Survey Of Neonates In Pomerania Research Articles

Association between maternal pre-pregnancy body mass index and offspring’s outcomes at 9 to 15 years of age

ObjectiveMaternal pre-pregnancy underweight, overweight and obesity might increase the risk for worse short- and long-term outcome in the offspring. There is a need for further study into the relationship between maternal pre-pregnancy body mass index (BMI) and the combined outcome of physical development, state of health and social behavior in children. Question: Is maternal pre-pregnancy BMI associated with the child outcome in terms of physical development, state of health and social behavior (school and leisure time behavior) at the age of 9 to 15 years?MethodsIn the population-based birth cohort study Survey of Neonates in Pomerania (SNIP) children at the age 9–15 years and their families were re-examined by questionnaire-based follow-up. 5725 mother–child pairs were invited to SNiP-follow-up. This analysis is based on the recall fraction of 24.1% (n = 1379). Based on the maternal pre-pregnancy BMI (ppBMI), 4 groups were formed: underweight (ppBMI < 19 kg/m2, n = 117), normal weight (ppBMI 19–24.99 kg/m2, n = 913, reference), overweight (ppBMI 25–30 kg). /m2, n = 237) and obesity (ppBMI > 30 kg/m2, n = 109).ResultsIn the multiple regression model, the BMI-z-score for children of mothers in the underweight group was −0.50 lower, and 0.50/1.07 higher in the overweight/obese group (p < 0.001) compared to reference at median age of 12 years. No differences were found in children of underweight mothers with regard to social behavior (interaction with friends and family), school and sports performance (coded from “very good” to “poor”), other leisure activities (watching television, using mobile phones, gaming), and health (occurrence of illnesses) compared to children of normal weight mothers. In contrast, maternal pre-pregnancy overweight and obesity were associated with lower school and sports performance, and higher screen time (smart phone, gaming, television) compared to children of normal weight mothers.ConclusionMaternal pre-pregnancy overweight and obesity but not underweight was negatively associated with school performance and leisure time behavior in the offspring at 9–15 years of age.

Antenatal Care and Health Behavior of Pregnant Women-An Evaluation of the Survey of Neonates in Pomerania.

The German maternity guidelines require regular medical checkup (MC) during pregnancy as a measure of prevention. Socioeconomic factors such as education, profession, income and origin, but also age and parity may influence the preventive and health behavior of pregnant women. The aim was to investigate the influence of these factors on the participation rate in MC of pregnant women. The current analysis is based on the prospective population-based birth cohort study Survey of Neonates in Pomerania, which was conducted in Western Pomerania, Germany. The data of 4092 pregnant women from 2004 to 2008 were analyzed regarding the antenatal care and health behavior. Up to 12 MC were regularly offered; participation in 10 MC is defined as standard screening according to maternity guidelines. Women participated in the first preventive MC on average in the 10th (±3.8 SD) week of pregnancy. 1343 (34.2%) women participated in standard screening and 2039 (51.9%) took a screening above standard. 547 (13.92%) women participated in less than the 10 standard MCs. In addition, about one-third of the pregnancies investigated in this study were unplanned. Bivariate analyses showed an association between better antenatal care behavior and higher maternal age, stabile partnerships and mother born in Germany, p < 0.05. On the contrary antenatal care below standard were more often found by women with unplanned pregnancies, less educational women and women with lower equivalent income, p < 0.001. Health behaviors also influenced antenatal care. Whereas the risk of antenatal care below standard increased by smoking during pregnancy (RRR 1.64; 95% CI 1.25, 2.14) and alcohol consumption (RRR 1.31; 95% CI 1.01, 1.69), supplementation intake was associated with decreased risk (iodine-RRR 0.66; 95% CI 0.53, 0.81; folic acid-RRR 0.56; 95% CI 0.44, 0.72). The health behavior of pregnant women also differs according to their social status. Higher maternal income was negatively correlated with smoking during pregnancy (OR 0.2; 95% CI 0.15, 0.24), but positively associated with alcohol consumption during pregnancy (OR 1.3; 95% CI 1.15, 1.48) and lower pre-pregnancy BMI (Coef. = 0.083, p < 0.001). Lower maternal education was positively correlated with smoking during pregnancy (OR 59.0; 95% CI 28.68, 121.23). Prenatal care according to maternity guidelines is well established with a high participation rate in MC during pregnancy of more than 85%. However, targeted preventive measures may address younger age, socioeconomic status and health-damaging behaviors (smoking, drinking) of the pregnant women because these factors were associated with antenatal care below standard.

Maternal socioeconomic and lifestyle factors and life dissatisfaction associated with a small for gestational age infant. The Survey of Neonates in Pomerania (SNiP)

PurposeThe aim is to investigate the associations of the mother’s socioeconomic and lifestyle factors and life satisfaction with the delivery of a small for gestational age (SGA) infant.MethodsData from 4598 participants of the population-based birth cohort study Survey of Neonates in Pomerania (SniP) including comprehensive information on pregnancies, mothers, and their offspring in Western Pomerania, Germany were used in this study. The associations were analyzed using linear and logistic regression models.ResultsAfter logistic regression analysis adjusted for height of the mother, women who delivered SGA infants, had lower education (p < 0.01) and smoked more frequently during pregnancy (p < 0.01) compared with mothers of adequate for gestational age (AGA) neonates. A mother with less than 10 years of education and one who continued smoking during pregnancy had an odds ratio (OR) of 2.23 [95% confidence interval (CI) = 1.44 to 3.46] and 2.68 (95% CI = 2.06–3.49) of having an SGA infant, respectively. There was no association between the employment of the mother (p = 0.28), the monthly income (p = 0.09), the family status (p = 0.80), the number of friendships outside the household that the mother would not wish to relinquish (p = 0.47), the number of people that she could rely on in case of an emergency (p = 0.75), or alcohol consumption prior to (p = 0.14) or during the pregnancy (p = 0.99) with SGA. Finally, women who delivered SGA infants were more frequently dissatisfied with their employment (p = 0.03) and financial status (p < 0.01).ConclusionsWomen who delivered SGA infants had more associated socioeconomic and lifestyle risk factors and were more frequently dissatisfied with their life conditions than mothers of AGA neonates.

Maternal pre-pregnancy underweight as a risk factor for the offspring: Survey of Neonates in Pomerania.

The aim was to investigate socio-economic risk factors for maternal underweight before pregnancy and then associations of underweight with neonatal outcomes. Data of 3401 mother-child dyads from the population-based birth cohort Survey of Neonates in Pomerania (SNiP) were analysed. Bivariate analysis showed that underweighted mothers were younger, smoked more often, had a lower equivalent income and lower socio-economic status (employment status and/or educational level) compared to women with normal weight. The final prediction model revealed that only younger maternal age (OR=0.93; 95%-CI=0.90-0.97) and maternal smoking during pregnancy (OR=2.52; 95%-CI=1.74-3.66) were associated with underweight. Compared to women with normal pre-pregnancy BMI, underweight women had an increased chance of premature labour (OR=1.73; 95% CI: 1.29-2.31) and a reduced placental weight. The offspring of underweight women had an increased risk of late preterm birth (OR=1.82; 95% CI: 1.21-2.74) and birthweight<2500g (OR=1.91; 95% CI: 1.23-2.95). Smoking during pregnancy and a younger age were identified as risk factors for maternal pre-pregnancy underweight which then was associated with late preterm birth and low birthweight.

Survey of Neonates in Pomerania (SNiP): Study design and cohort update

The health status of newborns is a major concern for parents and medical personnel. Recent studies have provided increasing evidence that factors from the foetal and perinatal periods of life influence health later in life. The "Follow-up of the Survey of Neonates in Pomerania" (SNiP-I-Follow-up) is the first follow-up of the population-based birth cohort study, SNiP-I, established in north-east Germany. The primary aim of SNiP-I-Follow-up study was the collection of longitudinal data on children and adolescents. The associations will be analysed between risk factors in pregnancy and the perinatal period and health status in infancy and later childhood. The population-based cohort study SNiP-I was conducted in Pomerania in north-east Germany between February 2002 and November 2008. All mothers from the SNiP-I birth cohort were recontacted when their children were from 9 to 15years of age. The SNiP-I-Follow-up study was carried out between December 2016 and August 2017 and is a questionnaire-based survey. Physical development, health status, and social behaviour (school and leisure behaviour) of children were analysed using a questionnaire comprising medical, epidemiological, and socio-economic data, associated health care risk factors, and life circumstances of newborns, children, and their parents. Out of 5725 children invited to participate in the SNiP-I-Follow-up study between December 2016 and August 2017, 29% (n=1665) children participated in the SNiP-I-Follow-up study, providing data on 1665 mothers-child dyads. Responders had higher socio-economic status, especially in relation to maternal education status. As a longitudinal birth cohort from rural Germany, the SNiP cohort will be a resource to address urgent research needs and contribute to overall population health.

Analyses of pathological cranial ultrasound findings in neonates that fall outside recent indication guidelines: results of a population-based birth cohort: survey of neonates in Pommerania (SNiP-study)

BackgroundRecent guidelines recommend a cranial ultrasound (CU) in neonates born at < 30 weeks gestation, admitted to the neonatal intensive care unit (NICU), or with a CU indication. Here, we addressed the need to extend these recommendations.MethodsWe retrospectively reviewed 5107 CUs acquired in the population-based Survey of Neonates in Pomerania, conducted in 2002 to 2008. Neonates with conspicuous CUs that were ≥ 30 weeks gestation without recent indications for CU were identified and assigned to the following groups: with (I) or without (II) admission to neonatal care. We designated CU conspicuities as mild (MC) or significant (SC), and we investigated related neurodevelopment during follow-up.ResultsOf 5107 neonates, 5064 were born at ≥30 weeks gestation and of those, 4306 received CUs without any indication for this examination. We found conspicuities in 7.7% (n = 47/610) of group I (n = 30 MC, n = 17 SC), and 3.2% (n = 117/3696) of group II (n = 100 MC, n = 17 SC). In group II, SC comprised, e.g., bilateral cysts, partial agenesis of the corpus callosum, and periventricular leukomalacia. Follow-up was available in 75% of infants in group II with MCs and SCs; of these, 12.8% had an abnormal neurological follow-up.ConclusionsWe detected a high number of conspicuities in neonates without a CU indication. However, we could not demonstrate that ultrasound findings were associated with the neurological follow-up or any advantage to an earlier diagnosis. Our data did not support extending current guidelines or a general CU screening policy for all neonates.

Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: a population-based study

BackgroundGestational diabetes mellitus (GDM) is the most frequent complication during pregnancy. Untreated GDM is a severe threat to maternal and neonatal health. Based on recent evidence, up to 15% of all pregnancies may be affected by GDM. We hypothesized that in a rural birth cohort, higher maternal BMI and adverse socioeconomic conditions would promote GDM, which in turn would lead to adverse effects on pregnancy outcomes.MethodsThe current study is a part of a population-based cohort study examining the health and socioeconomic information from 5801 mothers and their children. The study, titled the Survey of Neonates in Pomerania (SNiP), was based in northeastern Pomerania, Germany (2002–2008).ResultsThe cumulative incidence of GDM was 5.1%. Multiple logistic regression revealed prepregnancy overweight (OR 1.84 (95% CI 1.27–2.68)), prepregnancy obesity (OR 3.67 (2.48–5.44)) and maternal age (OR 1.06 (1.03–1.08)) as risk factors for GDM (p = 0.001). Alcohol use during pregnancy (OR 0.61 (0.41–0.90), a higher monthly income (OR 0.62 (0.46–0.83)), and the highest level of education (OR 0.44 (0.46–0.83)) decreased the risk of GDM.Newborns of GDM mothers had an increased risk of hypoglycaemia (OR 11.71 (7.49–18.30)) or macrosomia (OR 2.43 (1.41–4.18)) and were more often delivered by primary (OR 1.76 (1.21–2.60)) or secondary C-section (OR 2.00 (1.35–2.97)). Moreover, they were born 0.78 weeks (95% CI -1.09 – -0.48 weeks) earlier than infants of mothers without diabetes, resulting in higher percentage of late preterm infants with a gestational age of 32–36 weeks (11.1% vs. 6.96%).ConclusionsAge and BMI before pregnancy were the predominant mediators of the increased risk of GDM, whereas a higher income and educational level were protective. GDM affected relevant perinatal and neonatal outcomes based on its association with an increased risk of delivery by C-section, preterm birth, macrosomia at birth and neonatal hypoglycaemia.

Population-based study of the incidence of congenital hip dysplasia in preterm infants from the Survey of Neonates in Pomerania (SNiP)

BackgroundSome etiological factors involved in developmental dysplasia of the hip (DDH) occur in the last trimester of pregnancy, which could result in a decreased incidence of DDH in preterm infants. The aim of this study was to compare the incidence of DDH between preterm and term infants.MethodsUltrasound of the hip joint was performed in 2,534 term infants and 376 preterm infants within the population-based Survey of Neonates in Pomerania (SNiP) study.ResultsA total of 42 (1.66%) term infants had DDH (Graf type II c, 0.8%; type D, 0.3% left and 0.4% right; type III a, 0.2% left). Eighteen infants had bilateral findings. Hip dysplasia occurred more frequently in female neonates (32/1,182 vs. 10/1,302, p < 0.023; 95% CI 0.012–0.022, χ2 test). A familial disposition for DDH was found in 169 (6.7%) term infants and 181 (7.1%) infants in the overall population. In preterm infants, dysplasia of the hip was found in only three late preterm infants with gestational age between 36 and 37 weeks (n = 97) and not in preterm infants <36 weeks gestational age (n = 279). Regression analysis revealed a narrowly significant association between gestational week of birth and DDH (relative risk = 1.17; 95% confidence interval 0.99–1.37; p = 0.065).ConclusionOur study suggests that preterm infants <36 weeks gestational age have a decreased risk of DDH.

Breastfeeding motivation in Pomerania: Survey of neonates in Pomerania (SNiP-Study).

BackgroundThe Nationale Stillkommission was founded in Germany in 1994 to increase the acceptance of breastfeeding as the primary means of infant nutrition. Scientific studies like “Stillen und Säuglingsernährung (SuSe-Studie)”, and regional studies in Bavaria, Freiburg, Hamburg, and Berlin demonstrated breastfeeding initiation rates of 90 to 95%, but the total breastfeeding rate decreased to 25–61% after infants were 6 months old. One predictor of breastfeeding duration may be maternal motivation. The present study aimed to describe breastfeeding motivation.MethodsWe analysed data collected in 2004–2008, during a previous study, the Survey of Neonates in Pomerania (SNiP). We retrieved data regarding maternal breastfeeding motivation, family environment, and socioeconomic factors. We constructed a quantitative breastfeeding-motivation score to identify factors involved in maternal breastfeeding.ResultsNinety five percent of mothers who gave birth in the study period and area provided information in the survey. The breastfeeding initiation rate was 88.4%. Mothers’ intentions to provide exclusive breastfeeding (only breast milk, no other liquids or infant formula) increased linearly from 71.9% in 2005 to 76.8% in 2008. Women motivated to provide exclusive breastfeeding were, on average, older, primiparous, and able to deliver spontaneously more often than women with less breastfeeding motivation. Furthermore, women with no motivation to provide exclusive breastfeeding and women that intended to provide breastfeeding combined with a complementary nutrition source had visited prenatal classes less frequently, had lower levels education, had lower average incomes, had a German nationality more often, and used tobacco more often than women motivated to provide exclusive breastfeeding.ConclusionsBreastfeeding intentions increased during the SNiP Study. This study identified several factors that might serve for targeted breastfeeding promotion in mothers younger than 25 years, mothers with low education, and multiparous mothers or women who have received a caesarean section. Furthermore, breastfeeding motivation might be enhanced during pregnancy and/or after delivery by providing prenatal classes.

The impact of socioeconomic factors on the efficiency of voluntary toxoplasmosis screening during pregnancy: a population-based study

BackgroundCongenital toxoplasmosis is associated with severe complications. German state health insurance covers rubella, but not toxoplasmosis, immunity screening. We analysed the effect of socioeconomic factors on the efficiency of private toxoplasmosis screening during pregnancy.MethodsToxoplasmosis and rubella screening data (n = 5402 mothers) were collected within the population-based Survey of Neonates in Pomerania (SNiP).ResultsAt the first-trimester screening, 34.4 % (88.1 %) of expecting mothers were immune to toxoplasmosis (rubella). Susceptibility for toxoplasmosis (rubella) was observed in 39.6 % (8.9 %) and 25.8 % (2.95 %) were not tested. Data on a 2nd screening were available in a subgroup of women with negative immunity showing less than 45 % participation rate. Active toxoplasmosis (no rubella) infection was observed in 0.3 % (n = 17) of pregnant women. A multiple logistic regression model (AIC = 719.67; AUC = 0.725) revealed that the likelihood of participating in a second toxoplasmosis screening increased among women with a good level of education and a steady partnership and decreased with paternal unemployment and the absence of breastfeeding. The highest probability of non-participation in toxoplasmosis screening was found among women with temporal burden and family responsibilities. A cost-benefit analysis showed that covering general screening for toxoplasmosis with health insurance saved costs.ConclusionToxoplasmosis carried a substantial risk of infection during pregnancy. Although increased socioeconomic status was positively associated with the participation in toxoplasmosis screening, this was not the case when pregnant women had strong temporal burden and family responsibilities. This data supports the need for toxoplasmosis screening among pregnant women as a general healthcare benefit covered by insurance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0966-0) contains supplementary material, which is available to authorized users.

PO-0544 Voluntary Toxoplasmosis Screening In Pregnancy Underestimates Active Infection In Dependency Of Socioeconomic Factors: Data From A Population-based Survey Of Neonates In Pomerania (snip)

Background and purpose 40% of all initial infections with Toxoplasma gondii during pregnancy develop into connatal toxoplasmosis, which is associated with the risk of severe damage to the CNS, frequent premature deliveries, and stillbirths. In Germany, toxoplasmosis immunity screenings are not covered by the state health insurance as a general preventive care service, in contrast to screening for rubella immunity. Therefore, we analysed the impact of socioeconomic factors on the efficiency of private toxoplasmosis screening during pregnancy in a population-based study. Material and methods Toxoplasmosis and rubella screening data were collected from 5403 mothers during the period from May 2002 to June 2008 within the population-based Survey of Neonates in Pomerania (SNiP). Results At the first screening, 34.2% of expecting mothers were immune to toxoplasmosis, 75.2% had immunity against rubella after active immunisation. Negative immunity for toxoplasmosis was found in 39.7% and in 7.7% for rubella (missing information: toxoplasmosis: 25.8%; rubella 17.2%). Less than 10% of the women without immunity participated in a second toxoplasmosis screening. An active toxoplasmosis infection was found in 0.3% (n = 17) women during pregnancy. There were no infections with the rubella virus. Pregnant women with a higher socioeconomic status participated in screenings considerably more frequently. Conclusion Our population-based sample demonstrated a substantial risk of toxoplasmosis infection during pregnancy in contrast to the rubella risk. Furthermore, lower socioeconomic status adversely affects the rate of toxoplasmosis screening. This data support the need for toxoplasmosis screening for pregnant women as a general health care benefit covered by insurance.

Chronic diseases in pregnant women: prevalence and birth outcomes based on the SNiP-study

BackgroundThe subject of “pregnancy and disease” is of particular importance for maternal well-being and neonatal outcomes. The international literature has focused on acute diseases during pregnancy; however, there are only a few studies investigating chronic diseases in pregnant women. The focus of this study is on diseases of women in childbearing age that are not related to the pregnancy. The objective of the paper is to deliver population based prevalences of chronic dieases in childbearing women and compare the two groups of chronically ill women and healthy women in detail regarding sociodemography, peri- and prenatal parameters and birth outcomes.MethodsData of n = 5320 childbearing women were evaluated in the context of the population-based Survey of Neonates in Pomerania (SNiP). Data were obtained via face-to-face interviews, self-applied questionnaires, and abstraction from medical records at the time of giving birth. Sociodemographic and health status data were assessed, including chronic diseases that were taken out of medical records. A comprehensive set of pre- and perinatal varaiables were assessed.ResultsIn the SNiP, every fifth pregnant woman suffers from at least one chronic disease, and higher prevalence rates have been reported in the literature. There was a significant difference between chronically ill women and healthy women in age, education and income. Prenatal complications were more frequent in the healthy group than in the chronic disease group. Women with chronic diseases delivered by Cesarean section more frequently than women in the healthy group. Every tenth woman with at least one chronic disease gave birth to a premature infant, while only one in every 13 woman in the healthy control group gave birth to a premature infant.ConclusionsThis analysis is the first population-based study in which all chronic diseases could be taken into consideration. The population-based prevalences rates in the SNiP data are consistently lower than those found in the literature. There are differences between chronically ill women and healthy women in peri- and prenatal variables as well as birth outcome on the population level. However, they are less frequent than expected and further analyses are need focusing on specific diseases.

Inzidenz und Therapiedauer pathologischer Hüftbefunde im Rahmen der U2- und U3-Untersuchung (SNiP Studie)

Determination of the efficacy of an early ultrasound examination followed by immediate treatment of hip joint dysplasia as well as measuring the therapeutic success in a population-based cohort study of neonates. The Survey of Neonates in Pomerania (SNiP) study included 4,093 neonates which represents 95.1 % of the total neonatal population. Of these children 2,534 (61.9 %) underwent ultrasound examination of the hip joint during the U2 stage (3-10 days after birth). The mean gestational age was 38.9 weeks. The sonographic classification was performed according to Graf. Initially (U2 stage) 42 (1.66 %) children were reported to be in need of therapy (stage IIc or higher according to Graf). The analysis showed a significantly higher incidence in girls (32 girls vs. 10 boys, p < 0.023, χ(2) test) and in children who had a breech birth (116, 4.6 %). A genetic predisposition was ascertained in 180 (7.1 %) children. The children could be subdivided into two groups: 1) children who underwent hip joint ultrasound during both U2 and U3 and 2) children who were first screened at the U3 stage. Of the 49 out of 54 neonates where the ultrasound findings were positive at the U2 examination the hip joint was matured in 32 children at U3 (4-8 weeks), 11 children had to be treated for 8-12 weeks 5 children were treated for over 3 months and1 child needed surgical correction. The early diagnosis of hip maturation disorders and joint dysplasia facilitates early implementation of effective treatment. At our clinic over 60 % of the infants underwent the U2 check up and, given a pathological finding, could undergo early treatment. It was possible to successfully treat 78 % of these children with a Tübingen hip flexion splint in just 4-8 weeks. In contrast, infants who were first examined at the U3 stage needed treatment for 4-12 months. In our opinion, early diagnosis at the age of 3-10 days should be carried out for all newborns.

Ultrasound Screening Strategies for the Diagnosis of Congenital Anomalies of the Kidney and Urinary Tract

Congenital anomalies of the kidneys and urinary tract (CAKUT) are among the most common anomalies in newborn infants, and may cause chronic renal disease in newborns. We investigated the sensitivity and specificity of different ultrasound-based screening strategies for CAKUT. Newborns (n = 4331) were analyzed for CAKUT in at least one ultrasound examination as a part of the Survey of Neonates in Pomerania (SNiP), a 7-year population-based study on neonates in Western Pomerania (Germany). Intrauterine ultrasound examinations were compared with early postnatal ultrasound findings (from days 3 - 7 of life) and pathological findings within the first 6 months of postnatal life. Cases of CAKUT were detected in 309 (3.7 %) kidneys in one ultrasound examination at the following points of time at least: (i) prenatally in 56 newborns (18.2 %), (ii) 3 - 7 days postnatally in 201 newborns (65.2 %) and (iii) in 52 newborns (17 %) during the 6-month follow-up. The prevalence was significantly higher in male infants, and hydronephrosis was found to be the most frequent obstructive nephropathy (83.3 %). Significant co-morbidity was observed with CNS malformations. The diagnostic sensitivity was significantly higher in postnatal ultrasound screening (79.6 vs. 18.2 % prenatally), while the specificity was above 99 % at all time points. This study demonstrates a high prevalence of CAKUT and demonstrates the importance of combined prenatal and postnatal ultrasound examinations for early CAKUT diagnosis.

Changing maternity leave policy: Short-term effects on fertility rates and demographic variables in Germany

Changes in reproductive behaviour and decreasing fertility rates have recently led to policy actions that attempt to counteract these developments. Evidence on the efficacy of such policy interventions, however, is limited. The present analysis examines fertility rates and demographic variables of a population in Germany in response to new maternity leave regulations, which were introduced in January 2007. As part of a population-based survey of neonates in Pomerania (SNiP), all births in the study region from the period 23 months prior to January 1st, 2007 until 23 months afterwards were examined. Crude Birth Rates (CBR) per month, General Fertility Rates (GFR) per month, parity and sociodemographic variables were compared using bivariate techniques. Logistic regression analysis was performed. No statistically significant difference in the CBR or GFR after Jan. 1st, 2007 was found. There were statistically significant differences in other demographic variables, however. The proportion of mothers who (a) were employed full-time before pregnancy; (b) came from a higher socioeconomic status; and (c) had higher income levels all increased after January 1st, 2007. The magnitude of these effects was higher in multigravid women. Forward stepwise logistic regression found an odds ratio of 1.79 for women with a family income of more than 3000 euro to give birth after the new law was introduced. This is the first analysis of population-based data that examines fertility rates and sociodemographic variables in response to new legal regulations. No short-term effects on birth rates were detected, but there was a differential effect on the subgroup of multigravidae. The focus of this policy was to provide financial support, which is certainly important, but the complexity of having a child suggests that attitudinal and motivational aspects also need to be taken into account. Furthermore, these analyses were only able to evaluate the short-term consequences of the policy; further studies are needed to assess for different, long-term effects.

Survey of Neonates in Pomerania (SNiP): a population-based birth study - objectives, design and population coverage

Neonatal health is of major concern to parents, midwives, physicians and society as a whole, yet a prospective population-based birth cohort to collect comprehensive data on multiple issues including medical, social, environmental and genetic aspects remains to be established in Germany. The survey of newborns in Pomerania (SNiP) described in this paper attempts to take up this goal. The objectives of SNiP are to establish (a) a population-based birth cohort providing detailed information about neonatal health, morbidity and mortality, (b) a biobank with newborn DNA and serum from cord blood, placenta tissue samples and DNA obtained from oral mucosal swabs of the mothers, (c) a prospective study design by re-examination of the SNiP population prior to attendance at primary school. From March 2003 until November 2008 all childbearing mothers in a well-defined region in North-Eastern Germany were asked to participate with their newborns. Detailed data on health status of the newborn, pregnancy, medical and family history, socio-economic status and maternal life style were obtained via face-to-face interview, standardised questionnaires and medical records. Placental tissue samples, cord blood plasma and DNA were continuously collected; sampling of maternal DNA from mouth swabs started in 2007. As a result, during the study period n = 6747 births and n = 6828 babies were enrolled. A population coverage of 95% was achieved. The active participation rate was 75%. A non-responder analysis revealed no meaningful selection bias. Thus, SNiP is a population-based, representative study in Germany that is able to describe the health and living conditions of newborns and their families comprehensively. It can contribute to existing knowledge and to similar cohort studies since data are accessible by researchers.

Survey of Neonates in Pomerania (SniP): A population based analysis of the mothers’ quality of life after delivery with special relations to their social integration

Women's overall quality of life prior to delivery and the changes expected by the mothers within the near future have been analyzed addressing items like employment, finances, housing and relationships to family, friends and neighbours. Population based women were asked to answer a questionnaire (Survey of Neonates in Pomerania - SNIP) during their stay at the hospital after delivery. The area studied is North-East Germany. The study included 1553 women with 1122 questionnaires (72.3%) analyzed. Positive assessment concerning the quality of life was observed in 91.2% without expecting serious worsening after delivery. Negative assessments were found within the categories employment (23.3%) and finances (26.3%). Worsening was expected within employment (34%), finances (52.1%) and shortening of spare time (39.6%). Within all other categories no changes or even an improvement after delivery were expected. The overall assessment was correlated to the mothers' social relationship. Most women stated their own quality of life as positive, none expected serious worsening. Employment, finances and social bindings are factors with strong relationship on the mothers' self-assessment.

Prävalenz des Rauchens vor und während der Schwangerschaft - populationsbasierte Daten

Population-based data on smoking behavior in Germany of women before or during pregnancy have been lacking. Smoking rates of these women have now been recorded over a period of 3 years against the background of growing tobacco control activities in Germany. The study was conducted between 4/2003 and 3/2006 in the context of a prospective population-based survey about perinatal morbidity and mortality (Survey of Neonates in Pomerania - SNiP). This survey registers all newborns and their mothers in one defined region. Of the women eligible for the study 2 297 (68.1%) participated after delivery by giving data about their smoking behavior before and during pregnancy. 61.2% of the women had smoked at some time, 46.6% had smoked before, 24.2% into the 4. month and 20.5% into the last 4 weeks of pregnancy. Smoking rates remained unchanged over the 3 years that were studied. The rates of smokers who had quit by the time of delivery varied according to the length of school education: (<10 years: 30%; 10 y: 59%; >10 y: 84%) and age (<24 years: 45%; 25-30 y: 65%; >30 y: 77%). This study for the first time provides population-based data about the prevalence of smoking before and during pregnancy among women in Germany. The data show extremely high numbers of smokers, especially younger women and women of only 10 years or less of school education. Despite growing tobacco control activities no changes in smoking rates were observed over three years. These findings underline the need to develop effective interventions to prevent smoking of women before and during pregnancy.