II (DAS-II) scores at 36 months, the Conners' rating scales-revised at 48 months, and scores from the Child Behavior Checklist at 36 and 60 months. Thyroxine therapy did not influence neurodevelopment in either of the primary studies. Associations between neurodevelopment outcomes and maternal HDP were examined using univariable and multivariable analyses. A total of 112 woman-child dyads with HDP were compared with 1,067 woman-child dyads without HDP. In univariable analysis, mean maternal age (26.7 ± 5.9 vs. 27.8 ± 5.7 years, p = 0.032) and the frequency of nulliparity (45.5 vs. 31.0%, p = 0.002) differed significantly between the two groups. Maternal socioeconomic characteristics did not differ between the groups. After adjusting for potential confounders, there were no significant differences in any primary or secondary neurodevelopment outcome between offspring exposed to HDP and those unexposed. However, when dichotomized as low or high scores, we found higher rates of language delay (language scores <85: -1 standard deviation) at 2 years of age among offspring exposed to HDP compared with those unexposed (46.5 vs. 30.5%, adjusted odds ratio = 2.22, 95% confidence interval [CI]: 1.44-3.42). In this cohort of pregnant women, HDP diagnosis was associated with language delay at 2 years of age. However, other long-term neurodevelopmental outcomes in offspring were not associated with HDP. · No differences were found in neurodevelopment between offspring exposed to HDP and controls.. · Higher rates of language delay at 2 years of age were found in offspring exposed to HDP.. · The results did not differ when analysis was stratified by preterm birth..

Study of the association of the nutritional profile of pregnant women with the birth weight of newborns in Morocco.

Low birth weight (LBW) is an important predictor of neonatal morbidity and mortality. It reflects the nutritional status of the mother and the quality of health care services during pregnancy. The objective of this study is to determine the factors associated with low birth weight of children born to Moroccan pregnant women in the province of El Jadida. This cross-sectional case-control study was carried out in the maternity ward of El Jadida provincial hospital on 344 parturient women, half of whom had given birth to children with an LBW and the other half of children with normal weight (NW) at birth. Information on maternal gestational and socioeconomic characteristics as well as eating habits was collected using a questionnaire and anthropometric measurements were taken on the newborns. The study identified 172 parturient who gave birth to newborns with LBW and 172 parturient who gave birth to newborns of NW. The proportions of LBW are greater in first-time mothers (50.6%) and professionally inactive (86.6%). The mean weight of LBW newborns is 2013.95 ± 372.95g compared to 3380 ± 217.59g for NW newborns. The determined factors associated with LBW are the low socio-economic level (OR = 3.18; 95% CI: 1.09-9.23), insufficient monitoring of prenatal consultation (OR = 2.91; 95% CI: 1, 71-4.95), origin from rural areas (OR = 0.52; 95% CI: 0.30-0.91) and lack of nutritional education (OR = 0.17; 95% CI: 0, 09-0.34). The daily calcium intake in mothers of newborns with LBW is 33.82% of the recommended daily allowance (RDA), the daily iron requirement coverage was 50%, folates 66, 16% and zinc 87.72% of the RDA. Well-targeted and coordinated education and awareness-raising actions on early pregnancy and feeding pregnant women could have a positive impact on improving the birth rate of children with a weight deficit.

Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.

WHO has recommended using Robson's Ten Group Classification System (TGCS) to monitor and analyze CD rates. Its failure to take some maternal and organizational factors into account, however, could limit the interpretation of CD rate comparisons, because it may contribute to variations in hospital CD rates. To study the contribution of maternal socioeconomic and clinical characteristics and hospital organizational factors to the variation in CD rates when using Robson's ten-group classification system for CD rate comparisons. This prospective, observational, population-based study included all deliveries at a gestational age > 24 weeks at the 10 hospitals of the French MYPA perinatal network in the Paris area. CD rates were calculated for each TGCS group in each hospital. Interhospital variations in these rates were investigated with hierarchical logistic regression models to quantify the variation explained by differences in patient and hospital characteristics when the TGCS is considered. Variations in CD rates between hospitals were estimated with median odds ratios (MOR) to express interhospital variance on the standard odds ratio scale. The percentage of variation explained by TGCS and maternal and hospital characteristics was also calculated. The global CD rate was 24.0% (interhospital range: 17-32%). CD rates within each TGCS group differed significantly between hospitals (P<0.001). CD was significantly associated with maternal age (>40 years), severe preeclampsia, and two organizational factors: hospital status (private maternities) and the deliveries per staff member per 24 hours. The MOR in the empty model was 1.27 and did not change after taking the TGCS into account. Adding maternal characteristics and hospital organizational factors lowered the MOR to 1.14 and reduced the variation between hospital CD rates by 70%. Maternal characteristics and hospital factors are needed to address variation in CD rates among the TGCS groups. Therefore, comparisons of these rates that do not consider these factors should be interpreted carefully.

An Association between Maternal Occupations and Low Birth Weight Infants in Japan from 1995 to 2015.

Differences in low birth weight rate depending on maternal socioeconomic characteristics have not yet been demonstrated using the Vital Statistics in Japan; therefore, this study aimed to investigate these differences according to maternal occupations. “Report of Vital Statistics: Occupational and Industrial Aspects” and the Vital Statistics in Japan were used every five years from 1995 to 2015. Nine types of occupations were compared. The low birth weight rate was calculated according to maternal occupations and year. Also, the standardized low birth weight ratio was obtained by dividing the number of low-birth-weight infants for each maternal occupation by an expected number of low birth weight infants. The standardized low birth weight ratio for manual workers was the highest among all occupations from 2000 to 2015, and it was significantly higher than one throughout the years. The ratio for clerical workers was also significantly higher than one from 1995 to 2010. Whereas, the ratio for farmers was significantly lower than one in most of the years. It was suggested that health guidance and prenatal care are particularly needed for manual workers, and a study investigating the differences in prenatal characteristics among maternal occupations is necessary for finding a reason for disparity.

Associations of maternal early-pregnancy dietary glycemic index with childhood general, abdominal and ectopic fat accumulation

SummaryBackground & aimsMaternal hyperglycemia during pregnancy is an important risk factor for childhood adiposity. Maternal dietary glycemic index during pregnancy directly influences maternal and fetal glucose concentrations. We examined the associations of maternal early-pregnancy dietary glycemic index with offspring general, abdominal and ectopic fat accumulation among normal weight and overweight or obese pregnant women and their offspring.MethodsIn a population-based cohort study among 2488 Dutch pregnant women and their children, we assessed maternal dietary glycemic index by food frequency questionnaire at median 13.4 (95% range 10.7; 21.1) weeks gestation. Dietary glycemic index was used continuously and categorized into low (≤55), normal (56–69) and high (≥70) glycemic index diet. We measured offspring BMI, total fat mass and android/gynoid fat mass ratio by DXA, and visceral fat mass and liver fat fraction by MRI at 10 years.ResultsNo associations of maternal early-pregnancy dietary glycemic index with offspring adiposity were present among normal weight women and their children. Among overweight and obese women and their children, 1-Standard Deviation Score (SDS) increase in maternal early-pregnancy dietary glycemic index was associated with higher childhood BMI (0.10 SDS, 95% Confidence Interval (CI) 0.01; 0.19), total fat mass index (0.13 SDS, 95% CI 0.05; 0.22), visceral fat mass index (0.19 SDS, 95% CI 0.07; 0.32) and tended to be associated with a higher android/gynoid fat mass ratio (0.09 SDS, 95% CI −0.01; 0.19) and higher risk of childhood overweight (Odds Ratio (OR) 1.20, 95% CI 0.97; 1.48). Overweight and obese women consuming an early-pregnancy low-glycemic index diet, as compared to an early-pregnancy normal-glycemic index diet, had children with lower BMI, total fat mass index, visceral fat mass index and android/gynoid fat mass ratio at 10 years (p-values<0.05). No women consumed a high-glycemic index diet. No associations were explained by maternal socio-economic, lifestyle and dietary characteristics, birth or childhood characteristics. No associations with liver fat fraction were present.ConclusionsIn overweight or obese women and their children, a higher maternal early-pregnancy dietary glycemic index is associated with childhood general, abdominal and visceral fat accumulation, but not with liver fat. Intervention studies among overweight and obese pregnant women may need to target the dietary glycemic index to prevent childhood adiposity.

Maternal physical, socioeconomic, and demographic characteristics and childbirth complications in rural lowland Nepal: Applying an evolutionary framework to understand the role of phenotypic plasticity.

Evolutionary perspectives on human childbirth have primarily focused on characteristics of our species in general, rather than variability within and between contemporary populations. We use an evolutionary framework to explore how physical and demographic characteristics of mothers shape the risks of childbirth complications in rural lowland Nepal, where childbearing typically commences in adolescence and chronic undernutrition is widespread, though maternal overweight is increasing in association with nutrition transition. We conducted secondary analyses of data from a cluster-randomized trial. Women aged 14-35 years were categorized by age, number of previous pregnancies, height, body mass index (BMI), husband's education, and household wealth. Multivariable logistic regression models tested whether these characteristics independently predicted risks of episiotomy and cesarean section (CS, n= 14 261), and obstructed labor (OL, n= 5185). Risks were greatest among first-time adolescent mothers, though associations with age varied by outcome. Independent of age and parity, short stature and high BMI increased risks of CS and OL, whereas associations were weaker for episiotomy. Male offspring had increased risk of CS and OL but not episiotomy. Wealth was not associated with OL, but lower wealth and lower husband's education were associated with lower likelihood of episiotomy and CS. At the individual level, the risk childbirth complications is shaped by trade-offs between fertility, growth, and survival. Some biological markers of disadvantage (early childbearing, short stature) increased the risk, whereas low socio-economic status was associated with lower risk, indicating reduced access to relevant facilities. Independent of these associations, maternal age showed complex effects.

Count Models Analysis of Factors Associated with Under-Five Mortality in Ethiopia

Background. Under-five mortality has continued a key challenge to public health in Ethiopia, and other sub-Saharan Africa countries. The threat of under-five mortality is incessant and more studies are needed to generate new scientific evidence. This study aimed to model the number of under-five deaths a mother has experienced in her lifetime and factors associated with it in Ethiopia. Method. A retrospective cross-sectional study based on data obtained from the Ethiopian Demographic and Health Survey (DHS), 2016 was used. The response variable was the total number of under-five children died per mother in her lifetime. Variables such as maternal socioeconomic and demographic characteristics, health, and environmental factors were considered as risk factors of under-five mortality. Hurdle negative binomial (HNB) regression analysis was employed to determine the factors associated with under-five mortality. Results. The data showed that 27.2% (95%CI: 0263, 0.282) of women experienced under-five deaths. The study revealed the age of mother at first birth, the age of mother at the time of under-five mortality occurred, number of household members, household access to electricity, region, educational level of the mother, sex of household head, wealth index, mother residing with husband/partner at the time of under-five mortality occurred as factors associated with under-five mortality. Age of mother at first birth 18 to 24 (IRR = .663; 95%CI: 0.587, 0.749), 25 or higher years old (IRR = 0.424; 95%CI: 0.306, 0.588), access to electricity (IRR = 0.758; 95%CI: 0.588, 0.976), primary education level of the mother (IRR = 0.715; 95%CI: 0.584, 0.875) and the richer wealth index (IRR = 0.785; 95%CI: 0.624, 0.988) were associated with reduced incidence of under-five mortality controlling for other variables in the model. Whereas older age of mother 35 to 39 (IRR = 5.252; 95%CI: 2.992, 9.218), 40 to 44 (IRR = 7.429; 95%CI: 4.188, 13.177), 45 to 49 (IRR = 8.697; 95%CI: 4.853, 15.585), being a resident of the Benishangul-gumuz region (IRR = 1.781; 95%CI: 1.303, 2.434), female household head (IRR = 1.256; 95%CI: 1.034, 1.525) were associated with an increased incidence of under-five mortality. Conclusion. The findings suggested that early age of mothers’ at first birth and old ages of mothers’, female household head and being uneducated were found to increase the incidence of the under-five mortality, whereas access to electricity and living with husband was statistically associated with reduced incidence of under-five mortality. The implication of this study is that policymakers and stakeholders should provide health education for mothers not to give birth at an earlier age and improve living standards to achieve sustainable development goals.