Trends and racial differences in birth weight and related survival.

PubMed

Alexander, G R; Tompkins, M E; Allen, M C; Hulsey, T C

1999-06-01

In the past two decades, infant mortality rates in the United States declined in African-American and White populations. Despite this, racial disparities in infant mortality rates have increased and rates of low birth weight deliveries have shown little change. In this study, we examine temporal changes in birth weight distributions, birth weight specific neonatal mortality, and the birth weight threshold for an adverse risk of survival within both racial groups in order to explore the mechanisms for the disparities in infant mortality rates. Single live births born to South Carolina resident mothers between 1975 and 1994 and considered White or African-American based on the mother's report of maternal race on the birth certificate were selected for investigation. We define the birth weight threshold for adverse survival odds as the birth weight at which 50% or more of infants in the population died within the first month of life. Despite significant increases in very low birth weight percentages, neonatal mortality rates markedly declined. Birth weight specific neonatal mortality decreased for both races, although greater reductions accrued to White low birth weight infants. By the end of the study period, the birth weight at which over 50% of newborns died within the first month of life was 696 g for Whites and 673 g for African-Americans. The ongoing decline in neonatal mortality is mainly due to reductions in birth weight specific neonatal mortality, probably related to high-risk obstetric and neonatal care. Technological developments in these areas may have differentially benefited Whites, resulting in an increasing racial disparity in mortality rates. Moreover, the relatively greater and increasing mortality risk from postmaturity and macrosomia in infants of African-America mothers may further exacerbate the racial gap in infant mortality.

The close relation between birth, abortion and employment rates in Sweden from 1980 to 2004.

PubMed

Rahmqvist, Mikael

2006-09-01

Birth and abortion rates in Sweden have fluctuated since 1980 while the proportion between the rates are the same at the beginning and end of the period. An increase in birth rates in the late 1980s resulted in a peak in 1991 and 1992, with 124,000 live births each year. Thereafter followed a steady decline in the rate until 2000, when the number of live births was about 90,000. At that point, the trend changed to an increase. The aim of this analysis was to investigate any relation between employment rates and the number of live births among women aged 20-34, and at the same time to explore the trend for abortion rates compared to the trend for live births. The relation between employment status and live birth rate is statistically more significant for women than men, and the rates have a higher correlation for the period after 1986. Young adults in this age group are vulnerable to economic cycles that can explain this covariation but the decline in birth rates in economically developed societies has multidimensional aspects and many other possible explanations. Much has been done in recent years in Sweden to decrease household inequality for families with children to avoid the risk of relative poverty, but the fact that there is no explicit health policy to reduce the abortion level that remain unchanged since the early 1980s may appear as a notable lack of strategy in a country with many other health-related goals.

[Influence of the DNA integrity of optimized sperm on the embryonic development and clinical outcomes of in vitro fertilization and embryo transfer].

PubMed

Jiang, Wei-jie; Jin, Fan; Zhou, Li-ming

2016-05-01

To investigate the influence of the DNA integrity of optimized sperm on the embryonic development and clinical outcomes of in vitro fertilization and embryo transfer (IVF-ET). This study included 605 cycles of conventional IVF-ET for pure oviductal infertility performed from January 1, 2013 to December 31, 2014. On the day of retrieval, we examined the DNA integrity of the sperm using the sperm chromatin dispersion method. According to the ROC curve and Youden index, we grouped the cycles based on the sperm DNA fragmentation index (DFI) threshold value for predicting implantation failure, early miscarriage, and fertilization failure, followed by analysis of the correlation between DFI and the outcomes of IVF-ET. According to the DFI threshold values obtained, the 605 cycles fell into four groups (DFI value < 5%, 5-10%, 10-15%, and ≥ 15%). Statistically significant differences were observed among the four groups in the rates of fertilization, cleavage, high-quality embryo, implantation, clinical pregnancy, early miscarriage, and live birth (P < 0.05), but not in the rates of multiple pregnancy, premature birth, and low birth weight (P > 0.05). DFI was found to be correlated negatively with the rates of fertilization (r = -0.32, P < 0.01), cleavage (r = -0.19, P < 0.01), high-quality embryo (r = -0.40, P < 0.01), clinical pregnancy (r = -0.20, P < 0.01), and live birth (r = -0.09 P = 0.04), positively with the rate of early miscarriage (r = 0.23, P < 0.01), but not with the rates of multiple pregnancy (r = -0.01, P = 0.83), premature birth (r = 0.04, P = 0.54), and low birth weight (r = 0.03, P = 0.62). The DNA integrity of optimized sperm influences fertilization, embryonic development, early miscarriage, and live birth of IVF-ET, but its correlation with premature birth and low birth weight has to be further studied.

Kids having kids: the teen birth rate.

PubMed

Noonan, S S

1997-08-01

This article focuses on adolescent pregnancy and birth issues in the US. Although the birth rate among adolescents aged 10-19 years in New Jersey declined to 9609 infants per year in 1994, a decline of 7% from 1990, there remain concerns about the welfare of the mother and fetal development. Adolescent birth rates in New Jersey are higher for Black youths compared to White youths (100/1000 births vs. 25.4/1000). During 1990-94, births to girls aged 10-14 years increased from 241 to 284. There are many reasons for teenage pregnancy: abuse or coercion, peer pressure, misinformation, defiant behavior, person whims, and need for success through pregnancy. Pregnant teens frequently do not receive adequate prenatal care, maintain good nutrition, and/or refrain from unhealthy habits such as cigarette smoking, alcohol drinking, and/or drug use. The lack of prenatal care until late pregnancy may be due to lack of health insurance coverage or money for transportation. Teenagers have higher rates of premature births. Fetal development may be impaired due to lack of a proper maternal diet with a sufficient amount of folic acid, iron and protein, or food intake. Teenagers have twice the rate of spina bifida. Girls need to know the facts about the risk of premature birth and low birth weight associated with their cigarette smoking during pregnancy. Girls should be asked to reduce smoking to 3-5 cigarettes per week by the next visit and to stop entirely by the following visit. Teenagers need reinforcement in adopting the right eating patterns and curbing undesirable habits. Prenatal care should be comprehensive. The evidence suggests that fetal development is hampered by the competition for resources between the mother and fetus. Health care professionals must provide contraceptives and education; most hope that the repetitive cycle of repeat pregnancy and poverty does not continue.

What contributes to disparities in the preterm birth rate in European countries?

PubMed Central

Delnord, Marie; Blondel, Béatrice; Zeitlin, Jennifer

2015-01-01

Purpose of review In countries with comparable levels of development and healthcare systems, preterm birth rates vary markedly – a range from 5 to 10% among live births in Europe. This review seeks to identify the most likely sources of heterogeneity in preterm birth rates, which could explain differences between European countries. Recent findings Multiple risk factors impact on preterm birth. Recent studies reported on measurement issues, population characteristics, reproductive health policies as well as medical practices, including those related to subfertility treatments and indicated deliveries, which affect preterm birth rates and trends in high-income countries. We showed wide variation in population characteristics, including multiple pregnancies, maternal age, BMI, smoking, and percentage of migrants in European countries. Summary Many potentially modifiable population factors (BMI, smoking, and environmental exposures) as well as health system factors (practices related to indicated preterm deliveries) play a role in determining preterm birth risk. More knowledge about how these factors contribute to low and stable preterm birth rates in some countries is needed for shaping future policy. It is also important to clarify the potential contribution of artifactual differences owing to measurement. PMID:25692506

The use of missing birth record data as a marker for adverse reproductive outcomes: a geocoded analysis of birth record data.

PubMed Central

Headley, Adrienne J.; Fulcomer, Mark C.; Bastardi, Matthew M.; Im, Wansoo; Sass, Marcia M.; Chung, Katherine

2006-01-01

Adverse reproductive outcomes (AROs) disproportionately affect black American infants and significantly contribute to the U.S. infant mortality rate. Without accurate understanding of AROs, there remains little hope of ameliorating infant mortality rates or eliminating infant health disparities. However, despite the importance of monitoring infant mortality rates and health disparities, birth record data quality is not assured. Racial disparities in the reporting of birth record data have been documented, and missing birth record data for AROs appears to be disproportionate. Due to the extent of missing birth record data, innovative strategies have been developed to evaluate relationships between maternal socioeconomic status (SES) and community-based ARO rates. Because addresses convey aggregate information about income level, education and occupation, ZIP codes, census tracts and census block-groups have been applied to geocoding efforts. The goals of this study are to: 1) analyze the extent of missing birth record data for New Jersey areas with high rates of an ARO (preterm birth), 2) evaluate associations between the extent of missing birth record data and other AROs, and 3) consider how geocoding strategies could be applied to provide a basis for understanding maternal SES risk factors and ARO resource allocation for at-risk communities. PMID:16895276

[Problems of the birth rate of population and scientific-practical approaches to their solution].

PubMed

Deĭkun, M P

2003-01-01

Data are submitted to the effect that the population birth-rate is a national, political, and social problem rather than medical one only. An account is given of those factors affecting the level of birth-rate and health of newborn infants at the present stage of development of the society. Chief requirements the programme is to comply with are specified. Carrying out the projects suggested will, we believe, help in putting an end to further aggravation of the crisis.

Planned home birth: benefits, risks, and opportunities

PubMed Central

Zielinski, Ruth; Ackerson, Kelly; Kane Low, Lisa

2015-01-01

While the number of women in developed countries who plan a home birth is low, the number has increased over the past decade in the US, and there is evidence that more women would choose this option if it were readily available. Rates of planned home birth range from 0.1% in Sweden to 20% in the Netherlands, where home birth has always been an integrated part of the maternity system. Benefits of planned home birth include lower rates of maternal morbidity, such as postpartum hemorrhage, and perineal lacerations, and lower rates of interventions such as episiotomy, instrumental vaginal birth, and cesarean birth. Women who have a planned home birth have high rates of satisfaction related to home being a more comfortable environment and feeling more in control of the experience. While maternal outcomes related to planned birth at home have been consistently positive within the literature, reported neonatal outcomes during planned home birth are more variable. While the majority of investigations of planned home birth compared with hospital birth have found no difference in intrapartum fetal deaths, neonatal deaths, low Apgar scores, or admission to the neonatal intensive care unit, there have been reports in the US, as well as a meta-analysis, that indicated more adverse neonatal outcomes associated with home birth. There are multiple challenges associated with research designs focused on planned home birth, in part because conducting randomized controlled trials is not feasible. This report will review current research studies published between 2004 and 2014 related to maternal and neonatal outcomes of planned home birth, and discuss strengths, limitations, and opportunities regarding planned home birth. PMID:25914559

Impact of family planning programs in reducing high-risk births due to younger and older maternal age, short birth intervals, and high parity.

PubMed

Brown, Win; Ahmed, Saifuddin; Roche, Neil; Sonneveldt, Emily; Darmstadt, Gary L

2015-08-01

Several studies show that maternal and neonatal/infant mortality risks increase with younger and older maternal age (<18 and >34 years), high parity (birth order >3), and short birth intervals (<24 months). Family planning programs are widely viewed as having contributed to substantial maternal and neonatal mortality decline through contraceptive use--both by reducing unwanted births and by reducing the burden of these high-risk births. However, beyond averting births, the empirical evidence for the role of family planning in reducing high-risk births at population level is limited. We examined data from 205 Demographic and Health Surveys (DHS), conducted between 1985 and 2013, to describe the trends in high-risk births and their association with the pace of progress in modern contraceptive prevalence rate (yearly increase in rate of MCPR) in 57 developing countries. Using Blinder-Oaxaca decomposition technique, we then examine the contributions of family planning program, economic development (GDP per capita), and educational improvement (secondary school completion rate) on the progress of MCPR in order to link the net contribution of family planning program to the reduction of high-risk births mediated through contraceptive use. Countries that had the fastest progress in improving MCPR experienced the greatest declines in high-risk births due to short birth intervals (<24 months), high parity births (birth order >3), and older maternal age (>35 years). Births among younger women <18 years, however, did not decline significantly during this period. The decomposition analysis suggests that 63% of the increase in MCPR was due to family planning program efforts, 21% due to economic development, and 17% due to social advancement through women's education. Improvement in MCPR, predominately due to family planning programs, is a major driver of the decline in the burden of high-risk births due to high parity, shorter birth intervals, and older maternal age in developing countries. The lack of progress in the decline of births in younger women <18 years of age underscores the need for more attention to ensure that quality contraceptive methods are available to adolescent women in order to delay first births. This study substantiates the significance of family planning programming as a major health intervention for preventing high-risk births and associated maternal and child mortality, but it highlights the need for concerted efforts to strengthen service provision for adolescents. Copyright © 2015 Elsevier Inc. All rights reserved.

Population-based estimates of still birth, induced abortion and miscarriage in the Indian state of Bihar.

PubMed

Kochar, Priyanka S; Dandona, Rakhi; Kumar, G Anil; Dandona, Lalit

2014-12-17

We report population-based data on still birth, induced abortion and miscarriage from the Indian state of Bihar to assess the magnitude of the problem and to inform corrective action. A representative sample of women from all districts of Bihar with a pregnancy outcome in the last 12 months was obtained through multistage sampling in early 2012. Still birth rate was calculated as fetuses born with no sign of life at 7 or more months of gestation per 1,000 births. Induced abortion and miscarriage rates were defined as expulsion of dead fetuses at less than 7 months of gestation induced by any means or without inducement, respectively, per 1000 pregnancies that had an outcome. Multiple regression models were used to explore possible associations with stillbirths, induced abortions and miscarriages. Multi-level models were developed for the relatively less developed north zone and for the south zone of Bihar to examine contextual factors associated with still births, induced abortions and miscarriages. Still birth rate was estimated as 20 per 1,000 births (95% CI 15.6-24.5), and induced abortion and miscarriage rates as 8.6 (6.6-10.6), and 46 (40.8-51.3) per 1,000 pregnancies with outcome, respectively. The odds of induced abortion and miscarriage were significantly higher in the south zone (odds ratio 2.53 [95% CI 1.79-3.57] and 1.27 [95% CI 1.10-1.47], respectively). In the multi-level model for the north zone, the odds of induced abortion were higher for women with husband's having mean years of education higher than the state mean (2.62; 95% CI 1.47-4.69). Among the nine divisions of Bihar, comprising of groups of districts, higher induced abortion rate was associated with lower neonatal mortality rate (R(2) = 0.68, p = 0.01). These population-based data show a significant burden of still births in Bihar, suggesting that addressing these must become an important part of maternal and child health initiatives. The higher induced abortion in the more developed districts, and the inverse trend between induced abortion and neonatal mortality rates, have programmatic implications.

Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal.

PubMed

Maru, Sheela; Bangura, Alex Harsha; Mehta, Pooja; Bista, Deepak; Borgatta, Lynn; Pande, Sami; Citrin, David; Khanal, Sumesh; Banstola, Amrit; Maru, Duncan

2017-03-04

Increasing institutional births rates and improving access to comprehensive emergency obstetric care are central strategies for reducing maternal and neonatal deaths globally. While some studies show women consider service availability when determining where to deliver, the dynamics of how and why institutional birth rates change as comprehensive emergency obstetric care availability increases are unclear. In this pre-post intervention study, we surveyed two exhaustive samples of postpartum women before and after comprehensive emergency obstetric care implementation at a hospital in rural Nepal. We developed a logistic regression model of institutional birth factors through manual backward selection of all significant covariates within and across periods. Qualitatively, we analyzed birth stories through immersion crystallization. Institutional birth rates increased after comprehensive emergency obstetric care implementation (from 30 to 77%, OR 7.7) at both hospital (OR 2.5) and low-level facilities (OR 4.6, p < 0.01 for all). The logistic regression indicated that comprehensive emergency obstetric care availability (OR 5.6), belief that the hospital is the safest birth location (OR 44.8), safety prioritization in decision-making (OR 7.7), and higher income (OR 1.1) predict institutional birth (p ≤ 0.01 for all). Qualitative analysis revealed comprehensive emergency obstetric care awareness, increased social expectation for institutional birth, and birth planning as important factors. Comprehensive emergency obstetric care expansion appears to have generated significant demand for institutional births through increased safety perceptions and birth planning. Increasing comprehensive emergency obstetric care availability increases birth safety, but it may also be a mechanism for increasing the institutional birth rate in areas of under-utilization.

Evaluating the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme': A mixed method study in England.

PubMed

Marshall, Joyce L; Spiby, Helen; McCormick, Felicia

2015-02-01

caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' was a facilitative initiative developed to promote opportunities for normal birth and reduce caesarean section rates in England. to evaluate the 'Focus on Normal Birth and Reducing Caesarean section Rates' programme, by assessment of: impact on caesarean section rates, use of service improvements tools and participants׳ perceptions of factors that sustain or hinder work within participating maternity units. a mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. twenty Hospital Trusts in England (selected from 68 who applied) took part in the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. collection and analysis of mode of birth data from 20 participating hospital Trusts, web-based questionnaires administered to key individuals in all 20 Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. there was a marginal decline of 0.5% (25.9% from 26.4%) in mean total caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July-31 December 2008). Reduced total caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. it is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors. Copyright © 2014 Elsevier Ltd. All rights reserved.

Transition of population reproduction patterns in China.

PubMed

Zhou, X

1985-04-01

Rapid and drastic changes have taken place in the population reproduction pattern in China over the last 3 decades during which the traditional pattern of high birth rate and death rate gave way to the modern pattern of low birth rate and death rate. Man's capacity to reduce disease incidence and to lower mortality rates relies directly on the economic development of the society that makes the necessary conditions availiable to him. The drastic drop of the mortality rate in China since 1949 is not a result of the "propagation of Western medical knowledge and technology" alone; it is mainly an upshot of the changes in the social, political, and economic spheres that have taken place in the country. In the recent 10 years, China has brought down its birth rate and put population growth under plans, reflecting a deepening understanding of the objective laws in the realm of population development. This understanding includes the following aspects: 1) multiplication of human numbers is not the sole purpose of population growth, 2) the establishment of the socialist system has accelerated the mortality rate decline without being able to bring down the birth rate rapidly, and 3) population growth must be subjected to planning. With these points of understanding gradually deepened, China has made full use of its socialist institutional advantages to bring down its birth rate in a short time. The credit of the successful completion of fertility transition is due to China's advanced production relations and superior social system.

Determinants of institutional birth among women in rural Nepal: a mixed-methods cross-sectional study.

PubMed

Maru, Sheela; Rajeev, Sindhya; Pokhrel, Richa; Poudyal, Agya; Mehta, Pooja; Bista, Deepak; Borgatta, Lynn; Maru, Duncan

2016-08-27

Encouraging institutional birth is an important component of reducing maternal mortality in low-resource settings. This study aims to identify and understand the determinants of persistently low institutional birth in rural Nepal, with the goal of informing future interventions to reduce high rates of maternal mortality. Postpartum women giving birth in the catchment area population of a district-level hospital in the Far-Western Development Region of Nepal were invited to complete a cross-sectional survey in 2012 about their recent birth experience. Quantitative and qualitative methods were used to determine the institutional birth rate, social and demographic predictors of institutional birth, and barriers to institutional birth. The institutional birth rate for the hospital's catchment area population was calculated to be 0.30 (54 home births, 23 facility births). Institutional birth was more likely as age decreased (ORs in the range of 0.20-0.28) and as income increased (ORs in the range of 1.38-1.45). Institutional birth among women who owned land was less likely (OR = 0.82 [0.71, 0.92]). Ninety percent of participants in the institutional birth group identified safety and good care as the most important factors determining location of birth, whereas 60 % of participants in the home birth group reported distance from hospital as a key determinant of location of birth. Qualitative analysis elucidated the importance of social support, financial resources, birth planning, awareness of services, perception of safety, and referral capacity in achieving an institutional birth. Age, income, and land ownership, but not patient preference, were key predictors of institutional birth. Most women believed that birth at the hospital was safer regardless of where they gave birth. Future interventions to increase rates of institutional birth should address structural barriers including differences in socioeconomic status, social support, transportation resources, and birth preparedness.

Preterm Birth

MedlinePlus

... birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. In 2016, preterm birth affected ... develop. Read Your Baby Grows Throughout Your Entire Pregnancy [PDF-312KB]. Babies born too early (especially before 32 weeks) have higher rates of ...

Validity of pre and post-term birth rates based on the date of last menstrual period compared to early obstetric ultrasonography.

PubMed

Medeiros, Maria Nilza Lima; Cavalcante, Nádia Carenina Nunes; Mesquita, Fabrício José Alencar; Batista, Rosângela Lucena Fernandes; Simões, Vanda Maria Ferreira; Cavalli, Ricardo de Carvalho; Cardoso, Viviane Cunha; Bettiol, Heloisa; Barbieri, Marco Antonio; Silva, Antônio Augusto Moura da

2015-04-01

The aim of this study was to assess the validity of the last menstrual period (LMP) estimate in determining pre and post-term birth rates, in a prenatal cohort from two Brazilian cities, São Luís and Ribeirão Preto. Pregnant women with a single fetus and less than 20 weeks' gestation by obstetric ultrasonography who received prenatal care in 2010 and 2011 were included. The LMP was obtained on two occasions (at 22-25 weeks gestation and after birth). The sensitivity of LMP obtained prenatally to estimate the preterm birth rate was 65.6% in São Luís and 78.7% in Ribeirão Preto and the positive predictive value was 57.3% in São Luís and 73.3% in Ribeirão Preto. LMP errors in identifying preterm birth were lower in the more developed city, Ribeirão Preto. The sensitivity and positive predictive value of LMP for the estimate of the post-term birth rate was very low and tended to overestimate it. LMP can be used with some errors to identify the preterm birth rate when obstetric ultrasonography is not available, but is not suitable for predicting post-term birth.

Changes in Yearly Birth Prevalence Rates of Children with Down Syndrome in the Period 1986-2007 in the Netherlands

ERIC Educational Resources Information Center

de Graaf, G.; Haveman, M.; Hochstenbach, R.; Engelen, J.; Gerssen-Schoorl, K.; Poddighe, P.; Smeets, D.; van Hove, G.

2011-01-01

Background: The Netherlands are lacking reliable national empirical data in relation to the development of birth prevalence of Down syndrome. Our study aims at assessing valid national live birth prevalence rates for the period 1986-2007. Method: On the basis of the annual child/adult ratio of Down syndrome diagnoses in five out of the eight Dutch…

Preterm birth research: from disillusion to the search for new mechanisms.

PubMed

Buekens, P; Klebanoff, M

2001-07-01

No intervention has been shown to decrease the rate of preterm birth. There was thus a need for a new research agenda. The new emphasis is on social and biological mechanisms, including the impact on stress of racism and poverty, and gene-environment interactions. New markers are also under study, and pertain mostly to infection and inflammation. The impact on preterm birth of broad contextual factors, such as universal social protection, will need to be explored further. The recent trends toward increased rates of preterm births deserve much attention. New policies and interventions to decrease medically indicated preterm births should be urgently developed and evaluated. The failure to prevent preterm deliveries has been so disappointing that there is a risk that high rates of preterm births will be seen as unavoidable. The research programme launched by March of Dimes is a timely effort to foster new enthusiasm, to test new ideas and to generate new hypotheses.

Cross-Country Individual Participant Analysis of 4.1 Million Singleton Births in 5 Countries with Very High Human Development Index Confirms Known Associations but Provides No Biologic Explanation for 2/3 of All Preterm Births

PubMed Central

Ferrero, David M.; Jacobsson, Bo; Di Renzo, Gian Carlo; Norman, Jane E.; Martin, James N.; D’Alton, Mary; Castelazo, Ernesto; Howson, Chris P.; Sengpiel, Verena; Bottai, Matteo; Mayo, Jonathan A.; Shaw, Gary M.; Verdenik, Ivan; Tul, Nataša; Velebil, Petr; Cairns-Smith, Sarah; Rushwan, Hamid; Arulkumaran, Sabaratnam; Howse, Jennifer L.; Simpson, Joe Leigh

2016-01-01

Background Preterm birth is the most common single cause of perinatal and infant mortality, affecting 15 million infants worldwide each year with global rates increasing. Understanding of risk factors remains poor, and preventive interventions have only limited benefit. Large differences exist in preterm birth rates across high income countries. We hypothesized that understanding the basis for these wide variations could lead to interventions that reduce preterm birth incidence in countries with high rates. We thus sought to assess the contributions of known risk factors for both spontaneous and provider-initiated preterm birth in selected high income countries, estimating also the potential impact of successful interventions due to advances in research, policy and public health, or clinical practice. Methods We analyzed individual patient-level data on 4.1 million singleton pregnancies from four countries with very high human development index (Czech Republic, New Zealand, Slovenia, Sweden) and one comparator U.S. state (California) to determine the specific contribution (adjusting for confounding effects) of 21 factors. Both individual and population-attributable preterm birth risks were determined, as were contributors to cross-country differences. We also assessed the ability to predict preterm birth given various sets of known risk factors. Findings Previous preterm birth and preeclampsia were the strongest individual risk factors of preterm birth in all datasets, with odds ratios of 4.6–6.0 and 2.8–5.7, respectively, for individual women having those characteristics. In contrast, on a population basis, nulliparity and male sex were the two risk factors with the highest impact on preterm birth rates, accounting for 25–50% and 11–16% of excess population attributable risk, respectively (p<0.001). The importance of nulliparity and male sex on population attributable risk was driven by high prevalence despite low odds ratios for individual women. More than 65% of the total aggregated risk of preterm birth within each country lacks a plausible biologic explanation, and 63% of difference between countries cannot be explained with known factors; thus, research is necessary to elucidate the underlying mechanisms of preterm birth and, hence, therapeutic intervention. Surprisingly, variation in prevalence of known risk factors accounted for less than 35% of the difference in preterm birth rates between countries. Known risk factors had an area under the curve of less than 0.7 in ROC analysis of preterm birth prediction within countries. These data suggest that other influences, as yet unidentified, are involved in preterm birth. Further research into biological mechanisms is warranted. Conclusions We have quantified the causes of variation in preterm birth rates among countries with very high human development index. The paucity of explicit and currently identified factors amenable to intervention illustrates the limited impact of changes possible through current clinical practice and policy interventions. Our research highlights the urgent need for research into underlying biological causes of preterm birth, which alone are likely to lead to innovative and efficacious interventions. PMID:27622562

Cross-Country Individual Participant Analysis of 4.1 Million Singleton Births in 5 Countries with Very High Human Development Index Confirms Known Associations but Provides No Biologic Explanation for 2/3 of All Preterm Births.

PubMed

Ferrero, David M; Larson, Jim; Jacobsson, Bo; Di Renzo, Gian Carlo; Norman, Jane E; Martin, James N; D'Alton, Mary; Castelazo, Ernesto; Howson, Chris P; Sengpiel, Verena; Bottai, Matteo; Mayo, Jonathan A; Shaw, Gary M; Verdenik, Ivan; Tul, Nataša; Velebil, Petr; Cairns-Smith, Sarah; Rushwan, Hamid; Arulkumaran, Sabaratnam; Howse, Jennifer L; Simpson, Joe Leigh

2016-01-01

Preterm birth is the most common single cause of perinatal and infant mortality, affecting 15 million infants worldwide each year with global rates increasing. Understanding of risk factors remains poor, and preventive interventions have only limited benefit. Large differences exist in preterm birth rates across high income countries. We hypothesized that understanding the basis for these wide variations could lead to interventions that reduce preterm birth incidence in countries with high rates. We thus sought to assess the contributions of known risk factors for both spontaneous and provider-initiated preterm birth in selected high income countries, estimating also the potential impact of successful interventions due to advances in research, policy and public health, or clinical practice. We analyzed individual patient-level data on 4.1 million singleton pregnancies from four countries with very high human development index (Czech Republic, New Zealand, Slovenia, Sweden) and one comparator U.S. state (California) to determine the specific contribution (adjusting for confounding effects) of 21 factors. Both individual and population-attributable preterm birth risks were determined, as were contributors to cross-country differences. We also assessed the ability to predict preterm birth given various sets of known risk factors. Previous preterm birth and preeclampsia were the strongest individual risk factors of preterm birth in all datasets, with odds ratios of 4.6-6.0 and 2.8-5.7, respectively, for individual women having those characteristics. In contrast, on a population basis, nulliparity and male sex were the two risk factors with the highest impact on preterm birth rates, accounting for 25-50% and 11-16% of excess population attributable risk, respectively (p<0.001). The importance of nulliparity and male sex on population attributable risk was driven by high prevalence despite low odds ratios for individual women. More than 65% of the total aggregated risk of preterm birth within each country lacks a plausible biologic explanation, and 63% of difference between countries cannot be explained with known factors; thus, research is necessary to elucidate the underlying mechanisms of preterm birth and, hence, therapeutic intervention. Surprisingly, variation in prevalence of known risk factors accounted for less than 35% of the difference in preterm birth rates between countries. Known risk factors had an area under the curve of less than 0.7 in ROC analysis of preterm birth prediction within countries. These data suggest that other influences, as yet unidentified, are involved in preterm birth. Further research into biological mechanisms is warranted. We have quantified the causes of variation in preterm birth rates among countries with very high human development index. The paucity of explicit and currently identified factors amenable to intervention illustrates the limited impact of changes possible through current clinical practice and policy interventions. Our research highlights the urgent need for research into underlying biological causes of preterm birth, which alone are likely to lead to innovative and efficacious interventions.

Influence of birth rates and transmission rates on the global seasonality of rotavirus incidence.

PubMed

Pitzer, Virginia E; Viboud, Cécile; Lopman, Ben A; Patel, Manish M; Parashar, Umesh D; Grenfell, Bryan T

2011-11-07

Rotavirus is a major cause of mortality in developing countries, and yet the dynamics of rotavirus in such settings are poorly understood. Rotavirus is typically less seasonal in the tropics, although recent observational studies have challenged the universality of this pattern. While numerous studies have examined the association between environmental factors and rotavirus incidence, here we explore the role of intrinsic factors. By fitting a mathematical model of rotavirus transmission dynamics to published age distributions of cases from 15 countries, we obtain estimates of local transmission rates. Model-predicted patterns of seasonal incidence based solely on differences in birth rates and transmission rates are significantly correlated with those observed (Spearman's ρ = 0.65, p < 0.05). We then examine seasonal patterns of rotavirus predicted across a range of different birth rates and transmission rates and explore how vaccination may impact these patterns. Our results suggest that the relative lack of rotavirus seasonality observed in many tropical countries may be due to the high birth rates and transmission rates typical of developing countries rather than being driven primarily by environmental conditions. While vaccination is expected to decrease the overall burden of disease, it may increase the degree of seasonal variation in the incidence of rotavirus in some settings.

Do State-Based Policies Have an Impact on Teen Birth Rates and Teen Abortion Rates in the United States?

PubMed

Chevrette, Marianne; Abenhaim, Haim Arie

2015-10-01

The United States has one of the highest teen birth rates among developed countries. Interstate birth rates and abortion rates vary widely, as do policies on abortion and sex education. The objective of our study is to assess whether US state-level policies regarding abortion and sexual education are associated with different teen birth and teen abortion rates. We carried out a state-level (N = 51 [50 states plus the District of Columbia]) retrospective observational cross-sectional study, using data imported from the National Vital Statistics System. State policies were obtained from the Guttmacher Institute. We used descriptive statistics and regression analysis to study the association of different state policies with teen birth and teen abortion rates. The state-level mean birth rates, when stratifying between policies protective and nonprotective of teen births, were not statistically different-for sex education policies, 39.8 of 1000 vs 45.1 of 1000 (P = .2187); for mandatory parents' consent to abortion 45 of 1000, vs 38 of 1000 when the minor could consent (P = .0721); and for deterrents to abortion, 45.4 of 1000 vs 37.4 of 1000 (P = .0448). Political affiliation (35.1 of 1000 vs 49.6 of 1000, P < .0001) and ethnic distribution of the population were the only variables associated with a difference between mean teen births. Lower teen abortion rates were, however, associated with restrictive abortion policies, specifically lower in states with financial barriers, deterrents to abortion, and requirement for parental consent. While teen birth rates do not appear to be influenced by state-level sex education policies, state-level policies that restrict abortion appear to be associated with lower state teen abortion rates. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Are neonatal intensive care resources located according to need? Regional variation in neonatologists, beds, and low birth weight newborns.

PubMed

Goodman, D C; Fisher, E S; Little, G A; Stukel, T A; Chang , C H

2001-08-01

Despite marked growth in neonatal intensive care during the past 30 years, it is not known if neonatologists and beds are preferentially located in regions with greater newborn risk. This study reports the relationship between regional measures of intensive care capacity and low birth weight infants using newly developed market-based regions of neonatal intensive care. Cross-sectional small-area analysis of 246 neonatal intensive care regions (NICRs). 1996 American Medical Association and American Osteopathic Association masterfiles data of clinically active neonatologists; 1999 American Academy of Pediatrics Section on Perinatal Pediatrics survey of directors of neonatal intensive care units in the United States with 100% response rate; 1995 linked birth/death data. The number of total births per neonatologist across NICRs ranged from 390 to 8197 (median: 1722) and the number of total births per intensive care bed ranged from 72 to 1319 (median: 317). The associations between capacity measures and low birth weight rates across NICRs were statistically significant but negligible (R(2): 0.04 for neonatologists; 0.05 for beds). NICRs in the quintile with the greatest neonatologist capacity (average of only 863 births per neonatologist) had very low birth weight (VLBW) rates of 1.5% while those in the quintile of lowest neonatologist capacity (average of 3718 births per neonatologist) had VLBW rates of 1.3%; a similar lack of meaningful difference in VLBW rates was noted across quintiles of intensive care bed capacity. Including midlevel providers and intermediate care beds to the analyses did not alter the findings. Neonatal intensive care capacity is not preferentially located in regions with greater newborn need as measured by low birth weight rates. Whether greater capacity affords benefits to the newborns remains unknown.

Effects of Maternal Age and Age-Specific Preterm Birth Rates on Overall Preterm Birth Rates - United States, 2007 and 2014.

PubMed

Ferré, Cynthia; Callaghan, William; Olson, Christine; Sharma, Andrea; Barfield, Wanda

2016-11-04

Reductions in births to teens and preterm birth rates are two recent public health successes in the United States (1,2). From 2007 to 2014, the birth rate for females aged 15-19 years declined 42%, from 41.5 to 24.2 per 1,000 females. The preterm birth rate decreased 8.4%, from 10.41% to 9.54% of live births (1). Rates of preterm births vary by maternal age, being higher among the youngest and oldest mothers. It is unknown how changes in the maternal age distribution in the United States have affected preterm birth rates. CDC used birth data to assess the relative contributions of changes in the maternal age distribution and in age-specific preterm birth rates to the overall decrease in preterm birth rates. The preterm birth rate declined in all age groups. The effects of age distribution changes on the preterm birth rate decrease were different in younger and older mothers. The decrease in the proportion of births to mothers aged ≤19 and 20-24 years and reductions in age-specific preterm rates in all age groups contributed to the overall decline in the preterm birth rate. The increase in births to mothers aged ≥30 years had no effect on the overall preterm birth rate decrease. The decline in preterm births from 2007 to 2014 is related, in part, to teen pregnancy prevention and the changing maternal age distribution. Effective public health strategies for further reducing preterm birth rates need to be tailored to different age groups.

Preventing preterm births: trends and potential reductions with current interventionsin 39 very high human development index countries

PubMed Central

Chang, Hannah H.; Larson, Jim; Blencowe, Hannah; Spong, Catherine Y.; Howson, Christopher P.; Cairns-Smith, Sarah; Lackritz, Eve M.; Lee, Shoo K.; Mason, Elizabeth; Serazin, Andrew C.; Walani, Salimah; Simpson, Joe Leigh; Lawn, Joy E.

2013-01-01

Summary Background Each year,1.1 million babies die from prematurity, andmany survivors are disabled. Worldwide, 15 million babies are preterm(<37 weeks’ gestation),withtwo decades of increasing ratesinalmost all countries with reliable data. Improved care of babies has reduced mortality in high-income countries, although effective interventions have yet to be scaled-up in most low-income countries. A 50% reduction goal for preterm-specific mortality by 2025 has been set in the “Born Too Soon” report. However, for preterm birth prevention,understanding of drivers and potential impact of preventive interventions is limited. We examine trends and estimate the potential reduction in preterm birthsforvery high human development index (VHHDI) countries if current evidence-based interventions were widely implemented. This analysis is to inform a “Born Too Soon” rate reduction target. Methods Countries were assessed for inclusion based on availability and quality ofpreterm prevalence data (2000-2010), and trend analyses with projections undertaken. We analysed drivers of rate increases in the USA, 1998-2004. For 39 VHHDI countrieswith >10,000 births, country-by-country analyses were performed based on target population, incremental coverage increase,and intervention efficacy. Cost savings were estimated based on reported costs for preterm care in the USAadjusted usingWorld Bank purchasing power parity. Findings From 2010, even if all VHHDI countries achieved annual preterm birth rate reductions of the best performers, (Sweden and Netherlands), 2000-2010 or 2005-2010(Lithuania, Estonia)), rates would experience a relative reduction of<5% by 2015 on average across the 39 countries.Our analysis of preterm birth rise 1998-2004 in USA suggests half the change is unexplained, but important drivers includeinductions/cesareandelivery and ART.For all 39 VHHDI countries, five interventionsmodeling at high coveragepredicted 5%preterm birth rate relative reduction from 9.59 to 9.07% of live births:smoking cessation (0.01 rate reduction), decreasing multiple embryo transfers during assisted reproductive technologies (0.06), cervical cerclage (0.15), progesterone supplementation (0.01), and reduction of non-medically indicated labour induction or caesarean delivery (0.29).These translate to 58,000 preterm births averted and total annual economic cost savings of ~US$ 3 billion. Interpretation Even with optimal coverage of current interventions, many being complex to implement, the estimated potential reduction in preterm birth is tiny. Hence we recommenda conservative target of 5% preterm birth rate relative reductionby 2015. Our findings highlight the urgent need for discovery research into underlying mechanisms of preterm birth, and developmentof innovative interventions. Furthermore, the highest preterm birth rates occur in low-income settings where the causes of prematurity may differand have simpler solutions, such as birth spacing and treatment of infections in pregnancy. Urgent focus on these settings also is critical to reduce preterm births worldwide. PMID:23158883

Conversion to IUI versus continuance with IVF in low responder patients: A systematic review.

PubMed

Fujii, Dennis T; Quesnell, Jodi L; Heitmann, Ryan J

2018-06-01

Poor response to ovarian hyper-stimulation can be difficult to predict prior to stimulation even when factoring in patient age and ovarian reserve testing. When faced with the situation of poor response, patients and providers have the difficult decision to proceed with oocyte retrieval, convert to intrauterine insemination (IUI), or cancel the cycle. Although this is not an uncommon scenario, there is little data available to assist with the counseling of these patients. We performed a systematic review of published studies comparing clinical pregnancy and live births between those patients continuing with in-vitro fertilization (IVF) and those converting to IUI. PubMed and Ovid were searched for all retrospective and randomized studies using the Keywords 'in-vitro fertilization', 'intrauterine insemination', 'poor responders', 'clinical pregnancy' and 'live birth rates'. A total of seven retrospective studies and one randomized control trial were reviewed. When evaluating poor responders as a group, six studies reported higher overall clinical pregnancy rates and five studies reported overall increased live birth rates with continuance of IVF. When stratified by the number of follicles produced, continuance of IVF demonstrated higher clinical pregnancy and live birth rates with ≥ 2 follicles. When only one follicle developed there were no significant differences in clinical pregnancy or live birth rates between the two groups. In patients undergoing IVF with ≤4 follicles, continuance with IVF may lead to higher clinical pregnancy and live birth compared to conversion to IUI except in patients with monofollicular development, although additional randomized controlled trials are needed to confirm these findings. Published by Elsevier B.V.

Meat Science and Muscle Biology Symposium: in utero nutrition related to fetal development, postnatal performance, and meat quality of pork.

PubMed

Oksbjerg, N; Nissen, P M; Therkildsen, M; Møller, H S; Larsen, L B; Andersen, M; Young, J F

2013-03-01

Intrauterine growth restriction (IUGR) occurs naturally in pigs and leads to low birth weight of piglets due to undernutrition caused by placental insufficiency. For 2 main reasons, low birth weight causes economic loss. First, low birth weight pigs have a greater mortality and increasing the litter size causes more low birth weight piglets within litters. Second, surviving low birth weight piglets have reduced performance (i.e., ADG, feed conversion rate, and percentage meat). To develop dietary strategies for preventing IUGR, knowledge of the biological basis of IUGR is required. Muscle fiber number, formed during myogenesis, is correlated positively with performance traits and has been shown in several studies to be reduced in low birth weight pigs. Postnatal muscle hypertrophy is due to satellite cell number per fiber at birth and their rate of proliferation as well as protein deposition (i.e., protein synthesis and degradation). Previous studies and some recent ones indicate that low birth weight littermates in mice are born with fewer satellite cells and studies on pigs show that the rate of satellite cell proliferation may vary within litters. Proteomics studies show that protein synthesis and degradation is downregulated in IUGR pigs and low birth weight pigs also produce meat with less tenderness. Alternative maternal feeding strategies to prevent IUGR have been examined. Increasing maternal global nutrition had no beneficial effect on performance and muscle growth traits in several studies. Feeding excess maternal dietary protein also did not influence muscle growth traits whereas moderately decreased maternal dietary protein may decrease muscle fiber number and performance. On the other hand, addition of L-carnitine to the maternal gestation or lactation diet may increase birth and weaning weights or the muscle fiber number, respectively, in low birth weight pig offspring. Finally, promising data have been obtained on reproductive traits in pigs after addition of functional AA, such as arginine and glutamine, to the gestational diet. Although much is known about the biological basis of IUGR, we still need to learn much more about the mode of action before maternal dietary strategies can be developed to prevent IUGR.

Clinical and Cost Impact Analysis of a Novel Prognostic Test for Early Detection of Preterm Birth

PubMed Central

Caughey, Aaron B.; Zupancic, John A. F.; Greenberg, James M.; Garfield, Susan S.; Thung, Stephen F.; Iams, Jay D.

2016-01-01

Objective The objective of this study was to evaluate the potential impact to the U.S. health care system by adopting a novel test that identifies women at risk for spontaneous preterm birth. Methods A decision-analytic model was developed to assess clinical and cost outcomes over a 1-year period. The use of a prognostic test to predict spontaneous preterm birth in a hypothetical population of women reflective of the U.S. population (predictive arm) was compared with the current baseline rate of spontaneous preterm birth and associated infant morbidity and mortality (baseline care arm). Results In a population of 3,528,593 births, our model predicts a 23.5% reduction in infant mortality (8,300 vs. 6,343 deaths) with use of the novel test. The rate of acute conditions at birth decreased from 11.2 to 8.1%; similarly, the rate of developmental disabilities decreased from 13.2 to 11.5%. The rate of spontaneous preterm birth decreased from 9.8 to 9.1%, a reduction of 23,430 preterm births. Direct medical costs savings was $511.7M (− 2.1%) in the first year of life. Discussion The use of a prognostic test for reducing spontaneous preterm birth is a dominant strategy that could reduce costs and improve outcomes. More research is needed once such a test is available to determine if these results are borne out upon real-world use. PMID:27917307

Births: preliminary data for 2005.

PubMed

Hamilton, Brady E; Martin, Joyce A; Ventura, Stephanie J

2006-12-28

This report presents preliminary data for 2005 on births in the United States. U.S. data on births are shown by age, live-birth order, race, and Hispanic origin of mother. Data on marital status, cesarean delivery, preterm births, and low birthweight (LBW) are also presented. Data in this report are based on 99.2 percent of births for 2005. The records are weighted to independent control counts of all births received in state vital statistics offices in 2005. Comparisons are made with 2004 data. The crude birth rate in 2005 was 14.0 births per 1,000 total population, unchanged from 2004. The general fertility rate, however, rose to 66.7 births per 1,000 women aged 15-44 years in 2005, the highest level since 1993. The birth rate for teenagers declined by 2 percent in 2005, falling to 40.4 births per 1,000 women aged 15-19 years, the lowest ever recorded in the 65 years for which a consistent series of rates are available. The rate declined for teenagers 15-17 years to 21.4 births per 1,000, but was essentially stable for older teenagers 18-19 years. The birth rate for women aged 20-24 years rose in 2005, whereas the rate for women aged 25-29 years was essentially unchanged. The birth rates for women aged 30 years and over rose to levels not seen in almost 40 years. Childbearing by unmarried women increased to record levels for the Nation in 2005. The birth rate rose 3 percent to 47.6 births per 1,000 unmarried women aged 15-44 years; the proportion of all births to unmarried women increased to 36.8 percent. The cesarean delivery rate rose by 4 percent in 2005 to 30.2 percent of all births, another record high for the Nation. The preterm birth rate continued to rise (to 12.7 percent in 2005) as did the rate for LBW births (8.2 percent).

Pain sensitivity and temperament in extremely low-birth-weight premature toddlers and preterm and full-term controls.

PubMed

Grunau, R V; Whitfield, M F; Petrie, J H

1994-09-01

High-technology medical care of extremely low-birth-weight (ELBW) infants (< 1001 g) involves repeated medical interventions which are potentially painful and may later affect reaction to pain. At 18 months corrected age (CCA), we examined parent ratings of pain sensitivity and how pain sensitivity ratings related to child temperament and parenting style in 2 groups of ELBW children (49 with a birth weight of 480-800 g and 75 with a birth weight of 801-1000 g) and 2 control groups (42 heavier preterm (1500-2499 g) and 29 full-birth-weight (FBW) children (> 2500 g). Both groups of ELBW toddlers were rated by parents as significantly lower in pain sensitivity compared with both control groups. The relationships between child temperament and pain sensitivity rating varied systematically across the groups. Temperament was strongly related to rated pain sensitivity in the FBW group, moderately related in the heavier preterm and ELBW 801-1000 g groups, and not related in the lowest birth-weight group (< 801 g). Parental style did not mediate ratings of pain sensitivity. The results suggest that parents perceive differences in pain behavior of ELBW toddlers compared with heavier preterm and FBW toddlers, especially for those less than 801 g. Longitudinal research into the development of pain behavior for infants who experience lengthy hospitalization is warranted.

Efficient Term Development of Vitrified Ferret Embryos Using a Novel Pipette Chamber Technique1

PubMed Central

Sun, Xingshen; Li, Ziyi; Yi, Yaling; Chen, Juan; Leno, Gregory H.; Engelhardt, John F.

2008-01-01

Development of an efficient cryopreservation technique for the domestic ferret is key for the long-term maintenance of valuable genetic specimens of this species and for the conservation of related endangered species. Unfortunately, current cryopreservation procedures, such as slow-rate freezing and vitrification with open pulled straws, are inefficient. In this report, we describe a pipette tip-based vitrification method that significantly improves the development of thawed ferret embryos following embryo transfer (ET). Ferret embryos at the morula (MR), compact morula (CM), and early blastocyst (EB) stages were vitrified using an Eppendorf microloader pipette tip as the chamber vessel. The rate of in vitro development was significantly (P < 0.05) higher among embryos vitrified at the CM (93.6%) and EB (100%) stages relative to those vitrified at the MR stages (58.7%). No significant developmental differences were observed when comparing CM and EB vitrified embryos with nonvitrified control CM (100%) and EB (100%) embryos. In addition, few differences in the ultrastructure of intracellular lipid droplets or in microfilament structure were observed between control embryos and embryos vitrified at any developmental stage. Vitrified-thawed CM/EB embryos cultured for 2 or 16 h before ET resulted in live birth rates of 71.3% and 77.4%, respectively. These rates were not significantly different from the control live birth rate (79.2%). However, culture for 32 h (25%) or 48 h (7.8%) after vitrification significantly reduced the rate of live births. These data indicate that the pipette chamber vitrification technique significantly improves the live birth rate of transferred ferret embryos relative to current state-of-the-art methods.. PMID:18633142

Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project.

PubMed

Blondel, B; Macfarlane, A; Gissler, M; Breart, G; Zeitlin, J

2006-05-01

To compare rates of preterm birth among multiple births in European countries, to estimate their contribution to overall preterm birth rates and to explore factors which could explain differences between preterm birth rates. Analyses of data from vital statistics, birth registers or national samples of births. Eleven member states of the European Union. All live births or representative samples of births at national or regional level for the year 2000 or most recent year. Description of rates of preterm birth before 37 and 32 weeks, estimation of population attributable risks (PAR), study of associations between preterm birth rates in multiples and singletons and nonspontaneous labour using Spearman's rank correlation coefficient. Preterm birth rates, PAR, proportions of deliveries with nonspontaneous onset (caesarean sections before labour or induction of labour). The proportion of multiple births before 37 weeks varied from 68.4% in Austria to 42.2% in the Republic of Ireland. In half of the countries, over 20% of all preterm births were attributable to multiple births. A strong association was found between the proportions of births before 37 weeks among multiple and singleton births (r= 0.81; P < 0.001). An association was observed between the rates of preterm birth and the proportions of deliveries with nonspontaneous onset among twins. Wide variations in rates of preterm births and deliveries with nonspontaneous onset were found between countries, suggesting marked differences in clinical practice which could have long-term implications for the health of children from multiple births.

Endometrial Shedding Effect on Conception and Live Birth in Women With Polycystic Ovary Syndrome

PubMed Central

Diamond, Michael P.; Kruger, Michael; Santoro, Nanette; Zhang, Heping; Casson, Peter; Schlaff, William; Coutifaris, Christos; Brzyski, Robert; Christman, Gregory; Carr, Bruce R.; McGovern, Peter G.; Cataldo, Nicholas A.; Steinkampf, Michael P.; Gosman, Gabriella G.; Nestler, John E.; Carson, Sandra; Myers, Evan E.; Eisenberg, Esther; Legro, Richard S.

2013-01-01

Objective To estimate whether progestin-induced endometrial shedding, prior to ovulation induction with clomiphene citrate, metformin, or a combination of both, affects ovulation, conception, and live birth rates in women with polycystic ovary syndrome (PCOS). Methods A secondary analysis of the data from 626 women with PCOS from the National Institutes of Child Health and Human Development Cooperative Reproductive Medicine Network trial was performed. Women had been randomized to up to six cycles of clomiphene citrate alone, metformin alone, or clomiphene citrate plus metformin. Women were assessed for occurrence of ovulation, conception, and live birth in relation to prior bleeding episodes (after either ovulation or exogenous progestin-induced withdrawal bleed). Results While ovulation rates were higher in cycles preceded by spontaneous endometrial shedding than after anovulatory cycles (with or without prior progestin withdrawal), both conception and live birth rates were significantly higher after anovulatory cycles without progestin-induced withdrawal bleeding (live birth per cycle: spontaneous menses 2.2%; anovulatory with progestin withdrawal 1.6%; anovulatory without progestin withdrawal 5.3%; p<0.001). The difference was more marked when rate was calculated per ovulation (live birth per ovulation: spontaneous menses 3.0%; anovulatory with progestin withdrawal 5.4%; anovulatory without progestin withdrawal 19.7%; p < .001). Conclusion Conception and live birth rates are lower in women with PCOS after a spontaneous menses or progestin-induced withdrawal bleeding as compared to anovulatory cycles without progestin withdrawal. The common clinical practice of inducing endometrial shedding with progestin prior to ovarian stimulation may have an adverse effect on rates of conception and live birth in anovulatory women with PCOS. PMID:22525900

Preterm birth time trends in Europe: a study of 19 countries

PubMed Central

Zeitlin, J; Szamotulska, K; Drewniak, N; Mohangoo, AD; Chalmers, J; Sakkeus, L; Irgens, L; Gatt, M; Gissler, M; Blondel, B

2013-01-01

Objective To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery. Design Analysis of aggregate data from routine sources. Setting Nineteen European countries. Population Live births in 1996, 2000, 2004, and 2008. Methods Annual risk ratios of preterm birth in each country were estimated with year as a continuous variable for all births and by subgroup using log-binomial regression models. Main outcome measures Overall preterm birth rate and rate by multiplicity, gestational age group, and spontaneous versus non-spontaneous (induced or prelabour caesarean section) onset of labour. Results Preterm birth rates rose in most countries, but the magnitude of these increases varied. Rises in the multiple birth rate as well as in the preterm birth rate for multiple births contributed to increases in the overall preterm birth rate. About half of countries experienced no change or decreases in the rates of singleton preterm birth. Where preterm birth rates rose, increases were no more prominent at 35–36 weeks of gestation than at 32–34 weeks of gestation. Variable trends were observed for spontaneous and non-spontaneous preterm births in the 13 countries with mode of onset data; increases were not solely attributed to non-spontaneous preterm births. Conclusions There was a wide variation in preterm birth trends in European countries. Many countries maintained or reduced rates of singleton preterm birth over the past 15 years, challenging a widespread belief that rising rates are the norm. Understanding these cross-country differences could inform strategies for the prevention of preterm birth. PMID:23700966

Births: final data for 2008.

PubMed

Martin, Joyce A; Hamilton, Brady E; Sutton, Paul D; Ventura, Stephanie J; Mathews, T J; Osterman, Michelle J K

2010-12-08

This report presents 2008 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, and infant characteristics (period of gestation, birthweight, and multiple births). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as data on age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Descriptive tabulations of data reported on the birth certificates of the 4.25 million births that occurred in 2008 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census. A total of 4,247,694 births were registered in the United States in 2008, 2 percent less than in 2007. The general fertility rate declined 1 percent to 68.6 per 1,000. The teenage birth rate declined 2 percent to 41.5 per 1,000. Birth rates for women aged 20 to 39 years were down 1-3 percent, whereas the birth rate for women aged 40-44 rose to the highest level reported in more than 40 years. The total fertility rate declined 2 percent to 2,084.5 per 1,000 women. All measures of unmarried childbearing reached record levels-40.6 percent of births were to unmarried women in 2008. The cesarean delivery rate rose again to 32.3 percent. The preterm birth rate declined for the second consecutive year to 12.3 percent; the low birthweight rate was down very slightly. The twin birth rate increased 1 percent to 32.6 per 1,000; the triplet and higher-order multiple birth rate was stable.

Birth registration and access to health care: an assessment of Ghana's campaign success.

PubMed

Fagernäs, Sonja; Odame, Joyce

2013-06-01

Birth registration remains far from complete in many developing countries. This was true of Ghana before a major registration campaign was undertaken. This study, based on survey data, assesses the results of a registration campaign initiated in 2004-2005 in Ghana. Key strategies included: extending the legal period for free registration of infants; incorporating registration in child health promotion weeks; training community health workers to register births; using community registration volunteers; registering children during celebrations, and piloting community population registers. This paper discusses the contribution of these strategies to the increase in registration rates and shows the degree of association between birth registration and various health-care access indicators and family characteristics. The Ghana Births and Deaths Registry worked together with international organizations, mainly Plan International and the United Nations Children's Fund, to implement the birth registration campaign. Unlike many other sub-Saharan African countries, Ghana saw a substantial rise in registration rates over the campaign period. Campaign strategies improved accessibility and shortened distance to registration centres. Survey data show that the registration rate for children younger than 5 years rose from 44% in 2003 to 71% in 2008. Incorporation of birth registration into community health care, health campaigns and mobile registration activities can reduce the indirect costs of birth registration, especially in poorer communities, and yield substantial increases in registration rates. The link between the health sector and registration activities should be strengthened further and the use of community population registers expanded.

Preterm birth time trends in Europe: a study of 19 countries.

PubMed

Zeitlin, J; Szamotulska, K; Drewniak, N; Mohangoo, A D; Chalmers, J; Sakkeus, L; Irgens, L; Gatt, M; Gissler, M; Blondel, B

2013-10-01

To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery. Analysis of aggregate data from routine sources. Nineteen European countries. Live births in 1996, 2000, 2004, and 2008. Annual risk ratios of preterm birth in each country were estimated with year as a continuous variable for all births and by subgroup using log-binomial regression models. Overall preterm birth rate and rate by multiplicity, gestational age group, and spontaneous versus non-spontaneous (induced or prelabour caesarean section) onset of labour. Preterm birth rates rose in most countries, but the magnitude of these increases varied. Rises in the multiple birth rate as well as in the preterm birth rate for multiple births contributed to increases in the overall preterm birth rate. About half of countries experienced no change or decreases in the rates of singleton preterm birth. Where preterm birth rates rose, increases were no more prominent at 35-36 weeks of gestation than at 32-34 weeks of gestation. Variable trends were observed for spontaneous and non-spontaneous preterm births in the 13 countries with mode of onset data; increases were not solely attributed to non-spontaneous preterm births. There was a wide variation in preterm birth trends in European countries. Many countries maintained or reduced rates of singleton preterm birth over the past 15 years, challenging a widespread belief that rising rates are the norm. Understanding these cross-country differences could inform strategies for the prevention of preterm birth. © 2013 The Authors. BJOG: An International Journal of Obstetrics & Gynaecology published by John Wiley and Sons on behalf of the Royal College of Obstetricians and Gynaecologists.

Outcome of very-low-birth-weight infants in a developing country: a prospective study from the western region of Turkey.

PubMed

Duman, N; Kumral, A; Gülcan, H; Ozkan, H

2003-01-01

To illustrate neonatal outcomes, including morbidity, birth weight and gestational age-specific mortality, and care practices for very-low-birth-weight infants admitted to our tertiary neonatal intensive care unit in Turkey and compare these with the corresponding data from recent reports from developed countries. Perinatal data were collected prospectively from January 1996 to December 2000. Perinatal events and the neonatal course to 120 days of life, discharge, or death were evaluated. Of 173 infants, 82% survived until discharge to home or to 120 days of life. Survival was 13% for infants of 501-750 g at birth, 74% for those of 751-1000 g, 92% for those of 1001-1250 g and 87% for those of 1251-1500 g. Mortality rates were greater for male than for female infants (25% vs. 12%). The mean birth weight was 1218 (450-1500) g and the mean gestational age was 29.8 (23-36) weeks. The birth weight and gestational age distributions showed that the majority of infants (48%) weighed 1251-1500 g and were between 28 and 31 weeks' gestation (57%). Antenatal steroids were administered to only 19% of mothers. The overall Cesarean section rate was 77%. Respiratory distress syndrome was diagnosed in 36% and surfactant was administered to 98% of these infants. The rate of ventilator support was 54% for a mean duration of 9 days. Air leak syndromes were diagnosed in only nine infants (5%). Severe intracranial hemorrhage (grade > II) and periventricular leukomalacia developed in 9% of infants. Four infants had evidence of chronic lung disease. Retinopathy of prematurity (stage > II) was noted in only one infant, and proven necrotizing enterocolitis (Bell's classification stage > 2) was not observed. The rate of survival without major morbidity was 91%. The mean hospital stay was 40 days for survivors and 19 days for infants who died. Despite marked differences in socioeconomic conditions and tertiary care facilities, the mortality (except in the smallest babies) and morbidity rates were comparable with those of recent studies from developed countries.

Estimated impact of global population growth on future wilderness extent

NASA Astrophysics Data System (ADS)

Dumont, E.

2012-06-01

Wilderness areas in the world are threatened by the environmental impacts of the growing global human population. This study estimates the impact of birth rate on the future surface area of biodiverse wilderness and on the proportion of this area without major extinctions. The following four drivers are considered: human population growth (1), agricultural efficiency (2), groundwater drawdown by irrigation (3), and non-agricultural space used by humans (buildings, gardens, roads, etc.) (4). This study indicates that the surface area of biodiverse unmanaged land will reduce with about 5.4% between 2012 and 2050. Further, it indicates that the biodiverse land without major extinctions will reduce with about 10.5%. These percentages are based on a commonly used population trajectory which assumes that birth rates across the globe will reduce in a similar way as has occurred in the past in many developed countries. Future birth rate is however very uncertain. Plausible future birth rates lower than the expected rates lead to much smaller reductions in surface area of biodiverse unmanaged land (0.7% as opposed to 5.4%), and a reduction in the biodiverse land without major extinctions of about 5.6% (as opposed to 10.5%). This indicates that birth rate is an important factor influencing the quality and quantity of wilderness remaining in the future.

"How to have healthy children". Responses to the falling birth rate in Norway, c. 1900-1940.

PubMed

Blom, Ida

2008-01-01

This paper focuses on initiatives to improve infant health, as they developed in Norway especially during the interwar period. Falling birth rates were felt as a menace to the survival of the nation and specific initiatives were taken to oppose it. But crises engendered by the reduction in fertility strengthened opportunities for introducing policies to help the fewer children born survive and grow up to become healthy citizens. Legislation supporting mothers started in 1892 increased in the interwar years including economic features. Healthy mother and baby stations and hygienic clinics, aimed at controlling births were developed by voluntary organisations inspired from France and England respectively. A sterilization law (1934) paralleled some German policies.

Increasing low birth weight rates: deliveries in a tertiary hospital in istanbul.

PubMed

Akin, Yasemin; Cömert, Serdar; Turan, Cem; Unal, Orhan; Piçak, Abdülkadir; Ger, Lale; Telatar, Berrin

2010-09-01

Prevalence of low birth weight deliveries may vary across different environments. The necessity of determination of regional data prompted this study. Information of all deliveries from January 2004 to December 2008 was obtained from delivery registry records retrospectively. Initial data including birth weight, vital status, sex, maternal age and mode of delivery were recorded using medical files. The frequency of low birth weight, very low birth weight, extremely low birth weight and stillbirth deliveries were determined. Among 19,533 total births, there were 450 (23.04 per 1000) stillbirths. Low birth weight rate was 10.61%. A significant increase in yearly distribution of low birth weight deliveries was observed (P<0.001). Very low birth weight and extremely low birth weight delivery rates were 3.14% and 1.58% respectively. Among 2073 low birth weight infants, 333 (16.06%) were stillbirths. The stillbirth delivery rate and the birth of a female infant among low birth weight deliveries were significantly higher than infants with birth weight ≥2500g (P<0.001, OR=28.37), (P<0.001) retrospectively. There was no statistical difference between low birth weight and maternal age. The rate of cesarean section among low birth weight infants was 49.4%. High low birth weight and stillbirth rates, as well as the increase in low birth weight deliveries over the past five years in this study are striking. For reduction of increased low birth weight rates, appropriate intervention methods should be initiated.

Triplet Birth and Infant Development: The Impact of Intrauterine Growth and Maternal-Infant Interaction on the Infant's Emotional and Cognitive Development

ERIC Educational Resources Information Center

Eidelman, Arthur I.; Feldman, Ruth

2006-01-01

The explosion in the rate of multiple births has led to new questions about how adequately prepared parents are for the demands of raising triplets and the implications for the healthy development of the infants. The authors examined the relationship between mothering, infant social behavior, and cognitive development in a longitudinal study of 23…

Economic and other determinants of infant and child mortality in small developing countries: the case of Central America and the Caribbean.

PubMed

Hojman, D E

1996-03-01

This analysis involves empirically testing a theoretical model among 22 Central American and Caribbean countries during the 1990s that explains differences in infant and child mortality. Explanatory measures capture demographic, economic, health care, and educational characteristics. The model is expected to allow for an assessment of the potential impact of structural adjustment and external debt. It is pointed out that birth rates and child mortality rates followed similar patterns over time and between countries. In this study's regression analyses all variables in the three models that explain infant mortality are exogenous: low birth weight, immunization, gross domestic product per capita, years of schooling for women, population/nurse, and debt as a proportion of gross national product. As nations became richer, infant mortality declined. Infant mortality was lower in countries with high external debt. In models for explaining the birth rate and the child mortality rate, the best fit included variables for debt, real public expenditure on health care, water supply, and malnutrition. Analysis in a simultaneous model for 10 countries revealed that the birth rate and the child mortality rate were more responsive to shocks in exogenous variables in Barbados than in the Dominican Republic, and more responsive in the Dominican Republic than in Guatemala. The impact of each exogenous variable varied by country. In Barbados education was four times more effective in explaining the birth rate than water. In Guatemala, the most effective exogenous variable was malnutrition. Child mortality rates were affected more by multiplier effects. In richer countries, the most important impact on child survival was improved access to safe water, and the most important impact on the birth rate was increased real public expenditure on education per capita. For the poorest countries, findings suggest first improvement in malnutrition and then improvement in safe water supplies. Structural adjustment variables were found to have small impacts on the birth rate or limited impacts on child survival in poorer countries.

Endometrial thickness as a predictor of the reproductive outcomes in fresh and frozen embryo transfer cycles: A retrospective cohort study of 1512 IVF cycles with morphologically good-quality blastocyst.

PubMed

Zhang, Tao; Li, Zhou; Ren, Xinling; Huang, Bo; Zhu, Guijin; Yang, Wei; Jin, Lei

2018-01-01

To evaluate the relationship between endometrial thickness during fresh in vitro fertilization (IVF) cycles and the clinical outcomes of subsequent frozen embryo transfer (FET) cycles.FET cycles using at least one morphological good-quality blastocyst conducted between 2012 and 2013 at a university-based reproductive center were reviewed retrospectively. Endometrial ultrasonographic characteristics were recorded both on the oocyte retrieval day and on the day of progesterone supplementation in FET cycles. Clinical pregnancy rate, spontaneous abortion rate, and live birth rate were analyzed.One thousand five hundred twelve FET cycles was included. The results showed that significant difference in endometrial thickness on day of oocyte retrieval (P = .03) was observed between the live birth group (n = 844) and no live birth group (n = 668), while no significant difference in FET endometrial thickness was found (P = .261) between the live birth group and no live birth group. For endometrial thickness on oocyte retrieval day, clinical pregnancy rate ranged from 50.0% among patients with an endometrial thickness of ≤6 mm to 84.2% among patients with an endometrial thickness of >16 mm, with live birth rate from 33.3% to 63.2%. Multiple logistic regression analysis of factors related to live birth indicated endometrial thickness on oocyte retrieval day was associated with improved live birth rate (OR was 1.069, 95% CI: 1.011-1.130, P = .019), while FET endometrial thickness did not contribute significantly to pregnancy outcomes following FET cycles. The ROC curves revealed the cut-off points of endometrial thickness on oocyte retrieval day was 8.75 mm for live birth.Endometrial thickness during fresh IVF cycles was a better predictor of endometrial receptivity in subsequent FET cycles than FET cycle endometrial thickness. For those females with thin endometrium in fresh cycles, additional estradiol stimulation might be helpful for adequate endometrial development.

Endometrial thickness as a predictor of the reproductive outcomes in fresh and frozen embryo transfer cycles

PubMed Central

Zhang, Tao; Li, Zhou; Ren, Xinling; Huang, Bo; Zhu, Guijin; Yang, Wei; Jin, Lei

2018-01-01

Abstract To evaluate the relationship between endometrial thickness during fresh in vitro fertilization (IVF) cycles and the clinical outcomes of subsequent frozen embryo transfer (FET) cycles. FET cycles using at least one morphological good-quality blastocyst conducted between 2012 and 2013 at a university-based reproductive center were reviewed retrospectively. Endometrial ultrasonographic characteristics were recorded both on the oocyte retrieval day and on the day of progesterone supplementation in FET cycles. Clinical pregnancy rate, spontaneous abortion rate, and live birth rate were analyzed. One thousand five hundred twelve FET cycles was included. The results showed that significant difference in endometrial thickness on day of oocyte retrieval (P = .03) was observed between the live birth group (n = 844) and no live birth group (n = 668), while no significant difference in FET endometrial thickness was found (P = .261) between the live birth group and no live birth group. For endometrial thickness on oocyte retrieval day, clinical pregnancy rate ranged from 50.0% among patients with an endometrial thickness of ≤6 mm to 84.2% among patients with an endometrial thickness of >16 mm, with live birth rate from 33.3% to 63.2%. Multiple logistic regression analysis of factors related to live birth indicated endometrial thickness on oocyte retrieval day was associated with improved live birth rate (OR was 1.069, 95% CI: 1.011–1.130, P = .019), while FET endometrial thickness did not contribute significantly to pregnancy outcomes following FET cycles. The ROC curves revealed the cut-off points of endometrial thickness on oocyte retrieval day was 8.75 mm for live birth. Endometrial thickness during fresh IVF cycles was a better predictor of endometrial receptivity in subsequent FET cycles than FET cycle endometrial thickness. For those females with thin endometrium in fresh cycles, additional estradiol stimulation might be helpful for adequate endometrial development. PMID:29369190

Multiple births associated with assisted human reproduction in Canada.

PubMed

Cook, Jocelynn L; Geran, Leslie; Rotermann, Michelle

2011-06-01

Assisted human reproduction has been associated with increased rates of multiple births. Data suggest that twins and higher order multiple pregnancies are at risk for pre- and postnatal health complications that contribute to stress on both the family and the Canadian health care system. No published Canadian data estimate the contribution of assisted human reproduction to multiple birth rates. This study was designed to determine the contributions of age and assisted human reproduction to multiple birth rates in Canada. We performed analyses of existing Canadian databases, using a mathematical model from the Centers for Disease Control and Prevention. More specifically, data from the Canadian Vital Statistics: Births and Stillbirths database were combined with data from the Canadian Assisted Reproductive Technologies Register collected by the Canadian Fertility and Andrology Society. Datasets were standardized to age distributions of mothers in 1978. RESULTS suggest that in vitro fertilization, ovulation induction, and age each contribute more to the rates of triplets than to twins. As expected, the contribution of natural factors was higher to twins than to triplets. These are the first Canadian data analyzed to separate and measure the contributions of age and assisted reproductive technologies to multiple birth rates. Our findings are important for guiding physician and patient education and informing the development of treatment protocols that will result in lower-risk pregnancies and improved long-term health for women and their offspring.

Age-specific preterm birth rates after exclusion of risk factors--an analysis of the german perinatal survey.

PubMed

Voigt, M; Briese, V; Carstensen, M; Wolterdorf, F; Hallier, E; Straube, S

2010-08-01

A description of preterm birth rates - specified according to maternal age - after the exclusion of anamnestic risk factors. Data for this study were taken from the German Perinatal Survey of 1998-2000. We analysed data from 492,576 singleton pregnancies and determined preterm birth rates according to maternal age after a stepwise exclusion of anamnestic risk factors. There was a U-shaped dependence of preterm birth rates on maternal age. The lowest preterm birth rate (without excluding women with anamnestic risk factors) was 5.6% at a maternal age of 29 years. The prevalence of some anamnestic risk factors for preterm birth, such as previous stillbirths, spontaneous and induced abortions, and ectopic pregnancies, increased with maternal age. Excluding women with anamnestic risk factors lowered the preterm birth rates substantially. The lowest preterm birth rates were found in women with one previous live birth, without any anamnestic risk factors, and with a body mass index (BMI) of 25.00-29.99. With these restrictions, we found preterm birth rates of under 2% for women aged 24-31 years. The magnitude and age-dependence of the preterm birth rate can to some extent be explained with the age-dependent prevalence of anamnestic risk factors for preterm birth. Excluding women with anamnestic risk factors from our study population lowered the preterm birth rates substantially. © Georg Thieme Verlag KG Stuttgart · New York.

Increased prevalence of some birth defects in Korea, 2009-2010.

PubMed

Lamichhane, Dirga Kumar; Leem, Jong-Han; Park, Myungsook; Kim, Jung Ae; Kim, Hwan Cheol; Kim, Jin Hee; Hong, Yun-Chul

2016-03-22

Birth defects are a leading cause of neonatal and infant mortality, and several studies have indicated an increase in the prevalence of birth defects; more recent investigations have suggested that the trends of some defects are increasing in rapidly industrialized areas. This study estimates the prevalence rate and types of birth defects in Korea. This study used medical insurance benefit data of 403,250 infants aged less than one year from the National Health Insurance Corporation from seven metropolitan areas in Korea for 2009 and 2010. The prevalence rate of birth defects was 548.3 per 10,000 births (95% CI: 541.1-555.6), 306.8 among boys and 241.5 among girls. Anomalies of the circulatory system (particularly septal defects) were the most common (180.8 per 10,000), followed by defects of the genitourinary tract (130.1 per 10,000) (particularly obstructive genitourinary and undescended testis), musculoskeletal system (105.7 per 10,000), digestive system (24.7 per 10,000), and central nervous system (15.6 per 10,000). Relatively higher rates of some birth defects were found in the metropolitan areas. The high differences of birth prevalences for septal heart defects and undescended testis are probably due in part to progress in clinical management and more frequent prenatal diagnosis. Environmental exposure might play a critical role in the development of some birth defects. In attempting to describe the prevalence and spatio-temporal variations of birth defects in Korea, establishment of a registry system of birth defects and environmental surveillance are needed.

Where the thread of home births never broke - An interview with Susanne Houd.

PubMed

Santos, Mário J D S

2017-04-01

The option of a planned home birth defies medical and social normativity across countries. In Denmark, despite the dramatic decline in the home birth rates between 1960 and 1980, the right to choose the place of birth was preserved. Little has been produced documenting this process. To present and discuss Susanne Houd's reflection on the history and social dynamics of home birth in Denmark, based in an in-depth interview. This paper is part of wider Short Term Scientific Mission (STSM), in which this interview was framed as oral history. The whole interview transcript is presented, keeping the highest level of detail. In Susanne Houd's testimony, four factors were highlighted as contributing to the decline in the rate of home births from the 1960s to the 1970s: new maternity hospitals; the development of obstetrics as a research-based discipline; the compliance of midwives; and a shift in women's preference, favouring hospital birth. The development of the Danish home birth models was described by Susanne Houd in regard to the processes associated with the medicalisation of childbirth, the role of consumers, and the changing professional dynamics of midwifery. An untold history of home birth in Denmark was documented in this testimony. The Danish childbirth hospitalisation process was presented as the result of a complex interaction of factors. Susanne Houd's reflections reveal how the concerted action of consumers and midwives, framed as a system-challenging praxis, was the cornerstone for the sustainability of home birth models in Denmark. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

CFSC (Community and Family Study Center) study finds birth rates falling everywhere - family planning (family planning) is a factor.

PubMed

1978-08-01

The findings of the Community and Family Study Center study, based on estimated crude birthrates and total fertility rates for 1968 and 1975, indicate that there has been a significant reduction in fertility levels of both developed and developing countries. Despite regional variations, the estimates show an average proportional decline of 8.5% in total fertility rates between 1968 and 1975. Of the 148 nations studied, 113 were in developing regions and 35 in the developed regions. Information on important social and economic development factors, such as life expectancy, literacy, percent of labor force in agriculture, per capita income, and family planning program strength were gathered for each country. Analyses of these data are reported in "The Public Interest" (to be published) "Population Reference Bulletin," October 1978, and a paper presented at the 1978 Population Association of America Meetings in Atlanta, Georgia. The recent change in fertility affected 81% of the world's population, primarily the peoples of Asia, Latin America, and North America. The total fertility rate in the world in 1968 was 4635 and declined to 4068 in 1975. More substantial declines occurred in Asia and Latin America, where the number of fewer births 1000 women would bear under a given fertility schedule declined by 845 births and 617 births, respectively. As more research is conducted to investigate the underlying causes of this decline, it is likely to confirm the important role that family planning programs have had in developing nations. Although major improvements in the socioeconomic well-being of the developing areas continue as an essential goal, the need to maintain the organized provision of family planning services should not be understated.

A Secular Trend in Birth Weight and Delivery Practices in Periurban Vietnam During 2005-2012.

PubMed

Duong, Duc Minh; Nguyen, Anh Duy; Nguyen, Chuong Canh; Le, Vui Thi; Hoang, Son Ngoc; Bui, Ha Thi Thu

2017-07-01

The remarkable increase in Vietnamese economic conditions can increase the birth weight in neonates and better delivery practices among women. The Chi Linh Health and Demographic Surveillance System started in 2004. An open cohort of data consisting of about 57 561 people from 17 993 households has been followed primarily with respect to demography, economy, and education. The aim of this research is to study secular trends in delivery practice and birth weight in the past decade (2005-2012) in Chi Linh. We found a significant change in delivery rates at hospitals and cesarean section rates, but the birth weights over a decade of drastic economic development were stable. Furthermore, the findings show significant associations of birth weight and delivery practices with the child's sex, mother's age, and household income. Our results might be considered as representative for other similar periurban settings in Vietnam. We suggest that appropriate policies should be developed given the reduction in the use of delivery services in commune health centers in urban areas.

Development of Hydro-Epidemiology Studies to Establish Relationships Between Source-Water Contamination and Preterm Birth

NASA Astrophysics Data System (ADS)

Padilla, I. Y.; Meeker, J.; Alshawabkeh, A.; Cordero, J.; Giese, R.; Loch-Caruso, R.

2010-12-01

Puerto Rico has the highest rate of preterm birth in United States. Preliminary investigations suggest that the increase in preterm birth rates in Puerto Rico cannot be explained by changes in known factors, and that there is sufficient evidence that exposure to some contaminants contributes to preterm birth. Contamination in Puerto Rico is extensive with more than 150 contaminated sites and a vast contamination of water resources. Of particular concern is the contamination in the north-coast karst aquifer. This aquifer provides important freshwater resources for human consumption. The same characteristics that make karst aquifers highly productive make them highly vulnerable to contamination and impart an enormous capacity to store and convey contaminants from sources to potential exposures zones. As a result, there is an inherent risk of exposure to contamination thorough groundwater. This presentation will address work being conducted to: assess the extent of groundwater contamination in the north coast of Puerto Rico; evaluate potential relationship between exposure to contaminants and preterm birth; develop new technology for discovery, transport characterization, and green remediation of contaminants in karst aquifers.

Variation in rates of postterm birth in Europe: reality or artefact?

PubMed

Zeitlin, J; Blondel, B; Alexander, S; Bréart, G

2007-09-01

To compare rates of postterm birth in Europe. Analysis of data from vital statistics, birth registers, and national birth samples collected for the PERISTAT project. Thirteen European countries. All live births or representative samples of births for the year 2000 or most recent year available. Comparison of national and regional rates of postterm birth. Other indicators (birthweight, deliveries with a non-spontaneous onset and mortality) were used to assess the validity of postterm rates. The proportion of births at 42 completed weeks of gestation or later. Postterm rates varied greatly, from 0.4% (Austria, Belgium) to over 7% (Denmark, Sweden) of births. Higher postterm rates were associated with a greater proportion of babies with birthweight 4500 g or more. Fetal and early neonatal mortality rates were higher among postterm births than among births at 40 weeks. Countries with higher proportions of births with a nonspontaneous onset of labour had lower postterm birth rates. The shapes of the gestational-age distributions at term varied. In some countries, there was a sharp cutoff in deliveries at 40 weeks, while elsewhere this occurred at 41 weeks. These results suggest that practices for managing pregnancies continuing beyond term differ in Europe and raise questions about the health and other impacts in countries with markedly high or low postterm rates. Some variability in these rates may also be due to methods for determining gestational age, which has broader implications for international comparisons of gestational age, including rates of postterm and preterm births and small-for-gestational-age newborns.

Births to teenagers in the United States, 1940-2000.

PubMed

Ventura, S J; Mathews, T J; Hamilton, B E

2001-09-25

This report presents trends in national birth rates for teenagers, with particular focus on the decade of the 1990s. The percent change in rates for 1991-2000 is presented for the United States, and the change for 1991-99 is presented for States. Tabular and graphical descriptions of the trends in teenage birth rates for the Nation and each State, by age group, race, and Hispanic origin, are discussed. Birth rates for teenagers 15-19 years generally declined in the United States since the late 1950s, except for a brief, but steep, upward climb in the late 1980s until 1991. The 2000 rate (49 births per 1,000) is about half the peak rate recorded in 1957 (96 per 1,000). Still the U.S. rate is considerably higher than rates for other developed countries. During the 1990s rate declines were especially large for black teenagers. State-specific rates fell significantly in all States for ages 15-19 and 15-17 years, and in all but three States for ages 18-19 years. Overall the range of decline in State rates for ages 15-19 years was 11 to 36 percent. For teenagers 15-17 years, the range of decline by State was 13 to 43 percent. Reductions by State were largest for black teenagers 15-19 years, with rates falling 40 percent or more in seven States. The factors accounting for these declines include decreased sexual activity reflecting changing attitudes towards premarital sex, increases in condom use, and adoption of newly available hormonal contraception, implants, and injectables.

Delivering information: A descriptive study of Australian women’s information needs for decision-making about birth facility

PubMed Central

2012-01-01

Background Little information is known about what information women want when choosing a birth facility. The objective of this study was to inform the development of a consumer decision support tool about birth facility by identifying the information needs of maternity care consumers in Queensland, Australia. Methods Participants were 146 women residing in both urban and rural areas of Queensland, Australia who were pregnant and/or had recently given birth. A cross-sectional survey was administered in which participants were asked to rate the importance of 42 information items to their decision-making about birth facility. Participants could also provide up to ten additional information items of interest in an open-ended question. Results On average, participants rated 30 of the 42 information items as important to decision-making about birth facility. While the majority of information items were valued by most participants, those related to policies about support people, other women’s recommendations about the facility, freedom to choose one’s preferred position during labour and birth, the aesthetic quality of the facility, and access to on-site neonatal intensive care were particularly widely valued. Additional items of interest frequently focused on postnatal care and support, policies related to medical intervention, and access to water immersion. Conclusions The women surveyed had significant and diverse information needs for decision-making about birth facility. These findings have immediate applications for the development of decision support tools about birth facility, and highlight the need for tools which provide a large volume of information in an accessible and user-friendly format. These findings may also be used to guide communication and information-sharing by care providers involved in counselling pregnant women and families about their options for birth facility or providing referrals to birth facilities. PMID:22708648

Delivering information: a descriptive study of Australian women's information needs for decision-making about birth facility.

PubMed

Thompson, Rachel; Wojcieszek, Aleena M

2012-06-18

Little information is known about what information women want when choosing a birth facility. The objective of this study was to inform the development of a consumer decision support tool about birth facility by identifying the information needs of maternity care consumers in Queensland, Australia. Participants were 146 women residing in both urban and rural areas of Queensland, Australia who were pregnant and/or had recently given birth. A cross-sectional survey was administered in which participants were asked to rate the importance of 42 information items to their decision-making about birth facility. Participants could also provide up to ten additional information items of interest in an open-ended question. On average, participants rated 30 of the 42 information items as important to decision-making about birth facility. While the majority of information items were valued by most participants, those related to policies about support people, other women's recommendations about the facility, freedom to choose one's preferred position during labour and birth, the aesthetic quality of the facility, and access to on-site neonatal intensive care were particularly widely valued. Additional items of interest frequently focused on postnatal care and support, policies related to medical intervention, and access to water immersion. The women surveyed had significant and diverse information needs for decision-making about birth facility. These findings have immediate applications for the development of decision support tools about birth facility, and highlight the need for tools which provide a large volume of information in an accessible and user-friendly format. These findings may also be used to guide communication and information-sharing by care providers involved in counselling pregnant women and families about their options for birth facility or providing referrals to birth facilities.

Decreased baseline variability on fetal heart rate pattern in a fetus with heterotaxy syndrome.

PubMed

Yamada, Ryutaro; Takei, Kohta; Kaneshi, Yosuke; Morikawa, Mamoru; Cho, Kazutoshi; Minakami, Hisanori

2015-12-01

In a fetus with suspected heterotaxy syndrome, a decreased/absent baseline variability of fetal heart rate pattern developed at gestational week 36(+5) and continued for 5 days until birth at gestational week 37(+2), while repeat biophysical profile scorings with ultrasound were consistently unremarkable. This neonate weighing 2404 g with Apgar scores of 7 (1-min) and 8 (5-min) and umbilical arterial cord blood pH of 7.28 with base deficit of 3.9 mmol/L, showed a heart rate of 120 b.p.m. for 3 h after birth, but subsequently developed sinus bradycardia (84 b.p.m.) unresponsive to crying. Isoproterenol initiated 9 h after birth was effective in the increase of heart rate to 120 b.p.m. in this neonate. Brain magnetic resonance imaging at 16 days of age was unremarkable. The decreased/absent baseline variability of fetal heart rate pattern was speculated to have been caused by sinus node dysfunction, and not by reduced fetal oxygenation in this case. © 2015 Japan Society of Obstetrics and Gynecology.

[A follow-up on first-year growth and development of 61 very low birth weight preterm infants].

PubMed

Deng, Ying; Xiong, Fei; Wu, Meng-Meng; Yang, Fan

2016-06-01

To investigate the physical growth and psychomotor development of very low birth weight (VLBW) preterm infants in the first year after birth and related influencing factors. A total of 61 VLBW preterm infants received growth and development monitoring for 12 months. Z score was used to evaluate parameters for physical growth, and Denver Development Screen Test (DDST) was used for development screening. Among the 61 VLBW preterm infants, 27 (44.3%) were small-for-gestational-age (SGA) infants, and 34 (55.7%) were appropriate-for-gestational-age (AGA) infants. During the 1-year follow-up, the median weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), head circumference-for-age Z-score (HCZ), and weight-for-height Z score (WHZ) were >-1 SD in all age groups. The peaks of body mass index-for-age Z-score (BAZ) and WHZ appeared at 1 month of corrected age. At a corrected age of 40 weeks, the incidence rates of underweight, growth retardation, emaciation, microcephalus, overweight, and obesity were 15%, 16%, 11%, 13%, 20%, and 10%, respectively. Compared with those with a corrected age of 40 weeks, the infants with a corrected age of 6 months or 9-12 months had a significantly reduced incidence rate of overweight (3%) (P<0.05). Up to 1 year after birth, 15 infants (25%) had abnormal developmental quotient (DQ). The SGA group had a significantly higher incidence rate of abnormal DQ than the AGA group (P<0.05). SGA was the independent risk factor for retarded growth in the first year after birth in VLBW preterm infants. VLBW preterm infants experience an obvious growth deviation within 3 months of corrected age. Within the first year after birth, the proportion of infants with abnormal DQ screened by DDST is high.

Black/white differences in very low birth weight neonatal mortality rates among New York City hospitals.

PubMed

Howell, Elizabeth A; Hebert, Paul; Chatterjee, Samprit; Kleinman, Lawrence C; Chassin, Mark R

2008-03-01

We sought to determine whether differences in the hospitals at which black and white infants are born contribute to black/white disparities in very low birth weight neonatal mortality rates in New York City. We performed a population-based cohort study using New York City vital statistics records on all live births and deaths of infants weighing 500 to 1499 g who were born in 45 hospitals between January 1, 1996, and December 31, 2001 (N = 11 781). We measured very low birth weight risk-adjusted neonatal mortality rates for each New York City hospital and assessed differences in the distributions of non-Hispanic black and non-Hispanic white very low birth weight births among these hospitals. Risk-adjusted neonatal mortality rates for very low birth weight infants in New York City hospitals ranged from 9.6 to 27.2 deaths per 1000 births. White very low birth weight infants were more likely to be born in the lowest mortality tertile of hospitals (49%), compared with black very low birth weight infants (29%). We estimated that, if black women delivered in the same hospitals as white women, then black very low birth weight mortality rates would be reduced by 6.7 deaths per 1000 very low birth weight births, removing 34.5% of the black/white disparity in very low birth weight neonatal mortality rates in New York City. Volume of very low birth weight deliveries was modestly associated with very low birth weight mortality rates but explained little of the racial disparity. Black very low birth weight infants more likely to be born in New York City hospitals with higher risk-adjusted neonatal mortality rates than were very low birth weight infants, contributing substantially to black-white disparities.

Epidemiology and causes of preterm birth.

PubMed

Goldenberg, Robert L; Culhane, Jennifer F; Iams, Jay D; Romero, Roberto

2008-01-05

This paper is the first in a three-part series on preterm birth, which is the leading cause of perinatal morbidity and mortality in developed countries. Infants are born preterm at less than 37 weeks' gestational age after: (1) spontaneous labour with intact membranes, (2) preterm premature rupture of the membranes (PPROM), and (3) labour induction or caesarean delivery for maternal or fetal indications. The frequency of preterm births is about 12-13% in the USA and 5-9% in many other developed countries; however, the rate of preterm birth has increased in many locations, predominantly because of increasing indicated preterm births and preterm delivery of artificially conceived multiple pregnancies. Common reasons for indicated preterm births include pre-eclampsia or eclampsia, and intrauterine growth restriction. Births that follow spontaneous preterm labour and PPROM-together called spontaneous preterm births-are regarded as a syndrome resulting from multiple causes, including infection or inflammation, vascular disease, and uterine overdistension. Risk factors for spontaneous preterm births include a previous preterm birth, black race, periodontal disease, and low maternal body-mass index. A short cervical length and a raised cervical-vaginal fetal fibronectin concentration are the strongest predictors of spontaneous preterm birth.

Survival and developmental disability in infants with birth weights of 501 to 800 grams, born between 1979 and 1994.

PubMed

O'Shea, T M; Klinepeter, K L; Goldstein, D J; Jackson, B W; Dillard, R G

1997-12-01

Because the survival rate has increased for extremely low birth weight neonates, many have raised the concern that the rate of developmental disability among survivors will also increase. To address this concern, we analyzed changes over time in survival and major neurosensory impairment in a sample of extremely low birth weight infants born between July 1, 1979, and June 30, 1994. The study sample included 513 infants with birth weights of 501 to 800 g who were cared for in either of the two neonatal intensive care units that serve a 17-county region in northwest North Carolina and who were born to mothers residing in that region. At 1 year of age (corrected for gestation), survivors were examined by a pediatrician and were tested using the Bayley Scales of Infant Development. Major neurosensory impairment was defined as cerebral palsy, a Bayley Mental Developmental Index <68, or blindness. A total of 209/216 (97%) of survivors were examined at 1 year of age. Epoch of birth was defined as follows: epoch 1, July 1, 1979 to June 30, 1984; epoch 2, July 1, 1984 to June 30, 1989; and epoch 3, July 1, 1989 to June 30, 1994. Survival rates for epochs 1, 2, and 3 were, respectively, 24/120 (20%), 63/175 (36%), and 129/218 (59%). In contrast, the proportions with a major neurosensory impairment did not increase over time; rates for successive epochs were 6/24 (25%), 17/61 (28%), and 26/124 (21%). Rates of cerebral palsy were 3/24 (13%), 12/61 (20%), and 9/124 (7%); rates of delayed mental development were 4/24 (17%), 12/61 (20%), and 17/124 (14%); and rates of blindness were 2/24 (8%), 0/62, and 5/124 (4%), respectively. This analysis suggests that the increasing survival of extremely low birth weight neonates since the late 1970s has not resulted in an increased rate of major developmental problems identifiable at 1 year of age.

Low birth weight,very low birth weight rates and gestational age-specific birth weight distribution of korean newborn infants.

PubMed

Shin, Son-Moon; Chang, Young-Pyo; Lee, Eun-Sil; Lee, Young-Ah; Son, Dong-Woo; Kim, Min-Hee; Choi, Young-Ryoon

2005-04-01

To obtain the low birth weight (LBW) rate, the very low birth weight (VLBW) rate, and gestational age (GA)-specific birth weight distribution based on a large population in Korea, we collected and analyzed the birth data of 108,486 live births with GA greater than 23 weeks for 1 yr from 1 January to 31 December 2001, from 75 hospitals and clinics located in Korea. These data included birth weight, GA, gender of the infants, delivery type, maternal age, and the presence of multiple pregnancy. The mean birth weight and GA of a crude population are 3,188 +/-518 g and 38.7+/-2.1 weeks, respectively. The LBW and the VLBW rates are 7.2% and 1.4%, respectively. The preterm birth rate (less than 37 completed weeks of gestation) is 8.4% and the very preterm birth rate (less than 32 completed weeks of gestation) is 0.7%. The mean birth weights for female infants, multiple births, and births delivered by cesarean section were lower than those for male, singletons, and births delivered vaginally. The risk of delivering LBW or VLBW infant was higher for the teenagers and the older women (aged 35 yr and more). We have also obtained the percentile distribution of GA-specific birth weight in infants over 23 weeks of gestation.

The dynamics of reproductive rate, offspring survivorship and growth in the lined seahorse, Hippocampus erectus Perry, 1810

PubMed Central

Lin, Qiang; Li, Gang; Qin, Geng; Lin, Junda; Huang, Liangmin; Sun, Hushan; Feng, Peiyong

2012-01-01

Summary Seahorses are the vertebrate group with the embryonic development occurring within a special pouch in males. To understand the reproductive efficiency of the lined seahorse, Hippocampus erectus Perry, 1810 under controlled breeding experiments, we investigated the dynamics of reproductive rate, offspring survivorship and growth over births by the same male seahorses. The mean brood size of the 1-year old pairs in the 1st birth was 85.4±56.9 per brood, which was significantly smaller than that in the 6th birth (465.9±136.4 per brood) (P<0.001). The offspring survivorship and growth rate increased with the births. The fecundity was positively correlated with the length of brood pouches of males and trunk of females. The fecundity of 1-year old male and 2-year old female pairs was significantly higher than that from 1-year old couples (P<0.001). The brood size (552.7±150.4) of the males who mated with females that were isolated for the gamete-preparation, was larger than those (467.8±141.2) from the long-term pairs (P<0.05). Moreover, the offspring from the isolated females had higher survival and growth rates. Our results showed that the potential reproductive rate of seahorses H. erectus increased with the brood pouch development. PMID:23213429

Preterm birth and maternal country of birth in a French district with a multiethnic population.

PubMed

Zeitlin, J; Bucourt, M; Rivera, L; Topuz, B; Papiernik, E

2004-08-01

This analysis explores the association between preterm birth and maternal country of birth in a French district with a multiethnic population. Prospective observational study. District of Seine-Saint-Denis in France 48,746 singleton live births from a population-based birth register between October 1998 and December 2000. We compare preterm birth rates by mother's country of birth controlling for demographic and obstetric factors as well as insurance coverage and timing of initiation of antenatal care. Overall preterm birth rates and preterm birth rates by timing of delivery (<33 weeks versus 33-36 weeks of gestation), mode of onset (spontaneous or indicated preterm birth) and the presence of hypertension in pregnancy. Women born in Northern Africa, Southern Europe and South/East Asia did not have higher preterm birth rates than women born in continental France. Rates were significantly higher for women born in the overseas French districts in the Caribbean and Indian Ocean and Sub-Saharan Africa. Excess risk was greatest for early preterm births, medically indicated births and preterm births associated with hypertension. Patterns of preterm birth with relation to timing, mode of onset and medical complications among of Afro-Caribbean origin should be confirmed in future research.

Annual Summary of Vital Statistics: 2009

PubMed Central

Kirmeyer, Sharon E.; Martin, Joyce A.; Strobino, Donna M.; Guyer, Bernard

2012-01-01

The number of births in the United States decreased by 3% between 2008 and 2009 to 4 130 665 births. The general fertility rate also declined 3% to 66.7 per 1000 women. The teenage birth rate fell 6% to 39.1 per 1000. Birth rates also declined for women 20 to 39 years and for all 5-year groups, but the rate for women 40 to 44 years continued to rise. The percentage of all births to unmarried women increased to 41.0% in 2009, up from 40.6% in 2008. In 2009, 32.9% of all births occurred by cesarean delivery, continuing its rise. The 2009 preterm birth rate declined for the third year in a row to 12.18%. The low-birth-weight rate was unchanged in 2009 at 8.16%. Both twin and triplet and higher order birth rates increased. The infant mortality rate was 6.42 infant deaths per 1000 live births in 2009. The rate is significantly lower than the rate of 6.61 in 2008. Linked birth and infant death data from 2007 showed that non-Hispanic black infants continued to have much higher mortality rates than non-Hispanic white and Hispanic infants. Life expectancy at birth was 78.2 years in 2009. Crude death rates for children and adolescents aged 1 to 19 years decreased by 6.5% between 2008 and 2009. Unintentional injuries and homicide, the first and second leading causes of death jointly accounted for 48.6% of all deaths to children and adolescents in 2009. PMID:22291121

A facility birth can be the time to start family planning: postpartum intrauterine device experiences from six countries.

PubMed

Pfitzer, Anne; Mackenzie, Devon; Blanchard, Holly; Hyjazi, Yolande; Kumar, Somesh; Lisanework Kassa, Serawit; Marinduque, Bernabe; Mateo, Marie Grace; Mukarugwiro, Beata; Ngabo, Fidele; Zaeem, Shabana; Zafar, Zonobia; Smith, Jeffrey Michael

2015-06-01

Initiation of family planning at the time of birth is opportune, since few women in low-resource settings who give birth in a facility return for further care. Postpartum family planning (PPFP) and postpartum intrauterine device (PPIUD) services were integrated into maternal care in six low- and middle-income countries, applying an insertion technique developed in Paraguay. Facilities with high delivery volume were selected to integrate PPFP/PPIUD services into routine care. Effective PPFP/PPIUD integration requires training and mentoring those providers assisting women at the time of birth. Ongoing monitoring generated data for advocacy. The percentages of PPIUD acceptors ranged from 2.3% of women counseled in Pakistan to 5.8% in the Philippines. Rates of complications among women returning for follow-up were low. Expulsion rates were 3.7% in Pakistan, 3.6% in Ethiopia, and 1.7% in Guinea and the Philippines. Infection rates did not exceed 1.3%, and three countries recorded no cases. Offering PPFP/PPIUD at birth improves access to contraception. Copyright © 2015. Published by Elsevier Ireland Ltd.

Did the ever dead outnumber the living and when? A birth-and-death approach

NASA Astrophysics Data System (ADS)

Avan, Jean; Grosjean, Nicolas; Huillet, Thierry

2015-02-01

This paper is an attempt to formalize analytically the question raised in 'World Population Explained: Do Dead People Outnumber Living, Or Vice Versa?' Huffington Post, Howard (2012). We start developing simple deterministic Malthusian growth models of the problem (with birth and death rates either constant or time-dependent) before running into both linear birth and death Markov chain models and age-structured models.

Time trends and risk factor associated with premature birth and infants deaths due to prematurity in Hubei Province, China from 2001 to 2012.

PubMed

Xu, Haiqing; Dai, Qiong; Xu, Yusong; Gong, Zhengtao; Dai, Guohong; Ding, Ming; Duggan, Christopher; Hu, Zubin; Hu, Frank B

2015-12-10

The nutrition and epidemiologic transition has been associated with an increasing incidence of preterm birth in developing countries, but data from large observational studies in China have been limited. Our study was to describe the trends and factors associated with the incidence of preterm birth and infant mortality due to prematurity in Hubei Province, China. We conducted a population-based survey through the Maternal and Child Health Care Network in Hubei Province from January 2001 to December 2012. We used data from 16 monitoring sites to examine the trend and risk factors for premature birth as well as infant mortality associated with prematurity. A total of 818,481 live births were documented, including 76,923 preterm infants (94 preterm infants per 1,000 live births) and 2,248 deaths due to prematurity (2.75 preterm deaths per 1,000 live births). From 2001 to 2012, the incidence of preterm birth increased from 56.7 to 105.2 per 1,000 live births (P for trend < 0.05), while the infant mortality rate due to prematurity declined from 95.0 to 13.4 per 1,000 live births (P for trend < 0.05). Older maternal age, lower maternal education, use of assisted reproductive technology (ART), higher income, residence in urban areas, and infant male sex were independently associated with a higher incidence of preterm birth (all p values < 0.05). Shorter gestation, lower birth weight, and lower income were associated with a higher mortality rate, while use of newborn emergency transport services (NETS) was associated with a lower preterm mortality rate (all p values < 0.05). An increasing incidence of preterm birth and a parallel reduction in infant mortality due to prematurity were observed in Hubei Province from 2001 to 2012. Our results provide important information for areas of improvements in reducing incidence and mortality of premature birth.

Preconceptional antithyroid peroxidase antibodies, but not thyroid-stimulating hormone, are associated with decreased live birth rates in infertile women.

PubMed

Seungdamrong, Aimee; Steiner, Anne Z; Gracia, Clarisa R; Legro, Richard S; Diamond, Michael P; Coutifaris, Christos; Schlaff, William D; Casson, Peter; Christman, Gregory M; Robinson, Randal D; Huang, Hao; Alvero, Ruben; Hansen, Karl R; Jin, Susan; Eisenberg, Esther; Zhang, Heping; Santoro, Nanette

2017-10-25

To study whether preconceptual thyroid-stimulating hormone (TSH) and antithyroid peroxidase (TPO) antibodies are associated with poor reproductive outcomes in infertile women. Secondary analysis of data from two multicenter, randomized, controlled trials conducted by the Reproductive Medicine Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Multivariable logistic regression analyses were performed to assess the association between preconceptual TSH levels and anti-TPO antibodies. Not applicable. Serum samples from 1,468 infertile women were utilized. None. Cumulative conception, clinical pregnancy, miscarriage, and live birth rates were calculated. Conception, clinical pregnancy, miscarriage, and live birth rates did not differ between patients with TSH ≥2.5 mIU/L vs. TSH < 2.5 mIU/L. Women with anti-TPO antibodies had similar conception rates (33.3% vs. 36.3%) but higher miscarriage rates (43.9% vs. 25.3%) and lower live birth rates (17.1% vs. 25.4%) than those without anti-TPO antibodies. Adjusted, multivariable logistic regression models confirmed elevated odds of miscarriage (odds ratio 2.17, 95% confidence interval 1.12-4.22) and lower odds of live birth (oddr ratio 0.58, 95% confidence interval 0.35-0.96) in patients with anti-TPO antibodies. In infertile women, preconceptional TSH ≥2.5 mIU/L is not associated with adverse reproductive outcomes; however, anti-TPO antibodies are associated with increased risk of miscarriage and decreased probability of live birth. PPCOS II NCT00719186; AMIGOS NCT01044862. Copyright © 2017. Published by Elsevier Inc.

Inattention and development of toddlers born in preterm and with low birth weight.

PubMed

Huang, June-Hui; Huang, Huei-Lin; Chen, Hsiu-Lin; Lin, Lung-Chang; Tseng, Hsing-I; Kao, Tsung-Jen

2012-07-01

The objective of this study was to examine the impact of low birth weight and preterm birth on a toddler's inattention and development, including cognitive, language, motor, social-emotional and adaptive behaviors. A total of 105 toddlers enrolled for the study; they were divided into four groups: 40 full-term and normal birth weight (NBW, birth weight greater than 2500 g) toddlers, 24 moderate birth weight (MLBW, birth weight between 2499 and 1500 g) toddlers, 20 very to extremely low birth weight (V-ELBW, 12 between 1000 and 1499 g and 8 lower than 1000 g) toddlers, and 21 term toddlers who were recruited from a clinic of developmental delay as the developmental delay at risk (DDR) group. The Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III) and Disruptive Behavior Rating Scale-Toddler were used. The findings were as follows: (1) DDR group performed worst in BSID-III; (2) although there were no statistical differences among the NBW, MLBW, and V-ELBW groups in BSID-III, the lower the birth weight, the lower the average performance, especially in language, adaptive social behavior, and adaptive practical behavior; and (3) comparing the inattention score, the DDR group was the poorest, normal and V-ELBW groups were the best, and MLBW group was in the middle. In conclusion, low birth weight and preterm delivery affected children's inattention and development of language, adaptive social behavior, and adaptive practical behavior. Copyright © 2012. Published by Elsevier B.V.

The changing trends in live birth statistics in Korea, 1970 to 2010.

PubMed

Lim, Jae Woo

2011-11-01

Although Korean population has been growing steadily during the past four decades, the nation is rapidly becoming an aging society because of its declining birth rate combined with an increasing life expectancy. In addition, Korea has one of the lowest fertility rates in the world due to fewer married couples, advanced maternal age, and falling birth rate. The prevalence of low birth weight infants and multiple births has been increased compared with the decrease in the birth rate. Moreover, the number of congenital anomalies is expected to increase due to the advanced maternal age. In addition, the number of interracial children is expected to increase due to the rise in the number of international marriages. However, the maternal education level is high, single-mother birth rate is low, and the gender imbalance has lessened. The number of overweight babies has been decreased, as more pregnant women are receiving adequate prenatal care. Compared to the Asian average birth weight, the average birth weight is the highest in Asia. Moreover, the rate of low birth weight infants is low, and infant mortality is similarly low across Asia. Using birth data from Statistics Korea and studies of birth outcomes in Korea and abroad, this study aimed to assess the changes in maternal and infant characteristics associated with birth outcomes during the past four decades and identify necessary information infrastructures to study countermeasures the decrease in birth rate and increase in low birth weight infants in Korea.

Comparing regional infant death rates: the influence of preterm births <24 weeks of gestation.

PubMed

Smith, Lucy; Draper, Elizabeth S; Manktelow, Bradley N; Pritchard, Catherine; Field, David John

2013-03-01

To investigate regional variation in the registration of preterm births <24 weeks of gestation and the impact on infant death rates for English Primary Care Trusts (PCTs). Cohort study. England. All registered births (1 January 2005-31 December 2008) by gestational age and PCT (147 trusts) linked to infant deaths (up to 1 year of life). Late-fetal deaths at 22 and 23 weeks gestation (1 January 2005-31 December 2006). Extremely preterm (<24 weeks) birth rate per 1000 live births and percentage of births registered as live born by PCT. Infant death rate and rank of mortality for (1) all live births and (2) live births over 24 weeks gestation by PCT. Wide between-PCT variation existed in extremely preterm birth (<24 weeks) rates (per 1000 births) (90% central range (0.31, 1.91)) and percentages of births <24 weeks of gestation registered as live born (median 52.6%, 90% central range (26.3%, 79.5%)). Consequently, the percentage of infant deaths arising from these births varied (90% central range (6.7%, 31.9%)). Excluding births <24 weeks, led to significant changes in infant mortality rankings of PCTs, with a median worsening of 12 places for PCTs with low rates of live born preterm births <24 weeks of gestation compared with a median improvement of four ranks for those with higher live birth registration rates. Infant death rates in PCTs in England are influenced by variation in the registration of births where viability is uncertain. It is vital that this variation is minimised before infant mortality is used as indicator for monitoring health and performance and targeting interventions.

International comparisons of preterm birth: higher rates of late preterm birth are associated with lower rates of stillbirth and neonatal death.

PubMed

Lisonkova, S; Sabr, Y; Butler, B; Joseph, K S

2012-12-01

To examine international rates of preterm birth and potential associations with stillbirths and neonatal deaths at late preterm and term gestation. Ecological study. Canada, USA and 26 countries in Europe. All deliveries in 2004. Information on preterm birth (<37, 32-36, 28-31 and 24-27 weeks of gestation) and perinatal deaths was obtained for 28 countries. Data sources included files and publications from Statistics Canada, the EURO-PERISTAT project and the National Center for Health Statistics. Pearson correlation coefficients and random-intercept Poisson regression were used to examine the association between preterm birth rates and gestational age-specific stillbirth and neonatal death rates. Rate ratios with 95% confidence intervals were estimated after adjustment for maternal age, parity and multiple births. Stillbirths and neonatal deaths ≥ 32 and ≥ 37 weeks of gestation. International rates of preterm birth (<37 weeks) ranged between 5.3 and 11.4 per 100 live births. Preterm birth rates at 32-36 weeks were inversely associated with stillbirths at ≥ 32 weeks (adjusted rate ratio 0.94, 95% CI 0.92-0.96) and ≥ 37 weeks (adjusted rate ratio 0.88, 95% CI 0.85-0.91) of gestation and inversely associated with neonatal deaths at ≥ 32 weeks (adjusted rate ratio 0.88, 95% CI 0.85-0.91) and ≥ 37 weeks (adjusted rate ratio 0.82, 95% CI 0.78-0.86) of gestation. Countries with high rates of preterm birth at 32-36 weeks of gestation have lower stillbirth and neonatal death rates at and beyond 32 weeks of gestation. Contemporary rates of preterm birth are indicators of both perinatal health and obstetric care services. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Economic development and family size.

PubMed

Rios, R J

1991-01-01

The demographic transition in Latin America has resulted in increased family size rather than the Western European model of reduced family size. In 1905, both fertility and mortality were high in Latin America, but mortality declined more rapidly in Latin America than in Europe. In 1905, the crude birth rate for 15 selected countries averaged 44/1000 population. Western fertility at a comparable transition point was much lower at 30/1000. Between 1905 and 1960, fertility declines were evident in Uruguay, Argentina, Cuba, and Chile. Between 1960 and 1985, fertility declines appeared in Costa Rica, Panama, Brazil, and Colombia. Fertility declines were smaller in the other Latin American countries. Crude birth rates declined markedly by 1985 but may overestimate fertility decline, which is more accurately measured by standardized birth rates. Fertility decline was evident in Argentina, Chile, and Costa Rica for standardized birth rates, survivorship ratio, and births surviving past the age of 15 years. Theoretically, families are expected to reduce family size when survivorship is assured; when mortality is 25%, only four children need be planned instead of six when mortality is 50%. A result of falling mortality is a cheaper cost of producing children, which may stimulate parents to raise bigger families. Western fertility decline has been attributed to mortality decline, urbanization, increased female labor force participation, rising wages, and more efficient contraception. Comparable economic development in Latin America has not resulted in large enough changes to encourage family size limitation. A table of fertility and economic indicators for selected countries in Latin America and Europe reflects the inverse relationship between income growth, urban growth, and growth in female educational status and fertility. The regression equation explains 60% of the variation in fertility rates among Latin American countries. Explanatory power increases to 75% when female high school enrollment is added to per capita gross national product. Fertility declines in Latin America in the future will be dependent on economic development, educational advancement for women, and a reduction in rural population.

Births: final data for 2004.

PubMed

Martin, Joyce A; Hamilton, Brady E; Sutton, Paul D; Ventura, Stephanie J; Menacker, Fay; Kirmeyer, Sharon

2006-09-29

This report presents 2004 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Descriptive tabulations of data reported on the birth certificates of the 4.1 million births that occurred in 2004 are presented. Denominators for population-based rates are post-censal estimates derived from the U.S. 2000 census. In 2004, 4,112,052 births were registered in the United States, less than 1 percent more than the number in 2003. The crude birth rate declined slightly; the general fertility rate increased by less than 1 percent. Childbearing among teenagers and women aged 20-24 years declined to record lows. Rates for women aged 25-34 and 45-49 years were unchanged, whereas rates for women aged 35-44 years increased. All measures of unmarried childbearing rose in 2004. Smoking during pregnancy continued to decline. No improvement was seen in the timely initiation of prenatal care. The cesarean delivery rate jumped 6 percent to another all-time high, whereas the rate of vaginal birth after previous cesarean fell by 13 percent. Preterm and low birthweight rates continued their steady rise. The twinning rate increased, but the rate of triplet and higher order multiple births was down slightly.

International variations in the gestational age distribution of births: an ecological study in 34 high-income countries.

PubMed

Delnord, Marie; Mortensen, Laust; Hindori-Mohangoo, Ashna D; Blondel, Béatrice; Gissler, Mika; Kramer, Michael R; Richards, Jennifer L; Deb-Rinker, Paromita; Rouleau, Jocelyn; Morisaki, Naho; Nassar, Natasha; Bolumar, Francisco; Berrut, Sylvie; Nybo Andersen, Anne-Marie; Kramer, Michael S; Zeitlin, Jennifer

2018-04-01

Few studies have investigated international variations in the gestational age (GA) distribution of births. While preterm births (22-36 weeks GA) and early term births (37-38 weeks) are at greater risk of adverse health outcomes compared to full term births (39-40 weeks), it is not known if countries with high preterm birth rates also have high early term birth rates. We examined rate associations between preterm and early term births and mean term GA by mode of delivery onset. We used routine aggregate data on the GA distribution of singleton live births from up to 34 high-income countries/regions in 1996, 2000, 2004, 2008 and 2010 to study preterm and early term births overall and by spontaneous or indicated onset. Pearson correlation coefficients were adjusted for clustering in time trend analyses. Preterm and early term births ranged from 4.1% to 8.2% (median 5.5%) and 15.6% to 30.8% (median 22.2%) of live births in 2010, respectively. Countries with higher preterm birth rates in 2004-2010 had higher early term birth rates (r > 0.50, P < 0.01) and changes over time were strongly correlated overall (adjusted-r = 0.55, P < 0.01) and by mode of onset. Positive associations between preterm and early term birth rates suggest that common risk factors could underpin shifts in the GA distribution. Targeting modifiable population risk factors for delivery before 39 weeks GA may provide a useful preterm birth prevention paradigm.

Population, poverty and economic development.

PubMed

Sinding, Steven W

2009-10-27

Economists, demographers and other social scientists have long debated the relationship between demographic change and economic outcomes. In recent years, general agreement has emerged to the effect that improving economic conditions for individuals generally lead to lower birth rates. But, there is much less agreement about the proposition that lower birth rates contribute to economic development and help individuals and families to escape from poverty. The paper examines recent evidence on this aspect of the debate, concludes that the burden of evidence now increasingly supports a positive conclusion, examines recent trends in demographic change and economic development and argues that the countries representing the last development frontier, those of Sub-Saharan Africa, would be well advised to incorporate policies and programmes to reduce high fertility in their economic development strategies.

Impact of timing of birth and resident duty-hour restrictions on outcomes for small preterm infants.

PubMed

Bell, Edward F; Hansen, Nellie I; Morriss, Frank H; Stoll, Barbara J; Ambalavanan, Namasivayam; Gould, Jeffrey B; Laptook, Abbot R; Walsh, Michele C; Carlo, Waldemar A; Shankaran, Seetha; Das, Abhik; Higgins, Rosemary D

2010-08-01

The goal was to examine the impact of birth at night, on the weekend, and during July or August (the first months of the academic year) and the impact of resident duty-hour restrictions on mortality and morbidity rates for very low birth weight infants. Outcomes were analyzed for 11,137 infants with birth weights of 501 to 1250 g who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry in 2001-2005. Approximately one-half were born before the introduction of resident duty-hour restrictions in 2003. Follow-up assessments at 18 to 22 months were completed for 4508 infants. Mortality rate, short-term morbidities, and neurodevelopmental outcome were examined with respect to the timing of birth. There was no effect of the timing of birth on mortality rate and no impact on the risks of short-term morbidities except that the risk of retinopathy of prematurity (stage > or =2) was higher after the introduction of duty-hour restrictions and the risk of retinopathy of prematurity requiring operative treatment was lower for infants born during the late night than during the day. There was no impact of the timing of birth on neurodevelopmental outcome except that the risk of hearing impairment or death was slightly lower among infants born in July or August. In this network, the timing of birth had little effect on the risks of death and morbidity for very low birth weight infants, which suggests that staffing patterns were adequate to provide consistent care.

Province-based study of neurologic disability among survivors weighing 500 through 1249 grams at birth.

PubMed

Robertson, C; Sauve, R S; Christianson, H E

1994-04-01

As the mortality of children weighing 500 through 1249 g at birth decreases, the published rates of neurologic disability among survivors have caused concern. Outcome information from a province-based study in which perinatal/neonatal regional care is well developed and includes high-risk identification, early referral, organized transport, and outreach education, provides data from a Canadian source for comparison with epidemiologic reports. Neurologic disability rates among 2- to 3-year-old survivors weighing 500 through 1249 g at birth is provided based on all live births/neonatal survivors/1-year survivors born in Alberta, Canada to Alberta residents in 1990. Corrected survival to 1-year was 163 of 229 or 71% of live births of the total group weighing 500 through 1249 g. Of 168 live births, 143 or 85% weighing 750 through 1249 g, free from lethal anomalies, survived. Based on 1-year survival, disability rates were: cerebral palsy, 67/1000; vision loss (acuity in the best seeing eye after correction, < 20/60), 12/1000; neurosensory hearing loss (loss of > or = 30 dB binaurally), 12/1000; and trainable/profound mental retardation, 18/1000. No survivor had a convulsive disorder. No vision loss or mental retardation as defined by this study occurred in survivors of > or = 750 g. All children with cerebral palsy were or were projected to become ambulatory. Neurologic disability among small preterm surviving infants can occur less frequently than suggested by published reports. We believe this provincial study supports the value of well developed regional perinatal programs.

Skeletal Growth Dysregulation in Australian Male Infants and Toddlers With Autism Spectrum Disorder.

PubMed

Green, Cherie C; Dissanayake, Cheryl; Loesch, Danuta Z; Bui, Minh; Barbaro, Josephine

2018-06-01

Recent findings suggest that children with Autism Spectrum Disorder (ASD) are larger in size for head circumference (HC), height, and weight compared to typically developing (TD) children; however, little is known about their rate of growth, especially in height and weight. The current study aimed to: (a) confirm and extend upon previous findings of early generalized overgrowth in ASD; and (b) determine if there were any differences in the rate of growth between infants and toddlers with ASD compared to their TD peers. Measurements of HC, height, and weight were available for 135 boys with ASD and 74 TD boys, from birth through 3 years of age. Size and growth rate in HC, height, and weight were analyzed using a linear mixed-effects model. Infants with ASD were significantly smaller in size at birth for HC, body length, and weight compared to TD infants (all P < 0.05); however, they grew at a significantly faster rate in HC and height in comparison to the TD children (P < 0.001); there was no significant difference between the groups in growth rate for weight (P > 0.05). The results confirmed that male infants and toddlers with ASD exhibit skeletal growth dysregulation early in life. Autism Res 2018, 11: 846-856. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Recent findings suggest that infants with Autism Spectrum Disorder (ASD) are smaller in size at birth compared to typically developing infants but grow larger than their peers during the first year. Little is known about their rate of growth, especially for height and weight. Our findings confirmed that infants with ASD are smaller in size at birth for head circumference (HC), height, and weight, but grow at a faster rate in HC and height than their peers from birth to 3 years. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

Spotlight: Togo.

PubMed

May, J F

1988-12-01

The Republic of Togo is a land of 21,622 square miles on the west coast of Africa, 8 degrees north of the equator. The country is divided between the Kabye people in the north (22%) and the Ewe people in the south (35%). The president, General Gnassingbe Eyadema, is a Kabye. The population of 3.3 million (1988) is growing at the rate of 3.3%/year, despite an infant mortality of 107 deaths/1000 live births and a life expectancy of only 54 years. The total fertility rate is 6.5 children/woman. The birth rate is 47 births/1000 population, and the death rate is 14/1000. Population growth, especially in the cities of Lome and Kara, where 1/4 of the population lives, is considered a major threat to development. A Demographic and Health Survey has been taken, and a Conference on Population and Development was held in Lome in 1987 to draft a national population policy statement. Family planning services need to be implemented to raise the contraceptive prevalence rate above its present 2%, and the population needs to be redistributed, but this requires investment of funds currently being used to service the foreign debt. The country's gross national product is only $300 per capita.

Population-wide folic acid fortification and preterm birth: testing the folate depletion hypothesis.

PubMed

Naimi, Ashley I; Auger, Nathalie

2015-04-01

We assess whether population-wide folic acid fortification policies were followed by a reduction of preterm and early-term birth rates in Québec among women with short and optimal interpregnancy intervals. We extracted birth certificate data for 1.3 million births between 1981 and 2010 to compute age-adjusted preterm and early-term birth rates stratified by short and optimal interpregnancy intervals. We used Joinpoint regression to detect changes in the preterm and early term birth rates and assess whether these changes coincide with the implementation of population-wide folic acid fortification. A change in the preterm birth rate occurred in 2000 among women with short (95% confidence interval [CI] = 1994, 2005) and optimal (95% CI = 1995, 2008) interpregnancy intervals. Changes in early term birth rates did not coincide with the implementation of folic acid fortification. Our results do not indicate a link between folic acid fortification and early term birth but suggest an improvement in preterm birth rates after implementation of a nationwide folic acid fortification program.

Births: preliminary data for 2000.

PubMed

Martin, J A; Hamilton, B E; Ventura, S J

2001-07-24

This report presents preliminary data for 2000 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, prenatal care, cesarean delivery, and low birthweight are also presented. Data in this report are based on more than 96 percent of births for 2000. The records are weighted to independent control counts of births received in State vital statistics offices in 2000. Comparisons are made with 1999 final data. The number of births rose 3 percent between 1999 and 2000. The crude birth rate increased to 14.8 per 1,000 population in 2000, 2 percent higher than the 1999 rate. The fertility rate rose 3 percent to 67.6 per 1,000 women aged 15-44 years between 1999 and 2000. The birth rate for teenagers, which has been falling since 1991, declined 2 percent in 2000 to 48.7 births per 1,000 females aged 15-19 years, another historic low. The rate for teenagers 15-17 years fell 4 percent, and the rate for 18-19 year olds was down 1 percent. Since 1991, rates have fallen 29 percent for teenagers 15-17 years and 16 percent for teenagers 18-19 years. Birth rates for all of the older age groups increased for 1999-2000: 1 percent among women aged 20-24 years, 3 percent for women aged 25-29 years, and 5 percent for women in their thirties. Rates for women aged 40-54 years were also up for 2000. The birth rate for unmarried women increased 2 percent to 45.2 births per 1,000 unmarried women aged 15-44 years in 2000, but was still lower than the peak reached in 1994. The number of births to unmarried women was up 3 percent, the highest number ever reported in the United States. However, the number of births to unmarried teenagers declined. The proportion of women who began prenatal care in the first trimester of pregnancy (83.2 percent) did not improve for 2000, nor did the rate of low birthweight (7.6 percent). The total cesarean rate rose for the fourth consecutive year to 22.9 percent, the result of both a rise in the rate of primary cesarean deliveries and a decline in the rate of vaginal births after previous cesarean delivery.

Transition probabilities for general birth-death processes with applications in ecology, genetics, and evolution

PubMed Central

Crawford, Forrest W.; Suchard, Marc A.

2011-01-01

A birth-death process is a continuous-time Markov chain that counts the number of particles in a system over time. In the general process with n current particles, a new particle is born with instantaneous rate λn and a particle dies with instantaneous rate μn. Currently no robust and efficient method exists to evaluate the finite-time transition probabilities in a general birth-death process with arbitrary birth and death rates. In this paper, we first revisit the theory of continued fractions to obtain expressions for the Laplace transforms of these transition probabilities and make explicit an important derivation connecting transition probabilities and continued fractions. We then develop an efficient algorithm for computing these probabilities that analyzes the error associated with approximations in the method. We demonstrate that this error-controlled method agrees with known solutions and outperforms previous approaches to computing these probabilities. Finally, we apply our novel method to several important problems in ecology, evolution, and genetics. PMID:21984359

Tackling Health Inequities in Chile: Maternal, Newborn, Infant, and Child Mortality Between 1990 and 2004

PubMed Central

Requejo, Jennifer Harris; Nien, Jyh Kae; Merialdi, Mario; Bustreo, Flavia; Betran, Ana Pilar

2009-01-01

Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged > 28 days and < 1 year), and children aged 1 to 4 years. We also calculated these statistics by 5-year intervals for Chile's poorest to richest district quintiles. Results. During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100 000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions. During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. PMID:19443831

Geographic variation in trends and characteristics of teen childbearing among American Indians and Alaska Natives, 1990-2007.

PubMed

Wingo, Phyllis A; Lesesne, Catherine A; Smith, Ruben A; de Ravello, Lori; Espey, David K; Arambula Solomon, Teshia G; Tucker, Myra; Thierry, Judith

2012-12-01

To study teen birth rates, trends, and socio-demographic and pregnancy characteristics of AI/AN across geographic regions in the US. The birth rate for US teenagers 15-19 years reached a historic low in 2009 (39.1 per 1,000) and yet remains one of the highest teen birth rates among industrialized nations. In the US, teen birth rates among Hispanic, non-Hispanic black, and American Indian/Alaska Native (AI/AN) youth are consistently two to three times the rate among non-Hispanic white teens. Birth certificate data for females younger than age 20 were used to calculate birth rates (live births per 1,000 women) and joinpoint regression to describe trends in teen birth rates by age (<15, 15-17, 18-19) and region (Aberdeen, Alaska, Bemidji, Billings, California, Nashville, Oklahoma, Portland, Southwest). Birth rates for AI/AN teens varied across geographic regions. Among 15-19-year-old AI/AN, rates ranged from 24.35 (California) to 123.24 (Aberdeen). AI/AN teen birth rates declined from the early 1990s into the 2000s for all three age groups. Among 15-17-year-olds, trends were approximately level during the early 2000s-2007 in six regions and declined in the others. Among 18-19-year-olds, trends were significantly increasing during the early 2000s-2007 in three regions, significantly decreasing in one, and were level in the remaining regions. Among AI/AN, cesarean section rates were lower in Alaska (4.1%) than in other regions (16.4-26.6%). This is the first national study to describe regional variation in AI/AN teen birth rates. These data may be used to target limited resources for teen pregnancy intervention programs and guide research.

Extinction probabilities and stationary distributions of mobile genetic elements in prokaryotes: The birth-death-diversification model.

PubMed

Drakos, Nicole E; Wahl, Lindi M

2015-12-01

Theoretical approaches are essential to our understanding of the complex dynamics of mobile genetic elements (MGEs) within genomes. Recently, the birth-death-diversification model was developed to describe the dynamics of mobile promoters (MPs), a particular class of MGEs in prokaryotes. A unique feature of this model is that genetic diversification of elements was included. To explore the implications of diversification on the longterm fate of MGE lineages, in this contribution we analyze the extinction probabilities, extinction times and equilibrium solutions of the birth-death-diversification model. We find that diversification increases both the survival and growth rate of MGE families, but the strength of this effect depends on the rate of horizontal gene transfer (HGT). We also find that the distribution of MGE families per genome is not necessarily monotonically decreasing, as observed for MPs, but may have a peak in the distribution that is related to the HGT rate. For MPs specifically, we find that new families have a high extinction probability, and predict that the number of MPs is increasing, albeit at a very slow rate. Additionally, we develop an extension of the birth-death-diversification model which allows MGEs in different regions of the genome, for example coding and non-coding, to be described by different rates. This extension may offer a potential explanation as to why the majority of MPs are located in non-promoter regions of the genome. Copyright © 2015 Elsevier Inc. All rights reserved.

Fast simulation of reconstructed phylogenies under global time-dependent birth-death processes.

PubMed

Höhna, Sebastian

2013-06-01

Diversification rates and patterns may be inferred from reconstructed phylogenies. Both the time-dependent and the diversity-dependent birth-death process can produce the same observed patterns of diversity over time. To develop and test new models describing the macro-evolutionary process of diversification, generic and fast algorithms to simulate under these models are necessary. Simulations are not only important for testing and developing models but play an influential role in the assessment of model fit. In the present article, I consider as the model a global time-dependent birth-death process where each species has the same rates but rates may vary over time. For this model, I derive the likelihood of the speciation times from a reconstructed phylogenetic tree and show that each speciation event is independent and identically distributed. This fact can be used to simulate efficiently reconstructed phylogenetic trees when conditioning on the number of species, the time of the process or both. I show the usability of the simulation by approximating the posterior predictive distribution of a birth-death process with decreasing diversification rates applied on a published bird phylogeny (family Cettiidae). The methods described in this manuscript are implemented in the R package TESS, available from the repository CRAN (http://cran.r-project.org/web/packages/TESS/). Supplementary data are available at Bioinformatics online.

Development of Non-contact Respiratory Monitoring System for Newborn Using a FG Vision Sensor

NASA Astrophysics Data System (ADS)

Kurami, Yoshiyuki; Itoh, Yushi; Natori, Michiya; Ohzeki, Kazuo; Aoki, Yoshimitsu

In recent years, development of neonatal care is strongly hoped, with increase of the low-birth-weight baby birth rate. Especially respiration of low-birth-weight baby is incertitude because central nerve and respiratory function is immature. Therefore, a low-birth-weight baby often causes a disease of respiration. In a NICU (Neonatal Intensive Care Unit), neonatal respiration is monitored using cardio-respiratory monitor and pulse oximeter at all times. These contact-type sensors can measure respiratory rate and SpO2 (Saturation of Peripheral Oxygen). However, because a contact-type sensor might damage the newborn's skin, it is a real burden to monitor neonatal respiration. Therefore, we developed the respiratory monitoring system for newborn using a FG (Fiber Grating) vision sensor. FG vision sensor is an active stereo vision sensor, it is possible for non-contact 3D measurement. A respiratory waveform is calculated by detecting the vertical motion of the thoracic and abdominal region with respiration. We attempted clinical experiment in the NICU, and confirmed the accuracy of the obtained respiratory waveform was high. Non-contact respiratory monitoring of newborn using a FG vision sensor enabled the minimally invasive procedure.

Determinants of preterm birth rates in Canada from 1981 through 1983 and from 1992 through 1994.

PubMed

Joseph, K S; Kramer, M S; Marcoux, S; Ohlsson, A; Wen, S W; Allen, A; Platt, R

1998-11-12

The rates of preterm birth have increased in many countries, including Canada, over the past 20 years. However, the factors underlying the increase are poorly understood. We used data from the Statistics Canada live-birth and stillbirth data bases to determine the effects of changes in the frequency of multiple births, registration of births occurring very early in gestation, patterns of obstetrical intervention, and use of ultrasonographic dating of gestational age on the rates of preterm birth in Canada from 1981 through 1983 and from 1992 through 1994. All births in 9 of the 12 provinces and territories of Canada were included. Logistic-regression analysis and Poisson regression analysis were used to estimate changes between the two three-year periods, after adjustment for the above-mentioned determinants of the likelihood of preterm births. Preterm births increased from 6.3 percent of live births in 1981 through 1983 to 6.8 percent in 1992 through 1994, a relative increase of 9 percent (95 percent confidence interval, 7 to 10 percent). Among singleton births, preterm births increased by 5 percent (95 percent confidence interval, 3 to 6 percent). Multiple births increased from 1.9 percent to 2.1 percent of all live births; the rates of preterm birth among live births resulting from multiple gestations increased by 25 percent (95 percent confidence interval, 21 to 28 percent). Adjustment for the determinants of the likelihood of preterm birth reduced the increase in the rate of preterm birth to 3 percent among all live births and 1 percent among singleton births. The recent increase in preterm births in Canada is largely attributable to changes in the frequency of multiple births, obstetrical intervention, and the use of ultrasound-based estimates of gestational age.

Using the effects of maternal nutritional indicators (hemoglobin and total protein) on baby's birth weight outcome to forecast a paradigm shift toward increased levels of non-communicable diseases in children.

PubMed

Ahmadu, Baba Usman; Yakubu, Nyandaiti; Yusuph, Haruna; Alfred, Marshall; Bazza, Buba; Lamurde, Abdullahi Suleiman

2013-01-01

Maternal malnutrition can lead to low birth weight in babies, which puts them at risk of developing non-communicable diseases later in life. Evidence from developed countries has shown that low birth weight is associated with a predisposition to higher rates of non-communicable diseases later in life. However, information on this is lacking in developing countries. Thus, this work studied the effects of maternal nutritional indicators (hemoglobin and total protein) on birth weight outcome of babies to forecast a paradigm shift toward increased levels of non-communicable diseases in children. Mother-baby pairs were enrolled in this study using systematic random sampling. Maternal haemogblobin and total proteins were measured using micro-hematocrit and biuret methods, and birth weights of their babies were estimated using the bassinet weighing scale. Of the 168 (100%) babies that participated in this study, 122 (72.6%) were delivered at term and 142 (84.5%) had normal birth weights. Mean comparison of baby's birth weight and maternal hemoglobin was not significant (P = 0.483), that for maternal total protein was also not significant (P = 0.411). Even though positive correlation coefficients were observed between birth weight of babies, maternal hemoglobin and total proteins, these were however not significant. Maternal nutrition did not contribute significantly to low birth weight in our babies. Therefore, association between maternal nutrition and low birth weight to predict future development of non-communicable diseases in our study group is highly unlikely. However, we recommend further work.

Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study

PubMed Central

Phiri-Mazala, Grace; Guerina, Nicholas G; Kasimba, Joshua; Mulenga, Charity; MacLeod, William B; Waitolo, Nelson; Knapp, Anna B; Mirochnick, Mark; Mazimba, Arthur; Fox, Matthew P; Sabin, Lora; Seidenberg, Philip; Simon, Jonathon L; Hamer, Davidson H

2011-01-01

Objective To determine whether training traditional birth attendants to manage several common perinatal conditions could reduce neonatal mortality in the setting of a resource poor country with limited access to healthcare. Design Prospective, cluster randomised and controlled effectiveness study. Setting Lufwanyama, an agrarian, poorly developed district located in the Copperbelt province, Zambia. All births carried out by study birth attendants occurred at mothers’ homes, in rural village settings. Participants 127 traditional birth attendants and mothers and their newborns (3559 infants delivered regardless of vital status) from Lufwanyama district. Interventions Using an unblinded design, birth attendants were cluster randomised to intervention or control groups. The intervention had two components: training in a modified version of the neonatal resuscitation protocol, and single dose amoxicillin coupled with facilitated referral of infants to a health centre. Control birth attendants continued their existing standard of care (basic obstetric skills and use of clean delivery kits). Main outcome measures The primary outcome was the proportion of liveborn infants who died by day 28 after birth, with rate ratios statistically adjusted for clustering. Secondary outcomes were mortality at different time points; and comparison of causes of death based on verbal autopsy data. Results Among 3497 deliveries with reliable information, mortality at day 28 after birth was 45% lower among liveborn infants delivered by intervention birth attendants than control birth attendants (rate ratio 0.55, 95% confidence interval 0.33 to 0.90). The greatest reductions in mortality were in the first 24 hours after birth: 7.8 deaths per 1000 live births for infants delivered by intervention birth attendants compared with 19.9 per 1000 for infants delivered by control birth attendants (0.40, 0.19 to 0.83). Deaths due to birth asphyxia were reduced by 63% among infants delivered by intervention birth attendants (0.37, 0.17 to 0.81) and by 81% within the first two days after birth (0.19, 0.07 to 0.52). Stillbirths and deaths from serious infection occurred at similar rates in both groups. Conclusions Training traditional birth attendants to manage common perinatal conditions significantly reduced neonatal mortality in a rural African setting. This approach has high potential to be applied to similar settings with dispersed rural populations. Trial registration Clinicaltrials.gov NCT00518856. PMID:21292711

Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study.

PubMed

Gill, Christopher J; Phiri-Mazala, Grace; Guerina, Nicholas G; Kasimba, Joshua; Mulenga, Charity; MacLeod, William B; Waitolo, Nelson; Knapp, Anna B; Mirochnick, Mark; Mazimba, Arthur; Fox, Matthew P; Sabin, Lora; Seidenberg, Philip; Simon, Jonathon L; Hamer, Davidson H

2011-02-03

To determine whether training traditional birth attendants to manage several common perinatal conditions could reduce neonatal mortality in the setting of a resource poor country with limited access to healthcare. Prospective, cluster randomised and controlled effectiveness study. Lufwanyama, an agrarian, poorly developed district located in the Copperbelt province, Zambia. All births carried out by study birth attendants occurred at mothers' homes, in rural village settings. 127 traditional birth attendants and mothers and their newborns (3559 infants delivered regardless of vital status) from Lufwanyama district. Using an unblinded design, birth attendants were cluster randomised to intervention or control groups. The intervention had two components: training in a modified version of the neonatal resuscitation protocol, and single dose amoxicillin coupled with facilitated referral of infants to a health centre. Control birth attendants continued their existing standard of care (basic obstetric skills and use of clean delivery kits). The primary outcome was the proportion of liveborn infants who died by day 28 after birth, with rate ratios statistically adjusted for clustering. Secondary outcomes were mortality at different time points; and comparison of causes of death based on verbal autopsy data. Among 3497 deliveries with reliable information, mortality at day 28 after birth was 45% lower among liveborn infants delivered by intervention birth attendants than control birth attendants (rate ratio 0.55, 95% confidence interval 0.33 to 0.90). The greatest reductions in mortality were in the first 24 hours after birth: 7.8 deaths per 1000 live births for infants delivered by intervention birth attendants compared with 19.9 per 1000 for infants delivered by control birth attendants (0.40, 0.19 to 0.83). Deaths due to birth asphyxia were reduced by 63% among infants delivered by intervention birth attendants (0.37, 0.17 to 0.81) and by 81% within the first two days after birth (0.19, 0.07 to 0.52). Stillbirths and deaths from serious infection occurred at similar rates in both groups. Training traditional birth attendants to manage common perinatal conditions significantly reduced neonatal mortality in a rural African setting. This approach has high potential to be applied to similar settings with dispersed rural populations. Trial registration Clinicaltrials.gov NCT00518856.

Coverage of private sector community midwife services in rural Punjab, Pakistan: development and demand.

PubMed

Mumtaz, Zubia; Levay, Adrienne V; Jhangri, Gian S; Bhatti, Afshan

2015-11-25

In 2007, the Government of Pakistan introduced a new cadre of community midwives (CMWs) to address low skilled birth attendance rates in rural areas; this workforce is located in the private-sector. There are concerns about the effectiveness of the programme for increasing skilled birth attendance as previous experience from private-sector programmes has been sub-optimal. Indonesia first promoted private sector midwifery care, but the initiative failed to provide universal coverage and reduce maternal mortality rates. A clustered, stratified survey was conducted in the districts of Jhelum and Layyah, Punjab. A total of 1,457 women who gave birth in the 2 years prior to the survey were interviewed. χ(2) analyses were performed to assess variation in coverage of maternal health services between the two districts. Logistic regression models were developed to explore whether differentials in coverage between the two districts could be explained by differential levels of development and demand for skilled birth attendance. Mean cost of childbirth care by type of provider was also calculated. Overall, 7.9% of women surveyed reported a CMW-attended birth. Women in Jhelum were six times more likely to report a CMW-attended birth than women in Layyah. The mean cost of a CMW-attended birth compared favourably with a dai-attended birth. The CMWs were, however, having difficulty garnering community trust. The majority of women, when asked why they had not sought care from their neighbourhood CMW, cited a lack of trust in CMWs' competency and that they wanted a different provider. The CMWs have yet to emerge as a significant maternity care provider in rural Punjab. Levels of overall community development determined uptake and hence coverage of CMW care. The CMWs were able to insert themselves into the maternal health marketplace in Jhelum because of an existing demand. A lower demand in Layyah meant there was less 'space' for the CMWs to enter the market. To ensure universal coverage, there is a need to revisit the strategy of introducing a new midwifery workforce in the private sector in contexts of low demand and marketing the benefits of skilled birth attendance.

No Time for Complacency: Teen Births in California.

ERIC Educational Resources Information Center

Constantine, Norman A.; Nevarez, Carmen R.

California's recent investment in teen pregnancy prevention has contributed to the largest decline in teen birth rates and the second largest percentage reduction of all 50 states. California's annual teen birth rate is now similar to the national rate. This occurred while the highest teen birth rate group, Latinas, increased as a proportion of…

Projecting the potential impact of the Cap-Score™ on clinical pregnancy, live births, and medical costs in couples with unexplained infertility.

PubMed

Babigumira, Joseph B; Sharara, Fady I; Garrison, Louis P

2018-01-01

The Cap-Score™ was developed to assess the capacitation status of men, thereby enabling personalized management of unexplained infertility by choosing timed intrauterine insemination (IUI), versus immediate in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in individuals with a low Cap-Score™. The objective of this study was to estimate the differences in outcomes and costs comparing the use of the Cap-Score™ with timed IUI (CS-TI) and the standard of care (SOC), which was assumed to be three IUI cycles followed by three IVF-ICSI cycles. We developed and parameterized a decision-analytic model of management of unexplained infertility for women based on data from the published literature. We calculated the clinical pregnancy rates, live birth rates, and medical costs comparing CS-TI and SOC. We used Monte Carlo simulation to quantify uncertainty in projected estimates and performed univariate sensitivity analysis. Compared to SOC, CS-TI was projected to increase the pregnancy rate by 1-26%, marginally reduce live birth rates by 1-3% in couples with women below 40 years, increase live birth rates by 3-7% in couples with women over 40 years, reduce mean medical costs by $4000-$19,200, reduce IUI costs by $600-$1370, and reduce IVF costs by $3400-$17,800, depending on the woman's age. The Cap-Score™ is a potentially valuable clinical tool for management of unexplained infertility because it is projected to improve clinical pregnancy rates, save money, and, depending on the price of the test, increase access to treatment for infertility.

Epidemiologic Surveillance of Teenage Birth Rates in the United States, 2006-2012.

PubMed

Amin, Raid; Decesare, Julie Zemaitis; Hans, Jennifer; Roussos-Ross, Kay

2017-06-01

To investigate the geographic variation in the average teenage birth rates by county in the contiguous United States. Data from the National Center for Health Statistics were used in this retrospective cohort to count the total number of live births to females aged 15-19 years by county between 2006 and 2012. Software for disease surveillance and spatial cluster analysis was used to identify clusters of high or low teenage births in counties or areas of greater than 100,000 teenage females. The analysis was then adjusted for percentage of poverty and high school diploma achievement. The unadjusted analysis identified the top 10 clusters of teenage births. The cluster with the highest rate was a city and the surrounding 40 counties, demonstrating an average teen birth rate of 67 per 1,000 females in the age range, 87% higher than the rate in the contiguous United States. Adjustments for poverty rates and high school diploma achievement shifted the top clusters to other areas. Despite an overall national decline in the teenage birth rate, clusters of elevated teenage birth rates remain. These clusters are not random and remain higher than expected when adjusted for poverty and education. This data set provides a framework to focus targeted interventions to reduce teenage birth rates in this high-risk population.

Annual summary of vital statistics: 2005.

PubMed

Hamilton, Brady E; Miniño, Arialdi M; Martin, Joyce A; Kochanek, Kenneth D; Strobino, Donna M; Guyer, Bernard

2007-02-01

The general fertility rate in 2005 was 66.7 births per 1000 women aged 15 to 44 years, the highest level since 1993. The birth rate for teen mothers (aged 15 to 19 years) declined by 2% between 2004 and 2005, falling to 40.4 births per 1000 women, the lowest ever recorded in the 65 years for which there are consistent data. The birth rates for women > or = 30 years of age rose in 2005 to levels not seen in almost 40 years. Childbearing by unmarried women also increased to historic record levels for the United States in 2005. The cesarean-delivery rate rose by 4% in 2005 to 30.2% of all births, another record high. The preterm birth rate continued to rise (to 12.7% in 2005), as did the rate for low birth weight births (8.2%). The infant mortality rate was 6.79 infant deaths per 1000 live births in 2004, not statistically different from the rate in 2003. Pronounced differences in infant mortality rates by race and Hispanic origin continue, with non-Hispanic black newborns more than twice as likely as non-Hispanic white and Hispanic infants to die within 1 year of birth. The expectation of life at birth reached a record high in 2004 of 77.8 years for all gender and race groups combined. Death rates in the United States continued to decline, with death rates decreasing for 9 of the 15 leading causes. The crude death rate for children aged 1 to 19 years did not decrease significantly between 2003 and 2004. Of the 10 leading causes of death for 2004 in this age group, only the rates for influenza and pneumonia showed a significant decrease. The death rates increased for intentional self-harm (suicide), whereas rates for other causes did not change significantly for children. A large proportion of childhood deaths continue to occur as a result of preventable injuries.

Temporal Trends in Late Preterm and Early Term Birth Rates in 6 High-Income Countries in North America and Europe and Association With Clinician-Initiated Obstetric Interventions.

PubMed

Richards, Jennifer L; Kramer, Michael S; Deb-Rinker, Paromita; Rouleau, Jocelyn; Mortensen, Laust; Gissler, Mika; Morken, Nils-Halvdan; Skjærven, Rolv; Cnattingius, Sven; Johansson, Stefan; Delnord, Marie; Dolan, Siobhan M; Morisaki, Naho; Tough, Suzanne; Zeitlin, Jennifer; Kramer, Michael R

2016-07-26

Clinicians have been urged to delay the use of obstetric interventions (eg, labor induction, cesarean delivery) until 39 weeks or later in the absence of maternal or fetal indications for intervention. To describe recent trends in late preterm and early term birth rates in 6 high-income countries and assess association with use of clinician-initiated obstetric interventions. Retrospective analysis of singleton live births from 2006 to the latest available year (ranging from 2010 to 2015) in Canada, Denmark, Finland, Norway, Sweden, and the United States. Use of clinician-initiated obstetric intervention (either labor induction or prelabor cesarean delivery) during delivery. Annual country-specific late preterm (34-36 weeks) and early term (37-38 weeks) birth rates. The study population included 2,415,432 Canadian births in 2006-2014 (4.8% late preterm; 25.3% early term); 305,947 Danish births in 2006-2010 (3.6% late preterm; 18.8% early term); 571,937 Finnish births in 2006-2015 (3.3% late preterm; 16.8% early term); 468,954 Norwegian births in 2006-2013 (3.8% late preterm; 17.2% early term); 737,754 Swedish births in 2006-2012 (3.6% late preterm; 18.7% early term); and 25,788,558 US births in 2006-2014 (6.0% late preterm; 26.9% early term). Late preterm birth rates decreased in Norway (3.9% to 3.5%) and the United States (6.8% to 5.7%). Early term birth rates decreased in Norway (17.6% to 16.8%), Sweden (19.4% to 18.5%), and the United States (30.2% to 24.4%). In the United States, early term birth rates decreased from 33.0% in 2006 to 21.1% in 2014 among births with clinician-initiated obstetric intervention, and from 29.7% in 2006 to 27.1% in 2014 among births without clinician-initiated obstetric intervention. Rates of clinician-initiated obstetric intervention increased among late preterm births in Canada (28.0% to 37.9%), Denmark (22.2% to 25.0%), and Finland (25.1% to 38.5%), and among early term births in Denmark (38.4% to 43.8%) and Finland (29.8% to 40.1%). Between 2006 and 2014, late preterm and early term birth rates decreased in the United States, and an association was observed between early term birth rates and decreasing clinician-initiated obstetric interventions. Late preterm births also decreased in Norway, and early term births decreased in Norway and Sweden. Clinician-initiated obstetric interventions increased in some countries but no association was found with rates of late preterm or early term birth.

The relationship between preterm birth and underweight in Asian women.

PubMed

Neggers, Yasmin H

2015-08-15

Although vast improvements have been made in the survival of preterm infants, the toll of preterm birth (PTB) is particularly severe in Asia, with the Indian subcontinent leading the preterm birth rate. Despite the obesity epidemic, maternal underweight remains a common occurrence in developing countries. An association between maternal underweight and preterm birth has been reported in developed countries. A review of epidemiological studies in Asian women in whom association between maternal body mass index (BMI) and risk of PTB was measured, indicated no significant association between low maternal BMI and preterm birth. A hindrance in comparison of these studies is the use of different cut-off point for BMI in defining maternal underweight. As a commentary on published studies it is proposed that that country-specific BMI cut points should be applied for defining underweight for Asian women for the purpose of evaluating the association between maternal underweight and preterm birth. Copyright © 2015 Elsevier Inc. All rights reserved.

Body composition during early infancy and developmental progression from 1 to 5 years of age: the Infant Anthropometry and Body Composition (iABC) cohort study among Ethiopian children.

PubMed

Abera, Mubarek; Tesfaye, Markos; Admassu, Bitiya; Hanlon, Charlotte; Ritz, Christian; Wibaek, Rasmus; Michaelsen, Kim F; Friis, Henrik; Wells, Jonathan C; Andersen, Gregers S; Girma, Tsinuel; Kæstel, Pernille

2018-06-01

Early nutrition and growth have been found to be important early exposures for later development. Studies of crude growth in terms of weight and length/height, however, cannot elucidate how body composition (BC) might mediate associations between nutrition and later development. In this study, we aimed to examine the relation between fat mass (FM) or fat-free mass (FFM) tissues at birth and their accretion during early infancy, and later developmental progression. In a birth cohort from Ethiopia, 455 children who have BC measurement at birth and 416 who have standardised rate of BC growth during infancy were followed up for outcome variable, and were included in the statistical analysis. The study sample was restricted to mothers living in Jimma town who gave birth to a term baby with a birth weight ≥1500 g and no evident congenital anomalies. The relationship between the exposure and outcome variables was examined using linear-mixed regression model. The finding revealed that FFM at birth was positively associated with global developmental progression from 1 to 5 years (β=1·75; 95 % CI 0·11, 3·39) and from 4 to 5 years (β=1·34; 95 % CI 0·23, 2·44) in the adjusted model. Furthermore, the rate of postnatal FFM tissue accretion was positively associated with development at 1 year of age (β=0·50; 95 % CI 0·01, 0·99). Neither fetal nor postnatal FM showed a significant association. In conclusion, fetal, rather than postnatal, FFM tissue accretion was associated with developmental progression. Intervention studies are needed to assess whether nutrition interventions increasing FFM also increase cognitive development.

Preterm birth rates in Japan from 1979 to 2014: Analysis of national vital statistics.

PubMed

Sakata, Soyoko; Konishi, Shoko; Ng, Chris Fook Sheng; Watanabe, Chiho

2018-03-01

Secular trends of preterm birth in Japan between 1979 and 2014 were examined to determine whether changes could be explained by a shift in the distribution of maternal age at delivery and parity and/or by changes in age-specific preterm birth rates. Live birth data for 1979 to 2014 were obtained from the Japanese Ministry of Health, Labour and Welfare. Analyses were limited to singleton children born in Japan (n = 43 632 786). Preterm birth was defined using two cut-offs at < 37 or < 34 weeks of gestation. Crude and standardized rates of preterm birth were calculated for firstborn and later-born singletons by maternal age at delivery for specific time periods. Throughout the study period, the rates of preterm birth (both at < 37 and < 34 weeks of gestation) were higher among mothers aged 20 and younger, and mid-30s and older, compared to mothers in their 20s or early 30s. The rates of preterm birth at < 37 (but not at < 34) weeks decreased for mothers aged in their late 30s and 40s, and increased for mothers in their 20s and early 30s. Standardized rates of preterm birth showed a secular increase for preterm births at < 37 but not < 34 weeks of gestation. The rates of preterm birth among mothers aged in their 20s and early 30s increased between 1979 and 2014, which contributed to the secular increase in rates of preterm birth at < 37 weeks. © 2017 Japan Society of Obstetrics and Gynecology.

Birth planning in Cuba: a basic human right.

PubMed

Swanson, J M

1981-01-01

This paper reports on the development of birth planning in Cuba and strategies that are relevant to nurses in the communities of Cuba. Cuba reduced its crude birth rate by 40% from 1964-75 without formal family planning programs and resources. By 1975, Cuba had achieved the lowest birth rate in Latin America (21/1000) except Barbados (19/1000). By 1978, Cuba's crude birth rate declined to a low of 15.3/1000. The demographic transition in Cuba has been a process of equalization by: 1) community participation to ensure basic human rights for everyone, 2) increasing the status of women while providing child care centers, 3) providing equal availability of health care services including contraceptive services, sterilization, and abortion, and 4) focusing on individual birth choice, not on limiting population growth. Emphasis in Cuba for reducing fertility has been put on literacy, education, and infant mortality. The illiteracy rate in 1961 decreased from 20% to 4%. Infant mortality decreased from 38.8/1000 live births in 1970 to 22.3/1000 in 1978. 1/3 of Cuban women were participating fully in the labor force in 1978. Polyclinics have been established as preventive care medical centers throughout Cuba and health care is free. Family planning options are integrated into routine primary health care at polyclinics and assure equal access to the total Cuban population. Abortion is freely available and increased to 61/1000 in 1976. The implications for nursing are that: 1) the traditional work of nurses places them in a key position to help extend basic human rights beyond current levels, 2) nurses can initiate discussions of birth planning with women and men in a variety of settings, and 3) nurses can increase case-finding related to birth planning needs both in health care classes or within established groups in the community.

Cerebral palsy rates by birth weight, gestation and severity in North of England, 1991-2000 singleton births.

PubMed

Glinianaia, Svetlana V; Rankin, Judith; Colver, Allan

2011-02-01

To investigate changes in rates of cerebral palsy (CP) by birth weight, gestational age, severity of disability, clinical subtype and maternal age in the North of England, 1991-2000. Data on 908 cases of CP (816 singletons, 92 multiples) were analysed from the prospective population-based North of England Collaborative Cerebral Palsy Survey. Severity of disability, measured as a Lifestyle Assessment Score (LAS), was derived from the lifestyle assessment questionnaire. CP rates by birth weight, gestational age, birth weight standardised for gestational age and sex, severity of disability and maternal age were compared between 1991-1995 and 1996-2000 using rate ratios (RR). The prevalence of CP in singletons was 2.46 (95% CI 2.29 to 2.63) per 1000 neonatal survivors compared to 11.06 per 1000 (95% CI 8.81 to 13.3) in multiples (RR 4.49, 95% CI 3.62 to 5.57), with no significant change between quinquennia. The singleton CP rates were higher for lower birth weight groups than birth weight ≥2500 g; and there were no significant changes for any birth weight group between quinquennia. There were also no changes in rates of more severe disability (LAS≥30%) by birth weight, gestation or clinical subtype. For preterm and term births the patterns of Z-score of birth weight-for-gestation are similar, with CP rates increasing as Z-score deviates from the optimal weight-for-gestation, which is about 1 SD above the mean. In contrast to increasing rates in previous years, rates of CP and more severe CP were stable by birth weight, gestational age and clinical subtype for 1991-2000.

The rate of preterm birth in the United States is affected by the method of gestational age assignment.

PubMed

Duryea, Elaine L; McIntire, Donald D; Leveno, Kenneth J

2015-08-01

The objective of the study was to examine the rate of preterm birth in the United States using 2 different methods of gestational age assignment and determine which method more closely correlates with the known morbidities associated with preterm birth. Using National Center for Health Statistics data from 2012 United States birth certificates, we computed the rate of preterm birth defined as a birth at 36 or fewer completed weeks with gestational age assigned using the obstetric estimate as specified in the revised birth certificate. This rate was then compared with the rate when gestational age is calculated using the last menstrual period alone. The rates of neonatal morbidities associated with preterm birth were examined for each method of assigning gestational age. The rate of preterm birth was 9.7% when the obstetric estimate is used to calculate gestational age, which is significantly different from the rate of 11.5% when gestational age is calculated using the last menstrual period alone. In addition, the neonates identified as preterm by obstetric estimate were more likely to qualify as low birthweight (54% vs 42%; P < .001) and suffer morbidities such as need for assisted ventilation and surfactant use than those identified with the last menstrual period alone. That is to say obstetric estimate is more sensitive and specific for preterm birth by all available markers of prematurity. The preterm birth rate is 9.7% vs 11.5% and more closely correlates with adverse neonatal outcomes associated with preterm birth when gestational age is assigned using the obstetric estimate. This method of gestational age assignment is currently used by most industrialized nations and should be considered for future reporting of US outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Facts at a Glance: [Report on 1992 Data on Teen Fertility in the United States].

ERIC Educational Resources Information Center

Moore, Kristin, Comp.; And Others

This fact sheet contains data on teen pregnancy. The folowing information is provided: teen birth rate, 1960-1992; number of births to teens, 1960-1992; percent of non-marital teen births, 1960-1992; births to unmarried women, by age group, 1992; international comparison on teen birth rate; abortion rate among U.S. teens, 1973-1990; pregnancy…

Doula care, birth outcomes, and costs among Medicaid beneficiaries.

PubMed

Kozhimannil, Katy Backes; Hardeman, Rachel R; Attanasio, Laura B; Blauer-Peterson, Cori; O'Brien, Michelle

2013-04-01

We compared childbirth-related outcomes for Medicaid recipients who received prenatal education and childbirth support from trained doulas with outcomes from a national sample of similar women and estimated potential cost savings. We calculated descriptive statistics for Medicaid-funded births nationally (from the 2009 Nationwide Inpatient Sample; n = 279,008) and births supported by doula care (n = 1079) in Minneapolis, Minnesota, in 2010 to 2012; used multivariate regression to estimate impacts of doula care; and modeled potential cost savings associated with reductions in cesarean delivery for doula-supported births. The cesarean rate was 22.3% among doula-supported births and 31.5% among Medicaid beneficiaries nationally. The corresponding preterm birth rates were 6.1% and 7.3%, respectively. After control for clinical and sociodemographic factors, odds of cesarean delivery were 40.9% lower for doula-supported births (adjusted odds ratio = 0.59; P < .001). Potential cost savings to Medicaid programs associated with such cesarean rate reductions are substantial but depend on states' reimbursement rates, birth volume, and current cesarean rates. State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.

Spatial and temporal patterns in preterm birth in the United States.

PubMed

Byrnes, John; Mahoney, Richard; Quaintance, Cele; Gould, Jeffrey B; Carmichael, Suzan; Shaw, Gary M; Showen, Amy; Phibbs, Ciaran; Stevenson, David K; Wise, Paul H

2015-06-01

Despite years of research, the etiologies of preterm birth remain unclear. In order to help generate new research hypotheses, this study explored spatial and temporal patterns of preterm birth in a large, total-population dataset. Data on 145 million US births in 3,000 counties from the Natality Files of the National Center for Health Statistics for 1971-2011 were examined. State trends in early (<34 wk) and late (34-36 wk) preterm birth rates were compared. K-means cluster analyses were conducted to identify gestational age distribution patterns for all US counties over time. A weak association was observed between state trends in <34 wk birth rates and the initial absolute <34 wk birth rate. Significant associations were observed between trends in <34 wk and 34-36 wk birth rates and between white and African American <34 wk births. Periodicity was observed in county-level trends in <34 wk birth rates. Cluster analyses identified periods of significant heterogeneity and homogeneity in gestational age distributional trends for US counties. The observed geographic and temporal patterns suggest periodicity and complex, shared influences among preterm birth rates in the United States. These patterns could provide insight into promising hypotheses for further research.

Population, poverty and economic development

PubMed Central

Sinding, Steven W.

2009-01-01

Economists, demographers and other social scientists have long debated the relationship between demographic change and economic outcomes. In recent years, general agreement has emerged to the effect that improving economic conditions for individuals generally lead to lower birth rates. But, there is much less agreement about the proposition that lower birth rates contribute to economic development and help individuals and families to escape from poverty. The paper examines recent evidence on this aspect of the debate, concludes that the burden of evidence now increasingly supports a positive conclusion, examines recent trends in demographic change and economic development and argues that the countries representing the last development frontier, those of Sub-Saharan Africa, would be well advised to incorporate policies and programmes to reduce high fertility in their economic development strategies. PMID:19770153

The Changing Demographic Profile of the United States

DTIC Science & Technology

2006-05-05

3 Figure 3. Crude and Age-adjusted Death Rates : United States, 1950-2003...21 Appendix Table A. U.S. Population Growth Rates, Birth Rates, Death Rates , and Net Immigration Rates...P o p u la tio n Birth Rates Growth Rates Death Rates Net Immigration Rates Figure 2. Population Growth, Birth, Death, and Net Immigration Rates

[Spatial distribution of birth defects among children aged 0 to 5 years and its relationship with soil chemical elements in Chongqing].

PubMed

Dong, Yan; Zhong, Zhao-hui; Li, Hong; Li, Jie; Wang, Ying-xiong; Peng, Bin; Zhang, Mao-zhong; Huang, Qiao; Yan, Ju; Xu, Fei-long

2013-10-01

To explore the correlation between the incidence of birth defects and the contents of soil elements so as to provide a scientific basis for screening the related pathogenic factors that inducing birth defects for the development of related preventive and control strategies. MapInfo 7.0 software was used to draw the maps on spatial distribution regarding the incidence rates of birth defects and the contents of 11 chemical elements in soil in the 33 studied areas. Variables on the two maps were superposed for analyzing the spatial correlation. SAS 8.0 software was used to analyze single factor, multi-factors and principal components as well as to comprehensively evaluate the degrees of relevance. Different incidence rates of birth defects showed in the maps of spatial distribution presented certain degrees of negative correlation with anomalies of soil chemical elements, including copper, chrome, iodine, selenium, zinc while positively correlated with the levels of lead. Results from the principal component regression equation indicating that the contents of copper(0.002), arsenic(-0.07), cadmium(0.05), chrome (-0.001), zinc (0.001), iodine(-0.03), lead (0.08), fluorine(-0.002)might serve as important factors that related to the prevalence of birth defects. Through the study on spatial distribution, we noticed that the incidence rates of birth defects were related to the contents of copper, chrome, iodine, selenium, zinc, lead in soil while the contents of chrome, iodine and lead might lead to the occurrence of birth defects.

Economic influences on birth rates.

PubMed

Ermisch, J

1988-11-01

A researcher uses an econometric analysis to test his theory that economic developments influence birth rates in post World War II in Great Britain. The base of the analysis consists of a group of equilibrium relationships examining the levels of conditional birth rates (at each birth order and each mother's age) and the levels of economic variables, e.g., ratio of women's hourly wage after taxes. The leading cause of a decrease in births, especially after 1974, was an increase in women's net wages in comparison to men's net wages. Additional evidence suggested that higher women's wages increase the cost of an additional child by raising missed earnings, and this higher opportunity cost reduces the chance of another birth. On the other hand, if men's earnings are higher, couples have more children and at a young age. Further, the higher the real house prices the more likely women are to postpone starting a family and, in the case of 20-24 year old women, these high prices also deter them from having a 2nd child. Higher house prices do not affect higher order births, however. When all other things are equal, women from larger families have a tendency to begin having children in their 30s and produce smaller families than those women from smaller families. Large child allowances encourage 3rd-4th births and early motherhood. To increase fertility to replacement level over the long term, the current level of child allowances would have to double costing about 5 billion British pounds or 1.5% of the gross domestic product.

Translations on Eastern Europe. Political, Sociological, and Military Affairs, No. 1406

DTIC Science & Technology

1977-06-27

of our century, Bulgaria was a country with one of the highest birth rates in the world. It reached h2.k live-born children per 1,000 of the...fecundity (fertility) of the Bulgarian women. As a result of this, the birth rate in Bulgaria has declined from 30.1 live-born children per 1,000 persons...development of the Bulgarian population. The study has shown that the average number of live-born children during the 1965-1975 period declined from

Prenatal development in fishers (Martes pennanti)

USGS Publications Warehouse

Frost, H.C.; Krohn, W.B.; Bezembluk, E.A.; Lott, R.; Wallace, C.R.

2005-01-01

We evaluated and quantified prenatal growth of fishers (Martes pennanti) using ultrasonography. Seven females gave birth to 21 kits. The first identifiable embryonic structures were seen 42 d prepartum; these appeared to be unimplanted blastocysts or gestational sacs, which subsequently implanted in the uterine horns. Maternal and fetal heart rates were monitored from first detection to birth. Maternal heart rates did not differ among sampling periods, while fetal hearts rates increased from first detection to birth. Head and body differentiation, visible limbs and skeletal ossification were visible by 30, 23 and 21 d prepartum, respectively. Mean diameter of gestational sacs and crown-rump lengths were linearly related to gestational age (P < 0.001). Biparietal and body diameters were also linearly related to gestational age (P < 0.001) and correctly predicted parturition dates within 1-2 d. ?? 2004 Elsevier Inc. All rights reserved.

Ecological analysis of teen birth rates: association with community income and income inequality.

PubMed

Gold, R; Kawachi, I; Kennedy, B P; Lynch, J W; Connell, F A

2001-09-01

To examine whether per capita income and income inequality are independently associated with teen birth rate in populous U.S. counties. This study used 1990 U.S. Census data and National Center for Health Statistics birth data. Income inequality was measured with the 90:10 ratio, a ratio of percent of cumulative income held by the richest and poorest population deciles. Linear regression and analysis of variance were used to assess associations between county-level average income, income inequality, and teen birth rates among counties with population greater than 100,000. Among teens aged 15-17, income inequality and per capita income were independently associated with birth rate; the mean birth rate was 54 per 1,000 in counties with low income and high income inequality, and 19 per 1,000 in counties with high income and low inequality. Among older teens (aged 18-19) only per capita income was significantly associated with birth rate. Although teen childbearing is the result of individual behaviors, these findings suggest that community-level factors such as income and income inequality may contribute significantly to differences in teen birth rates.

Patient and cycle characteristics predicting high pregnancy rates with single-embryo transfer: an analysis of the Society for Assisted Reproductive Technology outcomes between 2004 and 2013.

PubMed

Mersereau, Jennifer; Stanhiser, Jamie; Coddington, Charles; Jones, Tiffany; Luke, Barbara; Brown, Morton B

2017-11-01

To analyze factors associated with high live birth rate and low multiple birth rate in fresh and frozen-thawed assisted reproductive technology (ART) cycles. Retrospective cohort analysis. Not applicable. The study population included 181,523 women undergoing in vitro fertilization with autologous fresh first cycles, 27,033 with fresh first oocyte donor cycles, 37,658 with fresh second cycles, and 35,446 with frozen-thawed second cycles. None. Live birth rate and multiple birth rate after single-embryo transfer (SET) and double embryo transfer (DET) were measured, in addition to cycle characteristics. In patients with favorable prognostic factors, including younger maternal age, transfer of a blastocyst, and additional embryos cryopreserved, the gain in the live birth rate from SET to DET was approximately 10%-15%; however, the multiple birth rate increased from approximately 2% to greater than 49% in both autologous and donor fresh and frozen-thawed transfer cycles. This study reports a 10%-15% reduction in live birth rate and a 47% decrement in multiple birth rate with SET compared with DET in the setting of favorable patient prognostic factors. Our findings present an opportunity to increase the rate of SET across the United States and thereby reduce the multiple birth rate and its associated poor perinatal outcomes with assisted reproductive technology pregnancies. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Descriptive epidemiology of birth trauma in the United States in 2003.

PubMed

Sauber-Schatz, Erin K; Markovic, Nina; Weiss, Harold B; Bodnar, Lisa M; Wilson, John W; Pearlman, Mark D

2010-03-01

The rate of birth trauma in the US has been reported to range between 0.2 and 37 birth traumas per 1000 births. Because of the minimal number of population-based studies and the inconsistencies among the published birth trauma rates, the rate of birth trauma in the US remains unclear. This is a cross-sectional study that was conducted using 890 582 in-hospital birth discharges from the 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database. A neonate was defined as having birth trauma if their hospital discharge record contained an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code from 767.0 to 767.9. Weighted data were used to calculate rates for all birth traumas and specific types of birth traumas, and rates and odds ratios by demographic, hospital and clinical variables. Weighted data represented a national estimate of 3 920 787 in-hospital births. Birth trauma was estimated to occur in 29 per 1000 births. The three most frequently diagnosed birth traumas were injuries to the scalp, other injuries to the skeleton and fracture of the clavicle. Significant univariable predictors for birth trauma included male gender, Asian or Pacific Islander race, living in urban or wealthy areas, being born in Western, urban and/or teaching hospital, a co-diagnosis of high birthweight, instrument delivery, malpresentation and other complications during labour and delivery. Birth trauma risk factors including those identified in this study may be useful to consider during labour and delivery. In conclusion, additional research is necessary to identify ways to reduce birth trauma and subsequent infant morbidity and mortality.

Teen Birth Rate. Facts at a Glance

ERIC Educational Resources Information Center

Franzetta, Kerry; Ikramullah, Erum; Manlove, Jennifer; Moore, Kristin Anderson; Terry-Humen, Elizabeth

2005-01-01

Preliminary data for 2003 from the National Center for Health Statistics show the teen birth rate continues to decline, reaching historic lows for teens in each age group. The 2003 rate of 41.7 births per 1,000 females 15-19 was 33 per cent lower than the 1991 peak rate of 61.8. The 2003 birth rate for teens aged 15-17 (22.4) was 42 per cent lower…

Induced abortion: a means of postponing childbirth? Changes in maternal age at induced abortion and child birth in Norway during 1979-2007.

PubMed

Vlietman, Marianne; Sarfraz, Aashi Ambareen; Eskild, Anne

2010-12-01

the maternal age at child birth is increasing. If induced abortion is an important means of postponing childbirth in a population, it is to be expected that in young women the rate of conceived pregnancies is stable over time, but the induced abortion rate is increasing. We studied birth rates, induced abortion rates and the sum of these rates by maternal age during four decades. register-based study. all women 15-49 years living in Norway. we present temporal changes in birth rates and induced abortion rates within age groups during the period 1979-2007. We also estimated the sum rate of births and induced abortions. Data were obtained from national statistics. live births and induced abortions per 1000 women per year. the induced abortion rates have been relatively stable within age groups, except for a decrease in women 15-19 years (from 24.2 in 1979 to 17.0 in 2007) and an increase in women 20-24 years (from 23.2 to 29.5). The birth rates however, have decreased dramatically in women 20-24 years old (from 113.6 to 60.5). Hence, the sum rate of births and induced abortions in women 20-24 years old has decreased from 136.8 to 90.0. In women 30 years old or older, the birth rates have increased. the induced abortion rate has been relatively stable in all age groups over time, suggesting a limited influence of induced abortions on the postponement of childbearing.

Reduced Disparities in Birth Rates Among Teens Aged 15-19 Years - United States, 2006-2007 and 2013-2014.

PubMed

Romero, Lisa; Pazol, Karen; Warner, Lee; Cox, Shanna; Kroelinger, Charlan; Besera, Ghenet; Brittain, Anna; Fuller, Taleria R; Koumans, Emilia; Barfield, Wanda

2016-04-29

Teen childbearing can have negative health, economic, and social consequences for mothers and their children (1) and costs the United States approximately $9.4 billion annually (2). During 1991-2014, the birth rate among teens aged 15-19 years in the United States declined 61%, from 61.8 to 24.2 births per 1,000, the lowest rate ever recorded (3). Nonetheless, in 2014, the teen birth rate remained approximately twice as high for Hispanic and non-Hispanic black (black) teens compared with non-Hispanic white (white) teens (3), and geographic and socioeconomic disparities remain (3,4), irrespective of race/ethnicity. Social determinants associated with teen childbearing (e.g., low parental educational attainment and limited opportunities for education and employment) are more common in communities with higher proportions of racial and ethnic minorities (4), contributing to the challenge of further reducing disparities in teen births. To examine trends in births for teens aged 15-19 years by race/ethnicity and geography, CDC analyzed National Vital Statistics System (NVSS) data at the national (2006-2014), state (2006-2007 and 2013-2014), and county (2013-2014) levels. To describe socioeconomic indicators previously associated with teen births, CDC analyzed data from the American Community Survey (ACS) (2010-2014). Nationally, from 2006 to 2014, the teen birth rate declined 41% overall with the largest decline occurring among Hispanics (51%), followed by blacks (44%), and whites (35%). The birth rate ratio for Hispanic teens and black teens compared with white teens declined from 2.9 to 2.2 and from 2.3 to 2.0, respectively. From 2006-2007 to 2013-2014, significant declines in teen birth rates and birth rate ratios were noted nationally and in many states. At the county level, teen birth rates for 2013-2014 ranged from 3.1 to 119.0 per 1,000 females aged 15-19 years; ACS data indicated unemployment was higher, and education attainment and family income were lower in counties with higher teen birth rates. State and county data can be used to understand disparities in teen births and implement community-level interventions that address the social and structural conditions associated with high teen birth rates.

A model for a spatially structured metapopulation accounting for within patch dynamics.

PubMed

Smith, Andrew G; McVinish, Ross; Pollett, Philip K

2014-01-01

We develop a stochastic metapopulation model that accounts for spatial structure as well as within patch dynamics. Using a deterministic approximation derived from a functional law of large numbers, we develop conditions for extinction and persistence of the metapopulation in terms of the birth, death and migration parameters. Interestingly, we observe the Allee effect in a metapopulation comprising two patches of greatly different sizes, despite there being decreasing patch specific per-capita birth rates. We show that the Allee effect is due to the way the migration rates depend on the population density of the patches. Copyright © 2013 Elsevier Inc. All rights reserved.

Variations in Teenage Birth Rates, 1991-98: National and State Trends.

ERIC Educational Resources Information Center

Ventura, Stephanie J.; Curtin, Sally C.; Mathews, T. J.

2000-01-01

This report presents national birth rates for teenagers for 1991-1998 and the percent change from 1991 to 1998. State-specific teenage birth rates by age, race, and Hispanic origin for 1991 and 1998, and the percent change, 1991 to 1998, are also presented. Tabular and graphical descriptions of the trends in teenage birth rates for the United…

Does planning of births affect childhood undernutrition? Evidence from demographic and health surveys of selected South Asian countries.

PubMed

Rana, Md Juel; Goli, Srinivas

2018-03-01

The prevalence of child undernutrition in South Asia is high, as is also the unmet need for family planning. In previous literature, the biodemographic relationship of family planning, particularly birth order and birth spacing, and nutritional status of children have been assessed separately. The aim of this study was to work on the hypothesis that the planning of births comprising timing, spacing, and number of births improves child undernutrition, especially in the areas with high prevalence of stunting and underweight. We used recent Demographic and Health Survey data from four selected South Asian countries. Binary logistic regression models were applied to estimate the adjusted percentage of stunting and underweight by identified independent factors. Findings suggested that after controlling for other socioeconomic factors, children in the first birth order with >24 mo of interval between marriage and first birth have a lower risk for stunting (20%; p <0.01) and underweight (14%; p <0.05), respectively, than other scenarios of the planning of births. The probability of child undernutrition is lower among children born with >24 mo of birth spacing than its counterpart in all birth orders, but the significance of birth spacing reduces with increasing birth orders. Appropriate planning of births using family planning methods in countries with high birth rates has the potential to reduce childhood undernutrition. Thus, the planning of births emerges as an important biodemographic approach to eradicate childhood undernutrition especially in developing regions like South Asia and thereby to achieve sustainable development goals by 2030. Copyright © 2017 Elsevier Inc. All rights reserved.

Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands.

PubMed

de Jonge, Ank; Peters, Lilian; Geerts, Caroline C; van Roosmalen, Jos J M; Twisk, Jos W R; Brocklehurst, Peter; Hollowell, Jennifer

2017-01-01

To compare mode of birth and medical interventions between broadly equivalent birth settings in England and the Netherlands. Data were combined from the Birthplace study in England (from April 2008 to April 2010) and the National Perinatal Register in the Netherlands (2009). Low risk women in England planning birth at home (16,470) or in freestanding midwifery units (11,133) were compared with Dutch women with planned home births (40,468). Low risk English women with births planned in alongside midwifery units (16,418) or obstetric units (19,096) were compared with Dutch women with planned midwife-led hospital births (37,887). CS rates varied across planned births settings from 6.5% to 15.5% among nulliparous and 0.6% to 5.1% among multiparous women. CS rates were higher among low risk nulliparous and multiparous English women planning obstetric unit births compared to Dutch women planning midwife-led hospital births (adjusted (adj) OR 1.89 (95% CI 1.64 to 2.18) and 3.66 (2.90 to 4.63) respectively). Instrumental vaginal birth rates varied from 10.7% to 22.5% for nulliparous and from 0.9% to 5.7% for multiparous women. Rates were lower in the English comparison groups apart from planned births in obstetric units. Transfer, augmentation and episiotomy rates were much lower in England compared to the Netherlands for all midwife-led groups. In most comparisons, epidural rates were higher among English groups. When considering maternal outcomes, findings confirm advantages of giving birth in midwife-led settings for low risk women. Further research is needed into strategies to decrease rates of medical intervention in obstetric units in England and to reduce rates of avoidable transfer, episiotomy and augmentation of labour in the Netherlands.

Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands

PubMed Central

Peters, Lilian; Geerts, Caroline C.; van Roosmalen, Jos J. M.; Twisk, Jos W. R.; Brocklehurst, Peter; Hollowell, Jennifer

2017-01-01

Objectives To compare mode of birth and medical interventions between broadly equivalent birth settings in England and the Netherlands. Methods Data were combined from the Birthplace study in England (from April 2008 to April 2010) and the National Perinatal Register in the Netherlands (2009). Low risk women in England planning birth at home (16,470) or in freestanding midwifery units (11,133) were compared with Dutch women with planned home births (40,468). Low risk English women with births planned in alongside midwifery units (16,418) or obstetric units (19,096) were compared with Dutch women with planned midwife-led hospital births (37,887). Results CS rates varied across planned births settings from 6.5% to 15.5% among nulliparous and 0.6% to 5.1% among multiparous women. CS rates were higher among low risk nulliparous and multiparous English women planning obstetric unit births compared to Dutch women planning midwife-led hospital births (adjusted (adj) OR 1.89 (95% CI 1.64 to 2.18) and 3.66 (2.90 to 4.63) respectively). Instrumental vaginal birth rates varied from 10.7% to 22.5% for nulliparous and from 0.9% to 5.7% for multiparous women. Rates were lower in the English comparison groups apart from planned births in obstetric units. Transfer, augmentation and episiotomy rates were much lower in England compared to the Netherlands for all midwife-led groups. In most comparisons, epidural rates were higher among English groups. Conclusions When considering maternal outcomes, findings confirm advantages of giving birth in midwife-led settings for low risk women. Further research is needed into strategies to decrease rates of medical intervention in obstetric units in England and to reduce rates of avoidable transfer, episiotomy and augmentation of labour in the Netherlands. PMID:28749944

Estimated number of preterm births and low birth weight children born in the United States due to maternal binge drinking.

PubMed

Truong, Khoa D; Reifsnider, Odette S; Mayorga, Maria E; Spitler, Hugh

2013-05-01

The objective of this study was to estimate the aggregate burden of maternal binge drinking on preterm birth (PTB) and low birth weight (LBW) across American sociodemographic groups in 2008. To estimate the aggregate burden of maternal binge drinking on preterm birth (PTB) and low birth weight (LBW) across American sociodemographic groups in 2008. A simulation model was developed to estimate the number of PTB and LBW cases due to maternal binge drinking. Data inputs for the model included number of births and rates of preterm and LBW from the National Center for Health Statistics; female population by childbearing age groups from the U.S. Census; increased relative risks of preterm and LBW deliveries due to maternal binge drinking extracted from the literature; and adjusted prevalence of binge drinking among pregnant women estimated in a multivariate logistic regression model using Behavioral Risk Factor Surveillance System survey. The most conservative estimates attributed maternal binge drinking to 8,701 (95% CI: 7,804-9,598) PTBs (1.75% of all PTBs) and 5,627 (95% CI 5,121-6,133) LBW deliveries in 2008, with 3,708 (95% CI: 3,375-4,041) cases of both PTB and LBW. The estimated rate of PTB due to maternal binge drinking was 1.57% among all PTBs to White women, 0.69% among Black women, 3.31% among Hispanic women, and 2.35% among other races. Compared to other age groups, women ages 40-44 had the highest adjusted binge drinking rate and highest PTB rate due to maternal binge drinking (4.33%). Maternal binge drinking contributed significantly to PTB and LBW differentially across sociodemographic groups.

Trihalomethanes in public drinking water and stillbirth and low birth weight rates: an intervention study.

PubMed

Iszatt, Nina; Nieuwenhuijsen, Mark J; Bennett, James E; Toledano, Mireille B

2014-12-01

During 2003-2004, United Utilities water company in North West England introduced enhanced coagulation (EC) to four treatment works to mitigate disinfection by-product (DBP) formation. This enabled examination of the relation between DBPs and birth outcomes whilst reducing socioeconomic confounding. We compared stillbirth, and low and very low birth weight rates three years before (2000-2002) with three years after (2005-2007) the intervention, and in relation to categories of THM change. We created exposure metrics for EC and trihalomethane (THM) concentration change (n=258 water zones). We linked 429,599 live births and 2279 stillbirths from national birth registers to the water zone at birth. We used Poisson regression to model the differences in birth outcome rates with an interaction between before/after the intervention and EC or THM change. EC treatment reduced chloroform concentrations more than non-treatment (mean -29.7 µg/l vs. -14.5 µg/l), but not brominated THM concentrations. Only 6% of EC water zones received 100% EC water, creating exposure misclassification concerns. EC intervention was not associated with a statistically significant reduction in birth outcome rates. Areas with the highest chloroform decrease (30 - 65 μg/l) had the greatest percentage decrease in low -9 % (-12, -5) and very low birth weight -16% (-24, -8) rates. The interaction between before/after intervention and chloroform change was statistically significant only for very low birth weight, p=0.02. There were no significant decreases in stillbirth rates. In a novel approach for studying DBPs and adverse reproductive outcomes, the EC intervention to reduce DBPs did not affect birth outcome rates. However, a measured large decrease in chloroform concentrations was associated with statistically significant reductions in very low birth weight rates. Copyright © 2014 Elsevier Ltd. All rights reserved.

Trends and Progress in Reducing Teen Birth Rates and the Persisting Challenge of Eliminating Racial/Ethnic Disparities.

PubMed

Ngui, Emmanuel M; Greer, Danielle M; Bridgewater, Farrin D; Salm Ward, Trina C; Cisler, Ron A

2017-08-01

We examined progress made by the Milwaukee community toward achieving the Milwaukee Teen Pregnancy Prevention Initiative's aggressive 2008 goal of reducing the teen birth rate to 30 live births/1000 females aged 15-17 years by 2015. We further examined differential teen birth rates in disparate racial and ethnic groups. We analyzed teen birth count data from the Wisconsin Interactive Statistics on Health system and demographic data from the US Census Bureau. We computed annual 2003-2014 teen birth rates for the city and four racial/ethnic groups within the city (white non-Hispanic, black non-Hispanic, Hispanic/Latina, Asian non-Hispanic). To compare birth rates from before (2003-2008) and after (2009-2014) goal setting, we used a single-system design to employ two time series analysis approaches, celeration line, and three standard deviation (3SD) bands. Milwaukee's teen birth rate dropped 54 % from 54.3 in 2003 to 23.7 births/1000 females in 2014, surpassing the goal of 30 births/1000 females 3 years ahead of schedule. Rate reduction following goal setting was statistically significant, as five of the six post-goal data points were located below the celeration line and points for six consecutive years (2010-2014) fell below the 3SD band. All racial/ethnic groups demonstrated significant reductions through at least one of the two time series approaches. The gap between white and both black and Hispanic/Latina teens widened. Significant reduction has occurred in the overall teen birth rate of Milwaukee. Achieving an aggressive reduction in teen births highlights the importance of collaborative community partnerships in setting and tracking public health goals.

Reducing the Primary Cesarean Birth Rate: A Quality Improvement Project.

PubMed

Javernick, Julie A; Dempsey, Amy

2017-07-01

Research continues to support vaginal birth as the safest mode of childbirth, but despite this, cesarean birth has become the most common surgical procedure performed on women. The rate has increased 500% since the 1970s without a corresponding improvement in maternal or neonatal outcomes. A Colorado community hospital recognized that its primary cesarean birth rate was higher than national and state benchmark levels. To reduce this rate, the hospital collaborated with its largest maternity care provider group to implement a select number of physiologic birth practices and measure improvement in outcomes. Using a pre- and postprocess measure study design, the quality improvement project team identified and implemented 3 physiologic birth parameters over a 12-month period that have been shown to promote vaginal birth. These included reducing elective induction of labor in women less than 41 weeks' gestation; standardizing triage to admit women at greater than or equal to 4 cm dilation; and increasing the use of intermittent auscultation as opposed to continuous fetal monitoring for fetal surveillance. The team also calculated each obstetrician-gynecologist's primary cesarean birth rate monthly and delivered these rates to the providers. Outcomes showed that the provider group decreased its primary cesarean birth rate from 28.9% to 12.2% in the 12-month postprocess measure period. The 57.8% decrease is statistically significant (odds ratio [OR], 0.345; z = 6.52, P < .001; 95% confidence interval [CI], 0.249-0.479). While this quality improvement project cannot be translated to other settings, promotion of physiologic birth practices, along with audit and feedback, had a statistically significant impact on the primary cesarean birth rate for this provider group and, consequently, on the community hospital where they attend births. © 2017 by the American College of Nurse-Midwives.

Fetal growth and subsequent risk of breast cancer: results from long term follow up of Swedish cohort.

PubMed

McCormack, V A; dos Santos Silva, I; De Stavola, B L; Mohsen, R; Leon, D A; Lithell, H O

2003-02-01

To investigate whether size at birth and rate of fetal growth influence the risk of breast cancer in adulthood. Cohort identified from detailed birth records, with 97% follow up. Uppsala Academic Hospital, Sweden. 5358 singleton females born during 1915-29, alive and traced to the 1960 census. Incidence of breast cancer before (at age <50 years) and after (> or = 50 years) the menopause. Size at birth was positively associated with rates of breast cancer in premenopausal women. In women who weighed > or =4000 g at birth rates of breast cancer were 3.5 times (95% confidence interval 1.3 to 9.3) those in women of similar gestational age who weighed <3000 g at birth. Rates in women in the top fifths of the distributions of birth length and head circumference were 3.4 (1.5 to 7.9) and 4.0 (1.6 to 10.0) times those in the lowest fifths (adjusted for gestational age). The effect of birth weight disappeared after adjustment for birth length or head circumference, whereas the effects of birth length and head circumference remained significant after adjustment for birth weight. For a given size at birth, gestational age was inversely associated with risk (P=0.03 for linear trend). Adjustment for markers of adult risk factors did not affect these findings. Birth size was not associated with rates of breast cancer in postmenopausal women. Size at birth, particularly length and head circumference, is associated with risk of breast cancer in women aged <50 years. Fetal growth rate, as measured by birth size adjusted for gestational age, rather than size at birth may be the aetiologically relevant factor in premenopausal breast cancer.

Temporal Trends in Late Preterm and Early Term Birth Rates in 6 High-Income Countries in North America and Europe and Association With Clinician-Initiated Obstetric Interventions

PubMed Central

Richards, Jennifer L.; Kramer, Michael S.; Deb-Rinker, Paromita; Rouleau, Jocelyn; Mortensen, Laust; Gissler, Mika; Morken, Nils-Halvdan; Skjærven, Rolv; Cnattingius, Sven; Johansson, Stefan; Delnord, Marie; Dolan, Siobhan M.; Morisaki, Naho; Tough, Suzanne; Zeitlin, Jennifer; Kramer, Michael R.

2017-01-01

IMPORTANCE Clinicians have been urged to delay the use of obstetric interventions (eg, labor induction, cesarean delivery) until 39 weeks or later in the absence of maternal or fetal indications for intervention. OBJECTIVE To describe recent trends in late preterm and early term birth rates in 6 high-income countries and assess association with use of clinician-initiated obstetric interventions. DESIGN Retrospective analysis of singleton live births from 2006 to the latest available year (ranging from 2010 to 2015) in Canada, Denmark, Finland, Norway, Sweden, and the United States. EXPOSURES Use of clinician-initiated obstetric intervention (either labor induction or prelabor cesarean delivery) during delivery. MAIN OUTCOMES AND MEASURES Annual country-specific late preterm (34–36 weeks) and early term (37–38 weeks) birth rates. RESULTS The study population included 2 415 432 Canadian births in 2006–2014 (4.8% late preterm; 25.3% early term); 305 947 Danish births in 2006–2010 (3.6% late preterm; 18.8% early term); 571 937 Finnish births in 2006–2015 (3.3% late preterm; 16.8% early term); 468 954 Norwegian births in 2006–2013 (3.8% late preterm; 17.2% early term); 737 754 Swedish births in 2006–2012 (3.6% late preterm; 18.7% early term); and 25 788 558 US births in 2006–2014 (6.0% late preterm; 26.9% early term). Late preterm birth rates decreased in Norway (3.9% to 3.5%) and the United States (6.8% to 5.7%). Early term birth rates decreased in Norway (17.6% to 16.8%), Sweden (19.4% to 18.5%), and the United States (30.2% to 24.4%). In the United States, early term birth rates decreased from 33.0% in 2006 to 21.1% in 2014 among births with clinician-initiated obstetric intervention, and from 29.7% in 2006 to 27.1% in 2014 among births without clinician-initiated obstetric intervention. Rates of clinician-initiated obstetric intervention increased among late preterm births in Canada (28.0% to 37.9%), Denmark (22.2% to 25.0%), and Finland (25.1% to 38.5%), and among early term births in Denmark (38.4% to 43.8%) and Finland (29.8% to 40.1%). CONCLUSIONS AND RELEVANCE Between 2006 and 2014, late preterm and early term birth rates decreased in the United States, and an association was observed between early term birth rates and decreasing clinician-initiated obstetric interventions. Late preterm births also decreased in Norway, and early term births decreased in Norway and Sweden. Clinician-initiated obstetric interventions increased in some countries but no association was found with rates of late preterm or early term birth. PMID:27458946

Effect of periodontal treatment on preterm birth rate: a systematic review of meta-analyses.

PubMed

López, Néstor J; Uribe, Sergio; Martinez, Benjamín

2015-02-01

Preterm birth is a major cause of neonatal morbidity and mortality in both developed and developing countries. Preterm birth is a highly complex syndrome that includes distinct clinical subtypes in which many different causes may be involved. The results of epidemiological, molecular, microbiological and animal-model studies support a positive association between maternal periodontal disease and preterm birth. However, the results of intervention studies carried out to determine the effect of periodontal treatment on reducing the risk of preterm birth are controversial. This systematic review critically analyzes the methodological issues of meta-analyses of the studies to determine the effect of periodontal treatment to reduce preterm birth. The quality of the individual randomized clinical trials selected is of highest relevance for a systematic review. This article describes the methodological features that should be identified a priori and assessed individually to determine the quality of a randomized controlled trial performed to evaluate the effect of periodontal treatment on pregnancy outcomes. The AMSTAR and the PRISMA checklist tools were used to assess the quality of the six meta-analyses selected, and the bias domain of the Cochrane Collaboration's Tool was applied to evaluate each of the trials included in the meta-analyses. In addition, the methodological characteristics of each clinical trial were assessed. The majority of the trials included in the meta-analyses have significant methodological flaws that threaten their internal validity. The lack of effect of periodontal treatment on preterm birth rate concluded by four meta-analyses, and the positive effect of treatment for reducing preterm birth risk concluded by the remaining two meta-analyses are not based on consistent scientific evidence. Well-conducted randomized controlled trials using rigorous methodology, including appropriate definition of the exposure, adequate control of confounders for preterm birth and application of effective periodontal interventions to eliminate periodontal infection, are needed to confirm the positive association between periodontal disease and preterm birth. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth

PubMed Central

2014-01-01

Background The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency. Methods We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth. Results The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth). Conclusions Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth. PMID:24670050

Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth.

PubMed

Joseph, K S; Fahey, John; Shankardass, Ketan; Allen, Victoria M; O'Campo, Patricia; Dodds, Linda; Liston, Robert M; Allen, Alexander C

2014-03-27

The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency. We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth. The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth). Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth.

Impact of the Red River catastrophic flood on women giving birth in North Dakota, 1994-2000.

PubMed

Tong, Van T; Zotti, Marianne E; Hsia, Jason

2011-04-01

To document changes in birth rates, birth outcomes, and pregnancy risk factors among women giving birth after the 1997 Red River flood in North Dakota. We analyzed detailed county-level birth files pre-disaster (1994-1996) and post-disaster (1997-2000) in North Dakota. Crude birth rates and adjusted fertility rates were calculated. The demographic and pregnancy risk factors were described among women delivering singleton births. Logistic regression was conducted to examine associations between the disaster and low birth weight (<2,500 g), preterm birth (<37 weeks), and small for gestational age infants adjusting for confounders. The crude birth rate and direct-adjusted fertility rate decreased significantly after the disaster in North Dakota. The proportion of women giving birth who were older, non-white, unmarried, and had a higher education increased. Compared to pre-disaster, there were significant increases in the following maternal measures after the disaster: any medical risks (5.1-7.1%), anemia (0.7-1.1%), acute or chronic lung disease (0.4-0.5%), eclampsia (0.3-2.1%), and uterine bleeding (0.3-0.4%). In addition, there was a significant increase in births that were low birth weight (OR 1.11, 95% CI 1.03-1.21) and preterm (OR 1.09, 95% CI 1.03-1.16) after adjusting for maternal characteristics and smoking. Following the flood, there was an increase in medical risks, low birth weight, and preterm delivery among women giving birth in North Dakota. Further research that examines birth outcomes of women following a catastrophic disaster is warranted.

Vital signs: teen pregnancy--United States, 1991--2009.

PubMed

2011-04-08

In 2009, approximately 410,000 teens aged 15-19 years gave birth in the United States, and the teen birth rate remains higher than in other developed countries. To describe U.S. trends in teen births and related factors, CDC used data on 1) teen birth rates during 1991-2009 from the National Vital Statistics System, 2) sexual intercourse and contraceptive use among high school students during 1991-2009 from the national Youth Risk Behavior Survey, and 3) sex education, parent communication, use of long-acting reversible contraceptives (LARCs), and receipt of reproductive health services among teens aged 15-19 years from the 2006-2008 National Survey of Family Growth. In 2009, the national teen birth rate was 39.1 births per 1,000 females, a 37% decrease from 61.8 births per 1,000 females in 1991 and the lowest rate ever recorded. State-specific teen birth rates varied from 16.4 to 64.2 births per 1,000 females and were highest among southern states. Birth rates for black and Hispanic teens were 59.0 and 70.1 births per 1,000 females, respectively, compared with 25.6 for white teens. From 1991 to 2009, the percentage of high school students who ever had sexual intercourse decreased from 54% to 46%, and the percentage of students who had sexual intercourse in the past 3 months but did not use any method of contraception at last sexual intercourse decreased from 16% to 12%. From 1999 to 2009, the percentage of students who had sexual intercourse in the past 3 months and used dual methods at last sexual intercourse (condoms with either birth control pills or the injectable contraceptive Depo-Provera) increased from 5% to 9%. During 2006-2008, 65% of female teens and 53% of male teens received formal sex education that covered saying no to sex and provided information on methods of birth control. Overall, 44% of female teens and 27% of male teens had spoken with their parents about both topics, but among teens who had ever had sexual intercourse, 20% of females and 31% of males had not spoken with their parents about either topic. Only 2% of females who had sexual intercourse in the past 3 months used LARCs at last sexual intercourse. Teen birth rates in the United States have declined but remain high, especially among black and Hispanic teens and in southern states. Fewer high school students are having sexual intercourse, and more sexually active students are using some method of contraception. However, many teens who have had sexual intercourse have not spoken with their parents about sex, and use of LARCs remains rare. Teen childbearing is associated with adverse consequences for mothers and their children and imposes high public sector costs. Prevention of teen pregnancy requires evidence-based sex education, support for parents in talking with their children about pregnancy prevention and other aspects of sexual and reproductive health, and ready access to effective and affordable contraception for teens who are sexually active.

Systematic review of birth cohort studies in Africa

PubMed Central

Campbell, Alasdair; Rudan, Igor

2011-01-01

Aim In sub-Saharan Africa, unacceptably high rates of mortality amongst women and children continue to persist. The emergence of research employing new genomic technologies is advancing knowledge on cause of disease. This review aims to identify birth cohort studies conducted in sub-Saharan Africa and to consider their suitability as a platform to support genetic epidemiological studies. Methods A systematic literature review was conducted to identify birth cohort studies in sub-Saharan Africa across the following databases: MEDLINE, EMBASE, AFRO and OpenSIGLE. A total of 8110 papers were retrieved. Application of inclusion/exclusion criteria retained only 189 papers, of which 71 met minimum quality criteria and were retained for full text analysis. Results The search revealed 28 birth cohorts: 14 of which collected biological data, 10 collected blood samples and only one study collected DNA for storage. These studies face many methodological challenges: notably, high rates of attrition and lack of funding for several rounds of study follow up. Population-based ‘biobanks’ have emerged as a major approach to harness genomic technologies in health research and yet the sub-Saharan African region still awaits large scale birth cohort biobanks collecting DNA and associated health and lifestyle data. Conclusion Investment in this field, together with related endeavours to foster and develop research capacity for these studies, may lead to an improved understanding of the determinants of intrauterine growth and development, birth outcomes such as prematurity and low birth weight, the links between maternal and infant health, survival of infectious diseases in the first years of life, and response to vaccines and antibiotic treatment. PMID:23198102

Effects of meteorological factors and the lunar cycle on onset of parturition in cows.

PubMed

Ammann, T; Hässig, M; Rüegg, S; Bleul, U

2016-04-01

The present paper summarizes a comprehensive retrospective study that was undertaken to investigate effects of meteorological factors and lunar cycle on gestation length and daily birth rate in cows. To this end, all cattle births in Switzerland between 2008 and 2010 (n=2,091,159) were related to detailed matched weather recordings. The study revealed some statistically significant effects of climate (temperature, barometric pressure, relative humidity) and weather (thunderstorms, heat index) on gestational length. Thunderstorms on the day before birth reduced the gestation length by 0.5 days. An increase in the birth rate was correlated with the temperature on the day before birth and the barometric pressure 3 days before birth. Differences in the barometric pressure >15hPa increased the birth rate by 4%. Nevertheless, the effects were not consistent and the modeled size of effect was so small that a clinical implication is unlikely. Although the daily birth rate was unevenly distributed across the lunar cycle, no clear pattern could be identified. Compared to the mean birth rate across the lunar cycle the highest daily birth rate was detected on day 4 after new moon (+1.9%) and the lowest on day 20 (-2.1%). Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Socioeconomic development and girl child survival in rural North India: solution or problem?

PubMed

Krishnan, Anand; Dwivedi, Purva; Gupta, Vivek; Byass, Peter; Pandav, Chandrakant S; Ng, Nawi

2013-05-01

Socioeconomic development has been considered as a solution to the problem of sex differentials at birth and under-five mortality. This paper analyses longitudinal data from the Ballabgarh Health and Demographic Surveillance System (HDSS) site in north India to check its veracity. A cohort of children born between 1 January 2006 and 31 December 2011 at Ballabgarh HDSS were followed till death, emigration, 3 years of age or end of the study. Socioeconomic status (SES) was measured by caste, parental combined years of schooling and wealth index and divided into low, mid and high strata for each of them. Sex ratio at birth (SRB) was reported as the number of girls per 1000 boys. The Kaplan-Meier survival curves were drawn and a Cox Proportional HR of girls over boys was estimated. A total of 12 517 native born children (25 797 child years) were enrolled of which 710 died (death rate of 56.7/1000-live births and 27.5/1000 child-years. Socioeconomically advantaged children had significantly lower death rates. The SRB (10-16% lower) and neonatal death rate were consistently adverse for girls in the advantaged groups by all the three indicators of SES. The first month survival rates were better for girls in the lower SES categories (significant only in caste (HR 0.58; 0.37 to 0.91). High SES categories consistently showed adverse survival rates for girls (HR of 1.22 to 1.59). Better socioeconomic situation worsened the sex differentials, especially at birth. Therefore, specific interventions targeting gender issues are required, at least as a short-term measure.

Risk factors for congenital diaphragmatic hernia in the Bogota birth defects surveillance and follow-up program, Colombia.

PubMed

García, Ana M; Machicado, S; Gracia, G; Zarante, I M

2016-03-01

The mortality rate for congenital diaphragmatic hernia (CDH) remains high and prevention efforts are limited by the lack of known risk factors. The aim of this study was to determine prevalence, risk factors, and neonatal results associated with CDH on a surveillance system hospital-based in Bogotá, Colombia. The data used in this study were obtained from The Bogota Birth Defects Surveillance and Follow-up Program (BBDSFP), between January 2001 and December 2013. With 386,419 births, there were 81 cases of CDH. A case-control methodology was conducted with 48 of the total cases of CDH and 192 controls for association analysis. The prevalence of CDH was 2.1 per 10,000 births. In the case-control analysis, risk factors found were maternal age ≥35 years (OR, 33.53; 95 % CI, 7.02-160.11), infants with CDH were more likely to be born before 37 weeks of gestation (OR, 5.57; 95 % CI, 2.05-15.14), to weigh less than 2500 g at birth (OR, 9.05; 95 % CI, 3.51-23.32), and be small for gestational age (OR, 5.72; 95 % CI, 2.18-14.99) with a high rate of death before hospital discharge in the CDH population (CDH: 38 % vs BBDSFP: <1 %; p < 0.001). The prevalence of CDH calculated was similar to the one reported in the literature. CDH is strongly associated with a high rate of death before hospital discharge and the risk factors found were maternal age ≥35 years, preterm birth, be small for gestational age, and have low weight at birth. These neonatal characteristics in developing countries would help to identify early CDH. Prevention efforts have been limited by the lack of known risk factors and established epidemiological profiles, especially in developing countries.

Declines in Teenage Birth Rates, 1991-98: Update of National and State Trends.

ERIC Educational Resources Information Center

Ventura, Stephanie J.; Mathews, T. J.; Curtin, Sally C.

1999-01-01

This report includes national birth rates for teenagers for 1991-98; the percent of change, 1991-98; state-specific teenage birth rates for 1991 and 1997; and the percent change, 1991-97. Data are in the form of tabular and graphical descriptions of the trends in teenage birth rates by age group, race, and Hispanic origin of the mother. The data…

Embryo survival and birth rate after minimum volume vitrification or slow freezing of in vivo and in vitro produced ovine embryos.

PubMed

Dos Santos-Neto, P C; Cuadro, F; Barrera, N; Crispo, M; Menchaca, A

2017-10-01

The objective was to evaluate pregnancy outcomes and birth rate of in vivo derived vs. in vitro produced ovine embryos submitted to different cryopreservation methods. A total of 197 in vivo and 240 in vitro produced embryos were cryopreserved either by conventional freezing, or by vitrification with Cryotop or Spatula MVD methods on Day 6 after insemination/fertilization. After thawing/warming and transfer, embryo survival rate on Day 30 of gestation was affected by the source of the embryos (in vivo 53.3%, in vitro 20.8%; P < 0.05) and by the method of cryopreservation (conventional freezing 26.5%, Cryotop 52.0%, Spatula MVD 22.2%; P < 0.05). For in vivo derived embryos, survival rate after embryo transfer was 45.6% for conventional freezing, 67.1% for Cryotop, and 40.4% for Spatula MVD. For in vitro produced embryos, survival rate was 7.3% for conventional freezing, 38.7% for Cryotop, and 11.4% for Spatula MVD. Fetal loss from Day 30 to birth showed a tendency to be greater for in vitro (15.0%) rather than for in vivo produced embryos (5.7%), and was not affected by the cryopreservation method. Gestation length, weight at birth and lamb survival rate after birth were not affected by the source of the embryo, the cryopreservation method or stage of development (average: 150.5 ± 1.8 days; 4232.8 ± 102.8 g; 85.4%; respectively). This study demonstrates that embryo survival and birth rate of both in vivo and in vitro produced ovine embryos are improved by vitrification with the minimum volume Cryotop method. Copyright © 2017 Elsevier Inc. All rights reserved.

An analysis of suicide trends in Scotland 1950-2014: comparison with England & Wales.

PubMed

Dougall, Nadine; Stark, Cameron; Agnew, Tim; Henderson, Rob; Maxwell, Margaret; Lambert, Paul

2017-12-20

Scotland has disproportionately high rates of suicide compared with England. An analysis of trends may help reveal whether rates appear driven more by birth cohort, period or age. A 'birth cohort effect' for England & Wales has been previously reported by Gunnell et al. (B J Psych 182:164-70, 2003). This study replicates this analysis for Scotland, makes comparisons between the countries, and provides information on 'vulnerable' cohorts. Suicide and corresponding general population data were obtained from the National Records of Scotland, 1950 to 2014. Age and gender specific mortality rates were estimated. Age, period and cohort patterns were explored graphically by trend analysis. A pattern was found whereby successive male birth cohorts born after 1940 experienced higher suicide rates, in increasingly younger age groups, echoing findings reported for England & Wales. Young men (aged 20-39) were found to have a marked and statistically significant increase in suicide between those in the 1960 and 1965 birth cohorts. The 1965 cohort peaked in suicide rate aged 35-39, and the subsequent 1970 cohort peaked even younger, aged 25-29; it is possible that these 1965 and 1970 cohorts are at greater mass vulnerability to suicide than earlier cohorts. This was reflected in data for England & Wales, but to a lesser extent. Suicide rates associated with male birth cohorts subsequent to 1975 were less severe, and not statistically significantly different from earlier cohorts, suggestive of an amelioration of any possible influential 'cohort' effect. Scottish female suicide rates for all age groups converged and stabilised over time. Women have not been as affected as men, with less variation in patterns by different birth cohorts and with a much less convincing corresponding pattern suggestive of a 'cohort' effect. Trend analysis is useful in identifying 'vulnerable' cohorts, providing opportunities to develop suicide prevention strategies addressing these cohorts as they age.

Prediction of the demographic situation in urban districts as a factor of sustainable social and economic development of the transport infrastructure

NASA Astrophysics Data System (ADS)

Davydova, Tatyana; Zhutaeva, Evgeniya; Dubrovskaya, Tatyana

2017-10-01

Article considers the significance of the demographic forecast for the effective operation of the providing system of social and economic development of the urban transport infrastructure. Analysis of the factors which influence on the population of the city of Voronezh was performed and the population forecast for the year 2020 is presented on the basis of the classification by year of birth. Calculation was performed in three variants (with consideration of the use of classification by year of birth) in connection with an impact of modern social and economic situation on the negative tendencies formed in demographic processes. In the basis of variants were grounded different approaches to the dynamics of demographic processes. The main demographic indicators are the number of permanent residents, birth rates, death rates, migration rates. According to the results of the study, population of the urban district of the city of Voronezh is expected to increase in the specified period and migration inflow of the population has a dominant role in the formation in the formation of the number of the city population.

China's Demographic Dilemmas.

ERIC Educational Resources Information Center

Tien, H. Yuan; And Others

1992-01-01

China's herculean efforts to slow the increase of its giant population appear to have worked: the annual birth rate fell from about 35 births per 1,000 in the 1950s to 20 per 1,000 in the 1990s. This bulletin examines the development and consequences of the strict population planning control measures introduced in the 1970s, and strengthened in…

University-Community Collaboration to Promote Healthy Mothers and Infants: The Relationships and Parenting Support (RAPS) Program

ERIC Educational Resources Information Center

Williams, Patricia Hrusa; Oravecz, Linda M.

2016-01-01

Research highlights the vulnerability of Black mothers and their infants, who experience higher rates of stress, preterm birth, low birth weight, and infant mortality than other racial groups. This article describes the development and implementation of the Relationships and Parenting Support (RAPS) Program, a community-based, family-focused…

Twins: prevalence, problems, and preterm births.

PubMed

Chauhan, Suneet P; Scardo, James A; Hayes, Edward; Abuhamad, Alfred Z; Berghella, Vincenzo

2010-10-01

The rate of twin pregnancies in the United States has stabilized at 32 per 1000 births in 2006. Aside from determining chorionicity, first-trimester screening and second-trimester ultrasound scanning should ascertain whether there are structural or chromosomal abnormalities. Compared with singleton births, genetic amniocentesis-related loss at <24 weeks of gestation for twin births is higher (0.9% vs 2.9%, respectively). Selective termination for an anomalous fetus is an option, although the pregnancy loss rate is 7% at experienced centers. For singleton and twin births for African American and white women, approximately 50% of preterm births are indicated; approximately one-third of these births are spontaneous, and 10% of the births occur after preterm premature rupture of membranes. From 1989-2000, the rate of preterm twin births increased, for African American and white women alike, although the perinatal mortality rate has actually decreased. As with singleton births, tocolytics should be used judiciously and only for a limited time (<48 hours) in twin births. Administration of antenatal corticosteroids is an evidence-based recommendation. Copyright © 2010 Mosby, Inc. All rights reserved.

Characteristics and outcome of unplanned out-of-institution births in Norway from 1999 to 2013: a cross-sectional study.

PubMed

Gunnarsson, Björn; Smárason, Alexander K; Skogvoll, Eirik; Fasting, Sigurd

2014-10-01

To study the incidence, maternal characteristics and outcome of unplanned out-of-institution births (= unplanned births) in Norway. Register-based cross-sectional study. All births in Norway (n = 892 137) from 1999 to 2013 with gestational age ≥22 weeks. Analysis of data from the Medical Birth Registry of Norway from 1999 to 2013. Unplanned births (n = 6062) were compared with all other births (reference group). The annual incidence rate of unplanned births was 6.8/1000 births and remained stable during the period of study. Young multiparous women residing in remote municipalities were at the highest risk of experiencing unplanned births. The unplanned birth group had higher perinatal mortality rate for the period, 11.4/1000 compared with 4.9/1000 for the reference group (incidence rate ratio 2.31, 95% confidence interval 1.82-2.93, p < 0.001). Annual perinatal mortality rate for unplanned births did not change significantly (p = 0.80) but declined on average by 3% per year in the reference group (p < 0.001). The unplanned birth group had a lower proportion of live births in all birthweight categories. Live born neonates with a birthweight of 750-999 g in the unplanned birth group had a more than five times higher mortality rate during the first week of life, compared with reference births in the same birthweight category. Unplanned births are associated with adverse outcome. Excessive mortality is possibly caused by reduced availability of necessary medical interventions for vulnerable newborns out-of-hospital. © 2014 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

The Green Bay cesarean section study. III. Falling cesarean birth rates without a formal curtailment program.

PubMed

Sandmire, H F; DeMott, R K

1994-06-01

We observed decreases in cesarean birth rates at two Green Bay hospitals after the 1990 publication of our first cesarean section study. The purpose of this study was to determine the causes of those decreases and to see whether any outcome changes occurred with lower rates. An additional objective was to determine the perceptions of the 10 physicians regarding the determinants of cesarean birth rates. We compared recent cesarean birth rates (1990 to 1992) to former rates (1986 to 1988) for 10 of the 11 physicians analyzed in our previous studies. Newborn outcomes were analyzed to determine whether variations occur in comparing low to high cesarean rate physician groups. The total, primary, and repeat cesarean birth rates declined from 13.3% to 10.2%, 8.6% to 6.8%, and 4.7% to 3.4%, respectively, between 1986 to 1988 and 1990 to 1992. Variations in cesarean rates occurred among physicians and groups of physicians. Higher cesarean rates did not result in better perinatal outcome. Literature reports, residency training, continuing medical education attendance, and liability risks were the major determinants of cesarean birth as perceived by the 10 physicians in the study. The least important determinant, rated fifteenth of 15, was the national cesarean birth rate.

Hospital-wide breastfeeding rates vs. breastmilk provision for very-low-birth-weight infants.

PubMed

Lee, Henry C; Jegatheesan, Priya; Gould, Jeffrey B; Dudley, Raymond A

2013-03-01

To investigate the relationship between breastmilk feeding in very-low-birth-weight infants in the neonatal intensive care unit and breastmilk feeding rates for all newborns by hospital. This was a cross-sectional study of 111 California hospitals in 2007 and 2008. Correlation coefficients were calculated between overall hospital breastfeeding rates and breastmilk feeding rates of very-low-birth-weight infants. Hospitals were categorized in quartiles by crude and adjusted very-low-birth-weight infant rates to compare rankings between measures. Correlation between breastmilk feeding rates of very-low-birth-weight infants and overall breastfeeding rates varied by neonatal intensive care unit level of care from 0.13 for intermediate hospitals to 0.48 for regional hospitals. For hospitals categorized in the top quartile according to overall breastfeeding rate, only 46% were in the top quartile for both crude and adjusted very-low-birth-weight infant rates. On the other hand, when considering the lowest quartile for overall breastfeeding hospitals, three of 27 (11%) actually were performing in the top quartile of performance for very-low-birth-weight infant rates. Reporting hospital overall breastfeeding rates and neonatal intensive care unit breastmilk provision rates separately may give an incomplete picture of quality of care. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

Reduced Disparities in Birth Rates Among Teens

MedlinePlus

... teen births rates. Top of Page Community-wide Initiatives As part of a coordinated national teen pregnancy ... Health and CDC partnered to fund community-wide initiatives in areas with high rates of teen births, ...

Hot spots, cluster detection and spatial outlier analysis of teen birth rates in the U.S., 2003-2012.

PubMed

Khan, Diba; Rossen, Lauren M; Hamilton, Brady E; He, Yulei; Wei, Rong; Dienes, Erin

2017-06-01

Teen birth rates have evidenced a significant decline in the United States over the past few decades. Most of the states in the US have mirrored this national decline, though some reports have illustrated substantial variation in the magnitude of these decreases across the U.S. Importantly, geographic variation at the county level has largely not been explored. We used National Vital Statistics Births data and Hierarchical Bayesian space-time interaction models to produce smoothed estimates of teen birth rates at the county level from 2003-2012. Results indicate that teen birth rates show evidence of clustering, where hot and cold spots occur, and identify spatial outliers. Findings from this analysis may help inform efforts targeting the prevention efforts by illustrating how geographic patterns of teen birth rates have changed over the past decade and where clusters of high or low teen birth rates are evident. Published by Elsevier Ltd.

Hot spots, cluster detection and spatial outlier analysis of teen birth rates in the U.S., 2003–2012

PubMed Central

Khan, Diba; Rossen, Lauren M.; Hamilton, Brady E.; He, Yulei; Wei, Rong; Dienes, Erin

2017-01-01

Teen birth rates have evidenced a significant decline in the United States over the past few decades. Most of the states in the US have mirrored this national decline, though some reports have illustrated substantial variation in the magnitude of these decreases across the U.S. Importantly, geographic variation at the county level has largely not been explored. We used National Vital Statistics Births data and Hierarchical Bayesian space-time interaction models to produce smoothed estimates of teen birth rates at the county level from 2003–2012. Results indicate that teen birth rates show evidence of clustering, where hot and cold spots occur, and identify spatial outliers. Findings from this analysis may help inform efforts targeting the prevention efforts by illustrating how geographic patterns of teen birth rates have changed over the past decade and where clusters of high or low teen birth rates are evident. PMID:28552189

The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes.

PubMed

Carr, Jillian B; Packham, Analisa

2017-04-01

In 2011, the USA had the second highest teen birth rate of any developed nation, according to the World Bank, . In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the causal effects of state-level sex education policies from 2000-2011 on various teen sexual health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Age-specific birth rates in women with epilepsy: a population-based study.

PubMed

Farmen, Anette Huuse; Grundt, Jacob Holter; Tomson, Torbjörn; Nakken, Karl O; Nakling, Jakob; Mowinchel, Petter; Øie, Merete; Lossius, Morten I

2016-08-01

The aim of this study was to investigate birth rates and use of hormonal contraception in different age groups among women with epilepsy (WWE) in comparison to women without epilepsy. Demographic data and medical information on more than 25,000 pregnant women (40,000 births), representing 95% of all pregnancies in Oppland County, Norway, were registered in the Oppland Perinatal Database in the period 1989-2011. Data were analyzed with respect to epilepsy diagnoses, and 176 women with a validated epilepsy diagnosis (303 pregnancies) were identified. Age-specific birth rates in these women were estimated and compared with age-specific birth rates in women without epilepsy in the same county. In WWE over 25 years of age, birth rates were significantly lower than in those of the same age group without epilepsy. In women below 20 years of age, birth rates were similar in those with and without epilepsy. The use of hormonal contraceptives prior to pregnancy was lower among WWE under 25 years than in the corresponding age group without epilepsy. Health professionals who counsel WWE who are of fertile age should be aware of the strongly reduced birth rates in WWE over 25 years of age, and the lower rates of use of contraceptives among young WWE.

Observations of the birth of a small coronal hole

NASA Technical Reports Server (NTRS)

Solodyna, C. V.; Krieger, A. S.; Nolte, J. T.

1977-01-01

Using soft X-ray data from the S-054 X-ray spectrographic telescope aboard Skylab, we observed temporal changes in the emission structure of the X-ray corona associated with the birth of a small coronal hole. Designated as CH6, this coronal hole was born near the equator in a time interval less than 9-1/2 hr. By constructing a light curve for a point near the center of CH6, we observed a sudden 40% decrease in X-ray emission associated with the birth of this coronal hole. On a time scale of hours, the growth of CH6 in area proceeded faster than the average rate predicted by the diffusion of solar fields. The short term decay of CH6 followed the diffusive rate to within experimental uncertainty. On a time scale of one rotation, the subsequent development of CH6 was not consistent with steady growth at the average rate predicted by diffusion.

[Customized and non-customized French intrauterine growth curves. II - Comparison with existing curves and benefits of customization].

PubMed

Ego, A; Prunet, C; Blondel, B; Kaminski, M; Goffinet, F; Zeitlin, J

2016-02-01

Our aim is to compare the new French EPOPé intrauterine growth curves, developed to address the guidelines 2013 of the French College of Obstetricians and Gynecologists, with reference curves currently used in France, and to evaluate the consequences of their adjustment for fetal sex and maternal characteristics. Eight intrauterine and birthweight curves, used in France were compared to the EPOPé curves using data from the French Perinatal Survey 2010. The influence of adjustment on the rate of SGA births and the characteristics of these births was analysed. Due to their birthweight values and distribution, the selected intrauterine curves are less suitable for births in France than the new curves. Birthweight curves led to low rates of SGA births from 4.3 to 8.5% compared to 10.0% with the EPOPé curves. The adjustment for maternal and fetal characteristics avoids the over-representation of girls among SGA births, and reclassifies 4% of births. Among births reclassified as SGA, the frequency of medical and obstetrical risk factors for growth restriction, smoking (≥10 cigarettes/day), and neonatal transfer is higher than among non-SGA births (P<0.01). The EPOPé curves are more suitable for French births than currently used curves, and their adjustment improves the identification of mothers and babies at risk of growth restriction and poor perinatal outcomes. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Change in Population Characteristics and Teen Birth Rates in 77 Community Areas: Chicago, Illinois, 1999-2009.

PubMed

Gunaratne, Shauna; Masinter, Lisa; Kolak, Marynia; Feinglass, Joe

2015-01-01

We analyzed community area differences in teen births in Chicago, Illinois, from 1999 to 2009. We analyzed the association between changes in teen birth rates and concurrent measures of community area socioeconomic and demographic change. Mean annual changes in teen birth rates in 77 Chicago community areas were correlated with concurrent census-based population changes during the decade. Census measures included changes in race/ethnicity, adult high school dropouts, poverty or higher-income households, crowded housing, unemployment, English proficiency, foreign-born residents, or residents who moved in the last five years. We included non-collinear census measures with a p<0.1 bivariate association with change in teen births in a stepwise multiple linear regression model. Teen birth rates in Chicago fell faster than the overall birth rates, from 85 births per 1,000 teens in 1999 to 57 births per 1,000 teens in 2009. There were strong positive associations between increases in the percentage of residents who were black and Hispanic, poor, without a high school diploma, and living in crowded housing, and a negative association with an increase in higher-income households. Population changes in poverty, Hispanic population, and high school dropouts were the only significant measures in the final model, explaining almost half of the variance in teen birth rate changes. The study provides a model of census-based measures that can be used to evaluate predicted vs. observed rates of change in teen births across communities, offering the potential to more appropriately prioritize public health resources for preventing unintended teen pregnancy.

Change in Population Characteristics and Teen Birth Rates in 77 Community Areas: Chicago, Illinois, 1999–2009

PubMed Central

Gunaratne, Shauna; Masinter, Lisa; Kolak, Marynia

2015-01-01

Objective We analyzed community area differences in teen births in Chicago, Illinois, from 1999 to 2009. We analyzed the association between changes in teen birth rates and concurrent measures of community area socioeconomic and demographic change. Methods Mean annual changes in teen birth rates in 77 Chicago community areas were correlated with concurrent census-based population changes during the decade. Census measures included changes in race/ethnicity, adult high school dropouts, poverty or higher-income households, crowded housing, unemployment, English proficiency, foreign-born residents, or residents who moved in the last five years. We included non-collinear census measures with a p<0.1 bivariate association with change in teen births in a stepwise multiple linear regression model. Results Teen birth rates in Chicago fell faster than the overall birth rates, from 85 births per 1,000 teens in 1999 to 57 births per 1,000 teens in 2009. There were strong positive associations between increases in the percentage of residents who were black and Hispanic, poor, without a high school diploma, and living in crowded housing, and a negative association with an increase in higher-income households. Population changes in poverty, Hispanic population, and high school dropouts were the only significant measures in the final model, explaining almost half of the variance in teen birth rate changes. Conclusion The study provides a model of census-based measures that can be used to evaluate predicted vs. observed rates of change in teen births across communities, offering the potential to more appropriately prioritize public health resources for preventing unintended teen pregnancy. PMID:26345288

Cumulative birth rates with linked assisted reproductive technology cycles.

PubMed

Luke, Barbara; Brown, Morton B; Wantman, Ethan; Lederman, Avi; Gibbons, William; Schattman, Glenn L; Lobo, Rogerio A; Leach, Richard E; Stern, Judy E

2012-06-28

Live-birth rates after treatment with assisted reproductive technology have traditionally been reported on a per-cycle basis. For women receiving continued treatment, cumulative success rates are a more important measure. We linked data from cycles of assisted reproductive technology in the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for the period from 2004 through 2009 to individual women in order to estimate cumulative live-birth rates. Conservative estimates assumed that women who did not return for treatment would not have a live birth; optimal estimates assumed that these women would have live-birth rates similar to those for women continuing treatment. The data were from 246,740 women, with 471,208 cycles and 140,859 live births. Live-birth rates declined with increasing maternal age and increasing cycle number with autologous, but not donor, oocytes. By the third cycle, the conservative and optimal estimates of live-birth rates with autologous oocytes had declined from 63.3% and 74.6%, respectively, for women younger than 31 years of age to 18.6% and 27.8% for those 41 or 42 years of age and to 6.6% and 11.3% for those 43 years of age or older. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. Rates were higher with blastocyst embryos (day of transfer, 5 or 6) than with cleavage embryos (day of transfer, 2 or 3). At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used. Our results indicate that live-birth rates approaching natural fecundity can be achieved by means of assisted reproductive technology when there are favorable patient and embryo characteristics. Live-birth rates among older women are lower than those among younger women when autologous oocytes are used but are similar to the rates among young women when donor oocytes are used. (Funded by the National Institutes of Health and the Society for Assisted Reproductive Technology.).

Obligatory versus elective single embryo transfer in in vitro fertilization. A population-based analysis of data from the U.K. Human Fertilisation and Embryology Authority.

PubMed

Straughen, Jennifer K; Salihu, Hamisu M; Keith, Louis; Petrozzino, Jeffrey; Jones, Christopher

2013-01-01

To determine how obligatory single embryo transfer (SET) and elective SET influence pregnancy outcome. We compared women who underwent obligatory and elective SET using data from a comprehensive, population-based register from the United Kingdom Human Fertilisation and Embryology Authority, which contained all in vitro fertilization (IVF) treatments administered between 1991 and 1998. Generalized estimating equations were used to generate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to compare clinical pregnancy, live birth, and multiple birth rates. Obligatory and elective SET had similar clinical pregnancy and live birth rates and comparable multiple birth rates. Obligatory and elective SET were equally likely to end in a live birth (OR = 1.08; 95% CI = 0.90, 1.30). Similar results were found after restricting the data to women without previous IVF births (OR = 1.18; 95% CI = 0.98, 1.42) and without previous naturally conceived live births (OR = 1.16; 95% CI = 0.95, 1.43). This study suggests that obligatory SET can achieve pregnancy and live birth rates that are at least as good as elective SET. Equally important is the low multiple birth rate which was maintained in both forms of SET. More studies comparing elective versus obligatory SET can assist with achieving optimal pregnancy rates while preventing multiple births.

Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles.

PubMed

Smith, Andrew D A C; Tilling, Kate; Nelson, Scott M; Lawlor, Debbie A

The likelihood of achieving a live birth with repeat in vitro fertilization (IVF) is unclear, yet treatment is commonly limited to 3 or 4 embryo transfers. To determine the live-birth rate per initiated ovarian stimulation IVF cycle and with repeated cycles. Prospective study of 156,947 UK women who received 257,398 IVF ovarian stimulation cycles between 2003 and 2010 and were followed up until June 2012. In vitro fertilization, with a cycle defined as an episode of ovarian stimulation and all subsequent separate fresh and frozen embryo transfers. Live-birth rate per IVF cycle and the cumulative live-birth rates across all cycles in all women and by age and treatment type. Optimal, prognosis-adjusted, and conservative cumulative live-birth rates were estimated, reflecting 0%, 30%, and 100%, respectively, of women who discontinued due to poor prognosis and having a live-birth rate of 0 had they continued. Among the 156,947 women, the median age at start of treatment was 35 years (interquartile range, 32-38; range, 18-55), and the median duration of infertility for all 257,398 cycles was 4 years (interquartile range, 2-6; range, <1-29). In all women, the live-birth rate for the first cycle was 29.5% (95% CI, 29.3%-29.7%). This remained above 20% up to and including the fourth cycle. The cumulative prognosis-adjusted live-birth rate across all cycles continued to increase up to the ninth cycle, with 65.3% (95% CI, 64.8%-65.8%) of women achieving a live birth by the sixth cycle. In women younger than 40 years using their own oocytes, the live-birth rate for the first cycle was 32.3% (95% CI, 32.0%-32.5%) and remained above 20% up to and including the fourth cycle. Six cycles achieved a cumulative prognosis-adjusted live-birth rate of 68.4% (95% CI, 67.8%-68.9%). For women aged 40 to 42 years, the live-birth rate for the first cycle was 12.3% (95% CI, 11.8%-12.8%), with 6 cycles achieving a cumulative prognosis-adjusted live-birth rate of 31.5% (95% CI, 29.7%-33.3%). For women older than 42 years, all rates within each cycle were less than 4%. No age differential was observed among women using donor oocytes. Rates were lower for women with untreated male partner-related infertility compared with those with any other cause, but treatment with either intracytoplasmic sperm injection or sperm donation removed this difference. Among women in the United Kingdom undergoing IVF, the cumulative prognosis-adjusted live-birth rate after 6 cycles was 65.3%, with variations by age and treatment type. These findings support the efficacy of extending the number of IVF cycles beyond 3 or 4.

Variation in Cesarean Birth Rates by Labor and Delivery Nurses.

PubMed

Edmonds, Joyce K; O'Hara, Michele; Clarke, Sean P; Shah, Neel T

To examine variation in the cesarean birth rates of women cared for by labor and delivery nurses. Retrospective cohort study. One high-volume labor and delivery unit at an academic medical center in a major metropolitan area. Labor and delivery nurses who cared for nulliparous women who gave birth to term, singleton fetuses in vertex presentation. Data were extracted from electronic hospital birth records from January 1, 2013 through June 30, 2015. Cesarean rates for individual nurses were calculated based on the number of women they attended who gave birth by cesarean. Nurses were grouped into quartiles by their cesarean rates, and the effect of these rates on the likelihood of cesarean birth was estimated by a logit regression model adjusting for patient-level characteristics and clustering of births within nurses. Seventy-two nurses attended 3,031 births. The mean nurse cesarean rate was 26% (95% confidence interval [23.9, 28.1]) and ranged from 8.3% to 48%. The adjusted odds of cesarean for births attended by nurses in the highest quartile was nearly 3 times (odds ratio = 2.73, 95% confidence interval [2.3, 3.3]) greater than for births attended by nurses in the lowest quartile. The labor and delivery nurse assigned to a woman may influence the likelihood of cesarean birth. Nurse-level cesarean birth data could be used to design practice improvement initiatives to improve nurse performance. More precise measurement of the relative influence of nurses on mode of birth is needed. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Season of birth and multiple sclerosis in Tunisia.

PubMed

Sidhom, Youssef; Kacem, Imen; Bayoudh, Lamia; Ben Djebara, Mouna; Hizem, Yosr; Ben Abdelfettah, Sami; Gargouri, Amina; Gouider, Riadh

2015-11-01

Recent studies on date of birth of multiple sclerosis (MS) patients showed an association between month of birth and the risk of developing MS. This association has not been investigated in an African country. We aimed to determine if the risk of MS is associated with month of birth in Tunisia. Data concerning date of birth for MS patients in Tunisia (n = 1912) was obtained. Birth rates of MS patients were compared with all births in Tunisia matched by year of birth (n = 11,615,912). We used a chi-squared analysis and the Hewitt's non-parametric test for seasonality. The distribution of births among MS patients compared with the control population was not different when tested by the chi-squared test. The Hewitt's test for seasonality showed an excess of births between May and October among MS patients (p = 0.03). The peak of Births of MS patients in Tunisia was in July and the nadir in December. Our data does support the seasonality hypothesis of month of birth as risk factor for MS in Tunisia. Low vitamin D levels during pregnancy could be a possible explanation that needs further investigation. Copyright © 2015 Elsevier B.V. All rights reserved.

Global Incidence of Preterm Birth.

PubMed

Tielsch, James M

2015-01-01

Estimating the incidence of preterm birth depends on accurate assessment of gestational age and pregnancy outcomes. In many countries, such data are not routinely collected, making global estimates difficult. A recent systematic approach to this problem has estimated a worldwide incidence of 11.1 per 100 live births in 2010. Significant variation in rates by country and region of the world was noted, but this variation is smaller than observed for a number of other important reproductive outcomes. Rates range from approximately 5% in some northern European countries to over 15% in some countries in sub-Saharan Africa and Asia. Time trends suggest that preterm birth incidence is increasing, but much of this change may reflect changes in medically induced early delivery practices as improvements in survival of preterm infants has improved. Whether there have been major changes in spontaneous preterm birth is unknown. New approaches to classifying etiologic heterogeneity have been proposed and offer the promise of developing specific interventions to address the range of underlying causes of this important health problem. © 2015 Nestec Ltd., Vevey/S. Karger AG, Basel.

Racial and Ethnic Trends in Sudden Unexpected Infant Deaths: United States, 1995-2013.

PubMed

Parks, Sharyn E; Erck Lambert, Alexa B; Shapiro-Mendoza, Carrie K

2017-06-01

Immediately after the 1994 Back-to-Sleep campaign, sudden unexpected infant death (SUID) rates decreased dramatically, but they have remained relatively stable (93.4 per 100 000 live births) since 2000. In this study, we examined trends in SUID rates and disparities by race/ethnicity since the Back-to-Sleep campaign. We used 1995-2013 US period-linked birth-infant death data to evaluate SUID rates per 100 000 live births by non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander racial/ethnic groupings. To examine racial/ethnic disparities, we calculated rate ratios with NHWs as the referent group. Unadjusted linear regression was used to evaluate trends ( P < .05) in rates and rate ratios. The distribution and rates of SUID by demographic and birth characteristics were compared for 1995-1997 and 2011-2013, and χ 2 tests were used to evaluate significance. From 1995 to 2013, SUID rates were consistently highest for American Indian/Alaska Natives, followed by NHBs. The rate for NHBs decreased significantly, whereas the rate for NHWs also declined, but not significantly. As a result, the disparity between NHWs and NHBs narrowed slightly. The SUID rates for Hispanics and Asian/Pacific Islanders were lower than the rates for NHWs and showed a significant decrease, resulting in an increase in their advantage over NHWs. Each racial/ethnic group showed a unique trend in SUID rates since the Back-to-Sleep campaign. When implementing risk-reduction strategies, it is important to consider these trends in targeting populations for prevention and developing culturally appropriate approaches for racial/ethnic communities. Copyright © 2017 by the American Academy of Pediatrics.

Racial and Ethnic Trends in Sudden Unexpected Infant Deaths: United States, 1995–2013

PubMed Central

Parks, Sharyn E.; Erck Lambert, Alexa B.; Shapiro-Mendoza, Carrie K.

2017-01-01

BACKGROUND AND OBJECTIVES Immediately after the 1994 Back-to-Sleep campaign, sudden unexpected infant death (SUID) rates decreased dramatically, but they have remained relatively stable (93.4 per 100 000 live births) since 2000. In this study, we examined trends in SUID rates and disparities by race/ethnicity since the Back-to-Sleep campaign. METHODS We used 1995–2013 US period-linked birth-infant death data to evaluate SUID rates per 100 000 live births by non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander racial/ethnic groupings. To examine racial/ethnic disparities, we calculated rate ratios with NHWs as the referent group. Unadjusted linear regression was used to evaluate trends (P < .05) in rates and rate ratios. The distribution and rates of SUID by demographic and birth characteristics were compared for 1995–1997 and 2011–2013, and χ2 tests were used to evaluate significance. RESULTS From 1995 to 2013, SUID rates were consistently highest for American Indian/Alaska Natives, followed by NHBs. The rate for NHBs decreased significantly, whereas the rate for NHWs also declined, but not significantly. As a result, the disparity between NHWs and NHBs narrowed slightly. The SUID rates for Hispanics and Asian/Pacific Islanders were lower than the rates for NHWs and showed a significant decrease, resulting in an increase in their advantage over NHWs. CONCLUSIONS Each racial/ethnic group showed a unique trend in SUID rates since the Back-to-Sleep campaign. When implementing risk-reduction strategies, it is important to consider these trends in targeting populations for prevention and developing culturally appropriate approaches for racial/ethnic communities. PMID:28562272

Birth and fertility rates for states by Hispanic origin subgroups: United States, 1990 and 2000.

PubMed

Sutton, Paul D; Mathews, T J

2006-05-01

This report presents U.S. and State-level data on births, birth rates, and fertility rates for Hispanic origin subgroups for 1990 and 2000. Data for non-Hispanic whites and non-Hispanic blacks are provided for comparison. Data are presented in detailed tables, graphs, and maps. Between 1990 and 2000, the total U.S. Hispanic population increased 58 percent, from 22,353,999 to 35,305,818. Over the same period of time, births to Hispanic mothers increased 37 percent, from 595,073 to 815,868. The smaller increases in births compared with the population resulted in a falling birth rate among Hispanic mothers (26.7 in 1990 to 23.1 births per 1,000 total population in 2000). Birth and fertility rates for Mexican, Puerto Rican, and Cuban mothers all fell between 1990 and 2000. Among the Hispanic subgroups, fertility rates in 2000 ranged from 105.1 births per 1,000 women aged 15-44 years for Mexican women to 49.3 for Cuban women. Differences in fertility exist not only between Hispanic subgroups but also within groups among States. For example, total fertility rates for Puerto Rican mothers, which estimates the number of children a group of 1,000 women will have in their lifetime, ranged in 2000 from 1,616.5 in New York to 2,403.0 in Pennsylvania.

Coarse-graining and hybrid methods for efficient simulation of stochastic multi-scale models of tumour growth.

PubMed

de la Cruz, Roberto; Guerrero, Pilar; Calvo, Juan; Alarcón, Tomás

2017-12-01

The development of hybrid methodologies is of current interest in both multi-scale modelling and stochastic reaction-diffusion systems regarding their applications to biology. We formulate a hybrid method for stochastic multi-scale models of cells populations that extends the remit of existing hybrid methods for reaction-diffusion systems. Such method is developed for a stochastic multi-scale model of tumour growth, i.e. population-dynamical models which account for the effects of intrinsic noise affecting both the number of cells and the intracellular dynamics. In order to formulate this method, we develop a coarse-grained approximation for both the full stochastic model and its mean-field limit. Such approximation involves averaging out the age-structure (which accounts for the multi-scale nature of the model) by assuming that the age distribution of the population settles onto equilibrium very fast. We then couple the coarse-grained mean-field model to the full stochastic multi-scale model. By doing so, within the mean-field region, we are neglecting noise in both cell numbers (population) and their birth rates (structure). This implies that, in addition to the issues that arise in stochastic-reaction diffusion systems, we need to account for the age-structure of the population when attempting to couple both descriptions. We exploit our coarse-graining model so that, within the mean-field region, the age-distribution is in equilibrium and we know its explicit form. This allows us to couple both domains consistently, as upon transference of cells from the mean-field to the stochastic region, we sample the equilibrium age distribution. Furthermore, our method allows us to investigate the effects of intracellular noise, i.e. fluctuations of the birth rate, on collective properties such as travelling wave velocity. We show that the combination of population and birth-rate noise gives rise to large fluctuations of the birth rate in the region at the leading edge of front, which cannot be accounted for by the coarse-grained model. Such fluctuations have non-trivial effects on the wave velocity. Beyond the development of a new hybrid method, we thus conclude that birth-rate fluctuations are central to a quantitatively accurate description of invasive phenomena such as tumour growth.

Coarse-graining and hybrid methods for efficient simulation of stochastic multi-scale models of tumour growth

NASA Astrophysics Data System (ADS)

de la Cruz, Roberto; Guerrero, Pilar; Calvo, Juan; Alarcón, Tomás

2017-12-01

The development of hybrid methodologies is of current interest in both multi-scale modelling and stochastic reaction-diffusion systems regarding their applications to biology. We formulate a hybrid method for stochastic multi-scale models of cells populations that extends the remit of existing hybrid methods for reaction-diffusion systems. Such method is developed for a stochastic multi-scale model of tumour growth, i.e. population-dynamical models which account for the effects of intrinsic noise affecting both the number of cells and the intracellular dynamics. In order to formulate this method, we develop a coarse-grained approximation for both the full stochastic model and its mean-field limit. Such approximation involves averaging out the age-structure (which accounts for the multi-scale nature of the model) by assuming that the age distribution of the population settles onto equilibrium very fast. We then couple the coarse-grained mean-field model to the full stochastic multi-scale model. By doing so, within the mean-field region, we are neglecting noise in both cell numbers (population) and their birth rates (structure). This implies that, in addition to the issues that arise in stochastic-reaction diffusion systems, we need to account for the age-structure of the population when attempting to couple both descriptions. We exploit our coarse-graining model so that, within the mean-field region, the age-distribution is in equilibrium and we know its explicit form. This allows us to couple both domains consistently, as upon transference of cells from the mean-field to the stochastic region, we sample the equilibrium age distribution. Furthermore, our method allows us to investigate the effects of intracellular noise, i.e. fluctuations of the birth rate, on collective properties such as travelling wave velocity. We show that the combination of population and birth-rate noise gives rise to large fluctuations of the birth rate in the region at the leading edge of front, which cannot be accounted for by the coarse-grained model. Such fluctuations have non-trivial effects on the wave velocity. Beyond the development of a new hybrid method, we thus conclude that birth-rate fluctuations are central to a quantitatively accurate description of invasive phenomena such as tumour growth.

Where are the Sunday babies? II. Declining weekend birth rates in Switzerland.

PubMed

Lerchl, Alexander; Reinhard, Sarah C

2008-02-01

Birth dates from almost 3 million babies born between 1969 and 2005 in Switzerland were analyzed for the weekday of birth. As in other countries but with unprecedented amplitude, a very marked non-random distribution was discovered with decreasing numbers of births on weekends, reaching -17.9% in 2005. While most of this weekend births avoidance rate is due to fewer births on Sundays (up to -21.7%), the downward trend is primarily a consequence of decreasing births on Saturdays (up to -14.5%). For 2005, these percentages mean that 3,728 fewer babies are born during weekends than could be expected from equal distribution. Most interestingly and surprisingly, weekend birth-avoiding rates are significantly correlated with birth numbers (r = 0.86), i.e. the lower the birth number per year, the lower the number of weekend births. The increasing avoidance of births during weekends is discussed as being a consequence of increasing numbers of caesarean sections and elective labor induction, which in Switzerland reach 29.2 and 20.5%, respectively, in 2004. This hypothesis is supported by the observation that both primary and secondary caesarean sections are significantly correlated with weekend birth avoidance rates. It is therefore likely that financial aspects of hospitals are a factor determining the avoidance of weekend births by increasing the numbers of caesarean sections.

Where are the Sunday babies? II. Declining weekend birth rates in Switzerland

NASA Astrophysics Data System (ADS)

Lerchl, Alexander; Reinhard, Sarah C.

2008-02-01

Birth dates from almost 3 million babies born between 1969 and 2005 in Switzerland were analyzed for the weekday of birth. As in other countries but with unprecedented amplitude, a very marked non-random distribution was discovered with decreasing numbers of births on weekends, reaching -17.9% in 2005. While most of this weekend births avoidance rate is due to fewer births on Sundays (up to -21.7%), the downward trend is primarily a consequence of decreasing births on Saturdays (up to -14.5%). For 2005, these percentages mean that 3,728 fewer babies are born during weekends than could be expected from equal distribution. Most interestingly and surprisingly, weekend birth-avoiding rates are significantly correlated with birth numbers ( r = 0.86), i.e. the lower the birth number per year, the lower the number of weekend births. The increasing avoidance of births during weekends is discussed as being a consequence of increasing numbers of caesarean sections and elective labor induction, which in Switzerland reach 29.2 and 20.5%, respectively, in 2004. This hypothesis is supported by the observation that both primary and secondary caesarean sections are significantly correlated with weekend birth avoidance rates. It is therefore likely that financial aspects of hospitals are a factor determining the avoidance of weekend births by increasing the numbers of caesarean sections.

Impact of social service and public health spending on teenage birth rates across the USA: an ecological study

PubMed Central

Sipsma, Heather L; Canavan, Maureen; Gilliam, Melissa; Bradley, Elizabeth

2017-01-01

Objective To examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA. Design Ecological study. Setting USA. Participants 50 states. Primary outcome measure Our primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders. Results The unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=−0.20; 95% CI −0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001). Conclusion Higher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical. PMID:28611088

Why is the teen birth rate in the United States so high and why does it matter?

PubMed

Kearney, Melissa S; Levine, Phillip B

2012-01-01

Teens in the United States are far more likely to give birth than in any other industrialized country in the world. U.S. teens are two and a half times as likely to give birth as compared to teens in Canada, around four times as likely as teens in Germany or Norway, and almost 10 times as likely as teens in Switzerland. Among more developed countries, Russia has the next highest teen birth rate after the United States, but an American teenage girl is still around 25 percent more likely to give birth than her counterpart in Russia. Moreover, these statistics incorporate the almost 40 percent fall in the teen birth rate that the United States has experienced over the past two decades. Differences across U.S. states are quite dramatic as well. A teenage girl in Mississippi is four times more likely to give birth than a teenage girl in New Hampshire--and 15 times more likely to give birth as a teen compared to a teenage girl in Switzerland. This paper has two overarching goals: understanding why the teen birth rate is so high in the United States and understanding why it matters. Thus, we begin by examining multiple sources of data to put current rates of teen childbearing into the perspective of cross-country comparisons and recent historical context. We examine teen birth rates alongside pregnancy, abortion, and "shotgun" marriage rates as well as the antecedent behaviors of sexual activity and contraceptive use. We seek insights as to why the rate of teen childbearing is so unusually high in the United States as a whole, and in some U.S. states in particular. We argue that explanations that economists have tended to study are unable to account for any sizable share of the variation in teen childbearing rates across place. We describe some recent empirical work demonstrating that variation in income inequality across U.S. states and developed countries can explain a sizable share of the geographic variation in teen childbearing. To the extent that income inequality is associated with a lack of economic opportunity and heightened social marginalization for those at the bottom of the distribution, this empirical finding is potentially consistent with the ideas that other social scientists have been promoting for decades but which have been largely untested with large data sets and standard econometric methods. Our reading of the totality of evidence leads us to conclude that being on a low economic trajectory in life leads many teenage girls to have children while they are young and unmarried and that poor outcomes seen later in life (relative to teens who do not have children) are simply the continuation of the original low economic trajectory. That is, teen childbearing is explained by the low economic trajectory but is not an additional cause of later difficulties in life. Surprisingly, teen birth itself does not appear to have much direct economic consequence. Moreover, no silver bullet such as expanding access to contraception or abstinence education will solve this particular social problem. Our view is that teen childbearing is so high in the United States because of underlying social and economic problems. It reflects a decision among a set of girls to "drop-out" of the economic mainstream; they choose non-marital motherhood at a young age instead of investing in their own economic progress because they feel they have little chance of advancement. This thesis suggests that to address teen childbearing in America will require addressing some difficult social problems: in particular, the perceived and actual lack of economic opportunity among those at the bottom of the economic ladder.

Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services.

PubMed

Leal, Maria do Carmo; Esteves-Pereira, Ana Paula; Nakamura-Pereira, Marcos; Torres, Jacqueline Alves; Domingues, Rosa Maria Soares Madeira; Dias, Marcos Augusto Bastos; Moreira, Maria Elizabeth; Theme-Filha, Mariza; da Gama, Silvana Granado Nogueira

2016-01-01

A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk. This is a sub-analysis of a national population-based survey of postpartum women entitled "Birth in Brazil", performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services. Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s) and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8%) when compared to the ones receiving public services (rate of 2.4%), regardless of obstetric risk-adjusted OR of 2.3 (CI 1.5-3.6) for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1-2.3) for women of high obstetric risk. The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.

Increase in caesarean deliveries after the Australian Private Health Insurance Incentive policy reforms.

PubMed

Einarsdóttir, Kristjana; Kemp, Anna; Haggar, Fatima A; Moorin, Rachael E; Gunnell, Anthony S; Preen, David B; Stanley, Fiona J; Holman, C D'Arcy J

2012-01-01

The Australian Private Health Insurance Incentive (PHII) policy reforms implemented in 1997-2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA). All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (-21.4 to -19.3) decrease in public birth rates, a 51% (45.1 to 56.4) increase in private birth rates, a 5% (-5.3 to -5.1) and 8% (-8.9 to -7.9) decrease in unassisted and assisted vaginal deliveries respectively, a 5% (-5.3 to -5.1) increase in caesarean sections with labour and 10% (8.0 to 11.7) increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0-3 days in hospital following birth decreased by 20% (-21.5 to -18.5), but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1). Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.

Increased abundance of aromatase and follicle stimulating hormone receptor mRNA and decreased insulin-like growth factor-2 receptor mRNA in small ovarian follicles of cattle selected for twin births

USDA-ARS?s Scientific Manuscript database

Cattle genetically selected for twin ovulations and births (Twinner) exhibit increased ovarian follicular development, increased ovulation rate, and greater blood and follicular fluid IGF 1 concentrations compared with contemporary cattle not selected for twins (Control). Experimental objectives wer...

Reasons for and challenges of recent increases in teen birth rates: a study of family planning service policies and demographic changes at the state level.

PubMed

Yang, Zhou; Gaydos, Laura M

2010-06-01

After declining for over a decade, the birth rate in the United States for adolescents aged 15-19 years increased by 3% in 2006 and 1% again in 2007. We examined demographic and policy reasons for this trend at state level. With data merged from multiple sources, descriptive analysis was used to detect state-level trends in birth rate and policy changes from 2000 to 2006, and variations in the distribution of teen birth rates, sex education, and family planning service policies, and demographic features across each state in 2006. Regression analysis was then conducted to estimate the effect of several reproductive health policies and demographic features on teen birth rates at the state level. Instrument variable was used to correct possible bias in the regression analysis. Medicaid family planning waivers were found to reduce teen birth rates across all ages and races. Abstinence-only education programs were found to cause an increase in teen birth rates among white and black teens. The increasing Hispanic population is another driving force for high teen birth rates. Both demographic factors and policy changes contributed to the increase in teen birth rates between 2000 and 2006. Future policy and behavioral interventions should focus on promoting and increasing access to contraceptive use. Family planning policies should be crafted to address the special needs of teens from different cultural backgrounds, especially Hispanics. Copyright 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Understanding the role of violence as a social determinant of preterm birth.

PubMed

Masho, Saba W; Cha, Susan; Chapman, Derek A; Chelmow, David

2017-02-01

Preterm birth is one of the leading causes of infant morbidity and mortality. Although major strides have been made in identifying risk factors for preterm birth, the complexities between social and individual risk factors are not well understood. This study examines the association between neighborhood youth violence and preterm birth. A 10-year live birth registry data set (2004 through 2013) from Richmond, VA, a mid-sized, racially diverse city, was analyzed (N = 27,519). Data were geocoded and merged with census tract and police report data. Gestational age at birth was classified as <32 weeks, 32-36 weeks, and term ≥37 weeks. Using police report data, youth violence rates were calculated for each census tract area and categorized into quartiles. Hierarchical models were examined fitting multilevel logistic regression models incorporating randomly distributed census tract-specific intercepts assuming a binary distribution and a logit link function. Nearly a fifth of all births occurred in areas with the highest quartiles of violence. After adjusting for maternal age, race/ethnicity, education, paternal presence, parity, adequacy of prenatal care, pregnancy complications, history of preterm birth, insurance, and tobacco, alcohol, and drug use, census tracts with the highest level of violence had 38% higher odds of very preterm births (adjusted odds ratio, 1.38; 95% confidence interval, 1.06-1.80), than census tracts with the lowest level of violence. There is an association between high rate of youth violence and very preterm birth. Findings from this study may help inform future research to develop targeted interventions aimed at reducing community violence and very preterm birth in vulnerable populations. Copyright © 2016 Elsevier Inc. All rights reserved.

Within-litter variation in birth weight: impact of nutritional status in the sow.

PubMed

Yuan, Tao-lin; Zhu, Yu-hua; Shi, Meng; Li, Tian-tian; Li, Na; Wu, Guo-yao; Bazer, Fuller W; Zang, Jian-jun; Wang, Feng-lai; Wang, Jun-jun

2015-06-01

Accompanying the beneficial improvement in litter size from genetic selection for high-prolificacy sows, within-litter variation in birth weight has increased with detrimental effects on post-natal growth and survival due to an increase in the proportion of piglets with low birth-weight. Causes of within-litter variation in birth weight include breed characteristics that affect uterine space, ovulation rate, degree of maturation of oocytes, duration of time required for ovulation, interval between ovulation and fertilization, uterine capacity for implantation and placentation, size and efficiency of placental transport of nutrients, communication between conceptus/fetus and maternal systems, as well as nutritional status and environmental influences during gestation. Because these factors contribute to within-litter variation in birth weight, nutritional status of the sow to improve fetal-placental development must focus on the following three important stages in the reproductive cycle: pre-mating or weaning to estrus, early gestation and late gestation. The goal is to increase the homogeneity of development of oocytes and conceptuses, decrease variations in conceptus development during implantation and placentation, and improve birth weights of newborn piglets. Though some progress has been made in nutritional regulation of within-litter variation in the birth weight of piglets, additional studies, with a focus on and insights into molecular mechanisms of reproductive physiology from the aspects of maternal growth and offspring development, as well as their regulation by nutrients provided to the sow, are urgently needed.

Ergodicity bounds for birth-death processes with particularities

NASA Astrophysics Data System (ADS)

Zeifman, Alexander I.; Satin, Yacov; Korotysheva, Anna; Shilova, Galina; Kiseleva, Ksenia; Korolev, Victor Yu.; Bening, Vladimir E.; Shorgin, Sergey Ya.

2016-06-01

We introduce an inhomogeneous birth-death process with birth rates λk(t), death rates µk(t), and possible transitions to/from zero with rates βk(t), rk(t) respectively, and obtain ergodicity bounds for this process.

Smoking ban and small-for-gestational age births in Ireland.

PubMed

Kabir, Zubair; Daly, Sean; Clarke, Vanessa; Keogan, Sheila; Clancy, Luke

2013-01-01

Ireland introduced a comprehensive workplace smoke-free legislation in March, 2004. Smoking-related adverse birth outcomes have both health care and societal cost implications. The main aim of this study was to determine the impact of the Irish smoke-free legislation on small-for-gestationa- age (SGA) births. We developed a population-based birthweight (BW) percentile curve based on a recent study to compute SGA (BW <5(th) percentile) and very SGA (vSGA - BW<3(rd) percentile) for each gestational week. Monthly births born between January 1999 and December 2008 were analyzed linking with monthly maternal smoking rates from a large referral maternity university hospital. We ran individual control and CUSUM charts, with bootstrap simulations, to pinpoint the breakpoint for the impact of ban implementation ( = April 2004). Monthly SGA rates (%) before and after April 2004 was considered pre and post ban period births, respectively. Autocorrelation was tested using Durbin Watson (DW) statistic. Mixed models using a random intercept and a fixed effect were employed using SAS (v 9.2). A total of 588,997 singleton live-births born between January 1999 and December 2008 were analyzed. vSGA and SGA monthly rates declined from an average of 4.7% to 4.3% and from 6.9% to 6.6% before and after April 2004, respectively. No auto-correlation was detected (DW = ~2). Adjusted mixed models indicated a significant decline in both vSGA and SGA rates immediately after the ban [(-5.3%; 95% CI -5.43% to -5.17%, p<0.0001) and (-0.45%; 95% CI: -0.7% to -0.19%, p<0.0007)], respectively. Significant gradual effects continued post the ban periods for vSGA and SGA rates, namely, -0.6% (p<0.0001) and -0.02% (p<0.0001), respectively. A significant reduction in small-for-gestational birth rates both immediately and sustained over the post-ban period, reinforces the mounting evidence of the positive health effect of a successful comprehensive smoke-free legislation in a vulnerable population group as pregnant women.

Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss.

PubMed

Murugappan, Gayathree; Ohno, Mika S; Lathi, Ruth B

2015-05-01

To determine whether in vitro fertilization with preimplantation genetic screening (IVF/PGS) is cost effective compared with expectant management in achieving live birth for patients with unexplained recurrent pregnancy loss (RPL). Decision analytic model comparing costs and clinical outcomes. Academic recurrent pregnancy loss programs. Women with unexplained RPL. IVF/PGS with 24-chromosome screening and expectant management. Cost per live birth. The IVF/PGS strategy had a live-birth rate of 53% and a clinical miscarriage rate of 7%. Expectant management had a live-birth rate of 67% and clinical miscarriage rate of 24%. The IVF/PGS strategy was 100-fold more expensive, costing $45,300 per live birth compared with $418 per live birth with expectant management. In this model, IVF/PGS was not a cost-effective strategy for increasing live birth. Furthermore, the live-birth rate with IVF/PGS needs to be 91% to be cost effective compared with expectant management. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Teen Births: Examining the Recent Increase. Research Brief. Publication #2009-08

ERIC Educational Resources Information Center

Moore, Kristin Anderson

2009-01-01

After a 14-year decline, the teen birth rate increased in 2006, according to data from the National Center for Health Statistics. Between 2005 and 2006, the teen birth rate rose 3.5 percent, from 40.5 to 41.9 births per 1,000 females aged 15-19. The number of teen births rose by 20,843, from 414,593 to 435,436 births, the largest annual increase…

Births: Preliminary Data for 1999.

ERIC Educational Resources Information Center

Curtin, Sally C.; Martin, Joyce A.

2000-01-01

This report presents preliminary data for 1999 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of the mother. Data on marital status, prenatal care, cesarean delivery, and low birthweight rate are also presented. Data are based on a more than 97% sample of births for 1999. The crude birth rate in…

Smoking behavior of Mexicans: patterns by birth-cohort, gender, and education.

PubMed

Christopoulou, Rebekka; Lillard, Dean R; Balmori de la Miyar, Josè R

2013-06-01

Little is known about historical smoking patterns in Mexico. Policy makers must rely on imprecise predictions of human or fiscal burdens from smoking-related diseases. In this paper we document intergenerational patterns of smoking, project them for future cohorts, and discuss those patterns in the context of Mexico's impressive economic growth. We use retrospectively collected information to generate life-course smoking prevalence rates of five birth-cohorts, by gender and education. With dynamic panel data methods, we regress smoking rates on indicators of economic development. Smoking is most prevalent among men and the highly educated. Smoking rates peaked in the 1980s and have since decreased, slowly on average, and fastest among the highly educated. Development significantly contributed to this decline; a 1 % increase in development is associated with an average decline in smoking prevalence of 0.02 and 0.07 percentage points for women and men, respectively. Mexico's development may have triggered forces that decrease smoking, such as the spread of health information. Although smoking rates are falling, projections suggest that they will be persistently high for several future generations.

Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units

PubMed Central

Boo, Nem-Yun; Cheah, Irene Guat-Sim

2016-01-01

INTRODUCTION This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR). METHODS This was a retrospective study of 3,880 VLBW (≤ 1,500 g) infants admitted to 34 neonatal intensive care units (NICUs) in the MNNR. Sepsis was diagnosed in symptomatic infants with positive blood culture. RESULTS Sepsis developed in 623 (16.1%) infants; 61 (9.8%) had early-onset sepsis (EOS) and 562 (90.2%) had late-onset sepsis (LOS). The median EOS rate of all NICUs was 1.0% (interquartile range [IQR] 0%, 2.0%). Compared with NICUs reporting no EOS (n = 14), NICUs reporting EOS (n = 20) had significantly higher patient loads (total live births, admissions, VLBW infants, outborns); more mothers with a history of abortions, and antenatal steroids and intrapartum antibiotic use; more infants requiring resuscitation procedures at birth; higher rates of surfactant therapy, pneumonia and insertion of central venous catheters. The median LOS rate of all NICUs was 14.5% (IQR 7.8%, 19.2%). Compared with NICUs with LOS rates below the first quartile (n = 8), those above the third quartile (n = 8) used less intrapartum antibiotics, and had significantly bigger and more mature infants, more outborns, as well as a higher number of sick infants requiring ventilator support and total parenteral nutrition. CONCLUSION Patient loads, resuscitation at birth, status of infants on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis. PMID:26996633

Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units.

PubMed

Boo, Nem-Yun; Cheah, Irene Guat-Sim

2016-03-01

This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR). This was a retrospective study of 3,880 VLBW (≤ 1,500 g) infants admitted to 34 neonatal intensive care units (NICUs) in the MNNR. Sepsis was diagnosed in symptomatic infants with positive blood culture. Sepsis developed in 623 (16.1%) infants; 61 (9.8%) had early-onset sepsis (EOS) and 562 (90.2%) had late-onset sepsis (LOS). The median EOS rate of all NICUs was 1.0% (interquartile range [IQR] 0%, 2.0%). Compared with NICUs reporting no EOS (n = 14), NICUs reporting EOS (n = 20) had significantly higher patient loads (total live births, admissions, VLBW infants, outborns); more mothers with a history of abortions, and antenatal steroids and intrapartum antibiotic use; more infants requiring resuscitation procedures at birth; higher rates of surfactant therapy, pneumonia and insertion of central venous catheters. The median LOS rate of all NICUs was 14.5% (IQR 7.8%, 19.2%). Compared with NICUs with LOS rates below the first quartile (n = 8), those above the third quartile (n = 8) used less intrapartum antibiotics, and had significantly bigger and more mature infants, more outborns, as well as a higher number of sick infants requiring ventilator support and total parenteral nutrition. Patient loads, resuscitation at birth, status of infants on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis. Copyright: © Singapore Medical Association.

Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy

PubMed Central

Secura, Gina M.; Madden, Tessa; McNicholas, Colleen; Mullersman, Jennifer; Buckel, Christina M.; Zhao, Qiuhong; Peipert, Jeffrey F.

2014-01-01

Background The rate of teenage pregnancy in the United States is higher than in other developed nations. Teenage births result in substantial costs, including public assistance, health care costs, and income losses due to lower educational attainment and reduced earning potential. Methods The Contraceptive CHOICE Project was a large prospective cohort study designed to promote the use of long-acting, reversible contraceptive (LARC) methods to reduce unintended pregnancy in the St. Louis region. Participants were educated about reversible contraception, with an emphasis on the benefits of LARC methods, were provided with their choice of reversible contraception at no cost, and were followed for 2 to 3 years. We analyzed pregnancy, birth, and induced-abortion rates among teenage girls and women 15 to 19 years of age in this cohort and compared them with those observed nationally among U.S. teens in the same age group. Results Of the 1404 teenage girls and women enrolled in CHOICE, 72% chose an intrauterine device or implant (LARC methods); the remaining 28% chose another method. During the 2008–2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively. Conclusions Teenage girls and women who were provided contraception at no cost and educated about reversible contraception and the benefits of LARC methods had rates of pregnancy, birth, and abortion that were much lower than the national rates for sexually experienced teens. (Funded by the Susan Thompson Buffett Foundation and others.) PMID:25271604

Population trends and live birth rates associated with common ART treatment strategies.

PubMed

Chambers, Georgina M; Wand, Handan; Macaldowie, Alan; Chapman, Michael G; Farquhar, Cynthia M; Bowman, Mark; Molloy, David; Ledger, William

2016-11-01

Have ART live birth rates improved in Australia over the last 12 years? There were striking improvements in per-cycle live birth rates observed for frozen/thaw embryo transfers, blastocyst transfer and single embryo transfer (SET), while live birth rates following ICSI were lower than IVF for non-male factor infertility in most years. ART and associated techniques have become the predominant treatment of infertility over the past 30 years in most developed countries. However, there are differences in ART laboratory and clinical practices, and success rates worldwide. Australia has one of the highest ART utilization rates and lowest multiple birth rates in the world, thus providing a unique setting to investigate the contribution of common ART strategies in an unrestricted population of patients to ART success rates. A retrospective cohort study of 585 065 ART treatment cycles performed in Australia between 2002 and 2013 using the Australian and New Zealand Assisted Reproduction Database (ANZARD). An unrestricted population of all women who underwent autologous ART treatment between 2002 and 2013. Visual descriptive analysis was used to assess the trends in ART procedures by the calendar years. Adjusted odds ratios (aORs) of a live birth for four common ART techniques were calculated after controlling for important confounders including female age, infertility diagnosis, stage of the embryo (blastocyst versus cleavage stage), type of embryo (fresh versus thawed), fertilization method (IVF versus ICSI) and number of embryos transferred (SET versus multiple embryos). The overall live birth rate per embryo transfer increased from 19.2% in 2002 to 23.3% in 2013 (21.9-24.3% for fresh embryo transfers and 14.6-23.3% for frozen/thaw embryo transfers). This occurred concurrently with an increase in SET from 29.7% to 78.9%, and an increase in the average age of women undergoing treatment from 35.0 to 35.9 years. Individuals who had a frozen/thaw embryo transfer cycle in 2002 had 43% (aOR: 0.57, 95% CI: 0.53-0.61) reduced odds of a live birth compared with a fresh embryo transfer cycle. This contrasted with 16% (aOR: 0.84, 95% CI: 0.80-0.98) reduced odds of a live birth from frozen/thaw embryo transfer cycles in 2013. In 2013, the odds of blastocyst transfer resulting in a live birth were more than twice as great as for cleavage stage transfer (aOR 2.01, 95% CI: 1.92-2.11). The adjusted odds of live birth per SET compared with multiple embryo transfer increased significantly over the last 12 years, from a 38% reduced odds of a live birth follow SET in 2002 (aOR: 062, 95% CI: 0.57-0.67) compared to an 8% reduced odds in 2013 (aOR: 0.92, 95% CI: 0.87-0.98). The aOR of a live birth using ICSI compared to IVF in non-male factor patients was lower in most years bringing into question its widespread use. This is a retrospective cohort analysis and cannot confirm causality. High-level evidence on the effectiveness of particular ART techniques, particularly ICSI and blastocyst culture, requires prospective randomized controlled trials or detailed statistical analysis using large-scale data that counts for fertilization failure, embryo loss, prognostic factors and cycle characteristics. The most striking improvements in ART success rates in Australia have been observed for frozen/thaw embryo transfers, blastocyst transfer and SET. Further studies of the role of ICSI in non-male factor infertility and blastocyst transfer success rates that take into account embryo loss are needed. No funding was received to undertake this study. The authors declare that they do not have competing interests with this study. NA. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Global Prostate Cancer Incidence and Mortality Rates According to the Human Development Index.

PubMed

Khazaei, Salman; Rezaeian, Shahab; Ayubi, Erfan; Gholamaliee, Behzad; Pishkuhi, Mahin Ahmadi; Khazaei, Somayeh; Mansori, Kamyar; Nematollahi, Shahrzad; Sani, Mohadeseh; Hanis, Shiva Mansouri

2016-01-01

Prostate cancer (PC) is one of the leading causes of death, especially in developed countries. The human development index (HDI) and its dimensions seem correlated with incidence and mortality rates of PC. This study aimed to assess the association of the specific components of HDI (life expectancy at birth, education, gross national income per 1000 capita, health, and living standards) with burden indicators of PC worldwide. Information of the incidence and mortality rates of PC was obtained from the GLOBOCAN cancer project in year 2012 and data about the HDI 2013 were obtained from the World Bank database. The correlation between incidence, mortality rates, and the HDI parameters were assessed using STATA software. A significant inequality of PC incidence rates was observed according to concentration indexes=0.25 with 95% CI (0.22, 0.34) and a negative mortality concentration index of -0.04 with 95% CI (-0.09, 0.01) was observed. A positive significant correlation was detected between the incidence rates of PC and the HDI and its dimensions including life expectancy at birth, education, income, urbanization level and obesity. However, there was a negative significant correlation between the standardized mortality rates and the life expectancy, income and HDI.

Birth rates and pregnancy complications in adolescent pregnant women giving birth in the hospitals of Thailand.

PubMed

Butchon, Rukmanee; Liabsuetrakul, Tippawan; McNeil, Edward; Suchonwanich, Yolsilp

2014-08-01

To determine the rates of births in adolescent pregnant women in diferent regions of Thailand and assess the rates of complications occurring at pregnancy, childbirth, and postpartum in women admitted in the hospitals ofThailand. The secondary analysis of data from pregnant women aged 10 to 49 years, who were admitted to hospitals and recorded in the National Health Security Office database between October 2010 and September 2011 was carried out. Adolescent birth rate by the regions and rate of complications ofpregnancy, delivery, and postpartum by age groups were analyzed. Highest birth rate was found among women aged 19 years (58.3 per 1, 000 population). The distribution of adolescent births varied across regions of Thailand, which was high in central region. Rate of preterm delivery was highest (10%) in adolescent aged 10 to 14 years. Rate of diabetes mellitus (6%), preeclampsia (4%), and postpartum hemorrhage (3%) among women aged 35 to 49 years were substantially higher than those among women aged 34 years or less. Adolescent birth rate varied across regions of Thailand. Complications occurred differently by ages of women. Holistic policy and planning strategies for proper prevention and management among pregnant women in different age groups are needed

Memory of childbirth in the second year: the long-term effect of a negative birth experience and its modulation by the perceived intranatal relationship with caregivers.

PubMed

Stadlmayr, W; Amsler, F; Lemola, S; Stein, S; Alt, M; Bürgin, D; Surbek, D; Bitzer, J

2006-12-01

To assess the memory of various subdimensions of the birth experience in the second year postpartum, and to identify women in the first weeks postpartum at risk of developing a long-term negative memory. DESIGN, METHOD, OUTCOME MEASURES: New mothers' birth experience (BE) was assessed 48-96 hours postpartum (T1) by means of the SIL-Ger and the BBCI (perception of intranatal relationships); early postnatal adjustment (week 3 pp: T1(bis)) was also assessed. Then, four subgroups of women were defined by means of a cluster-analysis, integrating the T1/T1(bis) variables. To evaluate the memory of the BE, the SIL-Ger was again applied in the second year after childbirth (T2). First, the ratings of the SIL-Ger dimensions of T1 were compared to those at T2 in the whole sample. Then, the four subgroups were compared with respect to their ratings of the birth experience at T2 (correlations, ANOVAs and t-tests). In general, fulfillment, emotional adaptation, physical discomfort, and anxiety improve spontaneously over the first year postpartum, whereas in negative emotional experience, control, and time-going-slowly no shift over time is observed. However, women with a negative overall birth experience and a low level of perceived intranatal relationship at T1 run a high risk of retaining a negative memory in all of the seven subdimensions of the birth experience. Women at risk of developing a negative long-term memory of the BE can be identified at the time of early postpartum, when the overall birth experience and the perceived intranatal relationship are taken into account.

Reducing infant mortality.

PubMed

Johnson, T R

1994-01-01

Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.

Paradoxical Impact of Ileal Pouch-Anal Anastomosis on Male and Female Fertility in Patients With Ulcerative Colitis.

PubMed

Pachler, Frederik R; Brandsborg, Søren B; Laurberg, Søren

2017-06-01

Birth rates in males with ulcerative colitis and ileal pouch-anal anastomosis have not been studied. This study aimed to estimate birth rates in males and females with ulcerative colitis and study the impact of ileal pouch-anal anastomosis. This was a retrospective registry-based cohort study that was performed over a 30-year period. Records for parenting a child from the same period were cross-linked with patient records, and birth rates were calculated using 15 through 49 years as age limits. All data were prospectively registered. All patients with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis between 1980 and 2010 were identified in Danish national databases. The primary outcomes measured were birth rates in females and males with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis. We included 27,379 patients with ulcerative colitis (12,812 males and 14,567 females); 1544 had ileal pouch-anal anastomosis (792 males and 752 females). Patients with ulcerative colitis have slightly reduced birth rates (males at 40.8 children/1000 years, background population 43.2, females at 46.2 children/1000 years, background population 49.1). After ileal pouch-anal anastomosis, males had increased birth rates at 47.8 children/1000 years in comparison with males with ulcerative colitis without ileal pouch-anal anastomosis (40.5 children/1000 years), whereas females had reduced birth rates at 27.6 children/1000 years in comparison with females with ulcerative colitis without ileal pouch-anal anastomosis (46.8 children/1000 years). Only birth rates were investigated and not fecundability. Furthermore, there is a question about misattributed paternity, but this has previously been shown to be less than 5%. Ulcerative colitis per se has little impact on birth rates in both sexes, but ileal pouch-anal anastomosis surgery leads to a reduction in birth rates in females and an increase in birth rates in males. This has clinical impact when counseling patients before ileal pouch-anal anastomosis surgery.

[Percentage of births and fertility rates in adolescents in Mexico (2008-2012): stratification and priorization of municipalities with high risk].

PubMed

Reyes-Pablo, Adelmo Eloy; Navarrete-Hernández, Eduardo; Canún-Serrano, Sonia; Valdés-Hernández, Javier

2015-12-01

Mexico in 2008 was designed as the first place of adolescent pregnancy at the Organization for Economic Cooperation and Development, with specific fertility rate (SFR) for 15-1 9years of age of 64.2/1,000 woman at the same age. Estimate of percentage births and SFR in adolescent population at national, state and municipal level in Mexico in 2008-2012 at the total group of adolescents 10 to 1 9 years old and by subgroups of 10-14 and 15 tol 9 years old, identifying the priority municipalities with adolescence pregnancies. Data bases of certificates of live birth and fetal death with gestational age of 22-45 weeks were joined in 2008-2012. A data base of 1 0'585,032 births in 2008-2012 was obtained, 98.9% were live births and 1.1% was stillbirths. The SFR nationwide for the period 2008-2012 were of the order of 3.l for the group of 10-1 4years, 75.3 for 15-19, 39.6 for the total group of 10-19 years and 66.1 for 20 to 49 years per 1000 women for the same age. In the last decade it has increased teen pregnancy as well as the percentage of births and the fertility rate in this age group, worrying situation for the high risk of biological, psychological and social damage that pregnancy early.

State variation in rates of cesarean and VBAC delivery: 1989 and 1993.

PubMed

Clarke, S C; Taffel, S M

1996-01-01

There is wide variation among states in rates of cesarean and vaginal births after cesarean (VBAC) deliveries. In general, states in the South have the highest cesarean rates, states in the West have the lowest, and states in the Northeast and Midwest are intermediate. Louisiana had the highest overall rate in 1993 (27.7 per 100 births) while Alaska had the lowest rate (15.2). The majority of states had declines in their cesarean rate between 1989 and 1993. Patterns in primary cesarean rates are similar to those of the overall rate-states in the South generally have the highest rates while states in the West have the lowest rates. Primary cesarean rates ranged between a high of 19.6 in Louisiana to a low of 10.6 in Wisconsin. In general, states with low cesarean rates have among the highest rates of VBAC delivery. Alaska had the highest VBAC rate (40.0), which was almost quadruple the rate of Louisiana (11.2), the state with the lowest rate. Most states had substantial increases in VBAC rates between 1989 and 1993. When examining cesarean rates by maternal age and birth order, states with the highest overall rates also have among the highest age/birth order-specific rates. Cesarean rates were lowest for mothers under 25 years of age having a second or higher order birth in Alaska, 10.4, and highest for mothers 35 years of age or over having a first birth in Mississippi, 51.3. Standardized cesarean rates which were adjusted for differences between states in maternal age and birth order distributions did not diminish the variation among areas.

Linear trends and seasonality of births and perinatal outcomes in Upper East Region, Ghana from 2010 to 2014.

PubMed

Osei, Eric; Agbemefle, Isaac; Kye-Duodu, Gideon; Binka, Fred Newton

2016-03-04

Seasonal variations greatly influence birth patterns differently from country to country. In Ghana, there is paucity of information on birth seasonal patterns. This retrospective study described the trends and seasonality of births and perinatal outcomes in Upper East Region of Ghana. Births occurring in each month of the calendar years (2010-2014; inclusive) were extracted from the District Health Information Management System (DHIMS2) database of the Bolgatanga Municipal Health Directorate and exported into Microsoft Excel spread sheet and Epi Ifo for analysis. Analysis was carried out by calculating average number of births per month correcting for unequal month length using 30 days. A Chi-square test for trend was performed to check for statistical significance (p < 0.05) in trends and seasonality of birth and perinatal outcomes. There were 24,171 health facility deliveries, of which 97.7% were singleton deliveries and 2.3% were multiple (two or three) deliveries. There was a consistent rise in the annual health facility deliveries controlled for the number of fertile women, from 4169 in 2010 to 5474 in 2014 (p < 0.0001). Monthly birth distribution displayed a periodic pattern with peaks in May, September and October and troughs during the months of January, February and July (p < 0.0001). Women were likely to give birth during the raining season than the dry season. Caesarean Section (CS) rate showed a steady rise over the years (124 per 1000 births in 2010 to 185 per 1000 births in 2014 (p < 0.0001) with overall rate of 14.6%. Stillbirth (SB) rate, however decreased slightly over the years from 29 per 1000 births to 23 per 1000 births (p = 0.197) with overall SB rate of 2.6%. Similarly, Low Birth Weight (LBW) declined from 77 per 1000 live births to 71 per 1000 live births from 2010 to 2014 (p < 0.0001). Seasonal (rainy and dry) distributions did not show a clear difference in birth frequencies. Health facility delivery was persistently high in the Bolgatanga Municipality with birth peaking in May, September and October. Despite the rising rate of caesarean section, stillbirth rate did not significantly improved over the years. A prospective study may reveal the reasons for the increasing caesarean section rate. Additionally, understanding the factors that affect the decreasing trends of low birth weight in the municipality is crucial to public health policy makers in Ghana.

Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison.

PubMed

Thornton, Patrick; McFarlin, Barbara L; Park, Chang; Rankin, Kristin; Schorn, Mavis; Finnegan, Lorna; Stapleton, Susan

2017-01-01

High rates of cesarean birth are a significant health care quality issue, and birth centers have shown potential to reduce rates of cesarean birth. Measuring this potential is complicated by lack of randomized trials and limited observational comparisons. Cesarean rates vary by provider type, setting, and clinical and nonclinical characteristics of women, but our understanding of these dynamics is incomplete. We sought to isolate labor setting from other risk factors in order to assess the effect of birth centers on the odds of cesarean birth. We generated low-risk cohorts admitted in labor to hospitals (n = 2527) and birth centers (n = 8776) using secondary data obtained from the American Association of Birth Centers (AABC). All women received prenatal care in the birth center and midwifery care in labor, but some chose hospital admission for labor. Analysis was intent to treat according to site of admission in spontaneous labor. We used propensity score adjustment and multivariable logistic regression to control for cohort differences and measured effect sizes associated with setting. There was a 37% (adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 0.50-0.79) to 38% (adjusted OR, 0.62; 95% CI, 0.49-0.79) decreased odds of cesarean in the birth center cohort and a remarkably low overall cesarean rate of less than 5% in both cohorts. These findings suggest that low rates of cesarean in birth centers are not attributable to labor setting alone. The entire birth center care model, including prenatal preparation and relationship-based midwifery care, should be studied, promoted, and implemented by policy makers interested in achieving appropriate cesarean rates in the United States. © 2016 by the American College of Nurse-Midwives.

Estimation of birth population-based perinatal-neonatal mortality and preterm rate in China from a regional survey in 2010.

PubMed

Sun, L; Yue, H; Sun, B; Han, L; Qi, M; Tian, Z; Lu, S; Shan, C; Luo, J; Fan, Y; Li, S; Dong, M; Zuo, X; Zhang, Y; Lin, W; Xu, J; Heng, Y

2013-11-01

To estimate birth population-based perinatal-neonatal mortality and preterm rate in China from a regional survey in 2010. Data of total births in 2010 obtained from 151 level I-III hospitals in Huai'an, Jiangsu, were prospectively collected and analyzed. From 61,227 birth registries (including 60,986 live births and 241 stillbirths), we derive a birth rate of 11.3‰ (of 5.4 million regional population), a male-to-female ratio of 116:100 and valid data from 60,615 newborns. Mean birth weight (BW) was 3441 ± 491 g with 13.6% macrosomia. Low BW was 2.8% (1691/60,372) with 8.83% mortality. Preterm rate was 3.72% (2239/60,264) with 7.61% mortality. Cesarean section rate was 52.9% (31,964/60,445), multiple pregnancy 1.8% (1088/60,567) and birth defects 6.7‰ (411/61,227). There were 97.4% healthy newborns and 2.2% (1298) requiring hospitalized after birth. The perinatal mortality was 7.7‰ (471/61,227, including 241 stillbirths, 230 early neonatal deaths). The neonatal mortality was 4.4‰ (269/60,986). The main causes of neonatal death were birth asphyxia (24.5%), respiratory diseases (21.5%), prematurity related organ dysfunction (18.5%) and congenital anomalies (7.7%), whereas incidence of congenital heart disease and respiratory distress syndrome was 8.6‰ and 6.1‰, respectively. This regional birth population-based data file contains low perinatal-neonatal mortality rates, associated with low proportion of LBW and preterm births, and incidences of major neonatal disease, by which we estimate, in a nationwide perspective, in 16 million annual births, preterm births should be around 800,000, perinatal and neonatal mortality may be 128,000-144,000 and 80,000-96,000, respectively, along with 100,000 respiratory distress syndrome.

Likelihood of home death associated with local rates of home birth: influence of local area healthcare preferences on site of death.

PubMed

Silveira, Maria J; Copeland, Laurel A; Feudtner, Chris

2006-07-01

We tested whether local cultural and social values regarding the use of health care are associated with the likelihood of home death, using variation in local rates of home births as a proxy for geographic variation in these values. For each of 351110 adult decedents in Washington state who died from 1989 through 1998, we calculated the home birth rate in each zip code during the year of death and then used multivariate regression modeling to estimate the relation between the likelihood of home death and the local rate of home births. Individuals residing in local areas with higher home birth rates had greater adjusted likelihood of dying at home (odds ratio [OR]=1.04 for each percentage point increase in home birth rate; 95% confidence interval [CI] = 1.03, 1.05). Moreover, the likelihood of dying at home increased with local wealth (OR=1.04 per $10000; 95% CI=1.02, 1.06) but decreased with local hospital bed availability (OR=0.96 per 1000 beds; 95% CI=0.95, 0.97). The likelihood of home death is associated with local rates of home births, suggesting the influence of health care use preferences.

Relationship between Periodontal Diseases and Preterm Birth: Recent Epidemiological and Biological Data

PubMed Central

Huck, O.; Tenenbaum, H.; Davideau, J.-L.

2011-01-01

For ten years, the incidence of preterm birth does not decrease in developed countries despite the promotion of public health programs. Many risk factors have been identified including ethnicity, age, tobacco, and infection. However, almost 50% of preterm birth causes remain unknown. The periodontal diseases are highly prevalent inflammatory and infectious diseases of tooth supporting tissues leading to an oral disability. They influence negatively general health worsening cardiovascular diseases and diabetes. Periodontal diseases have been also suspected to increase the rate of preterm birth, but data remain contradictory. The objective of this review is to present the principal results of epidemiological, biological, and interventional studies on the link between periodontal diseases and preterm birth. The conclusions of this work underline the importance for the physician/obstetrician to identify women at risk for preterm birth and to address these patients to dentist for periodontal examination and treatment in order to limit adverse pregnancy outcomes. PMID:22132334

Investigating the reasons for Spain's falling birth rate.

PubMed

Bosch, X

1998-09-12

On August 25, 1998, the Spanish National Institute of Statistics announced that Spain, which has had the most accelerated decrease in fecundity of all European countries during the last 25 years, had the lowest birth rate in Europe. Spain's average birth rate was 2.86 in 1970, 2.21 in 1980, and 1.21 in 1994. According to Eurostat, Spain's average birth rate in 1995 was 1.18, while the European Community's was 1.43. Although all the countries of the European Community have birth rates below 2.1, Spain's is 44% below this minimum rate needed to achieve generation replacement. In 1994 and 1997, in 5 northern communities, including the Basque country and Galicia, the birth rate was less than 1.0. The lowest birth rate (0.76 in 1997) was in the northern region of Asturias. Although southern autonomous regions have higher birth rates (between 1.21 and 1.44 for 1997) than northern ones, these are also decreasing (from 3.36 in 1970 to 1.29 in 1997 in Andalusia). Credit for the rapid decrease is given to improved quality of life and education, increased contraceptive usage, and social change. Employment of women has increased, and unemployed sons are remaining at home for longer periods. The most important reasons are 1) the increased number of single people and 2) the increased average age of women having their first child. The latter increase began in 1988. Most Spanish women now have their first child between the ages of 30 and 39 years. The average age was 28 years in 1975; in 1995, it was 30 years. Women from the northern autonomous regions have the highest average age at first birth (Basque women, 31.2 years in 1995). The pattern of fecundity in Spain is different from other countries in Europe. In Spain, the decrease started in the late 1960s and early 1970s. Until the 1980s, Spain had one of the highest birth rates in Europe. This was followed by a decrease in the 1990s. However, in 1997, there were 3000 more births than in 1996. The National Institute of Demography predicts a maximum birth rate of 1.8 for 2026. Specialists believe there will be an increase in fecundity until at least 2005, when women born during the Spanish "baby boom" of the 1960s will begin reaching childbearing age.

Continued Declines in Teen Births in the United States, 2015.

PubMed

Hamilton, Brady E; Mathews, T J

2016-09-01

•The teen birth rate declined to another historic low for the United States in 2015, down 8% from 2014 to 22.3 births per 1,000 females aged 15-19. •The birth rates for teenagers aged 15-17 and 18-19 declined in 2015 to 9.9 and 40.7, respectively, which are record lows for both groups. •In 2015, birth rates declined to 6.9 for Asian or Pacific Islander, 16.0 for non-Hispanic white, 25.7 for American Indian or Alaska Native, 31.8 for non-Hispanic black, and 34.9 for Hispanic female teenagers aged 15-19. •Birth rates fell to record lows for nearly all race and Hispanic-origin groups of females aged 15-19, 15-17, and 18-19 in 2015. The birth rate for teenagers aged 15-19 has fallen almost continuously since 1991, reaching historic lows for the nation every year since 2009 (1-4). Despite declines in all racial and ethnic groups, teen birth rates continue to vary considerably by race and ethnicity. Moreover, the U.S. teen birth rate remains higher than in other industrialized countries (5). Childbearing by teenagers continues to be a matter of public concern. This report presents the recent and long-term trends and disparity in teen childbearing by race and Hispanic origin. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Teen Births: A County-By-County Factbook. For Children for Ohio's Future.

ERIC Educational Resources Information Center

Hill, Susan

This Factbook provides state- and county-level statistical information on teen births in Ohio and discusses statewide trends from 1992 to 1996. The statistical portrait is based on 12 indicators: (1) number of infants born to teens; (2) teen birth rate; (3) repeat teen birth rate; (4) percentage of teen births to unmarried teens; (5) percentage of…

Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births.

PubMed

Chughtai, Abrar A; Wang, Alex Y; Hilder, Lisa; Li, Zhuoyang; Lui, Kei; Farquhar, Cindy; Sullivan, Elizabeth A

2018-02-01

Is perinatal mortality rate higher among births born following assisted reproductive technology (ART) compared to non-ART births? Overall perinatal mortality rates in ART births was higher compared to non-ART births, but gestational age-specific perinatal mortality rate of ART births was lower for very preterm and moderate to late preterm births. Births born following ART are reported to have higher risk of adverse perinatal outcomes compared to non-ART births. This population-based retrospective cohort study included 407 368 babies (391 952 non-ART and 15 416 ART)-393 491 singletons and 10 877 twins or high order multiples. All births (≥20 weeks of gestation and/or ≥400 g of birthweight) in five states and territories in Australia during the period 2007-2009 were included in the study, using National Perinatal Data Collection (NPDC). Primary outcome measures were rates of stillbirth, neonatal and perinatal deaths. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate the likelihood of perinatal death. Rates of multiple birth and low birthweight were significantly higher in ART group compared to the non-ART group (P < 0.01). Overall perinatal mortality rate was significantly higher for ART births (16.5 per 1000 births, 95% CI 14.5-18.6), compared to non-ART births (11.3 per 1000 births, 95% CI 11.0-11.6) (AOR 1.45, 95% CI 1.26-1.68). However, gestational age-specific perinatal mortality rate of ART births (including both singletons and multiples) was lower for very preterm (<32 weeks' gestation) and moderate to late preterm births (32-36 weeks' gestation) (AOR 0.61, 95% CI 0.53-0.70 and AOR 0.61, 95% CI 0.53-0.70, respectively) compared to non-ART births. Congenital abnormality and spontaneous preterm were the most common causes of neonatal deaths in both ART and non-ART group. Due to different cut-off limit for perinatal period in Australia, the results of this study should be interpreted with cautions for other countries. Australian definition of perinatal period commences at 20 completed weeks (140 days) of gestation and ends 27 completed days after birth which is different from the definition by World Health Organisation (commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth) and by Centers for Disease Control and Prevention (includes infant deaths under age 7 days and fetal deaths at 28 weeks of gestation or more). Preterm birth is the single most important contributing factor to increased risk of perinatal mortality among ART singletons compared to non-ART singletons. Further research on reducing early preterm delivery, with the aim of reducing the perinatal mortality among ART births is needed. Couples who access ART treatment should be fully informed regarding the risk of preterm birth and subsequent risk of perinatal death. There was no funding associated with this study. No conflict of interest was declared. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

National and state patterns of teen births in the United States, 1940-2013.

PubMed

Ventura, Stephanie J; Hamilton, Brady E; Matthews, T J

2014-08-20

This report presents trends from 1940 through 2013 in national birth rates for teenagers, with particular focus on the period since 1991. The percent changes in rates for 1991-2012 and for 2007-2012 are presented for the United States and for states. Preliminary data for 2013 are shown where available. Tabular and graphical descriptions of the trends in teen birth rates for the United States and each state, by age group, race, and Hispanic origin, are presented and discussed. Data are shown for the U.S. territories. Birth rates for U.S. teenagers have generally fallen in the United States since peaking in 1957. The rate fell 57% between 1991 and 2013. The 2013 preliminary rate (26.6 per 1,000 aged 15-19) is less than one-third of the historically highest rate (96.3 in 1957). During 1991-2012, rates fell for all race and Hispanic ethnicity groups, with the largest declines measured for non-Hispanic black teenagers. In the more recent period, 2007-2012, the declines have been steepest for Hispanic teenagers. Birth rates declined significantly for teenagers in all states during 1991-2012; during 2007-2012, rates fell for all but two states. The drop in teen birth rates translates into an estimated 4 million fewer births to teenagers from 1992 through 2012. The declines in teen birth rates reflect a number of behavioral changes, including decreased sexual activity, increases in the use of contraception at first sex and at most recent sex, and the adoption and increased use of hormonal contraception, injectables, and intrauterine devices. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Preterm birth and neurodevelopment: a review of outcomes and recommendations for early identification and cost-effective interventions.

PubMed

Sutton, Perri S; Darmstadt, Gary L

2013-08-01

This review summarizes research findings to date on neurological and health outcomes following preterm birth, tools to identify children at risk for neurodevelopmental impairment and interventions to prevent preterm birth and improve outcomes. We bring together findings from research in high- and low-income countries, with an aim to provide a global perspective on the issues. Around the world, preterm birth is rising in importance as a cause of under-five morbidity and mortality, and we project that this trend will continue over time, particularly given the lack of interventions to prevent the condition. With the development of improved screening instruments, further identification and scale up of cost-effective interventions to optimize early childhood development and accelerated research on the underlying biological mechanisms, we have an opportunity to reduce rates of neurodevelopmental impairment, particularly in countries with the highest burden.

The relation of age to low birth weight rates among foreign-born black mothers: a population-based exploratory study.

PubMed

Deal, Stephanie B; Bennett, Amanda C; Rankin, Kristin M; Collins, James W

2014-01-01

In stark contrast to the J or U- shaped relationship between age and low birth weight rates (< 2500g) seen among non-Latino White and Mexican American mothers, low birth weight rates among US-born Blacks are lowest in their teens and rise with increasing age (ie, weathering). The age-related pattern of low birth weight rates among foreign-born Black mothers is unknown. To determine the relationship between age and low birth weight rates among foreign-born Black mothers. Stratified analyses were performed on the 2003-2004 National Center for Health Statistics vital record datasets of foreign-born Black mothers. Maternal age was categorized into six subgroups. Potential confounding variables examined included marital status, parity, and prenatal care usage. Foreign-born Black mothers (N = 143,235) demonstrated a J/U-shaped age-related pattern of low birth weight rates with the lowest rates observed among those in their twenties and early thirties. The subgroups of 15-19 and 35-39 year old mothers had low birth weight rates of 12.0% and 11.4% compared to 9.1% for 25-29 year old mothers; RR = 1.31 (1.22-1.42) and 1.25 (1.20-1.31), respectively. The J/U-shaped age-related pattern persisted independent of marital status, parity and prenatal care usage. Foreign-born black mothers do not exhibit a weathering pattern of rising low birth weight rates with advancing age regardless of traditional individual-level risk factors. Further research into the age-related pattern of birth outcome among impoverished foreign-born Black mothers is warranted.

Teen Birth Rates for Urban and Rural Areas in the United States, 2007-2015.

PubMed

Hamilton, Brady E; Rossen, Lauren M; Branum, Amy M

2016-11-01

Data from the National Vital Statistics System •Birth rates for teenagers aged 15-19 declined in urban and rural counties from 2007 through 2015, with the largest declines in large urban counties and the smallest declines in rural counties. •From 2007 through 2015, the teen birth rate was lowest in large urban counties and highest in rural counties. •Declines in teen birth rates in all urban counties between 2007 and 2015 were largest in Arizona, Massachusetts, Connecticut, Minnesota, and Colorado, with 17 states experiencing a decline of 50% or more. •Declines in teen birth rates in all rural counties between 2007 and 2015 were largest (50% or more) in Colorado and Connecticut. •In 2015, teen birth rates were highest in rural counties and lowest in large urban counties for non-Hispanic white, non-Hispanic black, and Hispanic females. Teen birth rates have demonstrated an unprecedented decline in the United States since 2007 (1). Declines occurred in all states and among all major racial and Hispanic-origin groups, yet disparities by both geography and demographic characteristics persist (2,3). Although teen birth rates and related declines have been described by state, patterns by urban-rural location have not yet been examined. This report describes trends in teen birth rates in urban (metropolitan) and rural (nonmetropolitan) areas in the United States overall and by state from 2007 through 2015 and by race and Hispanic origin for 2015. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Trends and Characteristics of United States Out-of-Hospital Births 2004-2014: New Information on Risk Status and Access to Care.

PubMed

MacDorman, Marian F; Declercq, Eugene

2016-06-01

Out-of-hospital births are increasing in the United States. Our purpose was to examine trends in out-of-hospital births from 2004 to 2014, and to analyze newly available data on risk status and access to care. Newly available data from the revised birth certificate for 47 states and Washington, DC, were used to examine out-of-hospital births by characteristics and to compare them with hospital births. Trends from 2004 to 2014 were also examined. Out-of-hospital births increased by 72 percent, from 0.87 percent of United States births in 2004 to 1.50 percent in 2014. Compared with mothers who had hospital births, those with out-of-hospital births had lower prepregnancy obesity (12.5% vs 25.0%) and smoking (2.8% vs 8.5%) rates, and higher college graduation (39.3% vs 30.0%) and breastfeeding initiation (94.3% vs 80.8%) rates. Among planned home births, 67.1 percent were self-paid, compared with 31.9 percent of birth center and 3.4 percent of hospital births. Vaginal births after cesarean (VBACs) comprised 4.6 percent of planned home births and 1.6 percent of hospital and birth center births. Sociodemographic and medical risk status of out-of-hospital births improved substantially from 2004 to 2014. Improvements in risk status of out-of-hospital births from 2004 to 2014 suggest that appropriate selection of low-risk women is improving. High rates of self-pay for the costs of out-of-hospital birth suggest serious gaps in insurance coverage, whereas higher-than-average rates of VBAC could reflect lack of access to hospital VBACs. Mandating private insurance and Medicaid coverage could substantially improve access to out-of-hospital births. Improving access to hospital VBACs might reduce the number of out-of-hospital VBACs. © 2016 Wiley Periodicals, Inc.

Racial and Ethnic Disparities in Preterm Birth Among American Indian and Alaska Native Women.

PubMed

Raglan, Greta B; Lannon, Sophia M; Jones, Katherine M; Schulkin, Jay

2016-01-01

Preterm birth disproportionately affects American Indian/Alaska Native (AI/AN) women. This disparity in birth outcomes may stem from higher levels of exposure to psychosocial, sociodemographic, and medical risk factors. This paper reviews relevant research related to preterm birth in American Indian and Alaska Native women. This narrative review examines disparities in preterm birth rates between AI/AN and other American women, and addresses several maternal risk factors and barriers that contribute to elevated preterm birth rates among this racial minority group. Additionally, this paper focuses on recent evidence that geographical location can significantly impact preterm birth rates among AI/AN women. In particular, access to care among AI/AN women and differences between rural and urban areas are discussed.

The association between parity, infant gender, higher level of paternal education and preterm birth in Pakistan: a cohort study.

PubMed

Shaikh, Kiran; Premji, Shahirose S; Rose, Marianne S; Kazi, Ambreen; Khowaja, Shaneela; Tough, Suzanne

2011-11-02

High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth; however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth. In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression respectively, and had a blood cortisol level drawn. Women were followed up after delivery to determine birth outcomes. Correlation coefficients and Wilcoxon rank sum test was used to assess relationship between preterm birth, stress, depression and cortisol. Logistic regression analysis was used to determine the key factors predictive of preterm birth. 132 pregnant women participated of whom 125 pregnant women had both questionnaire and cortisol level data and an additional seven had questionnaire data only. Almost 20% of pregnant women (19·7%, 95% CI 13·3-27·5) experienced a high level of stress and nearly twice as many (40·9%, 95% CI 32·4-49·8%) experienced depressive symptoms. The median of cortisol level was 27·40 ug/dl (IQR 22·5-34·2). The preterm birth rate was 11·4% (95% CI 6·5-18). There was no relationship between cortisol values and stress scale or depression. There was a significant positive relationship between maternal depression and stress. Preterm birth was associated with higher parity, past delivery of a male infant, and higher levels of paternal education. Insufficient numbers of preterm births were available to warrant the development of a multivariable logistic regression model. Preterm birth was associated with higher parity, past delivery of a male infant, and higher levels of paternal education. There was no relationship between stress, and depression, cortisol and preterm birth. There were high rates of stress and depression among this sample suggesting that there are missed opportunities to address mental health needs in the prenatal period. Improved methods of measurement are required to better understand the psychobiological basis of preterm birth.

Impact of social service and public health spending on teenage birth rates across the USA: an ecological study.

PubMed

Sipsma, Heather L; Canavan, Maureen; Gilliam, Melissa; Bradley, Elizabeth

2017-06-13

To examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA. Ecological study. USA. 50 states. Our primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders. The unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=-0.20; 95% CI -0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001). Higher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The influence of female age on the cumulative live-birth rate of fresh cycles and subsequent frozen cycles using vitrified blastocysts in hyper-responders.

PubMed

Wu, Cheng-Hsuan; Lee, Tsung-Hsien; Chen, Hsiu-Hui; Chen, Chung-I; Huang, Chun-Chia; Lee, Maw-Sheng

2015-10-01

The aim of this research was to study the influence of female age on the cumulative live-birth rate of fresh and subsequent frozen cycles using vitrified blastocysts of the same cohort in hyper-responders. This was a retrospective study of 1137 infertile women undergoing their first in vitro fertilization treatment between 2006 and 2013. The main outcome measure was cumulative live births among the fresh and all vitrified blastocyst transfers combined after the same stimulation cycle. The results were also analyzed according to age (i.e., <35 years, 35-39 years, and ≥ 40 years). The mean number of retrieved oocytes was 19.9 ± 8.5 oocytes. The cumulative pregnancy rate was 89.2% and the cumulative live-birth rate was 73.3%. The cumulative live-birth rate declined from 73.9% for women younger than 35 years old to 67.3% for women 35-39 years old to 57.9% for women 40 years or older. Combined fresh and vitrified blastocyst transfer cycles can result in a high cumulative live-birth rate. The cumulative live-birth rates among older women are lower than the rates among younger women when autologous oocytes are used. Copyright © 2015. Published by Elsevier B.V.

Bacterial Hyaluronidase Promotes Ascending GBS Infection and Preterm Birth.

PubMed

Vornhagen, Jay; Quach, Phoenicia; Boldenow, Erica; Merillat, Sean; Whidbey, Christopher; Ngo, Lisa Y; Adams Waldorf, K M; Rajagopal, Lakshmi

2016-06-28

Preterm birth increases the risk of adverse birth outcomes and is the leading cause of neonatal mortality. A significant cause of preterm birth is in utero infection with vaginal microorganisms. These vaginal microorganisms are often recovered from the amniotic fluid of preterm birth cases. A vaginal microorganism frequently associated with preterm birth is group B streptococcus (GBS), or Streptococcus agalactiae However, the molecular mechanisms underlying GBS ascension are poorly understood. Here, we describe the role of the GBS hyaluronidase in ascending infection and preterm birth. We show that clinical GBS strains associated with preterm labor or neonatal infections have increased hyaluronidase activity compared to commensal strains obtained from rectovaginal swabs of healthy women. Using a murine model of ascending infection, we show that hyaluronidase activity was associated with increased ascending GBS infection, preterm birth, and fetal demise. Interestingly, hyaluronidase activity reduced uterine inflammation but did not impact placental or fetal inflammation. Our study shows that hyaluronidase activity enables GBS to subvert uterine immune responses, leading to increased rates of ascending infection and preterm birth. These findings have important implications for the development of therapies to prevent in utero infection and preterm birth. GBS are a family of bacteria that frequently colonize the vagina of pregnant women. In some cases, GBS ascend from the vagina into the uterine space, leading to fetal injury and preterm birth. Unfortunately, little is known about the mechanisms underlying ascending GBS infection. In this study, we show that a GBS virulence factor, HylB, shows higher activity in strains isolated from cases of preterm birth than those isolates from rectovaginal swabs of healthy women. We discovered that GBS rely on HylB to avoid immune detection in uterine tissue, but not placental tissue, which leads to increased rates of fetal injury and preterm birth. These studies provide novel insight into the underlying mechanisms of ascending infection. Copyright © 2016 Vornhagen et al.

Economic Assistance and Security. Rethinking U. S. Policy,

DTIC Science & Technology

1982-01-01

taxation, and community rewards, designed to lower fertility rates, hold possibilities of wider application. Greater use of and research in male ... contraceptive methods and concentration on increasing literacy among young women also have substantial potential for decreasing birth rates. And development

Reproductive health and genetic testing in the Third World.

PubMed

Penchaszadeh, V B

1993-09-01

New reproductive genetics means recently developed techniques to prevent the birth of children with specific defects or genetic diseases by testing individuals for sickle cell anemia, the thalassemias, Tay-Sachs disease, cystic fibrosis, or Down syndrome. Third World health services have many deficiencies with high maternal mortality rates (30-40 fold higher than in developed countries), the low percentage of births delivered by health personnel, the high rates of low birth weight babies, and high child malnutrition and infant mortality rates. The main issues in women's reproductive health are fertility regulation, abortion, maternal mortality, sexually transmitted diseases, and infertility. As a result of expansion in contraceptive use worldwide, the total fertility rate in developing countries has declined from 6.1 in 1965 to 3.9 in 1990. It is estimated that, worldwide, 36-53 million induced abortions are performed each year, most of them in developing nations. WHO estimates that more than 500,000 women die each year because of complications of pregnancy, most in developing countries. More than 95% of the 13 million estimated deaths of children under 5 years of age have occurred in these countries. Approximately 200 million people carry a potentially pathologic hemoglobinopathy gene, and about 250,000 children are born every year with hemoglobinopathy, most of them in the developing world. Reproductive genetic testing in big cities and in private for-profit ventures cater to the socioeconomic elite. Amniocentesis is often misused for fetal sex determination to abort female fetuses in India. Currently, in Cuba virtually every pregnant woman is tested for sickle cell trait and maternal serum alpha-fetoprotein levels between 15 and 20 weeks of gestation. It is predicted that the judicious use of reproductive genetic testing will be possible when health and quality of life issues are addressed properly.

Pre-Speech Assessment Scale: A Rating Scale for the Measurement of Pre-Speech Behaviors from Birth through Two Years. Revised Edition.

ERIC Educational Resources Information Center

Morris, Suzanne Evans

The manual contains the Pre-Speech Assessment Scale (PSAS) intended for use with cerebral palsied and other handicapped children to evaluate behaviors at the birth through 2-year age level. Introductory information covers the development of the PSAS, concepts underlying the PSAS, evaluation procedures, scoring the PSAS, and graphing procedures.…

Risk factors for premature birth in French Guiana: the importance of reducing health inequalities.

PubMed

Leneuve-Dorilas, Malika; Favre, Anne; Carles, Gabriel; Louis, Alphonse; Nacher, Mathieu

2017-11-27

French Guiana has the highest birth rate in South America. This French territory also has the highest premature birth rate and perinatal mortality rate of all French territories. The objective was to determine the premature birth rate and to identify the prevalence of risk factors of premature birth in French Guiana. A retrospective study of all births in French Guiana was conducted between January 2013 and December 2014 using the computerized registry compiling all live births over 22 weeks of gestation on the territory. During this period 12 983 live births were reported on the territory. 13.5% of newborns were born before 37 (1755/12 983). The study of the registry revealed that common sociodemographic risk factors of prematurity were present. In addition, past obstetrical history was also important: a scarred uterus increased the risk of prematurity adjusted odds ratio =1.4, 95%CI (1.2-1.6). Similarly, obstetrical surveillance, the absence of preparation for birth or of prenatal interview increased the risk of prematurity by 2.4 and 2.3, the excess fraction in the population was 69% and 72.2%, respectively. Known classical risk factors are important. In the present study excess fractions were calculated in order to prioritize interventions to reduce the prematurity rate.

Is more neonatal intensive care always better? Insights from a cross-national comparison of reproductive care.

PubMed

Thompson, Lindsay A; Goodman, David C; Little, George A

2002-06-01

Despite high per capita health care expenditure, the United States has crude infant survival rates that are lower than similarly developed nations. Although differences in vital recording and socioeconomic risk have been studied, a systematic, cross-national comparison of perinatal health care systems is lacking. To characterize systems of reproductive care for the United States, Australia, Canada, and the United Kingdom, including a detailed analysis of neonatal intensive care and mortality. Comparison of selected indicators of reproductive care and mortality from 1993-2000 through a systematic review of journal and government publications and structured interviews of leaders in perinatal and neonatal care. Compared with the other 3 countries, the United States has more neonatal intensive care resources yet provides proportionately less support for preconception and prenatal care. Unlike the United States, the other countries provided free family planning services and prenatal and perinatal physician care, and the United Kingdom and Australia paid for all contraception. The United States has high neonatal intensive care capacity, with 6.1 neonatologists per 10 000 live births; Australia, 3.7; Canada, 3.3; and the United Kingdom, 2.7. For intensive care beds, the United States has 3.3 per 10 000 live births; Australia and Canada, 2.6; and the United Kingdom, 0.67. Greater neonatal intensive care resources were not consistently associated with lower birth weight-specific mortality. The relative risk (United States as reference) of neonatal mortality for infants <1000 g was 0.84 for Australia, 1.12 for Canada, and 0.99 for the United Kingdom; for 1000 to 2499 g infants, the relative risk was 0.97 for Australia, 1.26 for Canada, and 0.95 for the United Kingdom. As reported elsewhere, low birth weight rates were notably higher in the United States, partially explaining the high crude mortality rates. The United States has significantly greater neonatal intensive care resources per capita, compared with 3 other developed countries, without having consistently better birth weight-specific mortality. Despite low birth weight rates that exceed other countries, the United States has proportionately more providers per low birth weight infant, but offers less extensive preconception and prenatal services. This study questions the effectiveness of the current distribution of US reproductive care resources and its emphasis on neonatal intensive care.

Geographic and racial variation in teen pregnancy rates in Wisconsin.

PubMed

Layde, Molly M; Remington, Patrick L

2013-08-01

Despite recent declines in teen birth rates, teenage pregnancy remains an important public health problem in Wisconsin with significant social, economic, and health-related effects. Compare and contrast teen birth rate trends by race, ethnicity, and county in Wisconsin. Teen (ages 15-19 years) birth rates (per 1000 teenage females) in Wisconsin from 2001-2010 were compared by racelethnicity and county of residence using data from the Wisconsin Interactive Statistics on Health. Teen birth rates in Wisconsin have declined by 20% over the past decade, from 35.5/1000 teens in 2001 to 28.3/1000 teens in 2010-a relative decline of 20.3%. However, trends vary by race, with declines among blacks (-33%) and whites (-26%) and increases among American Indians (+21%) and Hispanics (+30%). Minority teen birth rates continue to be 3 to 5 times greater than birth rates among whites. Rates varied even more by county, with an over 14-fold difference between Ozaukee County (7.8/1000) and Menominee County (114.2). Despite recent declines, teen pregnancy continues to be an important public health problem in Wisconsin. Pregnancy prevention programs should be targeted toward the populations and counties with the highest rates.

Bacterial Hyaluronidase Promotes Ascending GBS Infection and Preterm Birth

PubMed Central

Vornhagen, Jay; Quach, Phoenicia; Boldenow, Erica; Merillat, Sean; Whidbey, Christopher; Ngo, Lisa Y.; Adams Waldorf, K. M.

2016-01-01

ABSTRACT Preterm birth increases the risk of adverse birth outcomes and is the leading cause of neonatal mortality. A significant cause of preterm birth is in utero infection with vaginal microorganisms. These vaginal microorganisms are often recovered from the amniotic fluid of preterm birth cases. A vaginal microorganism frequently associated with preterm birth is group B streptococcus (GBS), or Streptococcus agalactiae. However, the molecular mechanisms underlying GBS ascension are poorly understood. Here, we describe the role of the GBS hyaluronidase in ascending infection and preterm birth. We show that clinical GBS strains associated with preterm labor or neonatal infections have increased hyaluronidase activity compared to commensal strains obtained from rectovaginal swabs of healthy women. Using a murine model of ascending infection, we show that hyaluronidase activity was associated with increased ascending GBS infection, preterm birth, and fetal demise. Interestingly, hyaluronidase activity reduced uterine inflammation but did not impact placental or fetal inflammation. Our study shows that hyaluronidase activity enables GBS to subvert uterine immune responses, leading to increased rates of ascending infection and preterm birth. These findings have important implications for the development of therapies to prevent in utero infection and preterm birth. PMID:27353757

Preconception Low-Dose Aspirin Restores Diminished Pregnancy and Live Birth Rates in Women With Low-Grade Inflammation: A Secondary Analysis of a Randomized Trial.

PubMed

Sjaarda, Lindsey A; Radin, Rose G; Silver, Robert M; Mitchell, Emily; Mumford, Sunni L; Wilcox, Brian; Galai, Noya; Perkins, Neil J; Wactawski-Wende, Jean; Stanford, Joseph B; Schisterman, Enrique F

2017-05-01

Inflammation is linked to causes of infertility. Low-dose aspirin (LDA) may improve reproductive success in women with chronic, low-grade inflammation. To investigate the effect of preconception-initiated LDA on pregnancy rate, pregnancy loss, live birth rate, and inflammation during pregnancy. Stratified secondary analysis of a multicenter, block-randomized, double-blind, placebo-controlled trial. Four US academic medical centers, 2007 to 2012. Healthy women aged 18 to 40 years (N = 1228) with one to two prior pregnancy losses actively attempting to conceive. Preconception-initiated, daily LDA (81 mg) or matching placebo taken up to six menstrual cycles attempting pregnancy and through 36 weeks' gestation in women who conceived. Confirmed pregnancy, live birth, and pregnancy loss were compared between LDA and placebo, stratified by tertile of preconception, preintervention serum high-sensitivity C-reactive protein (hsCRP) (low, <0.70 mg/L; middle, 0.70 to <1.95 mg/L; high, ≥1.95 mg/L). Live birth occurred in 55% of women overall. The lowest pregnancy and live birth rates occurred among the highest hsCRP tertile receiving placebo (44% live birth). LDA increased live birth among high-hsCRP women to 59% (relative risk, 1.35; 95% confidence interval, 1.08 to 1.67), similar to rates in the lower and mid-CRP tertiles. LDA did not affect clinical pregnancy or live birth in the low (live birth: 59% LDA, 54% placebo) or midlevel hsCRP tertiles (live birth: 59% LDA, 59% placebo). In women attempting conception with elevated hsCRP and prior pregnancy loss, LDA may increase clinical pregnancy and live birth rates compared with women without inflammation and reduce hsCRP elevation during pregnancy. Copyright © 2017 by the Endocrine Society

Perinatal Risks in "Late Motherhood" Defined Based On Parity and Preterm Birth Rate - an Analysis of the German Perinatal Survey (20th Communication).

PubMed

Schure, V; Voigt, M; Schild, R L; Hesse, V; Carstensen, M; Schneider, K T M; Straube, S

2012-01-01

Aim: "Late motherhood" is associated with greater perinatal risks but the term lacks precise definition. We present an approach to determine what "late motherhood" associated with "high risk" is, based on parity and preterm birth rate. Materials and Methods: Using data from the German Perinatal Survey of 1998-2000 we analysed preterm birth rates in women with zero, one, or two previous live births. We compared groups of "late" mothers (with high preterm birth rates) with "control" groups of younger women (with relatively low preterm birth rates). Data of 208 342 women were analysed. For women with zero (one; two) previous live births, the "control" group included women aged 22-26 (27-31; 29-33) years. Women in the "late motherhood" group were aged > 33 (> 35; > 38) years. Results: The "late motherhood" groups defined in this way were also at higher risk of adverse perinatal events other than preterm birth. For women with zero (one; two) previous live births, normal cephalic presentation occurred in 89 % (92.7 %; 93.3 %) in the "control" group, but only in 84.5 % (90 %; 90.4 %) in the "late motherhood" group. The mode of delivery was spontaneous or at most requiring manual help in 71.3 % (83.4 %; 85.8 %) in the "control" group, but only in 51.4 % (72.2 %; 76.4 %) in the "late motherhood" group. Five-minute APGAR scores were likewise worse for neonates of "late" mothers and the proportion with a birth weight ≤ 2499 g was greater. Conclusion: "Late motherhood" that is associated with greater perinatal risks can be defined based on parity and preterm birth rate.

Quantitative and qualitative trophectoderm grading allows for prediction of live birth and gender.

PubMed

Ebner, Thomas; Tritscher, Katja; Mayer, Richard B; Oppelt, Peter; Duba, Hans-Christoph; Maurer, Maria; Schappacher-Tilp, Gudrun; Petek, Erwin; Shebl, Omar

2016-01-01

Prolonged in vitro culture is thought to affect pre- and postnatal development of the embryo. This prospective study was set up to determine whether quality/size of inner cell mass (ICM) (from which the fetus ultimately develops) and trophectoderm (TE) (from which the placenta ultimately develops) is reflected in birth and placental weight, healthy live-birth rate, and gender after fresh and frozen single blastocyst transfer. In 225 patients, qualitative scoring of blastocysts was done according to the criteria expansion, ICM, and TE appearance. In parallel, all three parameters were quantified semi-automatically. TE quality and cell number were the only parameters that predicted treatment outcome. In detail, pregnancies that continued on to a live birth could be distinguished from those pregnancies that aborted on the basis of TE grade and cell number. Male blastocysts had a 2.53 higher chance of showing TE of quality A compared to female ones. There was no correlation between the appearance of both cell lineages and birth or placental weight, respectively. The presented correlation of TE with outcome indicates that TE scoring could replace ICM scoring in terms of priority. This would automatically require a rethinking process in terms of blastocyst selection and cryopreservation strategy.

Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services

PubMed Central

Leal, Maria do Carmo; Esteves-Pereira, Ana Paula; Nakamura-Pereira, Marcos; Torres, Jacqueline Alves; Domingues, Rosa Maria Soares Madeira; Dias, Marcos Augusto Bastos; Moreira, Maria Elizabeth; Theme-Filha, Mariza; da Gama, Silvana Granado Nogueira

2016-01-01

Background A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk. Methods This is a sub-analysis of a national population-based survey of postpartum women entitled “Birth in Brazil”, performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services. Results Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s) and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8%) when compared to the ones receiving public services (rate of 2.4%), regardless of obstetric risk–adjusted OR of 2.3 (CI 1.5–3.6) for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1–2.3) for women of high obstetric risk. Conclusion The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care. PMID:27196102

Russia's population sink.

PubMed

Nelson, T

1996-01-01

Russia's public health problems, which are a result in part of uncontrolled development, are a lesson for developing countries. Trends in births and deaths in Russia indicate that as socioeconomic conditions declined in recent years, the death rate increased. During 1992-93 the death rate increased from 12.1 per 1000 population to 14.5, with 75% of the increase due to cardiovascular disease, accidents, murder, suicide, and alcohol poisoning. Quality of health care was given as one reason for the high cardiovascular disease rate that included deaths due to even mild heart attacks. 20-30% of deaths are attributed to pollution. 75% of rivers and lakes in the former Soviet Union are considered unfit for drinking, and 50% of tap water is unsanitary. An estimated 15% of Russia's land area is considered to be an ecological disaster zone. Births declined from a peak of 2.5 million in 1987 to 1.4 million in 1994. During this same period deaths increased from 1.5 million to 2.3 million. In 1994 deaths exceeded births by 880,000. Life expectancy declined from 65 to 57 years for men and from 75 years to 71 years for women. Infant mortality is rising. 11% of newborns had birth defects, and 60% showed evidence of allergies or vitamin D deficiencies. The death rate during pregnancy was 50 per 1000 births, and 75% of Russian women experienced complications during pregnancy. Women's health in the reproductive years was compromised by gynecological infections. A survey in 1992 revealed that 75% of Russian women gave insufficient income as a reason for reduced childbearing. The social conditions in Russia and the former Soviet republics reflect a lack of confidence in the future. Demographic trends are affected by a complex set of factors including economic collapse, economic change and uncertainty, inadequate health care, and poor environmental conditions. These changes occurred during the mid-1980s and before the collapse of the Soviet Union in 1991.

What has contributed to the change in life expectancy in Italy between 1980 and 1992?

PubMed

Ngongo, K N; Nante, N; Chenet, L; McKee, M

1999-07-01

Life expectancy at birth in southern Europe is known to be greater than expected in comparison with levels of economic development. This has been attributed to the 'Mediterranean diet'. There are, however, concerns that this comparative advantage is being lost. This paper examines the factors underlying changing life expectancy in Italy since 1980. The subjects of this analysis are obtained from data on all deaths in Italy between 1980 and 1992. Change in age specific death rates is calculated from selected causes and, using the method developed by Pollard, the contribution of deaths from different causes and at different ages to changing life expectancy at birth is estimated. Between 1980 and 1992, life expectancy at birth increased by 2.70 years for men and 2.75 years for women. Death rates have fallen among children and those over 40. In contrast, death rates have increased among men aged between 20 and 39 and have increased very slightly among women aged 25-29. Falling death rates from ischaemic heart disease are continuing to contribute to increasing life expectancy. Death rates from lung and breast cancer are rising among women but are compensated for by falling death rates from other cancers. Among men, falling death rates from cancer at younger ages are being offset by increases at older ages. The rising death rate among younger men is almost entirely due to AIDS, with accidents also making a small contribution. Life expectancy in Italy has improved throughout the 1980s, largely driven by falling death rates from cardiovascular diseases. Here are, however, some worrying trends, most notably the rising death rate among young men, due almost entirely to AIDS. The changing pattern of mortality has some similarities with Spain, another Mediterranean country, but there are also important differences.

Embryo quality is the main factor affecting cumulative live birth rate after elective single embryo transfer in fresh stimulation cycles.

PubMed

Niinimäki, Maarit; Veleva, Zdravka; Martikainen, Hannu

2015-11-01

The study was aimed to evaluate which factors affect the cumulative live birth rate after elective single embryo transfer in women younger than 36 years. Additionally, number of children in women with more than one delivery per ovum pick-up after fresh elective single embryo transfer and subsequent frozen embryo transfers was assessed. Retrospective cohort study analysing data of a university hospital's infertility clinic in 2001-2010. A total of 739 IVF/ICSI cycles with elective single embryo transfer were included. Analyses were made per ovum pick-up including fresh and subsequent frozen embryo transfers. Factors affecting cumulative live birth rates were examined in uni- and multivariate analyses. A secondary endpoint was the number of children born after all treatments. In the fresh cycles, the live birth rate was 29.2% and the cumulative live birth rate was 51.3%, with a twin rate of 3.4%. In the multivariate analysis, having two (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.12-2.67) or ≥3 top embryos (OR 2.66; 95% CI 1.79-3.95) was associated with higher odds for live birth after fresh and frozen embryo cycles. Age, body mass index, duration of infertility, diagnosis or total gonadotropin dose were not associated with the cumulative live birth rate. In cycles with one top embryo, the cumulative live birth rate was 40.2%, whereas it was 64.1% in those with at least three top embryos. Of women who had a live birth in the fresh cycle, 20.4% had more than one child after all frozen embryo transfers. Among women with three or more top embryos after ovum pick-up, 16.1% gave birth to more than one child. The cumulative live birth rate in this age group varies from 40% to 64% and is dependent on the quality of embryos. Women with three or more top embryos have good chance of having more than one child per ovum pick-up without elevated risk of multiple pregnancies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Evaluation of growth and development pattern in normal, low and very low birth weight neonates at 18 months of age.

PubMed

Abdeyazdan, Zahra; Ehsanpour, Soheila; Hemmati, Elahe

2014-01-01

Growth and development monitoring could lead to general judgment about children's health. With advances in NICUs establishment, the survival rate of very low birth weight (VLBW) neonates has increased in many countries including Iran. Because of the lack of studies about growth and development pattern of low birth weight (LBW) and VLBW neonates in Iran, the present study aimed to compare growth and development of normal, low and very low birth weight neonates at 18 months of age. In a cross- sectional descriptive study, 214 children with age 18 months were enrolled (90 LBW, 90 LBW and 34 VLBW) and their growth and development were assessed. Data gathering tool was a researcher made questionnaire including anthropometrics measures and developmental key points. Data analyzed by descriptive (mean and SD) and inferential (ANOVA) tests using SPSS version 15. There were significant differences in the mean of anthropometric indexes between three groups. Majority of subjects in three groups had normal weight growth trend. Mean scores of gross motor and fine motor development indexes had significant association with birth weight. Meanwhile, there was no significant association between mean scores of social/cognitive and also language developmental aspects and birth weight. Findings revealed that in LBW and VLBW children, growth indexes at the age of 18 months are so far from those of NBW neonates. Further nationwide prospective studies, with a longer period of time is needed to estimate when Iranian LBW children reach at the levels of NBW ones.

Metabolic costs and evolutionary implications of human brain development

PubMed Central

Kuzawa, Christopher W.; Chugani, Harry T.; Grossman, Lawrence I.; Lipovich, Leonard; Muzik, Otto; Hof, Patrick R.; Wildman, Derek E.; Sherwood, Chet C.; Leonard, William R.; Lange, Nicholas

2014-01-01

The high energetic costs of human brain development have been hypothesized to explain distinctive human traits, including exceptionally slow and protracted preadult growth. Although widely assumed to constrain life-history evolution, the metabolic requirements of the growing human brain are unknown. We combined previously collected PET and MRI data to calculate the human brain’s glucose use from birth to adulthood, which we compare with body growth rate. We evaluate the strength of brain–body metabolic trade-offs using the ratios of brain glucose uptake to the body’s resting metabolic rate (RMR) and daily energy requirements (DER) expressed in glucose-gram equivalents (glucosermr% and glucoseder%). We find that glucosermr% and glucoseder% do not peak at birth (52.5% and 59.8% of RMR, or 35.4% and 38.7% of DER, for males and females, respectively), when relative brain size is largest, but rather in childhood (66.3% and 65.0% of RMR and 43.3% and 43.8% of DER). Body-weight growth (dw/dt) and both glucosermr% and glucoseder% are strongly, inversely related: soon after birth, increases in brain glucose demand are accompanied by proportionate decreases in dw/dt. Ages of peak brain glucose demand and lowest dw/dt co-occur and subsequent developmental declines in brain metabolism are matched by proportionate increases in dw/dt until puberty. The finding that human brain glucose demands peak during childhood, and evidence that brain metabolism and body growth rate covary inversely across development, support the hypothesis that the high costs of human brain development require compensatory slowing of body growth rate. PMID:25157149

Metabolic costs and evolutionary implications of human brain development.

PubMed

Kuzawa, Christopher W; Chugani, Harry T; Grossman, Lawrence I; Lipovich, Leonard; Muzik, Otto; Hof, Patrick R; Wildman, Derek E; Sherwood, Chet C; Leonard, William R; Lange, Nicholas

2014-09-09

The high energetic costs of human brain development have been hypothesized to explain distinctive human traits, including exceptionally slow and protracted preadult growth. Although widely assumed to constrain life-history evolution, the metabolic requirements of the growing human brain are unknown. We combined previously collected PET and MRI data to calculate the human brain's glucose use from birth to adulthood, which we compare with body growth rate. We evaluate the strength of brain-body metabolic trade-offs using the ratios of brain glucose uptake to the body's resting metabolic rate (RMR) and daily energy requirements (DER) expressed in glucose-gram equivalents (glucosermr% and glucoseder%). We find that glucosermr% and glucoseder% do not peak at birth (52.5% and 59.8% of RMR, or 35.4% and 38.7% of DER, for males and females, respectively), when relative brain size is largest, but rather in childhood (66.3% and 65.0% of RMR and 43.3% and 43.8% of DER). Body-weight growth (dw/dt) and both glucosermr% and glucoseder% are strongly, inversely related: soon after birth, increases in brain glucose demand are accompanied by proportionate decreases in dw/dt. Ages of peak brain glucose demand and lowest dw/dt co-occur and subsequent developmental declines in brain metabolism are matched by proportionate increases in dw/dt until puberty. The finding that human brain glucose demands peak during childhood, and evidence that brain metabolism and body growth rate covary inversely across development, support the hypothesis that the high costs of human brain development require compensatory slowing of body growth rate.

Evaluation of vaccine coverage for low birth weight infants during the first year of life in a large managed care population.

PubMed

Batra, Jagmohan S; Eriksen, Eileen M; Zangwill, Kenneth M; Lee, Martin; Marcy, S Michael; Ward, Joel I

2009-03-01

There are few recent population-based assessments of vaccine coverage in premature infants available. This study assesses and compares age- and dose-specific immunization coverage in children of different birth weight categories during the first year of life. We performed a retrospective cohort analysis of computerized vaccination data from a large managed care organization in southern California. The participants were children born between January 1, 1997, and December 31, 2002, and continuously enrolled from birth to at least 12 months of age in the Southern California Kaiser Permanente health plan. We measured age-specific up-to-date and age-appropriate immunization rates according to birth weight (extremely low birth weight: <1000 g; very low birth weight: 1000-1499 g; low birth weight: 1500-2499 g; normal birth weight: >/=2500 g) for 4 vaccines (hepatitis B, diphtheria and tetanus toxoids with pertussis, Haemophilus influenzae type b, and poliovirus) through the first year of life. We identified 127 833 infants born during the study period and continuously enrolled through the first year of life; 120 048 were normal birth weight infants; 6491 were low birth weight infants; 788 were very low birth weight infants; and 506 were extremely low birth weight infants. Vaccine-specific age-appropriate immunization rates were 3% to 15% lower for low birth weight infants and 17% to 33% lower for extremely low birth weight infants compared with the rates for normal birth weight infants in the first 6 months of life. Extremely low birth weight infants had the lowest age-specific up-to-date immunization levels (5%-31% lower) compared with normal birth weight infants at each age assessed. By 12 months, extremely low birth weight infants still had significantly lower up-to-date levels (87%) compared with very low birth weight, low birth weight, and normal birth weight infants (91%-92%). Despite recommendations that lower birth weight infants be vaccinated as the same chronological age as normal birth weight infants, extremely low birth weight and very low birth weight infants are immunized at significantly lower rates relative to low birth weight and normal birth weight infants at 2, 4, and 6 months of age. However, by 12 months of age this finding persists only in extremely low birth weight infants.

Disparities in birth weight and gestational age by ethnic ancestry in South American countries.

PubMed

Wehby, George L; Gili, Juan A; Pawluk, Mariela; Castilla, Eduardo E; López-Camelo, Jorge S

2015-03-01

We examine disparities in birth weight and gestational age by ethnic ancestry in 2000-2011 in eight South American countries. The sample included 60,480 singleton live births. Regression models were estimated to evaluate differences in birth outcomes by ethnic ancestry controlling for time trends. Significant disparities were found in seven countries. In four countries-Brazil, Ecuador, Uruguay, and Venezuela-we found significant disparities in both low birth weight and preterm birth. Disparities in preterm birth alone were observed in Argentina, Bolivia, and Colombia. Several differences in continuous birth weight, gestational age, and fetal growth rate were also observed. There were no systematic patterns of disparities between the evaluated ethnic ancestry groups across the study countries, in that no racial/ethnic group consistently had the best or worst outcomes in all countries. Racial/ethnic disparities in infant health are common in several South American countries. Differences across countries suggest that racial/ethnic disparities are driven by social and economic mechanisms. Researchers and policymakers should acknowledge these disparities and develop research and policy programs to effectively target them.

Changes in Cesarean Delivery Rates by Gestational Age: United States, 1996-2011

MedlinePlus

... cesarean delivery rate : Number of births in multiple pregnancies delivered by cesarean per 100 multiple births. Gestational age categories Early preterm : Births prior to 34 completed weeks of ...

Birth-cohort patterns of mortality from ulcerative colitis and peptic ulcer.

PubMed

Sonnenberg, Amnon

2008-10-01

The aim was to follow the time trends of mortality from ulcerative colitis and compare them with those of gastric and duodenal ulcer. Mortality data from 21 different countries between 1941 and 2004 were analyzed. The age-specific death rates of each individual country, as well as the average age-specific rates of all countries, were plotted against the periods of birth and death. The average trends of mortality from ulcerative colitis, gastric and duodenal ulcer reveal distinctive and unique birth-cohort patterns of all three diseases. Similar to both types of peptic ulcer, the risk of developing ulcerative colitis started to rise in successive generations born during the second half of the 19(th) century. It peaked shortly before the turn of the century and has continued to decline since then. The rise and fall in the occurrence of ulcerative colitis preceded those of both ulcer types. The birth-cohort pattern indicates that exposure to the relevant risk factors of ulcerative colitis occurs during early life. As the model of H. pylori and its associated birth-cohort patterns of gastric and duodenal ulcer suggest, an enteric infection provides a possible explanation for such temporal trends of ulcerative colitis as well.

Race and ethnic differences in determinants of preterm birth in the USA: broadening the social context.

PubMed

Reagan, Patricia B; Salsberry, Pamela J

2005-05-01

Preterm births occur in 9.7% of all US singleton births. The rate for blacks is double that of whites and the rate is 25% higher for Hispanics than for whites. While a number of individual correlates with preterm birth have been identified, race and ethnic differences have not been fully explained. Influenced by a growing body of literature documenting a relationship among health, individual income, and neighborhood disadvantage, researchers interested in explaining racial differences in preterm birth are designing studies that extend beyond the individual. No studies of adverse birth outcomes have considered contextual effects beyond the neighborhood level. Only a handful of studies, comparing blacks and whites, have evaluated the influence of neighborhood disadvantage on preterm birth. This study examines how preterm birth among blacks, whites and Hispanics is influenced by social context, broadly defined to include measures of neighborhood disadvantage and cumulative exposure to state-level income inequality, controlling for individual risk factors. Neighborhood disadvantage is determined by Census tract data. Cumulative exposure to income inequality is measured by the fraction of the mother's life since age 14 spent residing in states with a state-level Gini coefficient above the median. The results for neighborhood disadvantage are highly sensitive across race/ethnicities to the measure used. We find evidence that neighborhood poverty rates and housing vacancy rates increased the rate of very preterm birth and decreased the rate of moderately preterm birth for blacks. The rate of very preterm increased with the fraction of female-headed households for Hispanics and decreased with the fraction of people employed in professional occupations for whites. We find direct effects of cumulative exposure to income inequality only for Hispanics. However, we do find indirect effects of context broadly defined on behaviors that increased the risk of preterm birth.

The quick and the dead: microbial demography at the yeast thermal limit.

PubMed

Maxwell, Colin S; Magwene, Paul M

2017-03-01

The niche of microorganisms is determined by where their populations can expand. Populations can fail to grow because of high death or low birth rates, but these are challenging to measure in microorganisms. We developed a novel technique that enables single-cell measurement of age-structured birth and death rates in the budding yeast, Saccharomyces cerevisiae, and used this method to study responses to heat stress in a genetically diverse panel of strains. We find that individual cells show significant heterogeneity in their rates of birth and death during heat stress. Genotype-by-environment effects on processes that regulate asymmetric cell division contribute to this heterogeneity. These lead to either premature senescence or early life mortality during heat stress, and we find that a mitochondrial inheritance defect explains the early life mortality phenotype of one of the strains we studied. This study demonstrates how the interplay of physiology, genetic variation and environmental variables influence where microbial populations survive and flourish. © 2016 John Wiley & Sons Ltd.

Birth order and its association with the onset of chronic fatigue syndrome.

PubMed

Brimacombe, Michael; Helmer, Drew A; Natelson, Benjamin H

2002-08-01

Chronic fatigue syndrome (CFS) is a medically unexplained illness that is diagnosed on the basis of a clinical case definition; so it probably is an illness with multiple causes producing the same clinical picture. One way of dealing with this heterogeneity is to stratify patients based on illness onset. We hypothesized that either the whole group of CFS patients or that group which developed CFS gradually would show a relation with birth order, while patients who developed CFS suddenly, probably due to a viral illness, would not show such a relation. We hypothesized the birth order effect in the gradual onset group because those patients have more psychological problems, and birth order effects have been shown for psychological characteristics. We compared birth order in our CFS patients to that in a comparison group derived from U.S. demographic data. We found a tendency that did not reach formal statistical significance for a birth order effect in the gradual onset group, but not in either the sudden onset or combined total group. However, the birth order effect we found was due to relatively increased rates of CFS in second-born children; prior birth order studies of personality characteristics have found such effects to be skewed toward first-born children. Thus, our data do support a birth order effect in a subset of patients with CFS. The results of this study should encourage a larger multicenter study to further explore and understand this relation.

Decision on Some Policies for Stronger Development of the Implementation of Family Planning, Council of Ministers, 15 September 1986.

PubMed

1987-01-01

This document contains the text of Viet Nam's 1986 Decision on family planning policies that sought to reduce the population growth rate to 1.7% by 1990. The decision called for a maximum of 2 children per family with a 5-year space between each child. Urban women should be at least 22 years old before giving birth, and rural women should be at least 20. If a first birth consists of twins, then the family size is counted as 2. If a second birth consists of twins or triplets, the family size is still counted as 2. Incentives in the form of cash or holidays are provided to individuals practicing family planning, and families with more than 2 children must pay rent at a more expensive rate.

Estimation of the growth curve and heritability of the growth rate for giant panda (Ailuropoda melanoleuca) cubs.

PubMed

Che, T D; Wang, C D; Jin, L; Wei, M; Wu, K; Zhang, Y H; Zhang, H M; Li, D S

2015-03-27

Giant panda cubs have a low survival rate during the newborn and early growth stages. However, the growth and developmental parameters of giant panda cubs during the early lactation stage (from birth to 6 months) are not well known. We examined the growth and development of giant panda cubs by the Chapman growth curve model and estimated the heritability of the maximum growth rate at the early lactation stage. We found that 83 giant panda cubs reached their maximum growth rate at approximately 75-120 days after birth. The body weight of cubs at 75 days was 4285.99 g. Furthermore, we estimated that the heritability of the maximum growth rate was moderate (h(2) = 0.38). Our study describes the growth and development of giant panda cubs at the early lactation stage and provides valuable growth benchmarks. We anticipate that our results will be a starting point for more detailed research on increasing the survival rate of giant panda cubs. Feeding programs for giant panda cubs need further improvement.

Trends of and factors associated with live-birth and abortion rates among HIV-positive and HIV-negative women.

PubMed

Haddad, Lisa B; Wall, Kristin M; Mehta, C Christina; Golub, Elizabeth T; Rahangdale, Lisa; Kempf, Mirjam-Colette; Karim, Roksana; Wright, Rodney; Minkoff, Howard; Cohen, Mardge; Kassaye, Seble; Cohan, Deborah; Ofotokun, Igho; Cohn, Susan E

2017-01-01

Little is known about fertility choices and pregnancy outcome rates among HIV-infected women in the current combination antiretroviral treatment era. We sought to describe trends and factors associated with live-birth and abortion rates among HIV-positive and high-risk HIV-negative women enrolled in the Women's Interagency HIV Study in the United States. We analyzed longitudinal data collected from Oct. 1, 1994, through Sept. 30, 2012, through the Women's Interagency HIV Study. Age-adjusted rates per 100 person-years live births and induced abortions were calculated by HIV serostatus over 4 time periods. Poisson mixed effects models containing variables associated with live births and abortions in bivariable analyses (P < .05) generated adjusted incidence rate ratios and 95% confidence intervals. There were 1356 pregnancies among 2414 women. Among HIV-positive women, age-adjusted rates of live birth increased from 1994 through 1997 to 2006 through 2012 (2.85-7.27/100 person-years, P trend < .0001). Age-adjusted rates of abortion in HIV-positive women remained stable over these time periods (4.03-4.29/100 person-years, P trend = .09). Significantly lower live-birth rates occurred among HIV-positive compared to HIV-negative women in 1994 through 1997 and 1997 through 2001, however rates were similar during 2002 through 2005 and 2006 through 2012. Higher CD4 + T cells/mm 3 (≥350 adjusted incidence rate ratio, 1.39 [95% CI 1.03-1.89] vs <350) were significantly associated with increased live-birth rates, while combination antiretroviral treatment use (adjusted incidence rate ratio, 1.35 [95% CI 0.99-1.83]) was marginally associated with increased live-birth rates. Younger age, having a prior abortion, condom use, and increased parity were associated with increased abortion rates among both HIV-positive and HIV-negative women. CD4 + T-cell count, combination antiretroviral treatment use, and viral load were not associated with abortion rates. Unlike earlier periods (pre-2001) when live-birth rates were lower among HIV-positive women, rates are now similar to HIV-negative women, potentially due to improved health status and combination antiretroviral treatment. Abortion rates remain unchanged, illuminating a need to improve contraceptive services. Copyright © 2016 Elsevier Inc. All rights reserved.

Placental weight and foetal growth rate as predictors of ischaemic heart disease in a Swedish cohort.

PubMed

Heshmati, A; Koupil, I

2014-06-01

Studies on placental size and cardiovascular disease have shown inconsistent results. We followed 10,503 men and women born in Uppsala, Sweden, 1915-1929 from 1964 to 2008 to assess whether birth characteristics, including placental weight and placenta/birth weight ratio, were predictive of future ischaemic heart disease (IHD). Adjustments were made for birth cohort, age, sex, mother's parity, birth weight, gestational age and social class at birth. Placental weight and birth weight were negatively associated with IHD. The effect of placental weight on IHD was stronger in individuals from medium social class at birth and in those with low education. Men and women from non-manual social class at birth had the lowest risk for IHD as adults. We conclude that low foetal growth rate rather than placental weight was more predictive of IHD in the Swedish cohort. However, the strong effect of social class at birth on risk for IHD did not appear to be mediated by foetal growth rate.

Teenage births to ethnic minority women.

PubMed

Berthoud, R

2001-01-01

This article analyses British age-specific fertility rates by ethnic group, with a special interest in child-bearing by women below the age of 20. Birth statistics are not analysed by ethnic group, and teenage birth rates have been estimated from the dates of birth of mothers and children in the Labour Force Survey. The method appears to be robust. Caribbean, Pakistani and especially Bangladeshi women were much more likely to have been teenage mothers than white women, but Indian women were below the national average. Teenage birth rates have been falling in all three South Asian communities.

The impact of first birth obstetric anal sphincter injury on the subsequent birth: a population-based linkage study.

PubMed

Ampt, Amanda J; Roberts, Christine L; Morris, Jonathan M; Ford, Jane B

2015-02-13

With rising obstetric anal sphincter injury (OASI) rates, the number of women at risk of OASI recurrence is in turn increasing. Decisions regarding mode of subsequent birth following an OASI are complex, and depend on a variety of factors. We sought to identify the risk factors for OASI recurrence from first and subsequent births, and to investigate the effect of OASI birth factors on planned caesarean for the second birth. Using two linked population datasets from New South Wales, Australia, we selected women giving birth between 2001 and 2011 with a first birth OASI and a subsequent birth. Multivariable logistic regression was used to identify the association of first and second birth factors with OASI recurrence, and to determine which factors were associated with a planned pre-labour caesarean at the second birth. Of 6,380 women with a first birth OASI who proceeded to a subsequent birth, 75.4% had a vaginal second birth, 19.4% a pre-labour caesarean, and 5.2% an intrapartum caesarean. Although the OASI recurrence rate of 5.7% was significantly higher than the first birth OASI rate of 4.5% (p < 0.01), this may not reflect a clinically significant increase. Following adjustment for first and second birth factors, first birth diabetes and second birthweight ≥3.5 kg were associated with increased likelihood of OASI recurrence, while first birthweight ≥4.0 kg and second gestation at 37-38 weeks were associated with decreased likelihood. A fourth degree tear at the first birth was the strongest factor associated with planned caesarean at the second birth, with other factors including epidural, spinal or general anaesthetic, birthweight, gestation, country of birth and maternal age. Compared with previous reports, the low OASI recurrence rate (approximately one in twenty) may reflect appropriate decision-making about subsequent mode of delivery following first birth OASI. This assertion is supported by evidence of different risk profiles for women who have planned caesareans compared with planned vaginal births.

Modeling month-season of birth as a risk factor in mouse models of chronic disease: from multiple sclerosis to autoimmune encephalomyelitis.

PubMed

Reynolds, Jacob D; Case, Laure K; Krementsov, Dimitry N; Raza, Abbas; Bartiss, Rose; Teuscher, Cory

2017-06-01

Month-season of birth (M-SOB) is a risk factor in multiple chronic diseases, including multiple sclerosis (MS), where the lowest and greatest risk of developing MS coincide with the lowest and highest birth rates, respectively. To determine whether M-SOB effects in such chronic diseases as MS can be experimentally modeled, we examined the effect of M-SOB on susceptibility of C57BL/6J mice to experimental autoimmune encephalomyelitis (EAE). As in MS, mice that were born during the M-SOB with the lowest birth rate were less susceptible to EAE than mice born during the M-SOB with the highest birth rate. We also show that the M-SOB effect on EAE susceptibility is associated with differential production of multiple cytokines/chemokines by neuroantigen-specific T cells that are known to play a role in EAE pathogenesis. Taken together, these results support the existence of an M-SOB effect that may reflect seasonally dependent developmental differences in adaptive immune responses to self-antigens independent of external stimuli, including exposure to sunlight and vitamin D. Moreover, our documentation of an M-SOB effect on EAE susceptibility in mice allows for modeling and detailed analysis of mechanisms that underlie the M-SOB effect in not only MS but in numerous other diseases in which M-SOB impacts susceptibility.-Reynolds, J. D., Case, L. K., Krementsov, D. N., Raza, A., Bartiss, R., Teuscher, C. Modeling month-season of birth as a risk factor in mouse models of chronic disease: from multiple sclerosis to autoimmune encephalomyelitis. © FASEB.

No significant association between prenatal exposure poliovirus epidemics and psychosis.

PubMed

Cahill, Matthew; Chant, David; Welham, Joy; McGrath, John

2002-06-01

To examine the association between prenatal exposure to poliovirus infection and later development of schizophrenia or affective psychosis in a Southern Hemisphere psychiatric register. We calculated rates of poliomyelitis cases per 10 000 background population and rates for schizophrenia(n = 6078) and affective psychosis (n = 3707)per 10 000 births for the period 1930-1964. Empirically weighted regression was used to measure the association between a given psychosis birth-rate and a poliomyelitis epidemic during gestation. There was no statistically significant association between exposure to a poliomyelitis epidemic during gestation and subsequent development of schizophrenia or affective psychosis. The lack of a consistent statistically significant association between poliovirus epidemics and schizophrenia suggests that either poliovirus may have a small effect which is only detectable with large data-sets and/or the effect may be modified by location. Further investigation of such inconsistencies may help elucidate candidate risk-modifying factors for schizophrenia.

Sperm DNA damage has a negative association with live-birth rates after IVF.

PubMed

Simon, L; Proutski, I; Stevenson, M; Jennings, D; McManus, J; Lutton, D; Lewis, S E M

2013-01-01

Sperm DNA damage has a negative impact on pregnancy rates following assisted reproduction treatment (ART). The aim of the present study was to examine the relationship between sperm DNA fragmentation and live-birth rates after IVF and intracytoplasmic sperm injection (ICSI). The alkaline Comet assay was employed to measure sperm DNA fragmentation in native semen and in spermatozoa following density-gradient centrifugation in semen samples from 203 couples undergoing IVF and 136 couples undergoing ICSI. Men were divided into groups according to sperm DNA damage. Following IVF, couples with <25% sperm DNA fragmentation had a live-birth rate of 33%; in contrast, couples with >50% sperm DNA fragmentation had a much lower live-birth rate of 13%. Following ICSI, no significant differences in sperm DNA damage were found between any groups of patients. Sperm DNA damage was also associated with low live-birth rates following IVF in both men and couples with idiopathic infertility: 39% of couples and 41% of men with idiopathic infertility have high sperm DNA damage. Sperm DNA damage assessed by the Comet assay has a close inverse relationship with live-birth rates after IVF. Sperm DNA damage has a negative impact on assisted reproduction treatment outcome, in particular, on pregnancy rates. The aim of the present study was to examine the relationship between sperm DNA fragmentation and live-birth rates after IVF and intracytoplasmic sperm injection (ICSI). The alkaline Comet assay was employed to measure sperm DNA fragmentation in native semen and in spermatozoa following density-gradient centrifugation in semen samples from 203 couples undergoing IVF and 136 couples undergoing ICSI. Men were divided into groups according to sperm DNA damage and treatment outcome. Following IVF, couples with <25% sperm DNA fragmentation had a live birth rate of 33%. In contrast, couples with >50% sperm DNA fragmentation had a much lower live-birth rate of 13% following IVF. Following ICSI, there were no significant differences in levels of sperm DNA damage between any groups of patients. Sperm DNA damage was also associated with the very low live-birth rates following IVF in both men and couples with idiopathic infertility: 39% of couples and 41% of men have high level of sperm DNA damage. Sperm DNA damage assessed by the Comet assay has a close inverse relationship with live-birth rates after IVF. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date

PubMed Central

2013-01-01

Background Hemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births. Methods We conducted an integrative review of published research studies and evaluation reports from programs that distributed misoprostol at the community level for prevention of PPH at home births. We reviewed methods and cadres involved in education of end-users, drug administration, distribution, and coverage, correct and incorrect usage, and serious adverse events. Results Eighteen programs were identified; only seven reported all data of interest. Programs utilized a range of strategies and timings for distributing misoprostol. Distribution rates were higher when misoprostol was distributed at a home visit during late pregnancy (54.5-96.9%) or at birth (22.5-83.6%), compared to antenatal care (ANC) distribution at any ANC visit (22.5-49.1%) or late ANC visit (21.0-26.7%). Coverage rates were highest when CHWs and traditional birth attendants distributed misoprostol and lower when health workers/ANC providers distributed the medication. The highest distribution and coverage rates were achieved by programs that allowed self-administration. Seven women took misoprostol prior to delivery out of more than 12,000 women who were followed-up. Facility birth rates increased in the three programs for which this information was available. Fifty-one (51) maternal deaths were reported among 86,732 women taking misoprostol: 24 were attributed to perceived PPH; none were directly attributed to use of misoprostol. Even if all deaths were attributable to PPH, the equivalent ratio (59 maternal deaths/100,000 live births) is substantially lower than the reported maternal mortality ratio in any of these countries. Conclusions Community-based programs for prevention of PPH at home birth using misoprostol can achieve high distribution and use of the medication, using diverse program strategies. Coverage was greatest when misoprostol was distributed by community health agents at home visits. Programs appear to be safe, with an extremely low rate of ante- or intrapartum administration of the medication. PMID:23421792

Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date.

PubMed

Smith, Jeffrey Michael; Gubin, Rehana; Holston, Martine M; Fullerton, Judith; Prata, Ndola

2013-02-20

Hemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births. We conducted an integrative review of published research studies and evaluation reports from programs that distributed misoprostol at the community level for prevention of PPH at home births. We reviewed methods and cadres involved in education of end-users, drug administration, distribution, and coverage, correct and incorrect usage, and serious adverse events. Eighteen programs were identified; only seven reported all data of interest. Programs utilized a range of strategies and timings for distributing misoprostol. Distribution rates were higher when misoprostol was distributed at a home visit during late pregnancy (54.5-96.9%) or at birth (22.5-83.6%), compared to antenatal care (ANC) distribution at any ANC visit (22.5-49.1%) or late ANC visit (21.0-26.7%). Coverage rates were highest when CHWs and traditional birth attendants distributed misoprostol and lower when health workers/ANC providers distributed the medication. The highest distribution and coverage rates were achieved by programs that allowed self-administration. Seven women took misoprostol prior to delivery out of more than 12,000 women who were followed-up. Facility birth rates increased in the three programs for which this information was available. Fifty-one (51) maternal deaths were reported among 86,732 women taking misoprostol: 24 were attributed to perceived PPH; none were directly attributed to use of misoprostol. Even if all deaths were attributable to PPH, the equivalent ratio (59 maternal deaths/100,000 live births) is substantially lower than the reported maternal mortality ratio in any of these countries. Community-based programs for prevention of PPH at home birth using misoprostol can achieve high distribution and use of the medication, using diverse program strategies. Coverage was greatest when misoprostol was distributed by community health agents at home visits. Programs appear to be safe, with an extremely low rate of ante- or intrapartum administration of the medication.

Rate of preterm births in pregnant women with common lower genital tract infection: a population-based study based on the clinical practice.

PubMed

Bánhidy, Ferenc; Acs, Nándor; Puho, Erzsébet H; Czeizel, Andrew E

2009-05-01

To estimate the rate of preterm births in pregnant women with lower genital tract infection, i.e. vulvovaginitis-bacterial vaginosis and to check their prevention by drug treatments in the usual clinical practice. The rate of preterm birth of pregnant women with or without lower genital tract infection was evaluated in the population-based large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities. Only prospectively and medically recorded diagnoses of vulvovaginitis-bacterial vaginosis were evaluated. Of 38,151 newborn infants, 2698 (7.1%) had mothers with vulvovaginitis-bacterial vaginosis diagnosed in early pregnancy and the rate of preterm births was 7.5% among them, while this figure was 9.3% in babies born to mothers without these recognized genital infections. After early diagnosis and treatment of vulvovaginitis-bacterial vaginosis, clotrimazole and ampicillin seemed to be most effective to reduce the preterm birth during the study period. However, the rate of preterm births was lower in babies born to mothers without recorded vulvovaginitis-bacterial vaginosis but treated by clotrimazole and ampicillin (7.2-7.8%) as well. The lower rate of preterm births in babies born to mothers with vulvovaginitis-bacterial vaginosis may be explained by their effective treatment. However, the high rate of preterm births in pregnant women without genital tract infection and antimicrobial treatment may be connected with asymptomatic or unrecognized symptomatic and untreated vaginal infections.

The Korean Neonatal Network: An Overview

PubMed Central

Chang, Yun Sil; Park, Hyun-Young

2015-01-01

Currently, in the Republic of Korea, despite the very-low-birth rate, the birth rate and number of preterm infants are markedly increasing. Neonatal deaths and major complications mostly occur in premature infants, especially very-low-birth-weight infants (VLBWIs). VLBWIs weigh less than 1,500 g at birth and require intensive treatment in a neonatal intensive care unit (NICU). The operation of the Korean Neonatal Network (KNN) officially started on April 15, 2013, by the Korean Society of Neonatology with support from the Korea Centers for Disease Control and Prevention. The KNN is a national multicenter neonatal network based on a prospective web-based registry for VLBWIs. About 2,000 VLBWIs from 60 participating hospital NICUs are registered annually in the KNN. The KNN has built unique systems such as a web-based real-time data display on the web site and a site-visit monitoring system for data quality surveillance. The KNN should be maintained and developed further in order to generate appropriate, population-based, data-driven, health-care policies; facilitate active multicenter neonatal research, including quality improvement of neonatal care; and ultimately lead to improvement in the prognosis of high-risk newborns and subsequent reduction in health-care costs through the development of evidence-based neonatal medicine in Korea. PMID:26566355

The Korean Neonatal Network: An Overview.

PubMed

Chang, Yun Sil; Park, Hyun-Young; Park, Won Soon

2015-10-01

Currently, in the Republic of Korea, despite the very-low-birth rate, the birth rate and number of preterm infants are markedly increasing. Neonatal deaths and major complications mostly occur in premature infants, especially very-low-birth-weight infants (VLBWIs). VLBWIs weigh less than 1,500 g at birth and require intensive treatment in a neonatal intensive care unit (NICU). The operation of the Korean Neonatal Network (KNN) officially started on April 15, 2013, by the Korean Society of Neonatology with support from the Korea Centers for Disease Control and Prevention. The KNN is a national multicenter neonatal network based on a prospective web-based registry for VLBWIs. About 2,000 VLBWIs from 60 participating hospital NICUs are registered annually in the KNN. The KNN has built unique systems such as a web-based real-time data display on the web site and a site-visit monitoring system for data quality surveillance. The KNN should be maintained and developed further in order to generate appropriate, population-based, data-driven, health-care policies; facilitate active multicenter neonatal research, including quality improvement of neonatal care; and ultimately lead to improvement in the prognosis of high-risk newborns and subsequent reduction in health-care costs through the development of evidence-based neonatal medicine in Korea.

The inner state differences of preterm birth rates in Brazil: a time series study.

PubMed

de Oliveira, Rosana Rosseto; Melo, Emiliana Cristina; Fujimori, Elizabeth; Mathias, Thais Aidar de Freitas

2016-05-17

Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality. The prevalence of premature births has increased worldwide, with regional differences. The objective of this study was to analyze the trend of preterm births in the state of Paraná, Brazil, according to Macro-regional and Regional Health Offices (RHOs). This is an ecological time series study using preterm births records from the national live birth registry system of Brazil's National Health Service - Live Birth Information System (Sinasc), for residents of the state of Paraná, Brazil, between 2000 and 2013. The preterm birth rates was calculated on a yearly basis and grouped into three-year periods (2000-2002, 2003-2005, 2006-2008, 2009-2011) and one two-year period (2012-2013), according to gestational age and mother's Regional Health Office of residence. The polynomial regression model was used for trend analysis. The predominance of preterm birth rate increased from 6.8 % in 2000 to 10.5 % in 2013, with an average increase of 0.20 % per year (r(2) = 0.89), and a greater share of moderate preterm births (32 to <37 weeks), which increased from 5.8 % to 9 %. The same pattern was observed for all Macro-regional Health Offices, with highlight to the Northern Macro-Regional Office, which showed the highest average rate of prematurity and average annual growth during that period (7.55 % and 0.35 %, respectively). The trend analysis of preterm birth rates according to RHO showed a growing trend for almost all RHOs - except for the 7(th) RHO where a declining trend was observed (-0.95 a year); and in the 20(th), 21(st) and 22(nd) RHOs which remained unchanged. In the last three-year of the study period (2011-2013), no RHO showed preterm birth rates below 7.3 % or prevalence of moderate preterm birth below 9.4 %. The results show an increase in preterm births with differences among Macro-regional and RHOs, which indicate the need to improve actions during the prenatal period according to the specificities of each region.

Estimated Number of Preterm Births and Low Birth Weight Children Born in the United States Due to Maternal Binge Drinking

PubMed Central

Truong, Khoa D; Reifsnider, Odette S; Mayorga, Maria E; Spitler, Hugh

2013-01-01

Objective To estimate the aggregate burden of maternal binge drinking on preterm birth (PTB) and low birth weight (LBW) across American sociodemographic groups in 2008. Methods A simulation model was developed to estimate the number of PTB and LBW cases due to maternal binge drinking. Data inputs for the model included number of births and rates of preterm and LBW from the National Center for Health Statistics; female population by childbearing age groups from the U.S. Census; increased relative risks of preterm and LBW deliveries due to maternal binge drinking extracted from the literature; and adjusted prevalence of binge drinking among pregnant women estimated in a multivariate logistic regression model using Behavioral Risk Factor Surveillance System survey. Results The most conservative estimates attributed maternal binge drinking to 8,701 (95% CI: 7,804–9,598) PTBs (1.75% of all PTBs) and 5,627 (95% CI 5,121–6,133) LBW deliveries in 2008, with 3,708 (95% CI: 3,375–4,041) cases of both PTB and LBW. The estimated rate of PTB due to maternal binge drinking was 1.57% among all PTBs to White women, 0.69% among Black women, 3.31% among Hispanic women, and 2.35% among other races. Compared to other age groups, women ages 40–44 had the highest adjusted binge drinking rate and highest PTB rate due to maternal binge drinking (4.33%). Conclusion Maternal binge drinking contributed significantly to PTB and LBW differentially across sociodemographic groups. PMID:22711260

On incomplete sampling under birth-death models and connections to the sampling-based coalescent.

PubMed

Stadler, Tanja

2009-11-07

The constant rate birth-death process is used as a stochastic model for many biological systems, for example phylogenies or disease transmission. As the biological data are usually not fully available, it is crucial to understand the effect of incomplete sampling. In this paper, we analyze the constant rate birth-death process with incomplete sampling. We derive the density of the bifurcation events for trees on n leaves which evolved under this birth-death-sampling process. This density is used for calculating prior distributions in Bayesian inference programs and for efficiently simulating trees. We show that the birth-death-sampling process can be interpreted as a birth-death process with reduced rates and complete sampling. This shows that joint inference of birth rate, death rate and sampling probability is not possible. The birth-death-sampling process is compared to the sampling-based population genetics model, the coalescent. It is shown that despite many similarities between these two models, the distribution of bifurcation times remains different even in the case of very large population sizes. We illustrate these findings on an Hepatitis C virus dataset from Egypt. We show that the transmission times estimates are significantly different-the widely used Gamma statistic even changes its sign from negative to positive when switching from the coalescent to the birth-death process.

Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996-2010.

PubMed

Chen, Lu; Xiao, Lin; Auger, Nathalie; Torrie, Jill; McHugh, Nancy Gros-Louis; Zoungrana, Hamado; Luo, Zhong-Cheng

2015-01-01

Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to non-Aboriginal (6.9 and 4.1 per 1000, respectively) births (all p<0.001). Compared to non-Aboriginal births, preterm birth rates were persistently (1.7-1.8 times) higher in Inuit, large-for-gestational-age birth rates were persistently (2.7-3.0 times) higher in First Nations births over the study period. Between 1996-2000 and 2006-2010, as compared to non-Aboriginal infants, the relative risk disparities increased for infant mortality (from 4.10 to 5.19 times) in Inuit, and for postneonatal mortality in Inuit (from 6.97 to 12.33 times) or First Nations (from 3.76 to 4.25 times) infants. Adjusting for maternal characteristics (age, marital status, parity, education and rural vs. urban residence) attenuated the risk differences, but significantly elevated risks remained in both Inuit and First Nations births for the risks of perinatal mortality (1.70 and 1.28 times, respectively), infant mortality (3.66 and 1.47 times, respectively) and postneonatal mortality (6.01 and 2.28 times, respectively) in Inuit and First Nations infants (all p<0.001). Aboriginal vs. non-Aboriginal disparities in adverse birth outcomes, perinatal and infant mortality are persistent or worsening over the recent decade in Quebec, strongly suggesting the needs for interventions to improve perinatal and infant health in Aboriginal populations, and for monitoring the trends in other regions in Canada.

Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996–2010

PubMed Central

Chen, Lu; Xiao, Lin; Auger, Nathalie; Torrie, Jill; McHugh, Nancy Gros-Louis; Zoungrana, Hamado; Luo, Zhong-Cheng

2015-01-01

Background Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. Methods We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996–2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Results Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to non-Aboriginal (6.9 and 4.1 per 1000, respectively) births (all p<0.001). Compared to non-Aboriginal births, preterm birth rates were persistently (1.7–1.8 times) higher in Inuit, large-for-gestational-age birth rates were persistently (2.7–3.0 times) higher in First Nations births over the study period. Between 1996–2000 and 2006–2010, as compared to non-Aboriginal infants, the relative risk disparities increased for infant mortality (from 4.10 to 5.19 times) in Inuit, and for postneonatal mortality in Inuit (from 6.97 to 12.33 times) or First Nations (from 3.76 to 4.25 times) infants. Adjusting for maternal characteristics (age, marital status, parity, education and rural vs. urban residence) attenuated the risk differences, but significantly elevated risks remained in both Inuit and First Nations births for the risks of perinatal mortality (1.70 and 1.28 times, respectively), infant mortality (3.66 and 1.47 times, respectively) and postneonatal mortality (6.01 and 2.28 times, respectively) in Inuit and First Nations infants (all p<0.001). Conclusions Aboriginal vs. non-Aboriginal disparities in adverse birth outcomes, perinatal and infant mortality are persistent or worsening over the recent decade in Quebec, strongly suggesting the needs for interventions to improve perinatal and infant health in Aboriginal populations, and for monitoring the trends in other regions in Canada. PMID:26397838

Effects of parenting role and parent-child interaction on infant motor development in Taiwan Birth Cohort Study.

PubMed

Chiang, Yi-Chen; Lin, Dai-Chan; Lee, Chun-Yang; Lee, Meng-Chih

2015-04-01

Previous studies have rarely focused on healthy infants' motor development, and nationwide birth cohort studies in Taiwan are limited. It has been shown that parent-child interactions significantly influence infant motor development and the effect of mother-infant attachment on infant development is stronger than father-infant attachment. However, it is not well understood that whether the mother-infant or father-infant interaction has the confounding effect on infant motor development. To understand healthy infant motor development in Taiwan; and to investigate the effects of parenting roles and parent-child interactions on infant motor development. Data were derived from the 1st through the 2nd waves of the Taiwan Birth Cohort Study-Pilot Database. Infants were classified into two categories (complete or incomplete development) according to their developmental milestones. Generalized estimating equations (GEE) and random effects models were used to clarify the possible long-term effects. The rate of infants who completed development in 6 months was 30.50%; however the rate was increased in 18 month-old children (80.01%). A mother's perceived infant care competence was the most important factor for infant motor development. "Whether or not the infant was the only baby in the family" and "parent-child interaction" had slightly significant effect on infant motor development. In conclusion, the mother's perceived competence must be strengthened and parent-infant interactions should be emphasized on a daily basis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Births to Parents with Asian Origins in the United States, 1992-2012.

PubMed

Kim, Do Hyun; Jeon, Jihyun; Park, Chang Gi; Sriram, Sudhir; Lee, Kwang Sun

2016-12-01

Despite a remarkable increase in Asian births in the U.S., studies on their birth outcomes have been lacking. We investigated outcomes of births to Asian parents and biracial Asian/White parents in the U.S. From the U.S. birth data (1992-2012), we selected singleton births to Korean, Chinese, Japanese, Filipino, Asian Indian, and Vietnamese. These births were divided into three groups; births to White mother/Asian father, Asian mother/White father, and births to the both ethnic Asian parents. We compared birth outcomes of these 18 subgroups to those of the White mother/White father group. Mean birthweights of births to the Asian parents were significantly lower, ranging 18 g to 295 g less than to the White parents. Compared to the rates of low birthweight (LBW) (4.6%) and preterm birth (PTB) (8.5%) in births to the White parents, births to Filipino parents had the highest rates of LBW (8.0%) and PTB (11.3%), respectively, and births to Korean parents had the lowest rates of both LBW (3.7%) and PTB (5.5%). This pattern of outcomes had changed little with adjustments of maternal sociodemographic and health factors. This observation was similarly noted also in births to the biracial parents, but the impact of paternal or maternal race on birth outcome was different by race/ethnicity. Compared to births to White parents, birth outcomes from the Asian parents or biracial Asian/White parents differed depending on the ethnic origin of Asian parents. The race/ethnicity was the strongest factor for this difference while other parental characteristics hardly explained this difference.

In the linear quadratic model, the Poisson approximation and the Zaider-Minerbo formula agree on the ranking of tumor control probabilities, up to a critical cell birth rate.

PubMed

Ballhausen, Hendrik; Belka, Claus

2017-03-01

To provide a rule for the agreement or disagreement of the Poisson approximation (PA) and the Zaider-Minerbo formula (ZM) on the ranking of treatment alternatives in terms of tumor control probability (TCP) in the linear quadratic model. A general criterion involving a critical cell birth rate was formally derived. For demonstration, the criterion was applied to a distinct radiobiological model of fast growing head and neck tumors and a respective range of 22 conventional and nonconventional head and neck schedules. There is a critical cell birth rate b crit below which PA and ZM agree on which one out of two alternative treatment schemes with single-cell survival curves S'(t) and S''(t) offers better TCP: [Formula: see text] For cell birth rates b above this critical cell birth rate, PA and ZM disagree if and only if b >b crit > 0. In case of the exemplary head and neck schedules, out of 231 possible combinations, only 16 or 7% were found where PA and ZM disagreed. In all 231 cases the prediction of the criterion was numerically confirmed, and cell birth rates at crossovers between schedules matched the calculated critical cell birth rates. TCP estimated by PA and ZM almost never numerically coincide. Still, in many cases both formulas at least agree about which one out of two alternative fractionation schemes offers better TCP. In case of fast growing tumors featuring a high cell birth rate, however, ZM may suggest a re-evaluation of treatment options.

Maternal depression during pregnancy is associated with increased birth weight in term infants.

PubMed

Ecklund-Flores, Lisa; Myers, Michael M; Monk, Catherine; Perez, Albany; Odendaal, Hein J; Fifer, William P

2017-04-01

Previous research of maternal depression during pregnancy suggests an association with low birth weight in newborns. Review of these studies reveals predominant comorbidity with premature birth. This current study examines antenatal depression and birth weight in term, medically low-risk pregnancies. Maternal physiological and demographic measures were collected as well. In total, 227 pregnant women were recruited to participate in four experimental protocols at Columbia University Medical Center. Results indicate that depressed pregnant women who carry to term had significantly higher heart rates, lower heart rate variability, and gave birth to heavier babies than those of pregnant women who were not depressed. Low income participants had significantly higher levels of depression, as well as significantly higher heart rates and lower heart rate variability, than those in higher income groups. In full-term infants, maternal prenatal depression appears to promote higher birth weight, with elevated maternal heart rate as a likely mediating mechanism. © 2016 Wiley Periodicals, Inc.

ICSI does not increase the cumulative live birth rate in non-male factor infertility.

PubMed

Li, Z; Wang, A Y; Bowman, M; Hammarberg, K; Farquhar, C; Johnson, L; Safi, N; Sullivan, E A

2018-06-12

What is the cumulative live birth rate following ICSI cycles compared with IVF cycles for couples with non-male factor infertility? ICSI resulted in a similar cumulative live birth rate compared with IVF for couples with non-male factor infertility. The ICSI procedure was developed for couples with male factor infertility. There has been an increased use of ICSI regardless of the cause of infertility. Cycle-based statistics show that there is no difference in pregnancy rates between ICSI and IVF in couples with non-male factor infertility. However, evidence indicates that ICSI is associated with an increased risk of adverse perinatal outcomes. A population-based cohort of 14 693 women, who had their first ever stimulated cycle with fertilization performed for at least one oocyte by either IVF or ICSI between July 2009 and June 2014 in Victoria, Australia was evaluated retrospectively. The pregnancy and birth outcomes following IVF or ICSI were recorded for the first oocyte retrieval (fresh stimulated cycle and associated thaw cycles) until 30 June 2016, or until a live birth was achieved, or until all embryos from the first oocyte retrieval had been used. Demographic, treatment characteristics and resulting outcome data were obtained from the Victorian Assisted Reproductive Treatment Authority. Data items in the VARTA dataset were collected from all fertility clinics in Victoria. Women were grouped by whether they had undergone IVF or ICSI. The primary outcome was the cumulative live birth rate, which was defined as live deliveries (at least one live birth) per woman after the first oocyte retrieval. A discrete-time survival model was used to evaluate the cumulative live birth rate following IVF and ICSI. The adjustment was made for year of treatment in which fertilization occurred, the woman's and male partner's age at first stimulated cycle, parity and the number of oocytes retrieved in the first stimulated cycle. A total of 4993 women undergoing IVF and 8470 women undergoing ICSI had 7980 and 13 092 embryo transfers, resulting in 1848 and 3046 live deliveries, respectively. About one-fifth of the women (19.0% of the IVF group versus 17.9% of the ICSI group) had three or more cycles during the study period. For couples who achieved a live delivery, the median time from oocyte retrieval to live delivery was 8.9 months in both IVF (range: 4.2-66.5) and ICSI group (range: 4.5-71.3) (P = 0.474). Fertilization rate per oocyte retrieval was higher in the IVF than in the ICSI group (59.8 versus 56.2%, P < 0.001). The overall cumulative live birth rate was 37.0% for IVF and 36.0% for ICSI. The overall likelihood of a live birth for women undergoing ICSI was not significantly different to that for women undergoing IVF (adjusted hazard ratio (AHR): 0.99, 95% CI: 0.92-1.06). For couples with a known cause of infertility, non-male factor infertility (female factor only or unexplained infertility) was reported for 64.0% in the IVF group and 36.8% in the ICSI group (P < 0.001). Among couples with non-male factor infertility, ICSI resulted in a similar cumulative live birth rate compared with IVF (AHR: 0.96, 95% CI: 0.85-1.10). Data were not available on clinic-specific protocols and processes for IVF and ICSI and the potential impact of these technique aspects on clinical outcomes. The reported causes of infertility were based on the treating clinician's classification which may vary between clinicians. This population-based study found ICSI resulted in a lower fertilization rate per oocyte retrieved and a similar cumulative live birth rate compared to conventional IVF. These data suggest that ICSI offers no advantage over conventional IVF in terms of live birth rate for couples with non-male factor infertility. No specific funding was received to undertake this study. There is no conflict of interest, except that M.B. is a shareholder in Genea Ltd. N/A.

An International Comparison of Death Classification at 22 to 25 Weeks' Gestational Age.

PubMed

Smith, Lucy K; Morisaki, Naho; Morken, Nils-Halvdan; Gissler, Mika; Deb-Rinker, Paromita; Rouleau, Jocelyn; Hakansson, Stellan; Kramer, Michael R; Kramer, Michael S

2018-06-13

To explore international differences in the classification of births at extremely low gestation and the subsequent impact on the calculation of survival rates. We used national data on births at 22 to 25 weeks' gestation from the United States (2014; n = 11 144), Canada (2009-2014; n = 5668), the United Kingdom (2014-2015; n = 2992), Norway (2010-2014; n = 409), Finland (2010-2015; n = 348), Sweden (2011-2014; n = 489), and Japan (2014-2015; n = 2288) to compare neonatal survival rates using different denominators: all births, births alive at the onset of labor, live births, live births surviving to 1 hour, and live births surviving to 24 hours. For births at 22 weeks' gestation, neonatal survival rates for which we used live births as the denominator varied from 3.7% to 56.7% among the 7 countries. This variation decreased when the denominator was changed to include stillbirths (ie, all births [1.8%-22.3%] and fetuses alive at the onset of labor [3.7%-38.2%]) or exclude early deaths and limited to births surviving at least 12 hours (50.0%-77.8%). Similar trends were seen for infants born at 23 weeks' gestation. Variation diminished considerably at 24 and 25 weeks' gestation. International variation in neonatal survival rates at 22 to 23 weeks' gestation diminished considerably when including stillbirths in the denominator, revealing the variation arises in part from differences in the proportion of births reported as live births, which itself is closely connected to the provision of active care. Copyright © 2018 by the American Academy of Pediatrics.

Trends in Birth Rates: New York City 1970-1995.

ERIC Educational Resources Information Center

Finkel, Madelon L.; Elkin, Elena

2001-01-01

Examined teen birth rates in New York City health districts over 25 years, noting ethnic variations. Data from Department of Health vital statistics indicated that the decline in the birth rate among New York City teens was most significant in health districts populated predominantly by blacks. There were substantial decreases among older teens…

Anti-müllerian hormone levels are associated with live birth rates in ART, but the predictive ability of anti-müllerian hormone is modest.

PubMed

Alson, Sara S E; Bungum, Leif J; Giwercman, Aleksander; Henic, Emir

2018-06-01

The aim was to evaluate the association between serum Anti-Müllerian Hormone (AMH) level and cumulative live birth rates (LBR) in patients undergoing their first in vitro fertilization (IVF) treatment cycle, and to compare serum AMH levels with Antral Follicle Count (AFC) and Ovarian Sensitivity Index (OSI) as predictors of live birth. A prospective cohort study of 454 patients under the age of 40 and with a regular menstrual cycle of 21-35 days, undergoing their first IVF treatment cycles between September 2010 and June 2015. Participants were divided into three groups based on their AMH level, (AMH ≤10, AMH 10-<30 and AMH ≥30 pmol/l). Any difference in AMH-distribution between patients with or without live birth was analyzed using a Mann-Whitney-test, and live birth rates were compared between groups by a chi-squared test for linear trend. The ability of AMH, OSI and AFC as predictors of live birth was assessed by a receiver operating characteristics-analysis and the area under the curve (AUC) was calculated. Patients with live birth had a higher AMH, median (range) 26 [0-137] pmol/l, compared with patients without live birth, AMH 22 [0-154] pmol/l, p = 0.035. Mean live birth rate (SD) was 0.36 (0.48) in the total cohort, 0.26 (0.44) in AMH-group <10, 0.34 (0.48) in AMH-group 10-<30, and 0.41(0.49) in AMH-group ≥30. Thus live birth rates increased with 8% per AMH-group (95% CI: 0.02 -0.14, p = 0.015). The AUC for AFC was 0.56, for AMH 0.57 and for OSI 0.63, respectively. AMH concentration in serum is associated with live birth rates after IVF. Our results suggest that both AMH, AFC and OSI have an equal but modest predictive ability in relation to live birth rate. Copyright © 2018 Elsevier B.V. All rights reserved.

Birth outcomes in Colorado's undocumented immigrant population.

PubMed

Reed, Mary M; Westfall, John M; Bublitz, Caroline; Battaglia, Catherine; Fickenscher, Alexandra

2005-10-04

The birth outcomes of undocumented women have not been systematically studied on a large scale. The growing number of undocumented women giving birth in the United States has important implications for clinical care and public health policy. The objective of this study was to describe birth outcomes of undocumented immigrants in Colorado. Retrospective descriptive study of singleton births to 5961 undocumented women using birth certificate data for 1998-1999. Undocumented mothers were younger, less educated, and more likely to be single. They had higher rates of anemia, were less likely to gain enough weight, and less likely to receive early prenatal care. They were much less likely to use alcohol or tobacco. Undocumented women had a lower rate of low birth weight (5.3% v 6.5%, P < .001) or preterm infants (12.9% v 14.5%; p = .001). Undocumented women experienced higher rates of labor complications including excessive bleeding (2.3% v 0.8%, p < .001) and fetal distress (8.7% v 3.6%, p < .001). Undocumented women have lower rates of preterm delivery and low birth weight infants, but higher rates of pregnancy related risk factors. Higher prevalence of some risk factors which are amenable to medical intervention reveals the need for improved prenatal care in this group.

Teen Birth Rate. Facts at a Glance.

ERIC Educational Resources Information Center

Moore, Kristin A., Comp.; Snyder, Nancy O., Comp.

Between 1986 and 1991 the teen birth rate rose by nearly one-fourth, although very small declines were evident in 1992 and 1993. This decline was concentrated among older teens; the number of births to adolescents aged 17 and younger continued to rise. The percentage of teen births that occurred outside of marriage rose to 72%. In 1991, the most…

[Birth rates evolution in Spain. Birth trends in Spain from 1941 to 2010].

PubMed

Andrés de Llano, J M; Alberola López, S; Garmendia Leiza, J R; Quiñones Rubio, C; Cancho Candela, R; Ramalle-Gómara, E

2015-01-01

The aim of this study was to analyse trends of births in Spain and its Autonomous Communities (CCAA) over a 70 year period (1941-2010). The crude birth rates per 1,000 inhabitants/year were calculated by CCAA using Joinpoint regression models. Change points in trend and annual percentage of change (APC) were identified. The distribution of 38,160,305 births between 1941 and 2010 shows important changes in trends both nationally and among the CCAA. There is a general pattern for the whole country, with 5 turning points being identified with changes in trend and annual percentage change (APC). Differences are also found among regions. The analysis of trends in birth rates and the annual rates of change should enable public health authorities to properly plan pediatric care resources in our country. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Born a bit too early: recent trends in late preterm births.

PubMed

Martin, Joyce A; Kirmeyer, Sharon; Osterman, Michelle; Shepherd, Ruth A

2009-11-01

The U.S. late preterm birth rate rose 20% from 1990 to 2006. If the late preterm rate had not risen from the 1990 level, more than 50,000 fewer infants would have been delivered late preterm in 2006. On average, more than 900 late preterm babies are born every day in the United States, or a total of one-third of 1 million infants (333,461). Increases in late preterm births are seen for mothers of all ages, and for non-Hispanic white and Hispanic mothers. The rate for black mothers declined during the 1990s, but has been on the rise since 2000. Late preterm birth rates rose for all U.S. states, but declined in the District of Columbia. The percentage of late preterm births for which labor was induced more than doubled from 1990 to 2006; the percentage of late preterm births delivered by cesarean also rose markedly.

What Works for Adolescent Reproductive Health: Lessons from Experimental Evaluations of Programs and Interventions. Fact Sheet. Publication #2008-20

ERIC Educational Resources Information Center

Ball, Victoria; Moore, Kristin A.

2008-01-01

The reproductive health of American adolescents has been, and continues to be, a matter of serious concern. America's teen birth rate--already the highest among developed nations--is again on the rise, and rates of sexually transmitted diseases among American teens are very high. As such, the development and identification of effective…

Health policies for the reduction of obstetric interventions in singleton full-term births in Catalonia.

PubMed

Pueyo, Maria-Jesus; Escuriet, Ramon; Pérez-Botella, M; de Molina, I; Ruíz-Berdun, D; Albert, S; Díaz, S; Torres-Capcha, P; Ortún, V

2018-04-01

To explore the effect of hospital's characteristics in the proportion of obstetric interventions (OI) performed in singleton fullterm births (SFTB) in Catalonia (2010-2014), while incentives were employed to reduce C-sections. Data about SFTB assisted at 42 public hospitals were extracted from the dataset of hospital discharges. Hospitals were classified according to the level of complexity, the volume of births attended, and the adoption of a non-medicalized delivery (NMD) strategy. The annual average change in the percentage for OI was calculated based on Poisson regression models. The rate of OI (35% of all SFTB) including C-sections (20.6%) remained stable through the period. Hospitals attending less complex cases had a lower average of OI, while hospitals attending lower volumes had the highest average. Higher levels of complexity increased the use of C-sections (+4% yearly) and forceps (+16%). The adoption of the NMD strategy decreased the rate of C-sections. The proportion of OI, including C-sections, remained stable in spite of public incentives to reduce them. The adoption of the NMD strategy could help in decreasing the rate of OI. To reduce the OI rate, new strategies should be launched as the development of low-risk pregnancies units, alignment of incentives and hospital payment, increased value of incentives and encouragement of a cultural shift towards non-medicalized births. Copyright © 2018 Elsevier B.V. All rights reserved.

Thin endometrium in donor oocyte recipients: enigma or obstacle for implantation?

PubMed

Dain, Lena; Bider, David; Levron, Jacob; Zinchenko, Viktor; Westler, Sharon; Dirnfeld, Martha

2013-11-01

To evaluate the combined effect of endometrial thickness and anatomic uterine factors on clinical outcome in oocyte donation recipients. Retrospective analysis of oocyte donation cycles conducted between 2005 and 2010. Two private IVF centers. A total of 737 donor oocyte cycles. None. Clinical pregnancy and live birth rates. No statistically significant difference was found in clinical pregnancy rates and live birth rates in cycles with endometrial thickness <6 mm compared with those with endometrial thickness >10 mm. However, a relatively high rate of live births was found within a medium range of endometrial thickness (8.2-10 mm). All intrauterine adhesion cases occurred in cycles with thinner endometrium. No statistically significant difference was found in clinical pregnancy rates and live birth rates in cycles with endometrial thickness <6 mm compared with those with thickness >6 mm. A relatively high rate of live births was found within a medium range of endometrial thickness (9.1-10 mm). Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Reducing Latin America’s Bumper Crop: Babies.

DTIC Science & Technology

birth control measures. Data was gathered using a literature search which relied heavily on periodicals and materials written as a result of on site research in Latin America by the American Universities Field Staff. The high birth rate in Latin America is caused primarily either by the prohibitions of the Catholic Church against artifical contraceptive methods nor by cultural attitudes towards large families. High birth rates are caused primarily by poverty, illiteracy, and underdevelopment. Where socioechnomic conditions have improved in Latin America birth rates have

Occupation Time Laws for Birth and Death Processes

DTIC Science & Technology

1960-07-30

given consists of the birth and death rates X,, ji,,. We present a theory in which the hypotheses (3), (4), and (6) are derived from knowledge of the...asymptotic behavior of the birth and death rates X.,A. as n -- oo. Both the methods and the results can be extended to general diffusion processes and...Linear growth. Let (110) Xn = it + a, n> 0, An = n+ b, nn> 1,jio=O. This describes a model of biological growth where the birth and death rates are

Born too soon: care before and between pregnancy to prevent preterm births: from evidence to action.

PubMed

Dean, Sohni V; Mason, Elizabeth; Howson, Christopher P; Lassi, Zohra S; Imam, Ayesha M; Bhutta, Zulfiqar A

2013-01-01

Providing care to adolescent girls and women before and between pregnancies improves their own health and wellbeing, as well as pregnancy and newborn outcomes, and can also reduce the rates of preterm birth. This paper has reviewed the evidence-based interventions and services for preventing preterm births, reported the findings from research priority exercise, and prescribed actions for taking this call further. Certain factors in the preconception period have been shown to increase the risk for prematurity and, therefore, preconception care services for all women of reproductive age should address these risk factors through preventing adolescent pregnancy, preventing unintended pregnancies, promoting optimal birth spacing, optimizing pre-pregnancy weight and nutritional status (including a folic acid-containing multivitamin supplement) and ensuring that all adolescent girls have received complete vaccination. Preconception care must also address risk factors that may be applicable to only some women. These include screening for and management of chronic diseases, especially diabetes; sexually-transmitted infections; tobacco and smoke exposure; mental health disorders, notably depression; and intimate partner violence. The approach to research in preconception care to prevent preterm births should include a cycle of development and delivery research that evaluates how best to scale up coverage of existing evidence-based interventions, epidemiologic research that assesses the impact of implementing these interventions and discovery science that better elucidates the complex causal pathway of preterm birth and helps to develop new screening and intervention tools. In addition to research, policy and financial investment is crucial to increasing opportunities to implement preconception care, and rates of prematurity should be included as a tracking indicator in global and national maternal child health assessments.

Neonatal Outcomes in the Birth Center Setting: A Systematic Review.

PubMed

Phillippi, Julia C; Danhausen, Kathleen; Alliman, Jill; Phillippi, R David

2018-01-01

This systematic review investigates the effect of the birth center setting on neonatal mortality in economically developed countries to aid women and clinicians in decision making. We searched the Google Scholar, CINAHL, and PubMed databases using key terms birth/birthing center or out of hospital with perinatal/neonatal outcomes. Ancestry searches identified additional studies, and an alert was set for new publications. We included primary source studies in English, published after 1980, conducted in a developed country, and researching planned birth in centers with guidelines similar to American Association of Birth Centers standards. After initial review, we conducted a preliminary analysis, assessing which measures of neonatal health, morbidity, and mortality were included across studies. Neonatal mortality was selected as the sole summary measure as other measures were sporadically reported or inconsistently defined. Seventeen studies were included, representing at least 84,500 women admitted to a birth center in labor. There were substantial differences of study design, sampling techniques, and definitions of neonatal outcomes across studies, limiting conclusive statements of the effect of intrapartum care in a birth center. No reviewed study found a statistically increased rate of neonatal mortality in birth centers compared to low-risk women giving birth in hospitals, nor did data suggest a trend toward higher neonatal mortality in birth centers. As in all birth settings, nulliparous women, women aged greater than 35 years, and women with pregnancies of more than 42 weeks' gestation may have an increased risk of neonatal mortality. There are substantial flaws in the literature concerning the effect of birth center care on neonatal outcomes. More research is needed on subgroups at risk of poor outcomes in the birth center environment. To expedite research, consistent use of national and international definitions of perinatal and neonatal mortality within data registries and greater detail on adverse outcomes would be beneficial. © 2018 by the American College of Nurse-Midwives.

The impact of changes in preterm birth among twins on stillbirth and infant mortality in the United States.

PubMed

Getahun, D; Demissie, K; Marcella, S W; Rhoads, G G

2014-11-01

To examine trends for preterm births, stillbirths, neonatal and infant deaths in twin births by gestational age and birth weight categories, as well as trends in induction of labor and cesarean delivery during 1995-2006. A trend analysis was performed on data derived from the National Centers for Health Statistics' Vital Statistics Data files (1995-2006). The primary outcomes examined were preterm birth, stillbirth, neonatal and infant mortality. During the study period, rates of labor induction among twins decreased by 8% and rates of cesarean delivery increased by 35%. Concurrently, the preterm birth rate increased by 13% from 54% in 1995-96 to 61% in 2005-06. The overall stillbirth rate, and neonatal and infant death rates decreased during the same period by 21% (95% confidence interval (CI): 18-25%), 13% (95% CI: 9-16%) and 12% (95% CI: 8-15%), respectively. There were significant reductions in neonatal death rates related to respiratory distress syndrome (RDS; 48%, 95% CI: 41-54%) and congenital anomalies (25%, 95% CI: 16-33%) during the study period. Reductions in post-neonatal infant mortality were mainly in RDS (88%) and sudden infant death syndrome (26%). Mortality rates among infants born by either induction of labor or cesarean delivery fell during the study period and remained much lower than the overall infant mortality rate. The findings of this study suggest that during 1995-2006 there was an increase in preterm birth rates and a decrease in labor inductions with a sharp decline in stillbirth, neonatal and infant mortality rates.

Recent changes in the trends of teen birth rates, 1981-2006.

PubMed

Wingo, Phyllis A; Smith, Ruben A; Tevendale, Heather D; Ferré, Cynthia

2011-03-01

To explore trends in teen birth rates by selected demographics. We used birth certificate data and joinpoint regression to examine trends in teen birth rates by age (10-14, 15-17, and 18-19 years) and race during 1981-2006 and by age and Hispanic origin during 1990-2006. Joinpoint analysis describes changing trends over successive segments of time and uses annual percentage change (APC) to express the amount of increase or decrease within each segment. For teens younger than 18 years, the decline in birth rates began in 1994 and ended in 2003 (APC: -8.03% per year for ages 10-14 years; APC: -5.63% per year for ages 15-17 years). The downward trend for 18- and 19-year-old teens began earlier (1991) and ended 1 year later (2004) (APC: -2.37% per year). For each study population, the trend was approximately level during the most recent time segment, except for continuing declines for 18- and 19-year-old white and Asian/Pacific Islander teens. The only increasing trend in the most recent time segment was for 18- and 19-year-old Hispanic teens. During these declines, the age distribution of teens who gave birth shifted to slightly older ages, and the percentage whose current birth was at least their second birth decreased. Teen birth rates were generally level during 2003/2004-2006 after the long-term declines. Rates increased among older Hispanic teens. These results indicate a need for renewed attention to effective teen pregnancy prevention programs in specific populations. Copyright © 2011. Published by Elsevier Inc.

Association between vaginal birth after cesarean delivery and primary cesarean delivery rates.

PubMed

Rosenstein, Melissa G; Kuppermann, Miriam; Gregorich, Steven E; Cottrell, Erika K; Caughey, Aaron B; Cheng, Yvonne W

2013-11-01

To estimate the association between vaginal birth after cesarean delivery (VBAC) rates and primary cesarean delivery rates in California hospitals. Hospital VBAC rates were calculated using birth certificate and discharge data from 2009, and hospitals were categorized by quartile of VBAC rate. Multivariable logistic regression analysis was performed to estimate the odds of cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation (nulliparous term singleton vertex) by hospital VBAC quartile while controlling for many patient-level and hospital-level confounders. There were 468,789 term singleton births in California in 2009 at 255 hospitals, 125,471 of which were low-risk nulliparous term singleton vertex. Vaginal birth after cesarean delivery rates varied between hospitals, with a range of 0-44.6%. Rates of cesarean delivery among low-risk nulliparous term singleton vertex women declined significantly with increasing VBAC rate. When adjusted for maternal and hospital characteristics, low-risk nulliparous term singleton vertex women who gave birth in hospitals in the highest VBAC quartile had an odds ratio of 0.55 (95% confidence interval 0.46-0.66) of cesarean delivery compared with women at hospitals with the lowest VBAC rates. Each percentage point increase in a hospital's VBAC rate was associated with a 0.65% decrease in the low-risk nulliparous term singleton vertex cesarean delivery rate. Hospitals with higher rates of VBAC have lower rates of primary cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation. II.

The Australian baby bonus maternity payment and birth characteristics in Western Australia.

PubMed

Einarsdóttir, Kristjana; Langridge, Amanda; Hammond, Geoffrey; Gunnell, Anthony S; Haggar, Fatima A; Stanley, Fiona J

2012-01-01

The Australian baby bonus maternity payment introduced in 2004 has been reported to have successfully increased fertility rates in Australia. We aimed to investigate the influence of the baby bonus on maternal demographics and birth characteristics in Western Australia (WA). This study included 200,659 birth admissions from WA during 2001-2008, identified from administrative birth and hospital data-systems held by the WA Department of Health. We estimated average quarterly birth rates after the baby bonus introduction and compared them with expected rates had the policy not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately by maternal demographics and birth characteristics. WA birth rates increased by 12.8% following the baby bonus implementation with the greatest increase being in mothers aged 20-24 years (26.3%, 95%CI = 22.0,30.6), mothers having their third (1.6%, 95%CI = 0.9,2.4) or fourth child (2.2%, 95%CI = 2.1,2.4), mothers living in outer regional and remote areas (32.4%, 95%CI = 30.2,34.6), mothers giving birth as public patients (1.5%, 95%CI = 1.3,1.8), and mothers giving birth in public hospitals (3.5%, 95%CI = 2.6,4.5). Interestingly, births to private patients (-4.3%, 95%CI = -4.8,-3.7) and births in private hospitals (-6.3%, 95%CI = -6.8,-5.8) decreased following the policy implementation. The introduction of the baby bonus maternity payment may have served as an incentive for women in their early twenties and mothers having their third or fourth child and may have contributed to the ongoing pressure and staff shortages in Australian public hospitals, particularly those in outer regional and remote areas.

A Binational Overview of Reproductive Health Outcomes Among US Hispanic and Mexican Women in the Border Region

PubMed Central

Mojarro, Octavio; Sutton, Paul D.; Ventura, Stephanie J.

2013-01-01

Introduction The US–Mexico border region has 15 million residents and 300,000 births annually. Reproductive health concerns have been identified on both sides of the border, but comparable information about reproductive health is not available. The objective of this study was to compare reproductive health indicators among populations in this region. Methods We used 2009 US Hispanic and Mexican birth certificate data to compare births inside the border region, elsewhere within the border states, and in the United States and Mexico overall. We examined trends in total fertility and birth rates using birth data from 2000 through 2009 and intercensal population estimates. Results Among women in the border region, US women had more lifetime births than Mexican women in 2009 (2.69 births vs 2.15 births) and throughout the decade. Birth rates in the group aged 15 to 19 years were high in both the US (73.8/1,000) and Mexican (86.7/1,000) border regions. Late or no prenatal care was nearly twice as prevalent in the border regions as in the nonborder regions of border states. Low birth weight and preterm and early-term birth were more prevalent in the US border than in the Mexican border region; US border rates were higher and Mexican rates were lower than their corresponding nonborder and national rates. We found some variations within border states. Conclusion These findings constitute the first population-based information on the reproductive health of the entire Hispanic US–Mexico border population. Evidence of disparities warrants exploration at state and local levels. Teen pregnancy and inadequate prenatal care are shared problems in US–Mexico border communities and suggest an area for binational cooperation. PMID:23948338

A binational overview of reproductive health outcomes among US Hispanic and Mexican women in the border region.

PubMed

McDonald, Jill A; Mojarro, Octavio; Sutton, Paul D; Ventura, Stephanie J

2013-08-15

The US-Mexico border region has 15 million residents and 300,000 births annually. Reproductive health concerns have been identified on both sides of the border, but comparable information about reproductive health is not available. The objective of this study was to compare reproductive health indicators among populations in this region. We used 2009 US Hispanic and Mexican birth certificate data to compare births inside the border region, elsewhere within the border states, and in the United States and Mexico overall. We examined trends in total fertility and birth rates using birth data from 2000 through 2009 and intercensal population estimates. Among women in the border region, US women had more lifetime births than Mexican women in 2009 (2.69 births vs 2.15 births) and throughout the decade. Birth rates in the group aged 15 to 19 years were high in both the US (73.8/1,000) and Mexican (86.7/1,000) border regions. Late or no prenatal care was nearly twice as prevalent in the border regions as in the nonborder regions of border states. Low birth weight and preterm and early-term birth were more prevalent in the US border than in the Mexican border region; US border rates were higher and Mexican rates were lower than their corresponding nonborder and national rates. We found some variations within border states. These findings constitute the first population-based information on the reproductive health of the entire Hispanic US-Mexico border population. Evidence of disparities warrants exploration at state and local levels. Teen pregnancy and inadequate prenatal care are shared problems in US-Mexico border communities and suggest an area for binational cooperation.

Cumulative teen birth rates among girls in foster care at age 17: an analysis of linked birth and child protection records from California.

PubMed

Putnam-Hornstein, Emily; King, Bryn

2014-04-01

This study used linked foster care and birth records to provide a longitudinal, population-level examination of the incidence of first and repeat births among girls who were in foster care at age 17. Girls in a foster care placement in California at the age of 17 between 2003 and 2007 were identified from statewide child protection records. These records were probabilistically matched to vital birth records spanning the period from 2001 to 2010. Linked data were used to estimate the cumulative percentage of girls who had given birth before age 20. Birth rates and unadjusted risk ratios were generated to characterize foster care experiences correlated with heightened teen birth rates. Between 2003 and 2007 in California, there were 20,222 girls in foster care at age 17. Overall, 11.4% had a first birth before age 18. The cumulative percentage who gave birth before age 20 was 28.1%. Among girls who had a first birth before age 18, 41.2% had a repeat teen birth. Significant variations by race/ethnicity and placement-related characteristics emerged. Expanded data and rigorous research are needed to evaluate prevention efforts and ensure parenting teens are provided with the needed services and supports. Copyright © 2013 Elsevier Ltd. All rights reserved.

Living in stressful neighbourhoods during pregnancy: an observational study of crime rates and birth outcomes

PubMed Central

Clemens, Tom

2017-01-01

Abstract Background: Patterns of adverse birth outcomes vary spatially and there is evidence that this may relate to features of the physical environment such as air pollution. However, other social characteristics of the environment such as levels of crime are relatively understudied. This study examines the association between crime rates and birth weight and prematurity. Methods: Maternity inpatient data recorded at birth, including residential postcode, was linked to a representative 5% sample of Scottish Census data and small area crime rates from Scottish Police forces. Coefficients associated with crime were reported from crude and confounder adjusted models predicting low birth weight (< 2500 g), mean birthweight, small for gestational age and prematurity for all singleton live births. Results: Total crime rates were associated with strong and significant reductions in mean birth weight and increases in the risks of both a small for gestational age baby and premature birth. These effects, with the exception of prematurity, were robust to adjustment for individual characteristics including smoking, ethnicity and other socio-economic variables as well as area based confounders including air pollution. Mean birth weight was robust to additional adjustment for neighbourhood income deprivation. Conclusion: The level of crime in a mother’s area of residence, which may be a proxy for the degree of threat felt and therefore stress experienced, appears to be an important determinant of the risk of adverse birth outcomes. PMID:27578830

QuickStats: Birth Rates Among Teens Aged 15-19 Years, by Race/Hispanic Ethnicity* - National Vital Statistics System, United States,(†) 2007 and 2015(§).

PubMed

2016-08-19

From 2007 to 2015, the birth rate for female teens aged 15-19 years declined 46%, from 41.5 to 22.3 births per 1,000, the lowest rate ever recorded for this population in the United States. In 2015, rates declined to record lows for all racial/ethnic populations, with declines ranging from 41% for non-Hispanic white teens to 54% for Hispanic teens. Despite the declines, teen birth rates by race/Hispanic ethnicity continued to reflect wide disparities, with rates ranging from 6.9 per 1,000 for Asian or Pacific Islander teens to 34.9 for Hispanic teens in 2015.

A midwifery-led in-hospital birth center within an academic medical center: successes and challenges.

PubMed

Perdion, Karen; Lesser, Rebecca; Hirsch, Jennifer; Barger, Mary; Kelly, Thomas F; Moore, Thomas R; Lacoursiere, D Yvette

2013-01-01

The University of California San Diego Community Women's Health Program (CWHP) has emerged as a successful and sustainable coexistence model of women's healthcare. The cornerstone of this midwifery practice is California's only in-hospital birth center. Located within the medical center, this unique and physically separate birth center has been the site for more than 4000 births. With 10% cesarean delivery and 98% breast-feeding rates, it is an exceptional example of low-intervention care. Integrating this previously freestanding birth center into an academic center has brought trials of mistrust and ineffectual communication. Education, consistent leadership, and development of multidisciplinary guidelines aided in overcoming these challenges. This collaborative model provides a structure in which residents learn to be respectful consultants and appreciate differences in medical practice. The CWHP and its Birth Center illustrates that through persistence and flexibility a collaborative model of maternity services can flourish and not only positively influence new families but also future generations of providers.

Trends in Dementia Incidence in a Birth Cohort Analysis of the Einstein Aging Study.

PubMed

Derby, Carol A; Katz, Mindy J; Lipton, Richard B; Hall, Charles B

2017-11-01

Trends in dementia incidence rates have important implications for planning and prevention. To better understand incidence trends over time requires separation of age and cohort effects, and few prior studies have used this approach. To examine trends in dementia incidence and concomitant trends in cardiovascular comorbidities among individuals aged 70 years or older who were enrolled in the Einstein Aging Study between 1993 and 2015. In this birth cohort analysis of all-cause dementia incidence in persons enrolled in the Einstein Aging Study from October 20, 1993, through November 17, 2015, a systematically recruited, population-based sample of 1348 participants from Bronx County, New York, who were 70 years or older without dementia at enrollment and at least one annual follow-up was studied. Poisson regression was used to model dementia incidence as a function of age, sex, educational level, race, and birth cohort, with profile likelihood used to identify the timing of significant increases or decreases in incidence. Birth year and age. Incident dementia defined by consensus case conference based on annual, standardized neuropsychological and neurologic examination findings, using criteria from the DSM-IV. Among 1348 individuals (mean [SD] baseline age, 78.5 [5.4] years; 830 [61.6%] female; 915 [67.9%] non-Hispanic white), 150 incident dementia cases developed during 5932 person-years (mean [SD] follow-up, 4.4 [3.4] years). Dementia incidence decreased in successive birth cohorts. Incidence per 100 person-years was 5.09 in birth cohorts before 1920, 3.11 in the 1920 through 1924 birth cohorts, 1.73 in the 1925 through 1929 birth cohorts, and 0.23 in cohorts born after 1929. Change point analyses identified a significant decrease in dementia incidence among those born after July 1929 (95% CI, June 1929 to January 1930). The relative rate for birth cohorts before July 1929 vs after was 0.13 (95% CI, 0.04-0.41). Prevalence of stroke and myocardial infarction decreased across successive birth cohorts, whereas diabetes prevalence increased. Adjustment for these cardiovascular comorbidities did not explain the decreased dementia incidence rates for more recent birth cohorts. Analyses confirm decreasing dementia incidence in this population-based sample. Whether decreasing incidence will contribute to reduced burden of dementia given the aging of the population is not known.

Immediate Outcome of Hypoxic Ischaemic Encephalopathy in Hypoxiate Newborns in Nepal Medical College.

PubMed

Shrestha, S; Shrestha, G S; Sharma, A

2016-05-01

Birth asphyxia is the fifth major cause of under-five child deaths after pneumonia, diarrhoea, neonatal infections and complications of preterm birth. It is one of the important causes of neonatal mortality and morbidity accounting up to 30% of neonatal death in Nepal. It is also an important cause of long-term neurological disability and impairment. The mortality rate due to birth asphyxia is considered a good guide to the quality of perinatal care. This study was conducted to assess the rate of birth asphyxia, risk factors and outcome of the babies who were asphyxiated at birth. A prospective study was conducted during the period of one year from April 2013 to March 2014 in Nepal Medical College. All the term babies born during the period with APGAR score at 5 minutes of < 7 were considered to have birth asphyxia and included in the study. Details of maternal risk factors during pregnancy and labor were analyzed. The newborn babies were assessed for clinical features of hypoxic ischemic encephalopathy (HIE) and its immediate outcome. Out of 2226 live births, 47 (15.9%) newborns had birth asphyxia with the rate of 21.1/1000 live births. The mortality rate due to birth asphyxia was 4.25%. Meconium stained liquor was present in 31(65.96%) cases during delivery and prolonged rupture of membrane in 7(14.89%). Early identification and close monitoring of high-risk mothers with maintaining partograph during labor help to reduce birth asphyxia.

Renal dysfunction in early adulthood following birth asphyxia in male spiny mice, and its amelioration by maternal creatine supplementation during pregnancy.

PubMed

Ellery, Stacey J; LaRosa, Domenic A; Cullen-McEwen, Luise A; Brown, Russell D; Snow, Rod J; Walker, David W; Kett, Michelle M; Dickinson, Hayley

2017-04-01

Acute kidney injury affects ~70% of asphyxiated newborns, and increases their risk of developing chronic kidney disease later in life. Acute kidney injury is driven by renal oxygen deprivation during asphyxia, thus we hypothesized that creatine administered antenatally would protect the kidney from the long-term effects of birth asphyxia. Pregnant spiny mice were fed standard chow or chow supplemented with 5% creatine from 20-d gestation (midgestation). One day prior to term (37-d gestation), pups were delivered by caesarean or subjected to intrauterine asphyxia. Litters were allocated to one of two time-points. Kidneys were collected at 1 mo of age to estimate nephron number (stereology). Renal function (excretory profile and glomerular filtration rate) was measured at 3 mo of age, and kidneys then collected for assessment of glomerulosclerosis. Compared with controls, at 1 mo of age male (but not female) birth-asphyxia offspring had 20% fewer nephrons (P < 0.05). At 3 mo of age male birth-asphyxia offspring had 31% lower glomerular filtration rate (P < 0.05) and greater glomerular collagen IV content (P < 0.01). Antenatal creatine prevented these renal injuries arising from birth asphyxia. Maternal creatine supplementation during pregnancy may be an effective prophylactic to prevent birth asphyxia induced acute kidney injury and the emergence of chronic kidney disease.

"Terrain Paper" on Demography and Higher Education.

ERIC Educational Resources Information Center

Hodgkinson, Harold L.

Major demographic trends and consequences for higher education are examined. The Baby Boom sharply increased birth rates from 1946 to 1964 and was followed by a decline in births that lasted from 1964 to 1978. Currently there is an increased birth rate, but of much smaller size than the Baby Boom rates, due largely to the smaller size of the…

Kids Count Alaska Data Book: 1996.

ERIC Educational Resources Information Center

Alaska Univ., Anchorage. Inst. of Social and Economic Research.

This statistical report examines findings on 15 indicators of children's well-being in Alaska: (1) percent of births with low birth weight; (2) infant mortality rate; (3) child poverty rate; (4) children in single parent families; (5) births to teenagers age 15 to 17; (6) teen (age 16 to 19) high school dropout rate; (7) teens not in school and…

HEALTH STATUS OF EXTREMELY LOW BIRTH WEIGHT CHILDREN AT AGE 8 YEARS: CHILD AND PARENT PERSPECTIVE

PubMed Central

Hack, Maureen; Forrest, Christopher B; Schluchter, Mark; Taylor, H. Gerry; Drotar, Dennis; Holmbeck, Grayson; Andreias, Laura

2013-01-01

Context Parental proxy reports have indicated poorer health for preterm children as compared to normal birth weight controls. The perspective of their children may however differ. Objective To compare the self reported health of preterm children to normal birth weight controls and the children’s perspective to that of their parents. Design Study of extremely low birth weight (<1kg) and normal birth weight children and their parents conducted 2006–2009. Setting Children’s hospital. Participants Eight year old extremely low birth weight (n=202) and normal birth weight (n=176) children of similar sociodemographic status. Main Outcome Measures The Child Health and Illness Profile child and parent reports. Results There was poor agreement between the parent and child ratings of health for both the extremely low birth weight and normal birth weight cohorts. Extremely low birth weight children rated their health similar to normal birth weight children. In contrast parents of extremely low birth weight children reported significantly poorer health for their children than parents of normal birth weight controls including poorer Satisfaction with health, Comfort and Achievement and less Risk avoidance. Conclusion There is poor agreement between child and parent reports of health. Eight year old extremely low birth weight children rate their health similar to that of normal birth weight controls. Their parents however report significantly poorer health. Both child and parent perspective needs to be considered when making health care decisions. PMID:21969395

Births to Parents with Asian Origins in the United States, 1992–2012

PubMed Central

2016-01-01

Despite a remarkable increase in Asian births in the U.S., studies on their birth outcomes have been lacking. We investigated outcomes of births to Asian parents and biracial Asian/White parents in the U.S. From the U.S. birth data (1992–2012), we selected singleton births to Korean, Chinese, Japanese, Filipino, Asian Indian, and Vietnamese. These births were divided into three groups; births to White mother/Asian father, Asian mother/White father, and births to the both ethnic Asian parents. We compared birth outcomes of these 18 subgroups to those of the White mother/White father group. Mean birthweights of births to the Asian parents were significantly lower, ranging 18 g to 295 g less than to the White parents. Compared to the rates of low birthweight (LBW) (4.6%) and preterm birth (PTB) (8.5%) in births to the White parents, births to Filipino parents had the highest rates of LBW (8.0%) and PTB (11.3%), respectively, and births to Korean parents had the lowest rates of both LBW (3.7%) and PTB (5.5%). This pattern of outcomes had changed little with adjustments of maternal sociodemographic and health factors. This observation was similarly noted also in births to the biracial parents, but the impact of paternal or maternal race on birth outcome was different by race/ethnicity. Compared to births to White parents, birth outcomes from the Asian parents or biracial Asian/White parents differed depending on the ethnic origin of Asian parents. The race/ethnicity was the strongest factor for this difference while other parental characteristics hardly explained this difference. PMID:27822934

Follicular fluid dehydroepiandrosterone sulfate is a credible marker of oocyte maturity and pregnancy outcome in conventional in vitro fertilization cycles.

PubMed

Chimote, Natachandra M; Nath, Nirmalendu M; Chimote, Nishad N; Chimote, Bindu N

2015-01-01

To investigate if the level of dehydroepiandrosterone sulfate (DHEA-s) in follicular fluid (FF) influences the competence of oocytes to fertilize, develop to the blastocyst stage, and produce a viable pregnancy in conventional in vitro fertilization (IVF) cycles. Prospective study of age-matched, nonpolycystic ovary syndrome (PCOS) women undergoing antagonist stimulation protocol involving conventional insemination and day 5 blastocyst transfer. FF levels of DHEA-s and E2 were measured by a radio-immuno-assay method using diagnostic kits. Fertilization rate, embryo development to the blastocyst stage and live birth rate were main outcome measures. Cycles were divided into pregnant/nonpregnant groups and also into low/medium/high FF DHEA-s groups. Statistical analysis was done by GraphPad Prism V software. FF DHEA-s levels were significantly higher in pregnant (n = 111) compared to nonpregnant (n = 381) group (1599 ± 77.45 vs. 1372 ± 40.47 ng/ml; P = 0.01). High (n = 134) FF DHEA-s group had significantly higher percentage of metaphase II (MII) oocytes (91.5 vs. 85.54 vs. 79.44%, P < 0.0001), fertilization rate (78.86 vs. 74.16 vs. 71.26%, P < 0.0001), cleavage rate (83.67 vs. 69.1 vs. 66.17%, P = 0.0002), blastocyst formation rate (37.15 vs. 33.01 vs. 26.95%, P < 0.0001), and live birth rate (29.85 vs. 22.22 vs. 14.78%, P = 0.017) compared to medium (n = 243) and low (n = 115) FF DHEA-s groups, respectively despite comparable number of oocytes retrieved and number of blastocysts transferred. FF DHEA-s levels correlated significantly with the attainment of MII oocytes (Pearson r = 0.41) and fertilization rates (Pearson r = 0.35). FF DHEA-s level influences the oocyte maturation process and is predictive of fertilization, embryo development to the blastocyst stage and live birth rates in non-PCOS women undergoing conventional IVF cycles.

Perinatal Risks in “Late Motherhood” Defined Based On Parity and Preterm Birth Rate – an Analysis of the German Perinatal Survey (20th Communication)

PubMed Central

Schure, V.; Voigt, M.; Schild, R. L.; Hesse, V.; Carstensen, M.; Schneider, K. T. M.; Straube, S.

2012-01-01

Aim: “Late motherhood” is associated with greater perinatal risks but the term lacks precise definition. We present an approach to determine what “late motherhood” associated with “high risk” is, based on parity and preterm birth rate. Materials and Methods: Using data from the German Perinatal Survey of 1998–2000 we analysed preterm birth rates in women with zero, one, or two previous live births. We compared groups of “late” mothers (with high preterm birth rates) with “control” groups of younger women (with relatively low preterm birth rates). Data of 208 342 women were analysed. For women with zero (one; two) previous live births, the “control” group included women aged 22–26 (27–31; 29–33) years. Women in the “late motherhood” group were aged > 33 (> 35; > 38) years. Results: The “late motherhood” groups defined in this way were also at higher risk of adverse perinatal events other than preterm birth. For women with zero (one; two) previous live births, normal cephalic presentation occurred in 89 % (92.7 %; 93.3 %) in the “control” group, but only in 84.5 % (90 %; 90.4 %) in the “late motherhood” group. The mode of delivery was spontaneous or at most requiring manual help in 71.3 % (83.4 %; 85.8 %) in the “control” group, but only in 51.4 % (72.2 %; 76.4 %) in the “late motherhood” group. Five-minute APGAR scores were likewise worse for neonates of “late” mothers and the proportion with a birth weight ≤ 2499 g was greater. Conclusion: “Late motherhood” that is associated with greater perinatal risks can be defined based on parity and preterm birth rate. PMID:25253904

Fertility effects of abortion and birth control pill access for minors.

PubMed

Guldi, Melanie

2008-11-01

This article empirically assesses whether age-restricted access to abortion and the birth control pill influence minors' fertility in the United States. There is not a strong consensus in previous literature regarding the relationship between laws restricting minors' access to abortion and minors' birth rates. This is the first study to recognize that state laws in place prior to the 1973 Roe v. Wade decision enabled minors to legally consent to surgical treatment-including abortion-in some states but not in others, and to construct abortion access variables reflecting this. In this article, age-specific policy variables measure either a minor's legal ability to obtain an abortion or to obtain the birth control pill without parental involvement. I find fairly strong evidence that young women's birth rates dropped as a result of abortion access as well as evidence that birth control pill access led to a drop in birth rates among whites.

Outcomes of very low birth weight infants in a newborn tertiary center in Turkey, 1997-2000.

PubMed

Atasay, Begüm; Günlemez, Ayla; Unal, Sevim; Arsan, Saadet

2003-01-01

Our purpose was to determine mortality and morbidity rates and selected outcome variables for infants weighing less than 1500 g, who were admitted to the neonatal intensive care unit of our hospital from 1997 to 2000. The ultimate goal of the study was to define a model for developing a regional database. Information on all very low birth weight (VLBW) admissions to a tertiary level neonatal intensive care unit (NICU) in Ankara between January 1997 and December 2000 was prospectively collected by three neonatologists using a standard manual of operation and definitions. The data consisted of patient information including sociodemographic characteristics; antenatal history; mode of delivery; APGAR scores; need for resuscitation; admission illness severity (Clinical Risk Index for Babies-CRIB) and therapeutic intensity (Neonatal Therapeutic Intensity Scoring System-NTISS); selected NICU parameters and procedures such as respiratory support, surfactant therapy, and postnatal corticosteroid therapy; and selected patient outcomes such as intraventricular hemorrhage, septicemia, necrotizing enterecolitis, retinopathy of prematurity, and chronic lung disease. The number of VLBW admissions to the NICU was 133, with 51 (28.6%) referrals from other maternity centers. The mean birth weight and gestational age of the infants were 1175 +/- 252 g and 30.3 +/- 2.9 weeks, respectively. One hundred and seventeen of 133 cases (88.7%) received at least one antenatal care visit. The median CRIB and NTISS scores were 4.5 and 31, respectively. Antenatal steroids had been given to 74 (55.6%) infants. Surfactant treatment and respiratory support were given to 33 (24.8%) and 73 (54.8%) infants, respectively. Among selected outcomes, chronic lung disease (CLD), threshold retinopathy of prematurity (ROP), severe intraventricular hemorrhage (IVH > or = grade III), nosocomial infection and necrotizing enterocolitis (NEC) were encountered in 14 (12.6%), 9 (8.1%), 3 (2.2%), 34 (25.5%) and 35 (26.3%) of the infants, respectively. Overall survival rate was 83.5% (111/133); most of the deceased cases were under 750 g (12/22). It was prospectively shown that 111 (100%) of the surviving infants could be regularly followed in a newborn follow-up clinic to provide health maintenance, developmental assessment and support. Compared with reports from other developing countries, VLBW infants at our center had higher survival rates. Compared to developed countries, survival rate was lower, especially for extremely very low birth weight infants. There is interaction between birth weight and survival rate. Among selected neonatal outcomes, chronic lung disease, threshold retinopathy, severe intraventricular hemorrhage (IVH > or = grade III) and nosocomial infection rates at this center were comparable with some reports from developed nations.

Early Childhood Longitudinal Study, Birth Cohort (ECLS-B): Methodology Report for the 9-Month Data Collection (2001-02). Volume 2: Sampling. NCES 2005-147

ERIC Educational Resources Information Center

Bethel, James; Green, James L.; Nord, Christine; Kalton, Graham; West, Jerry

2005-01-01

This report is Volume 2 of the methodology report that provides information about the development, design, and conduct of the 9-month data collection of the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). This volume begins with a brief overview of the ECLS-B, but focuses on the sample design, calculation of response rates, development…

Low birthweight and preterm birth rates 1 year before and after the Irish workplace smoking ban.

PubMed

Kabir, Z; Clarke, V; Conroy, R; McNamee, E; Daly, S; Clancy, L

2009-12-01

It is well-established that maternal smoking has adverse birth outcomes (low birthweight, LBW, and preterm births). The comprehensive Irish workplace smoking ban was successfully introduced in March 2004. We examined LBW and preterm birth rates 1 year before and after the workplace smoking ban in Dublin. A cross-sectional observational study analysing routinely collected data using the Euroking K2 maternity system. Coombe University Maternal Hospital. Only singleton live births were included for analyses (7593 and 7648, in 2003 and 2005, respectively). Detailed gestational and clinical characteristics were collected and analysed using multivariable logistic regression analyses and subgroup analyses. Maternal smoking rates, mean birthweights, and adjusted odds ratios (ORs) of LBW and preterm births in 2005 versus 2003. There was a 25% decreased risk of preterm births (OR, 0.75; 95% CI, 0.59-0.96), a 43% increased risk of LBW (OR, 1.43; 95% CI, 1.10-1.85), and a 12% fall in maternal smoking rates (from 23.4 to 20.6%) in 2005 relative to 2003. Such patterns were significantly maintained when specific subgroups were also analysed. Mean birthweights decreased in 2005, but were not significant (P=0.99). There was a marginal increase in smoking cessation before pregnancy in 2005 (P=0.047). Significant declines in preterm births and in maternal smoking rates after the smoking ban are welcome signs. However, the increased LBW birth risks might reflect a secular trend, as observed in many industrialised nations, and merits further investigations.

Variation in birth outcomes by mother's country of birth among non-Hispanic black women in the United States.

PubMed

Elo, Irma T; Vang, Zoua; Culhane, Jennifer F

2014-12-01

Rates of prematurity (PTB) and small-for-gestational age (SGA) were compared between US-born and foreign-born non-Hispanic black women. Comparisons were also made between Sub-Saharan African-born and Caribbean-born black women and by maternal country of birth within the two regions. Comparisons were adjusted for sociodemographic, health behavioral and medical risk factors available on the birth record. Birth record data (2008) from all states (n = 27) where mother's country of birth was recorded were used. These data comprised 58 % of all singleton births to non-Hispanic black women in that year. Pearson Chi square and logistic regression were used to investigate variation in the rates of PTB and SGA by maternal nativity. Foreign-born non-Hispanic black women had significantly lower rates of PTB (OR 0.727; CI 0. 726, 0.727) and SGA (OR 0.742; CI 0.739-0.745) compared to US-born non-Hispanic black women in a fully adjusted model. Sub-Saharan African-born black women compared to Caribbean-born black women had significantly lower rates of PTB and SGA. Within each region, the rates of PTB and SGA varied by mother's country of birth. These differences could not be explained by adjustment for known risk factors obtained from vital records. Considerable heterogeneity in rates of PTB and SGA among non-Hispanic black women in the US by maternal nativity was documented and remained unexplained after adjustment for known risk factors.

[Maternal and fetal outcome in Mexican women with rheumatoid arthritis].

PubMed

Saavedra, Miguel A; Sánchez, Antonio; Bustamante, Reyna; Miranda-Hernández, Dafhne; Soliz-Antezana, Jimena; Cruz-Domínguez, Pilar; Morales, Sara; Jara, Luis J

2015-01-01

To report our experience in maternal-fetal outcome in women with RA in a national medical referral center. A retrospective analysis of the records of pregnant women with rheumatoid arthritis attending at a Pregnancy and Autoimmune Rheumatic Diseases Clinic was performed. Maternal-fetal outcomes such as disease activity, preclampsia/eclampsia, rate of live births, abortions, stillbirths, preterm birth, weeks of gestation, birth weight, congenital malformations and use of anti-rheumatic drugs were studied. We included 73 pregnancies in 72 patients. Disease activity was documented in 47.2% of patients during pregnancy and/or postpartum and 87.7% of patients received some antirheumatic drug. Preclampsia developed in 8.2% of cases. The live birth rate was 98.6%, with preterm delivery in 15.9% and low weight at term in 17.6% of cases. Cesarean section was performed in 77.1% of cases. The disease activity was not associated with a higher percentage of maternal-fetal complications. Our study showed that most patients do not experience significant activity of RA during pregnancy, fetal outcome is satisfactory and disease activity did not appear to influence significantly the obstetric outcome.

Generalized Nonlinear Yule Models

NASA Astrophysics Data System (ADS)

Lansky, Petr; Polito, Federico; Sacerdote, Laura

2016-11-01

With the aim of considering models related to random graphs growth exhibiting persistent memory, we propose a fractional nonlinear modification of the classical Yule model often studied in the context of macroevolution. Here the model is analyzed and interpreted in the framework of the development of networks such as the World Wide Web. Nonlinearity is introduced by replacing the linear birth process governing the growth of the in-links of each specific webpage with a fractional nonlinear birth process with completely general birth rates. Among the main results we derive the explicit distribution of the number of in-links of a webpage chosen uniformly at random recognizing the contribution to the asymptotics and the finite time correction. The mean value of the latter distribution is also calculated explicitly in the most general case. Furthermore, in order to show the usefulness of our results, we particularize them in the case of specific birth rates giving rise to a saturating behaviour, a property that is often observed in nature. The further specialization to the non-fractional case allows us to extend the Yule model accounting for a nonlinear growth.

Opportunities for maternal transport for delivery of very low birth weight infants.

PubMed

Robles, D; Blumenfeld, Y J; Lee, H C; Gould, J B; Main, E; Profit, J; Melsop, K; Druzin, M

2017-01-01

To assess frequency of very low birth weight (VLBW) births at non-level III hospitals. Retrospective cohort study using linked California birth certificate and discharge data of 2008 to 2010 for deliveries of singleton or first-born infant of multiple gestations with birth weight 400 to 1500 g. Delivery rates by neonatal level of care were obtained. Risk of delivery at non-level III centers was estimated in univariable and multivariable models. Of the 1 508 143 births, 13 919 (9.2%) were VLBW; birth rate at non-level III centers was 14.9% (8.4% in level I and 6.5% in level II). Median rate of VLBW births was 0.3% (range 0 to 4.7%) annually at level I and 0.5% (range 0 to 1.6%) at level II hospitals. Antepartum stay for >24 h occurred in 14.0% and 26.9% of VLBW births in level I and level II hospitals, respectively. Further improvement is possible in reducing VLBW infant delivery at suboptimal sites, given the window of opportunity for many patients.

Teen birth rates in sexually abused and neglected females.

PubMed

Noll, Jennie G; Shenk, Chad E

2013-04-01

Prospectively track teen childbirths in maltreated and nonmaltreated females and test the hypothesis that child maltreatment is an independent predictor of subsequent teen childbirth over and above demographic characteristics and other risk factors. Nulliparous adolescent females (N = 435) aged 14 to 17 years were assessed annually through age 19 years. Maltreated females were referred by Child Protective Services agencies for having experienced substantiated sexual abuse, physical abuse, or neglect within the preceding 12 months. Comparison females were matched on race, family income, age and family constellation. Teen childbirth was assessed via self-report during annual interviews. Births were confirmed using hospital delivery records. Seventy participants gave birth during the study, 54 in the maltreated group and 16 in the comparison group. Maltreated females were twice as likely to experience teen childbirth after controlling for demographic confounds and known risk factors (odds ratio = 2.17, P = 0.01). Birth rates were highest for sexually abused and neglected females. Sexual abuse and neglect were both independent predictors of teen childbirth after controlling for demographic confounds, other risk factors and alternative forms of maltreatment occurring earlier in development. Results provide evidence that sexual abuse and neglect are unique predictors of subsequent teen childbirth. Partnerships between protective service providers and teen childbirth prevention strategists hold the best promise for further reducing the US teen birth rate. Additional research illuminating the pathways to teen childbirth for differing forms of maltreatment is needed so that tailored interventions can be realized.

Trends in twin neonatal mortality rates in the United States, 1989 through 1999: influence of birth registration and obstetric intervention.

PubMed

Ananth, Cande V; Joseph Ks, K s; Smulian, John C

2004-05-01

We sought to evaluate the contributions of changes in birth registration, labor induction, and cesarean delivery on trends in twin neonatal mortality rates. We conducted a population-based, retrospective cohort study of twin live births, using linked birth-infant death data in the United States (1989-1999). Relative risks and 95% confidence intervals that quantified changes in neonatal (0-27 days) mortality rates were derived from ecologic logistic regression models that were fit after aggregation of the data by each state in the United States. The frequency of live born twins who weighed <500 g increased 72%, from 0.7% in 1989 to 1.2% in 1999, of live born twins who weighed 500 to 749 g and 750 to 999 g increased by 55% and 28%, respectively, between 1989 and 1999. Preterm birth rates increased by 19%, from 46.2% in 1989 to 57.2% in 1999. The rate of labor induction increased from 5.8% to 13.9%, and the cesarean delivery rate increased from 49.8% to 56.3%. Between 1989 to 1991 and 1997 to 1999, the crude neonatal mortality rates among twins who weighed >or=500 g declined by 37% (95% CI, 35%-40%) from 21.5 to 13.6 per 1000 twin live births. Adjustments for preterm labor induction, preterm cesarean delivery, term labor induction, term cesarean delivery, and sociodemographic factors had little influence on neonatal mortality rate trends. Increases in preterm birth because of obstetric intervention among twins have not led to increases in twin neonatal mortality rates in the United States.

17-alpha Hydroxyprogesterone Caproate did not reduce the rate of recurrent preterm birth in a prospective cohort study

PubMed Central

Nelson, David B.; McIntire, Donald D.; McDonald, Jeffrey; Gard, John; Turrichi, Paula; Leveno, Kenneth J.

2017-01-01

Background 17-alpha hydroxyprogesterone caproate for prevention of recurrent preterm birth is recommended for use in the United States. Objective To assess the clinical effectiveness of 17-alpha hydroxyprogesterone caproate to prevent recurrent preterm birth ≤ 35 weeks compared to similar births in our obstetric population prior to the implementation of 17-alpha hydroxyprogesterone caproate. Study Design This was a prospective cohort study of 17-alpha hydroxyprogesterone caproate in our obstetric population. The primary outcome was the recurrence of birth ≤ 35 weeks for the entire study cohort compared to a historical referent rate of 16.8% of recurrent preterm birth in our population. There were three secondary outcomes. First, did 17-alpha hydroxyprogesterone caproate modify a woman’s history of preterm birth when taking into account her prior number and sequence of preterm and term births? Second, was recurrence of preterm birth related to 17-alpha hydroxyprogesterone caproate plasma concentration? Third, was duration of pregnancy modified by 17-alpha hydroxyprogesterone caproate treatment compared to a prior preterm birth? Results Between January 2012 and March 2016, 430 consecutive women with prior births ≤ 35 weeks were treated with 17-alpha hydroxyprogesterone caproate. Nearly two-thirds of the women (N=267) began injections ≤ 18 weeks and 394 (92%) received a scheduled weekly injection within 10 days of reaching 35 weeks or delivery. The overall rate of recurrent preterm birth was 25% (N=106) for the entire cohort compared to the 16.8% expected rate (P = 1.0). The three secondary outcomes were also negative. First, 17-alpha hydroxyprogesterone caproate did not significantly reduce the rates of recurrence regardless of prior preterm birth number or sequence. Second, plasma concentrations of 17-alpha hydroxyprogesterone caproate were not different (P=0.17 at 24 weeks; P=0.38 at 32 weeks) between women delivered ≤ 35 weeks and those delivered later in pregnancy. Third, the mean (± standard deviation) interval in weeks of recurrent preterm birth before 17-alpha hydroxyprogesterone caproate use was 0.4 ± 5.3 weeks and the interval of recurrent preterm birth after 17-alpha hydroxyprogesterone caproate treatment was 0.1 ± 4.7 weeks (P=0.63). A side effect of weekly 17-alpha hydroxyprogesterone caproate injections was an increase in gestational diabetes. Specifically, the rate of gestational diabetes was 13.4% in 17-alpha hydroxyprogesterone caproate treated women compared to 8% in case-matched controls (P=0.001). Conclusions 17-alpha hydroxyprogesterone caproate was ineffective for prevention of recurrent preterm birth and was associated with increased rates of gestational diabetes. PMID:28223163

Maternal intrapartum antibiotics and decreased vertical transmission of Lactobacillus to neonates during birth.

PubMed

Keski-Nisula, Leea; Kyynäräinen, Hanna-Reetta; Kärkkäinen, Ulla; Karhukorpi, Jari; Heinonen, Seppo; Pekkanen, Juha

2013-05-01

To estimate the transmission of maternal vaginal microbiota to neonates during term delivery, focusing on Lactobacillus flora in relation to various obstetric clinical factors. Fifty consecutive pregnant healthy women with singleton term pregnancies and their newborn infants. Vertical transmission of Lactobacillus flora to the newborn during delivery was evaluated in 45 mother-newborn pairs. Lactobacillus-dominant mixed flora was detected in 90% (N = 45) of vaginal samples, but only in 28% (N = 14) of neonatal cultures (transmission rate 31%). All neonates with Lactobacillus-dominant mixed flora had findings similar to those in maternal cultures. Cocci-dominant flora was the most common finding in neonates. Administration of antibiotics to the mother during the intrapartum period before birth and duration of rupture of membranes (ROM), regardless of maternal antibiotic treatment, were associated significantly with a decreased transmission rate of Lactobacillus-dominant mixed flora to neonates. Maternal intrapartum antibiotics and prolonged expectant management after ROM were associated with decreased transmission rate of vaginal Lactobacillus flora to the neonate during birth. As early colonization of Lactobacillus flora may have a preventive role in the development of allergic diseases later, the significance of intrapartum prophylactic antibiotics needs to be highlighted in forthcoming studies, especially as regards immunological development of the offspring. ©2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.

Inter-birth interval in zebras is longer following the birth of male foals than after female foals

NASA Astrophysics Data System (ADS)

Barnier, Florian; Grange, Sophie; Ganswindt, Andre; Ncube, Hlengisizwe; Duncan, Patrick

2012-07-01

Mammalian reproductive rates vary among individuals for physiological and environmental reasons. This study aims to determine reproductive rates from an individually monitored population of wild Plains zebras Equus quagga, and to assess the sources of variability in inter-birth intervals. The animals were monitored, where possible, every six months from 2004 to 2011. Thirty nine intervals corresponding to 65 births in 26 mares were identified, using direct observations and faecal steroid monitoring. Mean foaling rate of the population is 0.74 foal/year, and comparable with the literature. There was no significant effect of mother's age, nor of the season of previous birth on the length of inter-birth intervals. Inter-birth interval was significantly longer when the first foal was a male. This finding indicates that additional costs of having a son may delay future reproduction and thus reduce the total number of offspring a mare can have during her lifetime. Individually-based data provide critical information on the determinants of reproductive rates, and are therefore a key to understanding the causes of variations in life-history traits.

The contribution of preterm birth to the Black-White infant mortality gap, 1990 and 2000.

PubMed

Schempf, Ashley H; Branum, Amy M; Lukacs, Susan L; Schoendorf, Kenneth C

2007-07-01

We evaluated whether the decline of the racial disparity in preterm birth during the last decade was commensurate with a decline in the contribution of preterm birth to the infant mortality gap. We used linked files of 1990 and 2000 data on US infant births and deaths to partition the gap between Black and White infant mortality rates into differences in the (1) distribution of gestational age and (2) gestational age-specific mortality rates. Between 1990 and 2000, the Black-White infant mortality rate ratio did not change significantly (2.3 vs 2.4). Excess deaths among preterm Black infants accounted for nearly 80% of the Black-White infant mortality gap in both 1990 and 2000. The narrowing racial disparity in the preterm birth rate was counterbalanced by greater mortality reductions in White than in Black preterm infants. Extremely preterm birth (<28 weeks) was 4 times higher in Black infants and accounted for more than half of the infant mortality gap. Substantial reductions in the Black-White infant mortality gap will require improved prevention of extremely preterm birth among Black infants.

Contraindications in planned home birth in Iceland: A retrospective cohort study.

PubMed

Halfdansdottir, Berglind; Hildingsson, Ingegerd; Smarason, Alexander Kr; Sveinsdottir, Herdis; Olafsdottir, Olof A

2018-03-01

Icelandic national guidelines on place of birth list contraindications for home birth. Few studies have examined the effect of contraindication on home birth, and none have done so in Iceland. The aim of this study was to examine whether contraindications affect the outcome of planned home birth or have a different effect at home than in hospital. The study is a retrospective cohort study on the effect of contraindications for home birth on the outcome of planned home (n = 307) and hospital (n = 921) birth in 2005-2009. Outcomes were described for four different groups of women, by exposure to contraindications (unexposed vs. exposed) and planned place of birth (hospital vs. home). Linear and logistic regression analysis was used to evaluate the effect of the contraindications under study and to detect interactions between contraindications and planned place of birth. The key findings of the study were that contraindications were related to higher rates of adverse maternal and neonatal outcomes, regardless of place of birth; women exposed to contraindications had higher rates of adverse outcomes in planned home birth; and healthy, unexposed women had higher rates of adverse outcomes in planned hospital birth. Contraindications significantly increased the risk of transfer in labour and postpartum haemorrhage in planned home births. The defined contraindications for home birth had a negative effect on maternal and neonatal outcomes in Iceland, regardless of place of birth. The study results do not contradict the current national guidelines on place of birth. Copyright © 2017 Elsevier B.V. All rights reserved.

The need for a community-wide approach to promote healthy babies and prevent low birth weight.

PubMed Central

Stewart, P J; Nimrod, C

1993-01-01

A community-wide approach offers a potentially more effective way to promote healthy babies in healthy families and to prevent low birth weight. It can address the many factors associated with preterm birth and intrauterine growth restriction, the need to include all members of the community in effecting meaningful change in the incidence rate of adverse outcomes and the development of an effective mechanism to plan and coordinate the delivery of programs. Physicians have an essential role to play in this approach. The evaluation of such a program would complement current biomedical research on the prevention of preterm birth and intrauterine growth restriction. The work for this paper was supported by the Community Health Research Unit, funded by the Ontario Ministry of Health. PMID:8339173

Birth Rates Among Hispanics and Non-Hispanics and their Representation in Contemporary Obstetric Clinical Trials.

PubMed

Kahr, Maike K; De La Torre, Rosa; Racusin, Diana A; Suter, Melissa A; Mastrobattista, Joan M; Ramin, Susan M; Clark, Steven L; Dildy, Gary A; Belfort, Michael A; Aagaard, Kjersti M

2016-10-01

Objective Our study aims were to establish whether subjects enrolled in current obstetric clinical trials proportionately reflects the contemporary representation of Hispanic ethnicities and their birth rates in the United States. Methods Using comprehensive source data over a defined interval (January 2011-September 2015) on birth rates by ethnicity from the Centers for Disease Control and Prevention (CDC), we evaluated the proportional rate by ethnicity, then analyzed the observed to expected relative ratio of enrolled subjects. Results Hispanic women comprise a significant contribution to births in the United States (23% of all births). Systematic analysis of 90 published obstetric clinical trials showed a correlation between inclusion of Hispanic gravidae and the corresponding state's birth rates (r = 0.501, p < 0.001). While the mean was strongly correlated, individual clinical trials may have relatively over-enrolled (n = 31, or 34%) or under-enrolled (n = 33, or 37%) relative to their regional population. In 48% of obstetric clinical trials the Hispanic proportion of the study population was not reported. Conclusion Hispanic gravidae represent a significant number of contemporary U.S. births, and are generally adequately represented as obstetric subjects in clinical trials. However, this is trial-dependent, with significant trial-specific under- and over-enrollment of Hispanic subjects relative to the regional birth population. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Are residents of mountain-top mining counties more likely to have infants with birth defects? The West Virginia experience.

PubMed

Lamm, Steven H; Li, Ji; Robbins, Shayhan A; Dissen, Elisabeth; Chen, Rusan; Feinleib, Manning

2015-02-01

Pooled 1996 to 2003 birth certificate data for four central states in Appalachia indicated higher rates of infants with birth defects born to residents of counties with mountain-top mining (MTM) than born to residents of non-mining-counties (Ahern 2011). However, those analyses did not consider sources of uncertainty such as unbalanced distributions or quality of data. Quality issues have been a continuing problem with birth certificate analyses. We used 1990 to 2009 live birth certificate data for West Virginia to reassess this hypothesis. Forty-four hospitals contributed 98% of the MTM-county births and 95% of the non-mining-county births, of which six had more than 1000 births from both MTM and nonmining counties. Adjusted and stratified prevalence rate ratios (PRRs) were computed both by using Poisson regression and Mantel-Haenszel analysis. Unbalanced distribution of hospital births was observed by mining groups. The prevalence rate of infants with reported birth defects, higher in MTM-counties (0.021) than in non-mining-counties (0.015), yielded a significant crude PRR (cPRR = 1.43; 95% confidence interval [CI] = 1.36-1.52) but a nonsignificant hospital-adjusted PRR (adjPRR = 1.08; 95% CI = 0.97-1.20; p = 0.16) for the 44 hospitals. So did the six hospital data analysis ([cPRR = 2.39; 95% CI = 2.15-2.65] and [adjPRR = 1.01; 95% CI, 0.89-1.14; p = 0.87]). No increased risk of birth defects was observed for births from MTM-counties after adjustment for, or stratification by, hospital of birth. These results have consistently demonstrated that the reported association between birth defect rates and MTM coal mining was a consequence of data heterogeneity. The data do not demonstrate evidence of a "Mountain-top Mining" effect on the prevalence of infants with reported birth defects in WV. © 2014 Wiley Periodicals, Inc.

Are first-time mothers who plan home birth more likely to receive evidence-based care? A comparative study of home and hospital care provided by the same midwives.

PubMed

Miller, Suzanne; Skinner, Joan

2012-06-01

"Place of birth" studies have consistently shown reduced rates of obstetric intervention in low-technology birth settings, but the extent to which the place of birth per se has influenced the outcomes remains unclear. The objective of this study was to compare birth outcomes for nulliparous women giving birth at home or in hospital, within the practice of the same midwives. An innovative survey was generated following a focus group discussion that compared midwifery practice in different settings. Two groups of matched, low-risk first-time mothers, one group who planned to give birth at home and the other in hospital, were compared with respect to birth outcomes and midwifery care, and in relation to evidenced-based care guidelines for low-risk women. Survey data (response rate: 72%) revealed that women in the planned hospital birth group (n = 116) used more pharmacological pain management techniques, experienced more obstetric interventions, had a greater rate of postpartum hemorrhage, and achieved spontaneous vaginal birth less often than those in the planned home birth group (n = 109). All results were significant (p < 0.05). Despite care by the same midwives, first-time mothers who chose to give birth at home were not only more likely to give birth with no intervention but were also more likely to receive evidence-based care. (BIRTH 39:2 June 2012). © 2012, Copyright the Authors Journal compilation © 2012, Wiley Periodicals, Inc.

Changes in the distribution of high-risk births associated with changes in contraceptive prevalence.

PubMed

Stover, John; Ross, John

2013-01-01

Several birth characteristics are associated with high mortality risk: very young or old mothers, short birth intervals and high birth order. One justification for family planning programs is the health benefits associated with better spacing and timing of births. This study examines the extent to which the prevalence of these risk factors changes as a country transitions from high to low fertility. We use data from 194 national surveys to examine both cross section and within-country variation in these risk factors as they relate to the total fertility rate. Declines in the total fertility rate are associated with large declines in the proportion of high order births, those to mothers over the age of 34 and those with multiple risk factors; as well as to increasing proportions of first order births. There is little change in the proportion of births with short birth intervals except in sub-Saharan Africa. The use of family planning is strongly associated with fertility declines. The proportion of second and higher order births with demographic risk factors declines substantially as fertility declines. This creates a potential for reducing child mortality rates. Some of the reduction comes from modifying the birth interval distribution or by bringing maternal age at the time of birth into the 'safe' range of 18-35 years, and some comes from the actual elimination of births that would have a high mortality risk (high parity births).

Twin births in the Comoros.

PubMed

Abdul, M A

2000-11-01

To determine the prevalence and clinical significance of twin births in the Comoros Islands. Combined retrospective and non-randomised prospective study. Hospital El-Ma'aru Moroni Grand-Comoros and Center Medico-Chirurgical Domoni-Anjouan. One hundred and nine patients with twin deliveries. During the period of study, there were 4370 deliveries, out of which 109 were twin births, giving an incidence rate of 25/1,000 deliveries. Twin births rate increased with increasing parity. The perinatal mortality rate of twin delivery was seven times that of singleton. Low birthweight rate was 54% among twin births. Retention rate of second twin was 12%, with home delivery of the first co-twin in 62% of cases. Uterine atony and malpresentation were the principal factors in the aetiology of retained second twin. Multiple pregnancy is common in the Comoros and the epidemiology and clinical significance are consistent with established data. Clinicians and midwives in Comoros must be aware of these facts, and endeavour to make early diagnosis and institute appropriate management within the available scarce resources, in order to improve maternal and foetal outcome of twin births.

Local level epidemiological analysis of TB in people from a high incidence country of birth.

PubMed

Massey, Peter D; Durrheim, David N; Stephens, Nicola; Christensen, Amanda

2013-01-22

The setting for this analysis is the low tuberculosis (TB) incidence state of New South Wales (NSW), Australia. Local level analysis of TB epidemiology in people from high incidence countries-of-birth (HIC) in a low incidence setting has not been conducted in Australia and has not been widely reported. Local level analysis could inform measures such as active case finding and targeted earlier diagnosis. The aim of this study was to use a novel approach to identify local areas in an Australian state that have higher TB rates given the local areas' country of birth profiles. TB notification data for the three year period 2006-2008 were analysed by grouping the population into those from a high-incidence country-of-birth and the remainder. During the study period there were 1401 notified TB cases in the state of NSW. Of these TB cases 76.5% were born in a high-incidence country. The annualised TB notification rate for the high-incidence country-of-birth group was 61.2/100,000 population and for the remainder of the population was 1.8/100,000. Of the 152 Local Government Areas (LGA) in NSW, nine had higher and four had lower TB notification rates in their high-incidence country-of-birth populations when compared with the high-incidence country-of-birth population for the rest of NSW. The nine areas had a higher proportion of the population with a country of birth where TB notification rates are >100/100,000. Those notified with TB in the nine areas also had a shorter length of stay in Australia than the rest of the state. The areas with higher TB notification rates were all in the capital city, Sydney. Among LGAs with higher TB notification rates, four had higher rates in both people with a high-incidence country of birth and people not born in a high-incidence country. The age distribution of the HIC population was similar across all areas, and the highest differential in TB rates across areas was in the 5-19 years age group. Analysing local area TB rates and possible explanatory variables can provide useful insights into the epidemiology of TB. TB notification rates that take country of birth in local areas into account could enable health services to strategically target TB control measures.

Neonatal autonomic function after pregnancy complications and early cardiovascular development.

PubMed

Aye, Christina Y L; Lewandowski, Adam James; Oster, Julien; Upton, Ross; Davis, Esther; Kenworthy, Yvonne; Boardman, Henry; Yu, Grace Z; Siepmann, Timo; Adwani, Satish; McCormick, Kenny; Sverrisdottir, Yrsa B; Leeson, Paul

2018-05-23

Heart rate variability (HRV) has emerged as a predictor of later cardiac risk. This study tested whether pregnancy complications that may have long-term offspring cardiac sequelae are associated with differences in HRV at birth, and whether these HRV differences identify abnormal cardiovascular development in the postnatal period. Ninety-eight sleeping neonates had 5-min electrocardiogram recordings at birth. Standard time and frequency domain parameters were calculated and related to cardiovascular measures at birth and 3 months of age. Increasing prematurity, but not maternal hypertension or growth restriction, was associated with decreased HRV at birth, as demonstrated by a lower root mean square of the difference between adjacent NN intervals (rMSSD) and low (LF) and high-frequency power (HF), with decreasing gestational age (p < 0.001, p = 0.009 and p = 0.007, respectively). We also demonstrated a relative imbalance between sympathetic and parasympathetic tone, compared to the term infants. However, differences in autonomic function did not predict cardiovascular measures at either time point. Altered cardiac autonomic function at birth relates to prematurity rather than other pregnancy complications and does not predict cardiovascular developmental patterns during the first 3 months post birth. Long-term studies will be needed to understand the relevance to cardiovascular risk.

Trends in the delivery route of twin pregnancies in the United States, 2006-2013.

PubMed

Bateni, Zhoobin H; Clark, Steven L; Sangi-Haghpeykar, Haleh; Aagaard, Kjersti M; Blumenfeld, Yair J; Ramin, Susan M; Lee, Henry C; Fox, Karin A; Moaddab, Amirhossein; Shamshirsaz, Amir A; Salmanian, Bahram; Hosseinzadeh, Pardis; Racusin, Diana A; Erfani, Hadi; Espinoza, Jimmy; Dildy, Gary A; Belfort, Michael A; Shamshirsaz, Alireza A

2016-10-01

To determine the trends of cesarean delivery rate among twin pregnancies from 2006 to 2013. This is a population-based, cross-sectional analysis of twin live births from United State birth data files of the National Center for Health Statistics for calendar years 2006 through 2013. We stratified the population based on the gestational age groups, maternal race/ethnicity, advanced maternal age (AMA) which was defined by age more than 35 years and within the standard birth weight groups (group 1: birth weight 500-1499g, group 2: birth weight 1500-2499g and group 3: birth weight >2500g). We also analyzed the effect of different risk factors for cesarean delivery in twins. There were 1,079,102 infants born of twin gestations in the U.S. from 2006 to 2013, representing a small but significant increase in the proportion of twin births among all births (3.2% in 2006 versus 3.4% in 2013). The rate of cesarean delivery in twin live births peaked at 75.3% in 2009, and was significantly lower (74.8%) in 2013. The rate of the twin live birth with the breech presentation increased steadily from 26.3% in 2006 to 29.1% in 2013. For the fetus of the twin pregnancy presented as breech, the cesarean delivery rate peaked at 92.2% in 2010, falling slightly but significantly in the ensuing 3 years. The results demonstrated that the decrease in cesarean delivery rate was due to fewer cesareans in non-Hispanic white patients; all other ethnic subgroups showed increasing rates of cesarean delivery throughout the study. Gestational diabetes, gestational hypertension, previous cesarean delivery and breech presentation were all significant risk factors for cesarean delivery during the entire study period. Induction of labor and premature rupture of the membranes were associated with lower rates of cesarean delivery in twins. The recent decrease in the cesarean delivery rate in twin gestation appears to be largely attributable to a decline in cesarean among pregnancies complicated by breech presentation in non-Hispanic white women, and may reflect a health care disparity that deserves further research. Published by Elsevier Ireland Ltd.

Patients' age, myoma size, myoma location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy.

PubMed

Zhang, Ying; Hua, Ke Qin

2014-02-01

To investigate which clinical characteristics will influence the pregnancy rate and live birth rate after myomectomy. Data of clinical characteristics and reproductive outcome from 471 patients who wished to conceive and who underwent abdominal or laparoscopic myomectomy in the Obstetrics and Gynecology Hospital of Fudan University from January 2008 to June 2012 were retrospectively analyzed. Average age in the pregnancy group (30.0±3.7 years) and the nonpregnancy group (31.2±4.1 years) was statistically different (P=.000). The diameter of the biggest myoma had a positive relationship with the pregnancy rate when it was <10 cm (rs=0.095, P=.039). Abortions before myomectomy, operation type, number, location, and classification of myomas, uterine cavity penetration, and uterine volume seemed not to influence the pregnancy rate (P>.05). The location of the myoma may influence the live birth rate after myomectomy (rs=0.198, P=.002). Anterior and posterior myomas were associated with higher live birth rates than other locations (P=.001). The average interval between myomectomy and pregnancy was 16.0±8.7 months, and there was no difference between the abdominal (17.2±8.6 months) and laparoscopic (15.2±8.8 months) groups (P=.102). The interval in the live birth group was 15.0±8.4 months, and that in the non-live birth group was 18.9±9.3 months; the difference was significant (P=.005). Patients' age, myoma size and location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy.

Regional bias in birth defect prevalence rates for Arkansas: influence of incomplete ascertainment along surveillance system borders.

PubMed

Mosley, Bridget S; Simmons, Caroline J; Cleves, Mario A; Hobbs, Charlotte A

2002-01-01

As part of the continuing evaluation of the Arkansas Reproductive Health Monitoring System (ARHMS), we assessed the effects on birth defect prevalence rates introduced by incomplete case ascertainment along surveillance boundaries. Using data from ARHMS and Arkansas Vital Statistics for 1993-1998, we determined birth defect prevalence rates (per 10,000 live births), stratified by race, among three geographic comparison groups of counties. These included: (1) the Northeast Group, near the state border at Memphis, Tennessee; (2) the Central Group, surrounding Little Rock, Arkansas; and (3) the Southwest Group, near Texarkana, Texas. These counties have similar socioeconomic measures and proximity to health care facilities, but are differentiated by limitations imposed by ARHMS' surveillance borders. Maternal age-standardized rates from the control groups were used to impute expected rates, for the Northeast Group and statewide, which were compared with reported rates. We found that there were 620 fewer reported birth defect cases than expected for the Northeast Group. The Northeast Group's prevalence rates were approximately half of the control groups' rates (310.6 vs. 529.8, respectively, for Whites, and 240.8 vs. 550.1, respectively, for African-Americans). Incorporating the missed cases into statewide prevalence calculations could increase prevalence rates from 502.6 to 523.2 for Whites and from 527.4 to 590.7 for African-Americans. This study identified significant regional differences in reported birth defect rates in Arkansas. Case ascertainment might be incomplete in other surveillance systems lacking the means to share data with neighboring systems. Regional inaccuracy can hinder evaluation of localized birth defect trends or targeted prevention efforts. Copyright 2002 Wiley-Liss, Inc.

The impact of changes in preterm birth among twins on stillbirth and infant mortality in the United States

PubMed Central

Getahun, D; Demissie, K; Marcella, SW; Rhoads, GG

2015-01-01

OBJECTIVE To examine trends for preterm births, stillbirths, neonatal and infant deaths in twin births by gestational age and birth weight categories, as well as trends in induction of labor and cesarean delivery during 1995–2006. STUDY DESIGN A trend analysis was performed on data derived from the National Centers for Health Statistics’ Vital Statistics Data files (1995–2006). The primary outcomes examined were preterm birth, stillbirth, neonatal and infant mortality. RESULT During the study period, rates of labor induction among twins decreased by 8% and rates of cesarean delivery increased by 35%. Concurrently, the preterm birth rate increased by 13% from 54% in 1995–96 to 61% in 2005–06. The overall stillbirth rate, and neonatal and infant death rates decreased during the same period by 21% (95% confidence interval (CI): 18–25%), 13% (95% CI: 9–16%) and 12% (95% CI: 8–15%), respectively. There were significant reductions in neonatal death rates related to respiratory distress syndrome (RDS; 48%, 95% CI: 41–54%) and congenital anomalies (25%, 95% CI: 16–33%) during the study period. Reductions in post-neonatal infant mortality were mainly in RDS (88%) and sudden infant death syndrome (26%). Mortality rates among infants born by either induction of labor or cesarean delivery fell during the study period and remained much lower than the overall infant mortality rate. CONCLUSION The findings of this study suggest that during 1995–2006 there was an increase in preterm birth rates and a decrease in labor inductions with a sharp decline in stillbirth, neonatal and infant mortality rates. PMID:24968177

Background rates of adverse pregnancy outcomes for assessing the safety of maternal vaccine trials in sub-Saharan Africa.

PubMed

Orenstein, Lauren A V; Orenstein, Evan W; Teguete, Ibrahima; Kodio, Mamoudou; Tapia, Milagritos; Sow, Samba O; Levine, Myron M

2012-01-01

Maternal immunization has gained traction as a strategy to diminish maternal and young infant mortality attributable to infectious diseases. Background rates of adverse pregnancy outcomes are crucial to interpret results of clinical trials in Sub-Saharan Africa. We developed a mathematical model that calculates a clinical trial's expected number of neonatal and maternal deaths at an interim safety assessment based on the person-time observed during different risk windows. This model was compared to crude multiplication of the maternal mortality ratio and neonatal mortality rate by the number of live births. Systematic reviews of severe acute maternal morbidity (SAMM), low birth weight (LBW), prematurity, and major congenital malformations (MCM) in Sub-Saharan African countries were also performed. Accounting for the person-time observed during different risk periods yields lower, more conservative estimates of expected maternal and neonatal deaths, particularly at an interim safety evaluation soon after a large number of deliveries. Median incidence of SAMM in 16 reports was 40.7 (IQR: 10.6-73.3) per 1,000 total births, and the most common causes were hemorrhage (34%), dystocia (22%), and severe hypertensive disorders of pregnancy (22%). Proportions of liveborn infants who were LBW (median 13.3%, IQR: 9.9-16.4) or premature (median 15.4%, IQR: 10.6-19.1) were similar across geographic region, study design, and institutional setting. The median incidence of MCM per 1,000 live births was 14.4 (IQR: 5.5-17.6), with the musculoskeletal system comprising 30%. Some clinical trials assessing whether maternal immunization can improve pregnancy and young infant outcomes in the developing world have made ethics-based decisions not to use a pure placebo control. Consequently, reliable background rates of adverse pregnancy outcomes are necessary to distinguish between vaccine benefits and safety concerns. Local studies that quantify population-based background rates of adverse pregnancy outcomes will improve safety assessment of interventions during pregnancy.

The American Association of Birth Centers: history, membership, and current initiatives.

PubMed

Phillippi, Julia C; Alliman, Jill; Bauer, Kate

2009-01-01

The American Association of Birth Centers (AABC) is a multidisciplinary membership organization dedicated to the birth center model of care. This article reviews the history, membership, and current policy initiatives of the AABC. The history of AABC includes the promotion of research, education, and national and state policies that are supportive of birth center care. Current AABC priorities address three main pressures to birth center sustainability: high malpractice insurance rates, the lack of a federally mandated birth center facility fee, and low rates of certified nurse-midwife/certified midwife reimbursement. The AABC is addressing these concerns through lobbying, collaborating with other national organizations, and the promotion of birth research.

Improving the organisation of maternal health service delivery and optimising childbirth by increasing vaginal birth after caesarean section through enhanced women-centred care (OptiBIRTH trial): study protocol for a randomised controlled trial (ISRCTN10612254).

PubMed

Clarke, Mike; Savage, Gerard; Smith, Valerie; Daly, Deirdre; Devane, Declan; Gross, Mechthild M; Grylka-Baeschlin, Susanne; Healy, Patricia; Morano, Sandra; Nicoletti, Jane; Begley, Cecily

2015-11-30

The proportion of pregnant women who have a caesarean section shows a wide variation across Europe, and concern exists that these proportions are increasing. Much of the increase in caesarean sections in recent years is due to a cascade effect in which a woman who has had one caesarean section is much more likely to have one again if she has another baby. In some places, it has become common practice for a woman who has had a caesarean section to have this procedure again as a matter of routine. The alternative, vaginal birth after caesarean (VBAC), which has been widely recommended, results in fewer undesired results or complications and is the preferred option for most women. However, VBAC rates in some countries are much lower than in other countries. The OptiBIRTH trial uses a cluster randomised design to test a specially developed approach to try to improve the VBAC rate. It will attempt to increase VBAC rates from 25 % to 40 % through increased women-centred care and women's involvement in their care. Sixteen hospitals in Germany, Ireland and Italy agreed to join the study, and each hospital was randomly allocated to be either an intervention or a control site. If the OptiBIRTH intervention succeeds in increasing VBAC rates, its application across Europe might avoid the 160,000 unnecessary caesarean sections that occur every year at an extra direct annual cost of more than €150 million. Current Controlled Trials ISRCTN10612254 , registered 3 April 2013.

Induced abortion on demand and birth rate in Sami-speaking municipalities and a control group in Finnmark, Norway

PubMed Central

Norum, Jan; Svee, Tove E.; Heyd, Anca; Nieder, Carsten

2013-01-01

Objectives The objective of this study was to analyze the birth and induced abortion on demand (IAD) rate among women in Sami-speaking communities and a control group in Finnmark County, Norway. Methods The 6 northern municipalities included in the administration area of the Sami language law (study group) were matched with a control group of 9 municipalities. Population data (numbers, sex and age) were accessed from Statistics Norway. Data on birth rate and IAD during the time period 1999–2009 were derived from the Medical Birth Registry (MBR) of Norway. Data on number of women in fertile age (15–44 years) were obtained from Statistics Norway. Between 2001 and 2008, this age group was reduced by 12% (Sami) and 23% (controls), respectively. Results Finnmark County has a high IAD rate and 1 in 4 pregnancies (spontaneous abortions excluded) ended in IAD in the study and control groups. The total fertility rate per woman was 1.94 and 1.87 births, respectively. There was no difference between groups with regard to the IAD/birth ratio (P=0.94) or general fertility rate GFR (P=0.82). Conclusions Women in the Sami-majority area and a control group in Finnmark County experienced a similar frequency of IAD and fertility rate. PMID:23687638

Birth rates for U.S. teenagers reach historic lows for all age and ethnic groups.

PubMed

Hamilton, Brady E; Ventura, Stephanie J

2012-04-01

The widespread significant declines in teen childbearing that began after 1991 have strengthened in recent years. The teen birth rate dropped 17 percent from 2007 through 2010, a record low, and 44 percent from 1991. Rates fell across all teen age groups, racial and ethnic groups, and nearly all states. The drop in the U.S. rate has importantly affected the number of births to teenagers. If the 1991 rates had prevailed through the years 1992–2010, there would have been an estimated 3.4 million additional births to teenagers during that period. The impact of strong pregnancy prevention messages directed to teenagers has been credited with the birth rate declines (9–11). Recently released data from the National Survey of Family Growth, conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS), have shown increased use of contraception at first initiation of sex and use of dual methods of contraception (that is, condoms and hormonal methods) among sexually active female and male teenagers. These trends may have contributed to the recent birth rate declines (12). All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Nonparametric evaluation of birth cohort trends in disease rates.

PubMed

Tarone, R E; Chu, K C

2000-01-01

Although interpretation of age-period-cohort analyses is complicated by the non-identifiability of maximum likelihood estimates, changes in the slope of the birth-cohort effect curve are identifiable and have potential aetiologic significance. A nonparametric test for a change in the slope of the birth-cohort trend has been developed. The test is a generalisation of the sign test and is based on permutational distributions. A method for identifying interactions between age and calendar-period effects is also presented. The nonparametric method is shown to be powerful in detecting changes in the slope of the birth-cohort trend, although its power can be reduced considerably by calendar-period patterns of risk. The method identifies a previously unidentified decrease in the birth-cohort risk of lung-cancer mortality from 1912 to 1919, which appears to reflect a reduction in the initiation of smoking by young men at the beginning of the Great Depression (1930s). The method also detects an interaction between age and calendar period in leukemia mortality rates, reflecting the better response of children to chemotherapy. The proposed nonparametric method provides a data analytic approach, which is a useful adjunct to log-linear Poisson analysis of age-period-cohort models, either in the initial model building stage, or in the final interpretation stage.

Physician-led, hospital-linked, birth care centers can decrease cesarean section rates without increasing rates of adverse events.

PubMed

O'Hara, Margaret H; Frazier, Linda M; Stembridge, Travis W; McKay, Robert S; Mohr, Sandra N; Shalat, Stuart L

2013-09-01

This study compares outcomes at a hospital-linked, physician-led, birthing center to a traditional hospital labor and delivery service. Using de-identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998-2005. Compared with hospital service, birth care center delivery was associated with a lower rate of cesarean sections (adjusted Relative Risk = 0.73, 95% confidence interval 0.59-0.91; p < 0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk = 1.04, 95% confidence interval 0.97-1.13; p = 0.25) and a higher initiation of breastfeeding (adjusted Relative Risk = 1.28, 95% confidence interval 1.25-1.30; p ≤ 0.001). A maternal length of stay greater than 72 hours occurred less frequently in the birth care center (adjusted Relative Risk = 0.60, 95% confidence interval 0.55-0.66; p < 0.001). Comparing only women without major obstetrical risk factors, the differences in outcomes were reduced but not eliminated. Adverse maternal and infant outcomes were not increased at the birth care center. A hospital-linked, physician-led, birth care center has the potential to lower rates of cesarean sections without increasing rates of operative vaginal delivery or other adverse maternal and infant outcomes. © 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.

Financial incentives do not always work: an example of cesarean sections in Taiwan.

PubMed

Lo, Joan C

2008-10-01

To test the hypothesis that cesarean sections are less likely to be performed after equalizing the fees for vaginal births and cesarean sections. Population-based National Health Insurance inpatient claims in Taiwan are used. Pre-periods and post-periods are identified to investigate the impact of the policy changes. Logistic regressions are employed. The cesarean section rates for the first, second and higher-order births are 29, 37.4 and 39.3%, while the primary cesarean section rates are 29, 11.8 and 12.1%, respectively. After taking into consideration the case-mix and birth order, the second and higher-order births were approximately 60% less likely to be cesarean deliveries compared to the first births and the increase in the VBAC fee had an additional negative effect on them. A fee equalization policy was not found to influence the cesarean delivery. The total cesarean section rate was primarily determined by the cesarean section rate for the first birth. Cesarean section rates are greater for the higher-order births because of the practice "once a cesarean section, always a cesarean section". Against the background of a rapidly declining fertility rate, females play a more important role in the mode of delivery than ever before. As such, financial incentives designed specifically for obstetricians do not have the desired impact. Policies that are aimed at altering behavior should be designed within the social context.

Success rates and cost of a live birth following fresh assisted reproduction treatment in women aged 45 years and older, Australia 2002-2004.

PubMed

Sullivan, Elizabeth; Wang, Yueping; Chapman, Michael; Chambers, Georgina

2008-07-01

The aim of this study was to calculate assisted reproductive technology (ART) success rates for fresh autologous and donor cycles in women aged > or = 45 and the resultant cost per live birth. We performed a retrospective population-based study of 2339 ART cycles conducted in Australia, 2002-2004 to women aged > or = 45 years. The cost-outcome study was performed on fresh autologous treatment cycles. There were 1101 fresh autologous cycles initiated in women aged > or = 45, with a pregnancy rate of 1.9 per 100 initiated cycles. There were 21 women who achieved a clinical pregnancy with 15 (71%) ending in early pregnancy loss and 6 in live singleton births. The live birth rate following fresh autologous initiated cycles was 0.5% [95% confidence interval (CI): 0.1-1.0%]. Fresh donor recipients had an higher live birth rate of 19.1% (95% CI: 15.1-23.2) (odds ratio 43.2; 95% CI: 18.6-100.3) compared with women having fresh autologous cycles. The average cost of a live birth following fresh autologous cycles was 753,107 euros. The success rate of fresh autologous treatment for women aged > or = 45 years was < 1%. The very high cost of a live birth reflects a treatment failure rate of > 99%. The ART profession should counsel patients of the reality of the technology before the patients consent to treatment.

Trends in birth weight-specific and -adjusted infant mortality rates in Taiwan between 2004 and 2011.

PubMed

Liang, Fu-Wen; Chou, Hung-Chieh; Chiou, Shu-Ti; Chen, Li-Hua; Wu, Mei-Hwan; Lue, Hung-Chi; Chiang, Tung-Liang; Lu, Tsung-Hsueh

2018-06-01

A yearly increase in the proportion of very low birth weight (VLBW) live births has resulted in the slowdown of decreasing trends in crude infant mortality rates (IMRs). In this study, we examined the trends in birth weight-specific as well as birth weight-adjusted IMRs in Taiwan. We linked three nationwide datasets, namely the National Birth Reporting Database, National Birth Certification Registry, and National Death Certification Registry databases, to calculate the IMRs according to the birth weight category. Trend tests and mortality rate ratios in the periods 2010-2011 and 2004-2005 were used to examine the extent of reduction in birth weight-specific and birth weight-adjusted IMRs. The proportion of VLBW (<1500 g) infants among live births increased from 0.78% in 2004-2005 to 0.89% in 2010-2011, thus exhibiting a 15% increase. The extents of the decreases in birth weight-specific IMRs in the 500-999, 1000-1499, 1500-1999, 2000-2499, and 2500-2999 g birth weight categories were 15%, 33%, 43%, 30%, and 28%, respectively, from 2004-2005 to 2010-2011. The reduction in IMR in each birth weight category was larger than the reduction in the crude IMR (13%). By contrast, the IMR in the <500 g birth weight category exhibited a 56% increase during the study period. The IMRs were calculated by excluding all live births with a birth weight of <500 g. The birth weight-adjusted IMRs, which were calculated using a standard birth weight distribution structure for adjustment, exhibited similar extent reductions. In countries with an increasing proportion of VLBW live births, birth weight-specific or -adjusted IMRs are more appropriate than other indices for accurately assessing the real extent of reduction in IMRs. Copyright © 2017. Published by Elsevier B.V.

Disproportion in the falling birth rate.

PubMed

Gordon, R R

1977-10-08

Since 1962 there has been a disproportionately greater fall in the number of small (less than 1000 g) live births than total live births: this has applied to Sheffield and to England and Wales but more to the former. This may have affected falling neonatal mortality rates.

Temporal trends in Inuit, First Nations and non-Aboriginal birth outcomes in rural and northern Quebec.

PubMed

Simonet, Fabienne; Wilkins, Russell; Luo, Zhong-Cheng

2012-01-01

The objective was to assess trends in Inuit, First Nations and non-Aboriginal birth outcomes in the rural and northern regions of Quebec. In a birth cohort-based study of all births to residents of rural and northern Quebec from 1991 through 2000 (n = 177,193), we analyzed birth outcomes and infant mortality for births classified by maternal mother tongue (Inuit, First Nations or non-Aboriginal) and by community type (predominantly First Nations, Inuit or non-Aboriginal). From 1991-1995 to 1996-2000, there was a trend of increasing rates of preterm birth for all 6 study groups. In all rural and northern areas, low birth weight rates increased significantly only for the Inuit mother tongue group [RR1.45 (95% CI 1.05-2.01)]. Stillbirth rates showed a non-significant increase for the Inuit mother tongue group [RR1.76 (0.64-4.83)]. Neonatal mortality rates decreased significantly in the predominantly non-Aboriginal communities and in the non-Aboriginal mother tongue group [RR0.78 (0.66-0.92)], and increased non-significantly for the First Nations mother tongue group [RR2.17 (0.71-6.62)]. Perinatal death rates increased for the First Nations mother tongue grouping in northern areas [RR2.19 (0.99-4.85)]. There was a disconcerting rise of some mortality outcomes for births to First Nations and Inuit mother tongue women and to women in predominantly First Nations and Inuit communities, in contrast to some improvements for births to non-Aboriginal mother tongue women and to women in predominantly non-Aboriginal communities in rural or northern Quebec, indicating a need for improving perinatal and neonatal health for Aboriginal populations in rural and northern regions.

Call for neonatal nursing specialization in developing countries.

PubMed

Premji, Shahirose S; Spence, Kaye; Kenner, Carole

2013-01-01

In an attempt to reach Millennium Development Goals, health facility births, which are births occurring in health centers, facilities, or institutions under the care of a skilled birth attendant, are increasing in developing countries. We examined the state of neonatal nursing care in the context of issues related to the capacity of these health facilities to provide quality care and the high facility mortality rates in those neonates admitted to hospital. Neonatal nursing as a specialty within a community-hospital-community network system is proposed as an effective scaling-up strategy to improve neonatal survival. Establishment of international competency standards for neonatal nursing together with regulatory processes with mechanisms to facilitate specialty education forms the basis for the specialty of neonatal nursing. We have identified a strategy to mobilize financial resources for the development of the specialty of neonatal nursing. Evaluation of trends in mortality and identification of process indicators will facilitate examination of the effectiveness of the introduction of the specialty of neonatal nursing as a scaling-up strategy.

Birth weight among singletons born to foreign-born mothers in Taiwan: a population-based birth register study.

PubMed

Shen, Yu-Ming; See, Lai-Chu; Lin, Sheue-Rong

2009-01-01

We compared the birth weight of newborns born to foreign-born mothers (FBMs) and Taiwan-born mothers (TBMs), using data from the 2005-2006 Taiwan Birth Registry of singleton live births. The Wilcox-Russell method, data restriction, and multiple linear regression were used to analyze the data. The rates of low birth weight (<2500 g) with 95% confidence intervals were computed for TBMs, and for each of the nationalities of FBMs. The mean birth weight of newborns of FBMs was 3157 g, which was higher than that of newborns of TBMs (3109 g). On analysis using the Wilcox-Russell method, both the rate and residual proportion of low-birth-weight (LBW) births were lower among newborns of FBMs (4.1% and 1.1%, respectively) than among newborns of TBMs (5.9% and 1.7%, respectively). After adjusting for sex, mode of delivery, maternal age, smoking status, predisposing maternal risk factors, and condition during pregnancy, the newborns of FBMs weighed 72.9 g (95% CI, 68.8 g to 77.0 g) more than the newborns of TBMs. When data were restricted to mothers without any adverse conditions and adjusted for maternal age, the differences in birth weight between the 2 groups remained unchanged. The rates of LBW deliveries among FBMs in Taiwan were significantly lower than those in their respective countries of origin. In Taiwan, newborns of FBMs had a higher birth weight than those of TBMs, even after accounting for potential confounding factors, and had lower rates of LBW deliveries than did mothers in their respective countries of origin.

Application of a validated prediction model for in vitro fertilization: comparison of live birth rates and multiple birth rates with 1 embryo transferred over 2 cycles vs 2 embryos in 1 cycle.

PubMed

Luke, Barbara; Brown, Morton B; Wantman, Ethan; Stern, Judy E; Baker, Valerie L; Widra, Eric; Coddington, Charles C; Gibbons, William E; Van Voorhis, Bradley J; Ball, G David

2015-05-01

The purpose of this study was to use a validated prediction model to examine whether single embryo transfer (SET) over 2 cycles results in live birth rates (LBR) comparable with 2 embryos transferred (DET) in 1 cycle and reduces the probability of a multiple birth (ie, multiple birth rate [MBR]). Prediction models of LBR and MBR for a woman considering assisted reproductive technology developed from linked cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System for 2006-2012 were used to compare SET over 2 cycles with DET in 1 cycle. The prediction model was based on a woman's age, body mass index (BMI), gravidity, previous full-term births, infertility diagnoses, embryo state, number of embryos transferred, and number of cycles. To demonstrate the effect of the number of embryos transferred (1 or 2), the LBRs and MBRs were estimated for women with a single infertility diagnosis (male factor, ovulation disorders, diminished ovarian reserve, and unexplained); nulligravid; BMI of 20, 25, 30, and 35 kg/m2; and ages 25, 35, and 40 years old by cycle (first or second). The cumulative LBR over 2 cycles with SET was similar to or better than the LBR with DET in a single cycle (for example, for women with the diagnosis of ovulation disorders: 35 years old; BMI, 30 kg/m2; 54.4% vs 46.5%; and for women who are 40 years old: BMI, 30 kg/m(2); 31.3% vs 28.9%). The MBR with DET in 1 cycle was 32.8% for women 35 years old and 20.9% for women 40 years old; with SET, the cumulative MBR was 2.7% and 1.6%, respectively. The application of this validated predictive model demonstrated that the cumulative LBR is as good as or better with SET over 2 cycles than with DET in 1 cycle, while greatly reducing the probability of a multiple birth. Copyright © 2015 Elsevier Inc. All rights reserved.

Living in stressful neighbourhoods during pregnancy: an observational study of crime rates and birth outcomes.

PubMed

Clemens, Tom; Dibben, Chris

2017-04-01

Patterns of adverse birth outcomes vary spatially and there is evidence that this may relate to features of the physical environment such as air pollution. However, other social characteristics of the environment such as levels of crime are relatively understudied. This study examines the association between crime rates and birth weight and prematurity. Maternity inpatient data recorded at birth, including residential postcode, was linked to a representative 5% sample of Scottish Census data and small area crime rates from Scottish Police forces. Coefficients associated with crime were reported from crude and confounder adjusted models predicting low birth weight (< 2500 g), mean birthweight, small for gestational age and prematurity for all singleton live births. Total crime rates were associated with strong and significant reductions in mean birth weight and increases in the risks of both a small for gestational age baby and premature birth. These effects, with the exception of prematurity, were robust to adjustment for individual characteristics including smoking, ethnicity and other socio-economic variables as well as area based confounders including air pollution. Mean birth weight was robust to additional adjustment for neighbourhood income deprivation. The level of crime in a mother's area of residence, which may be a proxy for the degree of threat felt and therefore stress experienced, appears to be an important determinant of the risk of adverse birth outcomes. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association.

Body size at birth and same-sex marriage in young adulthood.

PubMed

Frisch, Morten; Zdravkovic, Slobodan

2010-02-01

An unexplained excess of overweight has been reported among lesbians. In contrast, reports suggest that gay men may be, on average, slightly lighter and shorter than heterosexual men. We studied associations between weight, length, and body mass index (BMI) at birth and same-sex marriage in young adulthood among 818,671 Danes. We used linear regression to calculate differences in mean body measures at birth and Poisson regression analysis to calculate confounder-adjusted incidence rate ratios (IRR) of same-sex marriage according to body measures at birth. Overall, 739 persons entered same-sex marriage at age 18-32 years during 5.6 million person-years of follow-up. Birth year-adjusted mean body measures at birth were similar for same-sex married and other women. However, same-sex marriage rates were 65% higher among women of heavy birth weight (IRR = 1.65; 95% CI = 1.18-2.31, for > or =4000 vs. 3000-3499 g, p = .02), and rates were inversely associated with birth length (p (trend) = .04). For same-sex married men, birth year-adjusted mean weight (-72 g, p = .03), length (-0.3 cm, p = .04), and BMI (-0.1 kg/m(2), p = .09) at birth were lower than for other Danish men. Same-sex marriage rates were increased in men of short birth length (IRR = 1.45; 95% CI = 1.01-2.08, for < or =50 vs. 51-52 cm), although not uniformly so (p (trend) = .16). Our population-based findings suggest that overweight in lesbians may be partly rooted in constitutional factors. Novel findings of smaller average body measures at birth in same-sex marrying men need replication. Factors affecting intrauterine growth may somehow influence sexual and partner-related choices in adulthood.

[Prevalence of selected congenital anomalies in the Czech Republic: renal and cardiac anomalies and congenital chromosomal aberrations].

PubMed

Šípek, Antonín; Gregor, Vladimír; Horáček, Jiří; Šípek, Antonín; Langhammer, Pavel

2013-09-01

Analysis of the prevalence rates of selected diagnoses of congenital anomalies in the Czech Republic in 1994-2009. Retrospective epidemiological analysis of postnatal and total (including prenatally diagnosed cases) prevalence of congenital anomalies from the database of the National Registry of Congenital Anomalies of the Czech Republic. Data from the National Registry of Congenital Anomalies (NRCA) maintained by the Institute of Health Information and Statistics of the Czech Republic (IHIS CR) were used. Data on congenital anomalies in general and selected types of congenital anomalies were analyzed for the entire Czech Republic from 1994-2009. Additional data on prenatally diagnosed anomalies were obtained from medical genetics centres in the Czech Republic thanks to voluntary cooperation. This study analyzed postnatal and overall prevalence of congenital anomalies, with the latter including results of positive prenatal diagnosis. More detailed analysis was carried out for the following diagnoses: cystic kidney disease, renal agenesis/hypoplasia, tetralogy of Fallot, large vessel transposition, left heart hypoplasia, aortic coarctation, Down syndrome, Edward syndrome, and Patau syndrome. Cystic kidney disease showed a significant increase in 1999 and 2000, mainly due to postnatally diagnosed cases. This can be explained, on the one hand, by the modification made to the reporting of congenital anomalies in the Czech Republic and, on the other hand, by an earlier and more complete detection of postnatal cases. Since 2000, there has been a significant increase in reported cystic kidney disease as a result of postnatal kidney screening. In 1994-1999, the prevalence rates of this diagnosis ranged from 1.7 to 3.1 per 10,000 live births. Similar trend is seen in the prevalence of renal agenesis/hypoplasia. In the monitored period, prenatally diagnosed cases showed a slight increase while postnatally diagnosed cases showed a considerable rise. In 1994-1999, the prevalence rates of renal agenesis/hypoplasia ranged between 1.7 and 3.0 per 10,000 live births and in 2000-2009, between 3.9 and 7.7 per 10,000 live births. A major contributor to the upward trend is more frequent detection of unilateral renal agenesis/hypoplasia. The prevalence of tetralogy of Fallot remains nearly unchanged, with prenatally diagnosed cases accounting for more than 20% since 2000. The mean postnatal prevalence rate was 3.20 per 10,000 live births and the overall prevalence rate was 3.54 per 10,000 live births. A similar prevalence trend is seen in large vessel transposition. The mean postnatal prevalence rate was 3.01 per 10,000 live births and the mean overall prevalence rate was 3.38 per 10,000 live births. The proportion of prenatally diagnosed left heart hypoplasia showed a slow upward trend, reaching more than 75% in 2006. The mean postnatal prevalence rate was 1.44 per 10,000 live births and the mean overall prevalence rate was 2.86 per 10,000 live births. Aortic coarctation was diagnosed prenatally most often in 2003 (15.25%), with a mean of 7.5% for the whole period analyzed. Despite the prenatal diagnostic outcomes, the postnatal prevalence rates of left heart hypoplasia did not substantially vary in 1994-2009. The mean postnatal prevalence rate was 4.87 per 10,000 live births and the mean overall prevalence rate was 5.26 per 10,000 live births. The prevalence rates of prenatally diagnosed Down syndrome were continuously increasing from 4.79 to 17.73 per 10,000 live births and conversely, the postnatal prevalence rates were continuously decreasing from 7.79 to 3.31 per 10,000 live births. Increase in the overall prevalence rates can be explained mainly by the demographic situation in the Czech Republic in recent years: the average age at first birth and the first birth rate for women aged over 35 years were on the rise. The rate of prenatally diagnosed Down syndrome doubled from 40% to 80%. Similarly, the prevalence rate of prenatally diagnosed Edwards syndrome was on the rise while that of postnatally diagnosed cases was declining. The rate of prenatally diagnosed cases rose from 63% to 96% over the last two years. The mean prevalence rate of postnatally diagnosed cases was 0.72 per 10,000 live births and the mean overall prevalence rate was 3.78 per 10,000 live births. Similarly, the rate of prenatally diagnosed Patau syndrome increased from 30% in 1997 to 100% in 2009 and the rate of postnatally diagnosed cases was declining. The mean prevalence rate of postnatally diagnosed cases was 0.40 per 10,000 live births and the mean overall prevalence rate was 1.38 per 10,000 live births. The overall prevalence rates of the monitored diagnoses from the group of congenital kidney disease (cystic kidney disease and renal agenesis/hypoplasia) were on the rise in the monitored -period mainly due to advances in imaging technologies (ultrasonography) and their use in both prenatal and postnatal diagnosis. Increase in postnatally diagnosed cases can be attributed primarily to the reporting of less severe cases (cystic kidney disease) or unilateral anomalies (renal agenesis and hypoplasia). As for the monitored congenital heart defects, advances in ultrasonographic imaging diagnosis played a considerable role in the increase of cases. The overall prevalence rate show a slow upward trend, but there is a significant decline in postnatally diagnosed cases due to prenatal diagnosis of a severe anomaly, left heart hypoplasia. As for congenital chromosomal aberrations, several interconnected factors influenced the final rate. Firstly, the proportion of prenatally diagnosed cases increases due to quantitative and qualitative improvements of the screening tests. They resulted in greater efficiency of prenatal diagnosis and, at the same time, in less need for invasive prenatal diagnostic procedures. Another factor is increase in average age at first birth and in the first birth rate for women aged over 35 years resulting in higher overall prevalence rates of Down syndrome, Edwards syndrome, and Patau syndrome in the Czech Republic.

Likelihood-based inference for discretely observed birth-death-shift processes, with applications to evolution of mobile genetic elements.

PubMed

Xu, Jason; Guttorp, Peter; Kato-Maeda, Midori; Minin, Vladimir N

2015-12-01

Continuous-time birth-death-shift (BDS) processes are frequently used in stochastic modeling, with many applications in ecology and epidemiology. In particular, such processes can model evolutionary dynamics of transposable elements-important genetic markers in molecular epidemiology. Estimation of the effects of individual covariates on the birth, death, and shift rates of the process can be accomplished by analyzing patient data, but inferring these rates in a discretely and unevenly observed setting presents computational challenges. We propose a multi-type branching process approximation to BDS processes and develop a corresponding expectation maximization algorithm, where we use spectral techniques to reduce calculation of expected sufficient statistics to low-dimensional integration. These techniques yield an efficient and robust optimization routine for inferring the rates of the BDS process, and apply broadly to multi-type branching processes whose rates can depend on many covariates. After rigorously testing our methodology in simulation studies, we apply our method to study intrapatient time evolution of IS6110 transposable element, a genetic marker frequently used during estimation of epidemiological clusters of Mycobacterium tuberculosis infections. © 2015, The International Biometric Society.

First Births to Maltreated Adolescent Girls: Differences Associated With Spending Time in Foster Care.

PubMed

King, Bryn

2017-05-01

Few studies have examined early parenting among girls receiving child welfare services (CWS) or disentangled the relationship between maltreatment, spending time in foster care, and adolescent childbirth. Using population-based, linked administrative data, this study calculated birth rates among maltreated adolescent girls and assessed differences in birth rates associated with spending time in foster care. Of the 85,766 girls with substantiated allegations of maltreatment during adolescence, nearly 18% subsequently gave birth. Among girls who spent time in foster care, the proportion was higher (19.5%). Significant variations ( p < .001) were observed in the rate of childbirth across demographic characteristics and maltreatment experiences. When accounting for all of the covariates, spending time in foster care was associated with a modestly higher rate of a first birth (Hazard Ratio [HR] = 1.10; 95% confidence interval = [1.06, 1.14]). While age at first substantiated allegation of maltreatment and race/ethnicity were significant predictors of adolescent childbirth, specific maltreatment experiences were associated with minimal or no differences in birth rates. The findings of this study suggest that the experience of spending time in care may not be a meaningful predictor of giving birth as a teen among CWS-involved adolescent girls and highlight subgroups of this population who may be more vulnerable to early childbirth.

The Association of Birth Complications and Externalizing Behavior in Early Adolescents: Direct and Mediating Effects

PubMed Central

Liu, Jianghong; Raine, Adrian; Wuerker, Anne; Venables, Peter H.; Mednick, Sarnoff

2012-01-01

Prior studies have shown that birth complications interact with psychosocial risk factors in predisposing to increased externalizing behavior in childhood and criminal behavior in adulthood. However, little is known about the direct relationship between birth complications and externalizing behavior. Furthermore, the mechanism by which the birth complications predispose to externalizing behavior is not well explored. This study aims to assess whether birth complications predispose to early adolescent externalizing behavior and to test whether Intelligence Quotient (IQ) mediates relationships between predictor and outcome variables. We used data from a prospective, longitudinal birth cohort of 1,795 3-year-old boys and girls from Mauritius to test hypotheses. Birth complications were assessed from hospital record data, malnutrition from a pediatric exam at age 3 years, psychosocial adversity from parental interviews at age 3 years, and externalizing behavior problems from parental ratings at age 11 years. We found that babies with birth complications are more likely to develop externalizing behavior problems at age 11. Low IQ was associated with birth complications and was found to mediate the link between early predictors and later externalizing behavior. These prospective, longitudinal findings have potential clinical implications for the identification of early adolescent externalizing behavior and for public health attempts to prevent the occurrence of child externalizing behavior problems. PMID:22485069

Low birth weight in São Luís, northeastern Brazil: trends and associated factors

PubMed Central

2014-01-01

Background To analyze trends in LBW (low birth weight) rate using birth registry data and identify factors associated with LBW in São Luís comparing two birth cohorts separated by a 12-year interval. Methods 2,426 births were included in 1997/98 and 5,040 in 2010. The dependent variable was LBW (<2,500 g). Multiple logistic regression was performed to determine the association of independent variables with LBW. Data were also obtained from SINASC (Brazilian National Birth Registry) to analyze stillbirth and LBW rates trends from 1996 to 2010, using 3-year moving averages. Results LBW, intrauterine growth restriction (IUGR) and preterm birth rates did not differ between the two cohorts. Despite this, birth registry data showed increasing LBW rate up to 2001, coinciding with decreasing stillbirth rate. Both stillbirth and LBW rates decreased thereafter. A significant reduction was observed in the percentage of teenage mothers, mothers with up to 4 years of education, family income up to one minimum wage and mothers who did not attend prenatal care. There was an increase in maternal age ≥35 years and schooling ≥12 years. The variables associated with LBW in 1997/98 were young maternal age (<18 years), maternal smoking during pregnancy and primiparity. Variables that remained in the adjusted model in 2010 were female gender, income <3 minimum wages, lack of prenatal care, maternal smoking during pregnancy and primiparity. Conclusions Although LBW rate did not differ between the two cohorts, this apparent stability masked an increase up to 2001 and a decrease thereafter. The rise in LBW rate paralleled reduction in the stillbirth rate, suggesting improvement in obstetrical and newborn care. Maternal, socioeconomic and demographic factors associated with LBW differed between the two cohorts, except for smoking during pregnancy and parity that were significantly associated with LBW in both cohorts. PMID:24885887

Rate of gestational weight gain, pre-pregnancy body mass index and preterm birth subtypes: a retrospective cohort study from Peru

PubMed Central

Carnero, AM; Mejía, CR; García, PJ

2014-01-01

Objective To examine the shape (functional form) of the association between the rate of gestational weight gain, pre-pregnancy body mass index (BMI), and preterm birth and its subtypes. Design Retrospective cohort study. Setting National reference obstetric centre in Lima, Peru. Population Pregnant women who delivered singleton babies during the period 2006–2009, resident in Lima, and beginning prenatal care at ≤12 weeks of gestation (n = 8964). Methods Data were collected from the centre database. The main analyses consisted of logistic regression with fractional polynomial modelling. Main outcome measures Preterm birth and its subtypes. Results Preterm birth occurred in 12.2% of women, being mostly idiopathic (85.7%). The rate of gestational weight gain was independently associated with preterm birth, and the shape of this association varied by pre-pregnancy BMI. In women who were underweight, the association was linear (per 0.1 kg/week increase) and protective (OR 0.88; 95% CI 0.82–1.00). In women of normal weight or who were overweight, the association was U-shaped: the odds of delivering preterm increased exponentially with rates <0.10 or >0.66 kg/week, and <0.04 or >0.50 kg/week, respectively. In women who were obese, the association was linear, but nonsignificant (OR 1.01; 95% CI 0.95–1.06). The association described for preterm birth closely resembled that of idiopathic preterm birth, although the latter was stronger. The rate of gestational weight gain was not associated with indicated preterm birth or preterm prelabour rupture of membranes. Conclusions In Peruvian pregnant women starting prenatal care at ≤12 weeks of gestation, the rate of gestational weight gain is independently associated with preterm birth, mainly because of its association with idiopathic preterm birth, and the shape of both associations varies by pre-pregnancy BMI. PMID:22607522

Rate of gestational weight gain, pre-pregnancy body mass index and preterm birth subtypes: a retrospective cohort study from Peru.

PubMed

Carnero, A M; Mejía, C R; García, P J

2012-07-01

To examine the shape (functional form) of the association between the rate of gestational weight gain, pre-pregnancy body mass index (BMI), and preterm birth and its subtypes.   Retrospective cohort study.   National reference obstetric centre in Lima, Peru.   Pregnant women who delivered singleton babies during the period 2006-2009, resident in Lima, and beginning prenatal care at ≤ 12 weeks of gestation (n=8964).   Data were collected from the centre database. The main analyses consisted of logistic regression with fractional polynomial modelling.   Preterm birth and its subtypes.   Preterm birth occurred in 12.2% of women, being mostly idiopathic (85.7%). The rate of gestational weight gain was independently associated with preterm birth, and the shape of this association varied by pre-pregnancy BMI. In women who were underweight, the association was linear (per 0.1 kg/week increase) and protective (OR 0.88; 95% CI 0.82-1.00). In women of normal weight or who were overweight, the association was U-shaped: the odds of delivering preterm increased exponentially with rates <0.10 or >0.66 kg/week, and <0.04 or >0.50 kg/week, respectively. In women who were obese, the association was linear, but non-significant (OR 1.01; 95% CI 0.95-1.06). The association described for preterm birth closely resembled that of idiopathic preterm birth, although the latter was stronger. The rate of gestational weight gain was not associated with indicated preterm birth or preterm prelabour rupture of membranes.   In Peruvian pregnant women starting prenatal care at ≤ 12 weeks of gestation, the rate of gestational weight gain is independently associated with preterm birth, mainly because of its association with idiopathic preterm birth, and the shape of both associations varies by pre-pregnancy BMI. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Abandoned Ideology: How the Iranian Revolution Failed Islamic Economics and Embraced Populism

DTIC Science & Technology

2010-09-01

adolescent fertility rates between 2000 and 2008 (Appendix E). Further, the government apparently achieved these reductions through education and...access to contraception rather than coercive means found elsewhere. This signals the 161 Amuzegar...at birth, total (years) 69 70 71 .. Fertility rate, total (births per woman) 2.3 2.1 2.0 .. Adolescent fertility rate (births per 1,000 women ages

Variation in Birth Outcomes by Mother’s Country of Birth Among Non-Hispanic Black Women in the United States

PubMed Central

Vang, Zoua; Culhane, Jennifer F.

2014-01-01

Rates of prematurity (PTB) and small-for-gestational age (SGA) were compared between US-born and foreign-born non-Hispanic black women. Comparisons were also made between Sub-Saharan African-born and Caribbean-born black women and by maternal country of birth within the two regions. Comparisons were adjusted for sociodemographic, health behavioral and medical risk factors available on the birth record. Birth record data (2008) from all states (n = 27) where mother’s country of birth was recorded were used. These data comprised 58 % of all singleton births to non-Hispanic black women in that year. Pearson Chi square and logistic regression were used to investigate variation in the rates of PTB and SGA by maternal nativity. Foreign-born non-Hispanic black women had significantly lower rates of PTB (OR 0.727; CI 0. 726, 0.727) and SGA (OR 0.742; CI 0.739–0.745) compared to US-born non-Hispanic black women in a fully adjusted model. Sub-Saharan African-born black women compared to Caribbean-born black women had significantly lower rates of PTB and SGA. Within each region, the rates of PTB and SGA varied by mother’s country of birth. These differences could not be explained by adjustment for known risk factors obtained from vital records. Considerable heterogeneity in rates of PTB and SGA among non-Hispanic black women in the US by maternal nativity was documented and remained unexplained after adjustment for known risk factors. PMID:24756226

Black-White Differences in Child Maltreatment Reports and Foster Care Placements: A Statistical Decomposition Using Linked Administrative Data.

PubMed

Maloney, Tim; Jiang, Nan; Putnam-Hornstein, Emily; Dalton, Erin; Vaithianathan, Rhema

2017-03-01

Introduction Official statistics have confirmed that relative to their presence in the population and relative to white children, black children have consistently higher rates of contact with child protective services (CPS). We used linked administrative data and statistical decomposition techniques to generate new insights into black and white differences in child maltreatment reports and foster care placements. Methods Birth records for all children born in Allegheny County, Pennsylvania, between 2008 and 2010 were linked to administrative service records originating in multiple county data systems. Differences in rates of involvement with child protective services between black and white children by age 4 were decomposed using nonlinear regression techniques. Results Black children had rates of CPS involvement that were 3 times higher than white children. Racial differences were explained solely by parental marital status (i.e., being unmarried) and age at birth (i.e., predominantly teenage mothers). Adding other covariates did not capture any further racial differences in maltreatment reporting or foster care placement rates, they simply shifted differences already explained by marital status and age to these other variables. Discussion Racial differences in rates of maltreatment reports and foster care placements can be explained by a basic model that adjusts only for parental marital status and age at the time of birth. Increasing access to early prevention services for vulnerable families may reduce disparities in child protective service involvement. Using birth records linked to other administrative data sources provides an important means to developing population-based research.

Birth outcomes for women using free-standing birth centers in South Auckland, New Zealand.

PubMed

Bailey, David John

2017-09-01

This study investigates maternal and perinatal outcomes for women with low-risk pregnancies laboring in free-standing birth centers compared with laboring in a hospital maternity unit in a large New Zealand health district. The study used observational data from 47 381 births to women with low-risk pregnancies in South Auckland maternity facilities 2003-2010. Adjusted odds ratios with 95% confidence intervals were calculated for instrumental delivery, cesarean section, blood transfusion, neonatal unit admission, and perinatal mortality. Labor in birth centers was associated with significantly lower rates of instrumental delivery, cesarean section and blood transfusion compared with labor in hospital. Neonatal unit admission rates were lower for infants of nulliparous women laboring in birth centers. Intrapartum and neonatal mortality rates for birth centers were low and were not significantly different from the hospital population. Transfers to hospital for labor and postnatal complications occurred in 39% of nulliparous and 9% of multiparous labors. Risk factors identified for transfer were nulliparity, advanced maternal age, and prolonged pregnancy ≥41 weeks' gestation. Labor in South Auckland free-standing birth centers was associated with significantly lower maternal intervention and complication rates than labor in the hospital maternity unit and was not associated with increased perinatal morbidity. © 2017 Wiley Periodicals, Inc.

Socioeconomic inequalities in very preterm birth rates.

PubMed

Smith, L K; Draper, E S; Manktelow, B N; Dorling, J S; Field, D J

2007-01-01

To investigate the extent of socioeconomic inequalities in the incidence of very preterm birth over the past decade. Ecological study of all 549 618 births in the former Trent health region, UK, from 1 January 1994 to 31 December 2003. All singleton births of 22(+0) to 32(+6) weeks gestation (7 185 births) were identified from population surveys of neonatal services and stillbirths. Poisson regression was used to calculate incidence of very preterm birth (22-32 weeks) and extremely preterm birth (22-28 weeks) by year of birth and decile of deprivation (child poverty section of the Index of Multiple Deprivation). Incidence of very preterm singleton birth rose from 11.9 per 1000 births in 1994 to 13.7 per 1000 births in 2003. Those from the most deprived decile were at nearly twice the risk of very preterm birth compared with those from the least deprived decile, with 16.4 per 1000 births in the most deprived decile compared with 8.5 per 1000 births in the least deprived decile (incidence rate ratio 1.94; 95% CI (1.73 to 2.17)). This deprivation gap remained unchanged throughout the 10-year period. The magnitude of socio-economic inequalities was the same for extremely preterm births (22-28 weeks incidence rate ratio 1.94; 95% CI (1.62 to 2.32)). This large, unique dataset of very preterm births shows wide socio-economic inequalities that persist over time. These findings are likely to have consequences on the burden of long-term morbidity. Our research can assist future healthcare planning, the monitoring of socio-economic inequalities and the targeting of interventions in order to reduce this persistent deprivation gap.

Rates of and factors associated with delivery-related perinatal death among term infants in Scotland.

PubMed

Pasupathy, Dharmintra; Wood, Angela M; Pell, Jill P; Fleming, Michael; Smith, Gordon C S

2009-08-12

Rates of obstetric intervention in labor, including cesarean delivery, have increased significantly in most developed countries. It is, however, unclear if this has been paralleled by decreased rates of perinatal and neonatal death associated with complications of labor at term. To determine whether rates of perinatal death at term, either during labor or in the neonatal period, have changed in Scotland during the last 20 years and whether this was associated with a reduction in deaths ascribed to intrapartum anoxia. A population-based, retrospective cohort study of linked data from a registry of births (Scottish Morbidity Record 02) and a registry of perinatal deaths (Scottish Stillbirth and Infant Death Survey) between 1988 and 2007. Participants included all births of a singleton infant in a cephalic presentation at term (N = 1,012,266), excluding those with perinatal death due to congenital anomaly or antepartum stillbirth. Delivery-related perinatal death, defined as intrapartum stillbirth or neonatal death unrelated to congenital abnormality. These events were also subdivided into those events ascribed to intrapartum anoxia and all other causes. The risk of death was modeled using logistic regression and analyses were adjusted for maternal age, height, parity, socioeconomic deprivation status, gestational age, birth weight percentile, fetal sex, onset of labor, and the annual number of births per hospital. During the study period, the risk of delivery-related perinatal death decreased from 8.8 to 5.5 per 10,000 births (unadjusted change, -38%; 95% confidence interval [CI], -51% to -21%). When analyzed by the cause of death, there was a significant decrease in the risk of death ascribed to intrapartum anoxia (5.7 to 3.0 per 10,000 births; unadjusted change, -48%; 95% CI, -62% to -29%), but no significant change in the risk of death ascribed to other causes. When deaths ascribed to intrapartum anoxia were analyzed by the time of death in relation to delivery, the reduction was similar comparing intrapartum stillbirths (2.6 to 1.1 per 10,000 births; unadjusted change, -60%; 95% CI, -75% to -34%) and neonatal deaths (3.1 to 1.9 per 10,000 births; unadjusted change, -38%; 95% CI, -59% to -7%). Adjustment for maternal, fetal, and obstetric factors was without material effect. Rates of intrapartum stillbirth and neonatal death at term decreased in Scotland between 1988 and 2007. This decrease was only significant for deaths ascribed to intrapartum anoxia.

Thirty years of the World Health Organization's target caesarean section rate: time to move on.

PubMed

Robson, Stephen J; de Costa, Caroline M

2017-03-06

It has been 30 years since the World Health Organization first recommended a "maximum" caesarean section (CS) rate of 15%. There are demographic differences across the 194 WHO member countries; recent analyses suggest the optimal global CS rate is almost 20%. Attempts to reduce CS rates in developed countries have not worked. The strongest predictor of caesarean delivery for the first birth of "low risk" women appears to be maternal age; a factor that continues to increase. Most women whose first baby is born by caesarean delivery will have all subsequent children by caesarean delivery. Outcomes that informed the WHO recommendation primarily relate to maternal and perinatal mortality, which are easy to measure. Longer term outcomes, such as pelvic organ prolapse and urinary incontinence, are closely related to mode of birth, and up to 20% of women will undergo surgery for these conditions. Pelvic floor surgery is typically undertaken for older women who are less fit for surgery. Serious complications such as placenta accreta occur with repeat caesarean deliveries, but the odds only reach statistical significance at the third or subsequent caesarean delivery. However, in Australia, parity is falling, and only 20% of women will have more than two births. We should aim to provide CS to women in need and to continue including women in the conversation about the benefits and disadvantages, both short and long term, of birth by caesarean delivery.

Sexual experience and contraceptive use among female teens - United States, 1995, 2002, and 2006-2010.

PubMed

2012-05-04

The 2010 U.S. teen birth rate of 34.3 births per 1,000 females reflected a 44% decline from 1990. Despite this trend, U.S. teen birth rates remain higher than rates in other developed countries; approximately 368,000 births occurred among teens aged 15-19 years in 2010, and marked racial/ethnic disparities persist. To describe trends in sexual experience and use of contraceptive methods among females aged 15-19 years, CDC analyzed data from the National Survey of Family Growth collected for 1995, 2002, and 2006-2010. During 2006-2010, 57% of females aged 15-19 years had never had sex (defined as vaginal intercourse), an increase from 49% in 1995. Younger teens (aged 15-17 years) were more likely not to have had sex (73%) than older teens (36%); the proportion of teens who had never had sex did not differ by race/ethnicity. Approximately 60% of sexually experienced teens reported current use of highly effective contraceptive methods (e.g., intrauterine device [IUD] or hormonal methods), an increase from 47% in 1995. However, use of highly effective methods varied by race/ethnicity, with higher rates observed for non-Hispanic whites (66%) than non-Hispanic black (46%) and Hispanic teens (54%). Addressing the complex issue of teen childbearing requires a comprehensive approach to sexual and reproductive health that includes continued promotion of delayed sexual debut and increased use of highly effective contraception among sexually experienced teens.

Variations in teenage birth rates, 1991-98: national and state trends.

PubMed

Ventura, S J; Curtin, S C; Mathews, T J

2000-04-24

This report presents national birth rates for teenagers for 1991-98 and the percent change, 1991-98. State-specific teenage birth rates by age, race, and Hispanic origin for 1991 and 1998 and the percent change, 1991 to 1998, are also presented. Tabular and graphical descriptions of the trends in teenage birth rates for the Nation and each State, by age group, race, and Hispanic origin of the mother, are discussed. Birth rates for teenagers 15-19 years declined nationally between 1991 and 1998 for all age and race and Hispanic origin populations, with the steepest declines recorded for black teenagers. State-specific rates fell significantly in all States for ages 15-19 years; declines ranged from 10 to 38 percent. In general, rates by State fell more for younger than for older teenagers, ranging by State from 10 to 46 percent for ages 15-17 years. Statistically significant reductions for older teenagers ranged from 3 to 39 percent. Reductions by State were largest for black teenagers 15-19 years, with rates falling 30 percent or more in 15 States. Among the factors accounting for these declines are decreased sexual activity, increases in condom use, and the adoption of the implant and injectable contraceptives.

Seasonality in twin birth rates, Denmark, 1936-84.

PubMed

Bonnelykke, B; Søgaard, J; Nielsen, J

1987-12-01

A study was made of seasonality in twin birth rate in Denmark between 1977 and 1984. We studied all twin births (N = 45,550) in all deliveries (N = 3,679,932) during that period. Statistical analysis using a simple harmonic sinusoidal model provided no evidence for seasonality. However, sequential polynomial analysis disclosed a significant fit to a fifth order polynomial curve with peaks in twin birth rates in May-June and December, along with troughs in February and September. A falling trend in twinning rate broke off in Denmark around 1970, and from 1970 to 1984 an increasing trend was found. The results are discussed in terms of possible environmental influences on twinning.

Spontaneous vaginal delivery in the birth-chair versus in the conventional dorsal position: a matched controlled comparison.

PubMed

Scholz, H S; Benedicic, C; Arikan, M G; Haas, J; Petru, E

2001-09-17

The aim of the study was to assess the effect of a birth-chair on obstetric outcome. We reviewed the hospital records of 220 consecutive pregnant women who gave birth on a birth-chair at our institution. The control group consisted of 440 pregnant women who preceded and followed the index cases and who had spontaneous vaginal deliveries in the conventional dorsal supine position. The controls were matched for parity and for the attending mid-wife. Patients who delivered in the birth-chair had significantly lower rates of episiotomy and manual separation of the placenta. The umbilical blood cord pH was significantly higher in neonates of the birth-chair group. The duration of labour, rate of perineal and vaginal injury, Apgar scores and rate of admission to a neonatal intermediate care unit were not influenced by the mode of delivery. Our data support previous studies that a birth-chair delivery may be a safe alternative to conventional delivery in the supine position.

The Kola Birth Registry and perinatal mortality in Moncegorsk, Russia.

PubMed

Vaktskjold, Arild; Talykova, Ljudmila; Chashchin, Valerij; Nieboer, Evert; Odland, Jon Øyvind

2004-01-01

A population-based birth registry has been set up for the Arctic town of Moncegorsk in north-western Russia. In this investigation, the quality and the content of the registry are assessed and the perinatal mortality (PM) rates in the period 1973-97 estimated. Enrollment in the Kola Birth Registry (KBR) involved the retrospective inclusion of all births with at least 28 weeks of gestation in Moncegorsk in the period 1973-97. The data in the registry were assessed for data entry errors, completeness of data and population coverage. The annual PM rates were estimated for live- and stillborns with at least 28 weeks of gestation. The KBR contains detailed information about the newborn, delivery, pregnancy and mother for 21 214 births by women from Moncegorsk, covering at least 96% of all the births by the population in the period studied. No records were missing data for gender and birth date of the newborn, and more than 99.9% of the records contained data about gestational age and birthweight. Data concerning the mothers' employment were missing in 0.4% of the records. The annual PM rate fell from more than 20 to less than 10 deaths per 1000 births during this period. The KBR provides an extensive data source useful for case-control and register-based prospective studies, and constitutes the first such compilation in Russia. The homogeneity of the population in Moncegorsk makes it advantageous for epidemiological investigations. The PM rate in Moncegorsk was lower than the overall rate in Russia.

Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success.

PubMed

Knight, H E; Gurol-Urganci, I; van der Meulen, J H; Mahmood, T A; Richmond, D H; Dougall, A; Cromwell, D A

2014-01-01

To investigate the demographic and obstetric factors associated with the uptake and success rate of vaginal birth after caesarean section (VBAC). Cohort study using data from Hospital Episode Statistics. English National Health Service. Women whose first birth resulted in a live singleton delivery by caesarean section between 1 April 2004 and 31 March 2011, and who had a second birth before 31 March 2012. Logistic regression to estimate adjusted odds ratios (OR). Attempted and successful VBAC. Among the 143,970 women in the cohort, 75,086 (52.2%) attempted a VBAC for their second birth. Younger women, those of non-white ethnicity and those living in a more deprived area had higher rates of attempted VBAC. Overall, 47,602 women (63.4%) who attempted a VBAC had a successful vaginal birth. Younger women and women of white ethnicity had higher success rates. Black women had a particularly low success rate (OR, 0.54; 95% confidence interval [CI], 0.50-0.57). Women who had an emergency caesarean section in their first birth also had a lower VBAC success rate, particularly those with a history of failed induction of labour (OR, 0.59; 95% CI, 0.53-0.67). In this national cohort, just over one-half of women with a primary caesarean section who were eligible for a trial of labour attempted a VBAC for their second birth. Of these, almost two-thirds successfully achieved a vaginal delivery. © 2013 Royal College of Obstetricians and Gynaecologists.

Iron deficiency anemia: pregnancy outcomes with or without iron supplementation.

PubMed

Bánhidy, Ferenc; Acs, Nándor; Puhó, Erzsébet H; Czeizel, Andrew E

2011-01-01

To estimate the efficacy of iron supplementation in anemic pregnant women on the basis of occurrence of pregnancy complications and birth outcomes. Comparison of the occurrence of medically recorded pregnancy complications and birth outcomes in pregnant women affected with medically recorded iron deficiency anemia and iron supplementation who had malformed fetuses/newborns (cases) and who delivered healthy babies (controls) in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities. Of 22,843 cases with congenital abnormalities, 3242 (14.2%), while of 38,151 controls, 6358 (16.7%) had mothers with anemia. There was no higher rate of preterm births and low birth weight in the newborns of anemic pregnant women supplemented by iron. However, anemic pregnant women without iron treatment had a significantly shorter gestational age at delivery with a somewhat higher rate of preterm births but these adverse birth outcomes were prevented with iron supplementation. The rate of total and some congenital abnormalities was lower than expected and explained mainly by the healthier lifestyle and folic acid supplements. The secondary findings of the study showed a higher risk of constipation-related hemorrhoids and hypotension in anemic pregnant women with iron supplementation. A higher rate of preterm birth was found in anemic pregnant women without iron treatment but this adverse birth outcome was prevented with iron supplementation. There was no higher rate of congenital abnormalities in the offspring of anemic pregnant women supplemented with iron and/or folic acid supplements. Copyright © 2011 Elsevier Inc. All rights reserved.

The Australian Baby Bonus Maternity Payment and Birth Characteristics in Western Australia

PubMed Central

Einarsdóttir, Kristjana; Langridge, Amanda; Hammond, Geoffrey; Gunnell, Anthony S.; Haggar, Fatima A.; Stanley, Fiona J.

2012-01-01

Background The Australian baby bonus maternity payment introduced in 2004 has been reported to have successfully increased fertility rates in Australia. We aimed to investigate the influence of the baby bonus on maternal demographics and birth characteristics in Western Australia (WA). Methods and Findings This study included 200,659 birth admissions from WA during 2001–2008, identified from administrative birth and hospital data-systems held by the WA Department of Health. We estimated average quarterly birth rates after the baby bonus introduction and compared them with expected rates had the policy not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately by maternal demographics and birth characteristics. WA birth rates increased by 12.8% following the baby bonus implementation with the greatest increase being in mothers aged 20–24 years (26.3%, 95%CI = 22.0,30.6), mothers having their third (1.6%, 95%CI = 0.9,2.4) or fourth child (2.2%, 95%CI = 2.1,2.4), mothers living in outer regional and remote areas (32.4%, 95%CI = 30.2,34.6), mothers giving birth as public patients (1.5%, 95%CI = 1.3,1.8), and mothers giving birth in public hospitals (3.5%, 95%CI = 2.6,4.5). Interestingly, births to private patients (−4.3%, 95%CI = −4.8,−3.7) and births in private hospitals (−6.3%, 95%CI = −6.8,−5.8) decreased following the policy implementation. Conclusions The introduction of the baby bonus maternity payment may have served as an incentive for women in their early twenties and mothers having their third or fourth child and may have contributed to the ongoing pressure and staff shortages in Australian public hospitals, particularly those in outer regional and remote areas. PMID:23145010

Progesterone to prevent spontaneous preterm birth

PubMed Central

Romero, Roberto; Yeo, Lami; Chaemsaithong, Piya; Chaiworapongsa, Tinnakorn; Hassan, Sonia

2014-01-01

Summary Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and its prevention is an important healthcare priority. Preterm parturition is one of the ‘great obstetrical syndromes’ and is caused by multiple etiologies. One of the mechanisms of disease is the untimely decline in progesterone action, which can be manifested by a sonographic short cervix in the midtrimester. The detection of a short cervix in the midtrimester is a powerful risk factor for preterm delivery. Vaginal progesterone can reduce the rate of preterm delivery by 45%, and the rate of neonatal morbidity (admission to neonatal intensive care unit, respiratory distress syndrome, need for mechanical ventilation, etc.). To prevent one case of spontaneous preterm birth <33 weeks of gestation, 12 patients with a short cervix would need to be treated. Vaginal progesterone reduces the rate of spontaneous preterm birth in women with a short cervix both with and without a prior history of preterm birth. In patients with a prior history of preterm birth, vaginal progesterone is as effective as cervical cerclage to prevent preterm delivery. 17α-Hydroxyprogesterone caproate has not been shown to be effective in reducing the rate of spontaneous preterm birth in women with a short cervix. PMID:24315687

State infant mortality: an ecologic study to determine modifiable risks and adjusted infant mortality rates.

PubMed

Paul, David A; Mackley, Amy; Locke, Robert G; Stefano, John L; Kroelinger, Charlan

2009-05-01

To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR's were standardized and states were compared with the United States adjusted rates. Models for IMR in individual states in 2001 (r2 = 0.66, P < 0.01) and 2002 (r2 = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are potentially modifiable, significantly contributed to differences in state IMR. State risk adjusted IMR indicate that other factors impact infant mortality after adjustment by race/ethnicity and other risk factors.

Where Do You Feel Safest? Demographic Factors and Place of Birth.

PubMed

Sperlich, Mickey; Gabriel, Cynthia; Seng, Julia

2017-01-01

The vast majority of planned out-of-hospital births in the United States occur among white women; no study has addressed whether black women prefer out-of-hospital birth less or whether this racial disparity is due to other causes such as constrained access. This study sought to answer the question of whether white and black women feel safest giving birth in out-of-hospital settings at different rates and whether this answer is associated with other socioeconomic indicators. An interview of 634 nulliparous women during the third trimester of their pregnancy in Michigan provided data regarding where women felt safest giving birth. Feeling safest giving birth out-of-hospital was examined in relation to socioeconomic factors including race, age, household income, education, residence in a high-crime neighborhood, partnered status, and type of insurance. This study found that black and white women say they feel safest giving birth in out-of-hospital settings at similar rates (11.5% and 13.1%, respectively). Logistic regression results showed that poverty and having education beyond high school were the only sociodemographic indicators significantly associated with feeling safest giving birth out-of-hospital. Disparities evident in planned home birth and birth center rates cannot be explained by racial differences in feelings toward out-of-hospital birth and should be addressed more specifically in public policy and future studies. © 2016 by the American College of Nurse-Midwives.

PubMed Central

Fill Malfertheiner, Sara; Gutknecht, Dagmar; Bals-Pratsch, Monika

2017-01-01

Background A hyperglycemic metabolic status with insulin resistance can have a negative effect on fertility and pregnancy outcomes. The aim of this retrospective study was to investigate disorders of glucose and insulin metabolism in women wanting to conceive who conceived spontaneously prior to planned assisted reproduction (ART). Associated risk factors of patients in terms of live births and miscarriages were also analyzed. Method Out of total study population of 589 pregnancies, the pregnancies of 129 women wishing to have children who conceived spontaneously prior to planned ART were analyzed in more detail. A 75 g OGTT (OGTT: oral glucose tolerance test) was carried out prior to conception and after determination of pregnancy, including glucose measurement and testing of insulin resistance. If anomalies or risk factors for gestational diabetes (GDM) were detected, patients received metformin therapy prior to conception (off-label use). The course and outcome of pregnancies in the defined cohort were recorded. Results The rate of spontaneous conception before planned ART after treatment for disorders of glucose/insulin metabolism was 21.9% (n = 129/589). 66.7% of the 129 pregnancies resulted in a live birth, 32 patients had a miscarriage. 76.0% of patients were treated with metformin (off-label use) for polycystic ovary syndrome (PCOS), positive risk profile for GDM, or abnormal glucose/insulin metabolism prior to conception. 55.8% of the cohort developed GDM. The insulin requirements of patients with GDM differed significantly depending on their metformin intake. 24.6% of GDM patients receiving metformin treatment developed GDM requiring insulin treatment compared to 53.8% who did not receive metformin medication. The PCOS rate in the study population who had live births was significantly higher (57.0%) than in the group who had miscarriages (31.3%). There were no significant differences with regard to rate of live births and rate of miscarriages with/without metformin treatment and GDM and metformin intake. Conclusion The high rate of spontaneous conceptions in the cohort of women wishing to conceive emphasizes the importance of optimizing glucose/insulin metabolism prior to conception. The high rate of GDM in a cohort of pregnant women with a history of sterility also emphasizes the importance of expanding diagnostic testing for sterility to include the investigation of glucose metabolism and testing for insulin resistance. It is possible that PCOS patients in particular could benefit from treatment with metformin prior to conception, and this could explain the high rate of live births in this patient cohort. PMID:29276231

Socioeconomic factors affecting marriage, divorce and birth rates in a Japanese population.

PubMed

Uchida, E; Araki, S; Murata, K

1993-10-01

The effects of low income, urbanisation and young age population on age-adjusted rates of first marriage, divorce and live birth among the Japanese population in 46 prefectures were analysed by stepwise regression for 1970 and for 1975. During this period, Japanese society experienced a drastic change from long-lasting economic growth to serious recession in 1973. In both 1970 and 1975, the first marriage rate for females was inversely related to low income and the divorce rates for both males and females were positively related to low income. The live birth rate was significantly related to low income, urbanisation and young age population only in 1975. The first marriage rate for females and the divorce rates for both sexes increased significantly but the first marriage rate for males and live birth rate significantly decreased between 1970 and 1975. These findings suggest that low income was the essential factor affecting first marriage for females and divorce for males and females.

Where are the Sunday babies? III. Caesarean sections, decreased weekend births, and midwife involvement in Germany

NASA Astrophysics Data System (ADS)

Lerchl, Alexander

2008-02-01

A previous study has shown a marked and continuing decline in weekend births in Germany between 1988 and 2003 (Lerchl, Naturwissenschaften 92:592-594, 2005). The present study was performed to investigate the possible influence of caesarean sections (CS) on weekend birth number and on the involvement of midwives in births for all 16 German states for the year 2003. In total, data from 706,721 births were sorted according to weekday of births and state, respectively, and the weekend births avoidance rates were calculated. Weekend births were consistently less frequent than births during the week, with an average of -15.3% for all states and due to fewer births on Saturdays (-13.6%) and Sundays (-16.7%). Between the states, weekend births avoidance rates ranged from -11.6% (Bremen) to -24.2% (Saarland). The proportion of CS was 25.5% for all states, ranging from 19.2% (Sachsen and Sachsen-Anhalt) to 30.5% (Saarland). CS and weekend births avoidance rates were significantly correlated, consistent with the hypothesis that primary (planned) CS are regularly scheduled on weekdays. The number of births per midwife (BPM) was calculated according to the number of active members in the states’ professional midwives’ organizations. The mean number of BPM was 59.5, ranging from 45.2 (Bremen) to 82.4 (Sachsen-Anhalt). CS and BPM were significantly correlated, consistent with the hypothesis that higher CS ratios are associated with lower midwife involvement in births. It is concluded that the decline in weekend births and lower involvement of midwives are caused, at least in part, by an increased number of caesarean sections.

Longitudinal study of neonatal brain tissue volumes in preterm infants and their ability to predict neurodevelopmental outcome.

PubMed

Gui, L; Loukas, S; Lazeyras, F; Hüppi, P S; Meskaldji, D E; Borradori Tolsa, C

2018-06-14

Premature birth has been associated with poor neurodevelopmental outcomes. However, the relation between such outcomes and brain growth in the neonatal period has not yet been fully elucidated. This study investigates longitudinal brain development between birth and term-equivalent age (TEA) by quantitative imaging in a cohort of premature infants born between 26 and 36 weeks gestational age (GA), to provide insight into the relation of brain growth with later neurodevelopmental outcomes. Longitudinal T2-weighted magnetic resonance images (MRI) of 84 prematurely born infants acquired shortly after birth and TEA were automatically segmented into cortical gray matter (CGM), unmyelinated white matter (UWM), subcortical gray matter (SGM), cerebellum (CB) and cerebrospinal fluid (CSF). General linear models and correlation analysis were used to study the relation between brain volumes and their growth, and perinatal variables. To investigate the ability of the brain volumes to predict children's neurodevelopmental outcome at 18-24 months and at 5 years of age, a linear discriminant analysis classifier was tested and several general linear models were fitted and compared by statistical tests. From birth to TEA, relative volumes of CGM, CB and CSF with respect to total intracranial volume increased, while relative volumes of UWM and SGM decreased. The fastest growing tissues between birth and TEA were found to be the CB and the CGM. Lower GA at birth was associated with lower growth rates of CGM, CB and total tissue. Among perinatal factors, persistent ductus arteriosus was associated with lower SGM, CB and IC growth rates, while sepsis was associated with lower CSF and intracranial volume growth rates. Model comparisons showed that brain tissue volumes at birth and at TEA contributed to the prediction of motor outcomes at 18-24 months, while volumes at TEA and volume growth rates contributed to the prediction of cognitive scores at 5 years of age. The family socio-economic status (SES) was not correlated with brain volumes at birth or at TEA, but was strongly associated with the cognitive outcomes at 18-24 months and 5 years of age. This study provides information about brain growth between birth and TEA in premature children with no focal brain lesions, and investigates their association with subsequent neurodevelopmental outcome. Parental SES was found to be a major determinant of neurodevelopmental outcome, unrelated to brain growth. However, further research is necessary in order to fully explain the variability of neurodevelopmental outcomes in this population. Copyright © 2018. Published by Elsevier Inc.

Geography of breast cancer incidence according to age & birth cohorts.

PubMed

Gregorio, David I; Ford, Chandler; Samociuk, Holly

2017-06-01

Geographic variation in breast cancer incidence across Connecticut was examined according to age and birth cohort -specific groups. We assigned each of 60,937 incident breast cancer cases diagnosed in Connecticut, 1986-2009, to one of 828 census tracts around the state. Global and local spatial statistics estimated rate variation across the state according to age and birth cohorts. We found the global distribution of incidence rates across places to be more heterogeneous for younger women and later birth cohorts. Concurrently, the spatial scan identified more locations with significantly high rates that pertained to larger proportions of at-risk women within these groups. Geographic variation by age groups was more pronounced than by birth cohorts. Geographic patterns of cancer incidence exhibit differences within and across age and birth cohorts. With the continued insights from descriptive epidemiology, our capacity to effectively limit spatial disparities in cancer will improve. Copyright © 2017 Elsevier Ltd. All rights reserved.

Determinants of cognitive development of low SES children in Chile: a post-transitional country with rising childhood obesity rates.

PubMed

Galván, Marcos; Uauy, Ricardo; Corvalán, Camila; López-Rodríguez, Guadalupe; Kain, Juliana

2013-09-01

Studies conducted in developing countries have noted associations between concurrent stunting, social-emotional problems and poor cognitive ability in young children. However, the relative contribution of these variables in Latin America is likely changing as undernutrition rates decline and prevalence of childhood obesity rises. We conducted a cross-sectional study of 106 normal-weight and 109 obese preschool children to compare the relative contribution of early nutrition, sociodemographic factors and psychosocial variables on cognitive development in normal-weight and obese preschool children in Chile. The study variables were categorized as: (1) socio-demographic (age, sex, birth order and socioeconomic) (2) early nutrition (maternal height, birth weight, birth length and height at 5 years) (3) psychosocial factors (maternal depression, social-emotional wellbeing and home space sufficiency). In order to assess determinants of cognitive development at 4-5 years we measured intelligence quotient (IQ); variability in normal children was mostly explained by socio-demographic characteristics (r(2) = 0.26), while in obese children early nutritional factors had a significant effect (r(2) = 0.12) beyond socio-demographic factors (r(2) = 0.19). Normal-weight children, who were first born, of slightly better SES and height Z score >1, had an IQ ≥ 6 points greater than their counterparts (p < 0.05). Obese children who were first born with birth weight >4,000 g and low risk of socio-emotional problems had on average ≥5 IQ points greater than their peers (p < 0.05). We conclude that in Chile, a post-transitional country, IQ variability of normal children was mostly explained by socio-demographic characteristics; while in obese children, early nutrition also played a significant role.

Associations between birth health, maternal employment, and child care arrangement among a community sample of mothers with young children.

PubMed

Chiao, Chi; Chyu, Laura; Ksobiech, Kate

2014-01-01

Although a large body of literature exists on how different types of child care arrangements affect a child's subsequent health and sociocognitive development, little is known about the relationship between birth health and subsequent decisions regarding type of nonparental child care as well as how this relationship might be influenced by maternal employment. This study used data from the Los Angeles Families and Neighborhoods Survey (L.A.FANS). Mothers of 864 children (ages 0-5) provided information regarding birth weight, maternal evaluation of a child's birth health, child's current health, maternal employment, type of child care arrangement chosen, and a variety of socioeconomic variables. Child care options included parental care, relative care, nonrelative care, and daycare center. Multivariate analyses found that birth weight and subjective rating of birth health had similar effects on child care arrangement. After controlling for a child's age and current health condition, multinomial logit analyses found that mothers with children with poorer birth health are more likely to use nonrelative and daycare centers than parental care when compared to mothers with children with better birth health. The magnitude of these relationships diminished when adjusting for maternal employment. Working mothers were significantly more likely to use nonparental child care than nonemployed mothers. Results suggest that a child's health early in life is significantly but indirectly related to subsequent decisions regarding child care arrangements, and this association is influenced by maternal employment. Development of social policy aimed at improving child care service should take maternal and family backgrounds into consideration.

Misclassification Bias and the Estimated Effect of Parental Involvement Laws on Adolescents' Reproductive Outcomes

PubMed Central

Joyce, Ted; Kaestner, Robert

2008-01-01

Objectives. We evaluated the presence of misclassification bias in the estimated effect of parental involvement laws on minors’ reproductive outcomes when subjection to such laws was measured by age at the time of pregnancy resolution. Methods. Using data from abortion and birth certificates, we evaluated the effect of Texas's parental notification law on the abortion, birth, and pregnancy rates of adolescents aged 17 years compared with those aged 18 years on the basis of age at the time of pregnancy resolution and age at conception. Results. On the basis of age at the time of the abortion or birth, the law was associated with a fall of 26%, 7%, and 11% in the abortion, birth, and pregnancy rates, respectively, of 17- relative to 18-year-olds. Based on age at the time of conception, the abortion rate fell 15%, the birth rate rose 2%, and the pregnancy rate remained unchanged. Conclusions. Previous studies of parental involvement laws should be interpreted with caution because their methodological limitations have resulted in an overestimation of the fall in abortions and underestimation of the rise in births, possibly leading to the erroneous conclusion that pregnancies decline in response to such laws. PMID:18309128

An evaluation of vital registers as sources of data for infant mortality rates in Cameroon.

PubMed

Ndong, I; Gloyd, S; Gale, J

1994-06-01

Infant mortality rates have been widely used as indicators of health status and the availability, utilization and effectiveness of health services. Two principal sources of data for infant mortality rates are vital registers and censuses. This study was designed to evaluate the accuracy of vital registers as sources of data for infant mortality rates in Cameroon. A household census of births and infant deaths that occurred in Buea Subdivision between 1 November 1991 and 31 October 1992 was conducted to determine the proportion that were registered and the reasons why the remainder were not registered. The registration coverage was found to be 62% for births and 4% for infant deaths. The most frequently reported reasons for not registering births were lack of money, lack of time and a complicated registration procedure. For infant deaths the reasons were lack of knowledge and no perceived benefits. Vital registers of birth and death are not an accurate source of data for infant mortality rates in Cameroon. Motivation for birth and death registration appear to be dependent on the perceived benefits. A mechanism of registration that uses medical institutions may substantially increase registration coverage for births and infant deaths.

Self-reported practices among traditional birth attendants surveyed in western Kenya: a descriptive study.

PubMed

Bucher, Sherri; Konana, Olive; Liechty, Edward; Garces, Ana; Gisore, Peter; Marete, Irene; Tenge, Constance; Shipala, Evelyn; Wright, Linda; Esamai, Fabian

2016-08-12

The high rate of home deliveries conducted by unskilled birth attendants in resource-limited settings is an important global health issue because it is believed to be a significant contributing factor to maternal and newborn mortality. Given the large number of deliveries that are managed by unskilled or traditional birth attendants outside of health facilities, and the fact that there is on-going discussion regarding the role of traditional birth attendants in the maternal newborn health (MNH) service continuum, we sought to ascertain the practices of traditional birth attendants in our catchment area. The findings of this descriptive study might help inform conversations regarding the roles that traditional birth attendants can play in maternal-newborn health care. A structured questionnaire was used in a survey that included one hundred unskilled birth attendants in western Kenya. Descriptive statistics were employed. Inappropriate or outdated practices were reported in relation to some obstetric complications and newborn care. Encouraging results were reported with regard to positive relationships that traditional birth attendants have with their local health facilities. Furthermore, high rates of referral to health facilities was reported for many common obstetric emergencies and similar rates for reporting of pregnancy outcomes to village elders and chiefs. Potentially harmful or outdated practices with regard to maternal and newborn care among traditional birth attendants in western Kenya were revealed by this study. There were high rates of traditional birth attendant referrals of pregnant mothers with obstetric complications to health facilities. Policy makers may consider re-educating and re-defining the roles and responsibilities of traditional birth attendants in maternal and neonatal health care based on the findings of this survey.

Analysis of birth defects among children 3 years after conception through assisted reproductive technology in China.

PubMed

Yin, Li; Hang, Fu; Gu, Long-jie; Xu, Bei; Ma, Ding; Zhu, Gui-jin

2013-11-01

Previous studies inconsistently suggest that assisted reproduction technology (ART) may increase the risk of birth defects in children. Live birth infants, conceived by in vitro fertilization fresh embryo transfer (IVF), intracytoplasmic sperm injection fresh embryo transfer (ICSI), or frozen-thawed embryo transfer (FET) in Reproductive Center of Tongji Hospital (Wuhan, China) between 1997 and 2008, were followed up at birth and after 3 years. Preterm pregnancy, multiple pregnancy, sex ratio (male/female), congenital malformation were compared. A total of 4,236 children were born after ART (IVF 2,543, ICSI 908, FET 785). Compared with IVF, the rate of preterm pregnancy and sex ratio in ICSI were lower (p < 0.05); the rate of multiple pregnancy in ICSI and FET were all lower than IVF (p < 0.05). Congenital defects were comparable in all groups at birth. In total, 2,908 children participated in the second follow-up from 34 months to 60 months with an average of 40 months, and the cases of birth defects had doubled (3 years: 5.16%, birth: 2.22%). The birth defect rate in boys conceived through ICSI was significantly higher than the IVF group after 3-year follow-up (ICSI boys: 8.62%, IVF boys: 5.21% [p < 0.05]), even though there was no significant difference at birth. Compared with IVF, FET may not increase risk of birth defects. Children conceived through ICSI, especially males, had higher rates of congenital malformations that were inapparent at birth. So longitudinal monitoring may provide insights into the risks of ART. Copyright © 2013 Wiley Periodicals, Inc., a Wiley company.

Regardless of where they give birth, women living in non-metropolitan areas are less likely to have an epidural than their metropolitan counterparts.

PubMed

Powers, Jennifer R; Loxton, Deborah J; O'Mara, Ashleigh T; Chojenta, Catherine L; Ebert, Lyn

2013-06-01

Can differences in Australian birth intervention rates be explained by women's residence at the time of childbearing?. Data were collected prospectively via surveys in 1996, 2000, 2003, 2006 and 2009 from women, born between 1973 and 1978, of the Australian Longitudinal Study on Women's Health. Analysis included data from 5886 women who had given birth to their first child between 1994 and 2009. Outcome measures were self-report of birth interventions: pharmacological pain relief (epidural and spinal block analgesia, inhalational analgesia and intramuscular injections), surgical births (an elective or emergency caesarean section) and instrumental births (forceps and ventouse). Primiparous women residing in non-metropolitan areas of Australia experienced fewer birth interventions than women residing in metropolitan areas: 43% versus 56% received epidural analgesia; 8% versus 11% had elective caesarean sections; and 16% versus 18% had emergency caesarean sections. Differences in maternal age and private health insurance status at first birth accounted for differences in surgical birth rates but did not fully explain differences in epidural analgesia. Non-metropolitan women had fewer birth interventions, particularly epidural analgesia, than metropolitan women. Differences in maternal age and private health insurance do not fully explain the differences in epidural analgesia rates, suggesting care provided to labouring women may differ by area of residence. The difference in epidural analgesia rates may be due to lack of choice in maternity services, however it could also be due to differing expectations leading to differences in birth interventions for primiparous women living in metropolitan and non-metropolitan areas. Copyright © 2012 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Place matters: variation in the black/white very preterm birth rate across U.S. metropolitan areas, 2002-2004.

PubMed

Kramer, Michael R; Hogue, Carol R

2008-01-01

We reported on the distribution of very preterm (VPT) birth rates by race across metropolitan statistical areas (MSAs). Rates of singleton VPT birth for non-Hispanic white, non-Hispanic black, and Hispanic women were calculated with National Center for Health Statistics 2002-2004 natality files for infants in 168 MSAs. Subanalysis included stratification by parity, age, smoking, maternal education, metropolitan size, region, proportion of MSA that was black, proportion of black population living below the poverty line, and indices of residential segregation. The mean metropolitan-level VPT birth rate was 12.3, 34.8, and 15.7 per 1,000 live births for white, black, and Hispanic women, respectively. There was virtually no overlap in the white and black distributions. The variation in mean risk across cities was three times greater for black women compared with white women. The threefold disparity in mean rate, and two- to threefold increased variation as indicated by standard deviation, was maintained in all subanalyses. Compared with white women, black women have three times the mean VPT birth risk, as well as three times the variance in city-level rates. The racial disparity in VPT birth rates was composed of characteristics that were constant across MSAs, as well as factors that varied by MSA. The increased sensitivity to place for black women was unexplained by measured maternal and metropolitan factors. Understanding determinants of differences in both the mean risk and the variation of risk among black and white women may contribute to reducing the disparity in risk between races.

Birth rates among female cancer survivors: a population-based cohort study in Sweden.

PubMed

Hartman, Mikael; Liu, Jenny; Czene, Kamila; Miao, Hui; Chia, Kee Seng; Salim, Agus; Verkooijen, Helena M

2013-05-15

More women of fertile age are long-term survivors of cancer. However, population-based data on birth rates of female cancer survivors are rare. A total of 42,691 women ≤ 45 years with a history of cancer were identified from the Swedish Multi-Generation Register and the Swedish Cancer Register, for whom relative birth rates were calculated as compared to the background population, ie, standardized birth ratios (SBRs). Independent factors associated with reduced birth rates among cancer survivors were estimated using Poisson modeling. Compared to the background population, cancer survivors were 27% less likely to give birth (SBR = 0.73, 95% confidence interval [CI] = 0.72-0.75). Large difference in SBRs existed by cancer site, with high SBRs for survivors of melanoma skin, thoracic, head and neck, and thyroid cancers, and low SBRs for reproductive, breast, brain and eye, and hematopoietic cancer survivors. Parity status at diagnosis affected fertility: women who already had a child at the time of diagnosis were less likely to give birth (SBR = 0.50, 95% CI = 0.48-0.53) than were nulliparous women (SBR = 0.87, 95% CI = 0.85-0.90). Multivariate analysis showed that cancer site (reproductive organs), age at onset of cancer (< 12 years), and parity status were all significant and independent predictors of a reduced probability of giving birth after diagnosis. Cancer survivors are less likely to give birth compared with the background population. Large variations in the likelihood to give birth after diagnosis were seen according to age at onset, cancer site, and parity status at diagnosis. Copyright © 2013 American Cancer Society.

The History and Challenges Surrounding Ovarian Stimulation in the Treatment of Infertility

PubMed Central

Beall, Stephanie A.; Decherney, Alan

2014-01-01

OBJECTIVE To examine the history of superovulation for ovulation induction, its contributions to reproductive medicine and its impact on multiple births. DESIGN A search of the relevant literature using Pubmed and other online tools. RESULT(S) Infertility has been a condition known and studied for thousands of years. However, it was not until this past century that effective treatments were developed. With the advancement of our knowledge of the hypothalamic-pituitary axis, therapies utilizing gonadotropins were developed to stimulate ovulation. Not only were we now able to treat anovulatory infertility, but also induce superovulation for in vitro fertilization. With these successes came consequences, including increased multiple pregnancies. Several countries recognized the high costs associated with multiple births and implemented regulations on the infertility industry. The rate of triplet and higher-order multiples has declined over the past decade. This is largely attributed to a decreased number of embryos transferred. Nonetheless, the twin rate has remained consistently high. CONCLUSION(S) Superovulation has become a routine medical therapy used for ovulation induction and in vitro fertilization. With the development of this technology have come effective therapies for infertility and new ethical and medical challenges. Since the advent of gonadotropin therapy we have already developed technologies to improve monitoring and decrease hyperstimulation and high order multiple pregnancies. In the future, we anticipate new tools devised to optimize one embryo for one singleton live birth. PMID:22463773

Embryo transfer by reproductive endocrinology fellows vs attending physicians: are live birth rates comparable?

PubMed

Eaton, Jennifer L; Zhang, Xingqi; Barnes, Randall B

2014-11-01

To compare live birth rates following ultrasound-guided embryo transfer (ET) by reproductive endocrinology and infertility fellows versus attending physicians. Women who underwent their first day-3, fresh, nondonor ET between Oct. 1, 2005, and April 1, 2011, at our academic center were included in this retrospective cohort study. Embryos were designated high quality if they had 8 cells, less than 10% fragmentation, and no asymmetry. ET was performed with the afterload technique under ultrasound guidance. Categorical variables were evaluated with the χ(2) test and continuous variables with the Student t test. Logistic regression was performed to assess the relationship between ET physician and live birth rate while adjusting for potential confounders. Seven hundred sixty women underwent ET by an attending physician, and 104 by a fellow. Baseline characteristics were similar between the groups. The live birth rate was 31% following ET by an attending physician, compared with 34% following ET by a fellow (P = .65). Logistic regression adjusting for potential confounders demonstrated no significant association between ET physician and live birth rate. This retrospective study demonstrated no significant difference in live birth rates following ultrasound-guided ET by fellows vs attending physicians at our institution. These data suggest that academic practices using the afterload method and ultrasound guidance can train fellows to perform ET without compromising success rates. Copyright © 2014 Elsevier Inc. All rights reserved.

Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data.

PubMed

de Jonge, Ank; Baron, Ruth; Westerneng, Myrte; Twisk, Jos; Hutton, Eileen K

2013-08-01

the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking. secondary analyses using published data from the Euro-PERISTAT study. women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term). odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data. combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births. compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3). the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain. Copyright © 2013 Elsevier Ltd. All rights reserved.

The impact of breast cancer-specific birth cohort effects among younger and older Chinese populations.

PubMed

Sung, Hyuna; Rosenberg, Philip S; Chen, Wan-Qing; Hartman, Mikael; Lim, Wei-Yen; Chia, Kee Seng; Wai-Kong Mang, Oscar; Tse, Lapah; Anderson, William F; Yang, Xiaohong R

2016-08-01

Historically low breast cancer incidence rates among Asian women have risen worldwide; purportedly due to the adoption of a "Western" life style among younger generations (i.e., the more recent birth cohorts). However, no study has simultaneously compared birth cohort effects between both younger and older women in different Asian and Western populations. Using cancer registry data from rural and urban China, Singapore and the United States (1990-2008), we estimated age-standardized incidence rates (ASR), annual percentage change (EAPC) in the ASR, net drifts, birth cohort specific incidence rates and cohort rate ratios (CRR). Younger (30-49 years, 1943-1977 birth cohorts) and older women (50-79 years; 1913-1957 birth cohorts) were assessed separately. CRRs among Chinese populations were estimated using birth cohort specific rates with US non-Hispanic white women (NHW) serving as the reference population with an assigned CRR of 1.0. We observed higher EAPCs and net drifts among those Chinese populations with lower ASRs. Similarly, we observed the most rapidly increasing cohort-specific incidence rates among those Chinese populations with the lowest baseline CRRs. Both trends were more significant among older than younger women. Average CRRs were 0.06-0.44 among older and 0.18-0.81 among younger women. Rapidly rising cohort specific rates have narrowed the historic disparity between Chinese and US NHW breast cancer populations particularly in regions with the lowest baseline rates and among older women. Future analytic studies are needed to investigate risk factors accounting for the rapid increase of breast cancer among older and younger women separately in Asian populations. © 2016 UICC.

High birth rates despite easy access to contraception and abortion: a cross-sectional study.

PubMed

Hognert, Helena; Skjeldestad, Finn E; Gemzell-Danielsson, Kristina; Heikinheimo, Oskari; Milsom, Ian; Lidegaard, Øjvind; Lindh, Ingela

2017-12-01

The aim of this study was to describe and compare contraceptive use, fertility, birth, and abortion rates in the Nordic countries. National data on births, abortions, fertility rate (1975-2013), redeemed prescriptions of hormonal contraceptives and sales figures of copper intrauterine devices (2008-2013) among women 15-49 years of age in the Nordic countries were collected and analyzed. Use of hormonal contraceptives and copper intrauterine devices varied between 31 and 44%. The highest use was in Denmark (39-44%) and Sweden (40-42%). Combined hormonal contraception followed by the levonorgestrel-releasing intrauterine system were the most common methods. During 1975-2013 abortion rates decreased in Denmark (from 27/1000 women to 15/1000 women aged 15-44/1000 women) and Finland (from 20 to 10/1000 women), remained stable in Norway (≈16) and Sweden (≈20) and increased in Iceland (from 6 to 15/1000 women). Birth rates remained stable around 60/1000 women aged 15-44 in all countries except for Iceland where the birth rate decreased from 95 to 65/1000 women. Abortion rates were highest in the age group 20-24 years. In the same age group, Sweden had a lower contraceptive use (51%) compared with Denmark (59%) and Norway (56%) and a higher abortion rate 33/1000 compared with Denmark (25/1000) and Norway (27/1000). In contrast to the declining average fertility and birth rates in Europe, rates in the Nordic countries remain high and stable despite high contraceptive use and liberal access to abortion on women's request. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Ages and Stages Questionnaires: feasibility of postal surveys for child follow-up.

PubMed

Troude, Pénélope; Squires, Jane; L'Hélias, Laurence Foix; Bouyer, Jean; de La Rochebrochard, Elise

2011-10-01

The Ages and Stages Questionnaire (ASQ), completed by parents and caregivers, has been shown to be an accurate tool for screening children who need further developmental assessment. To assess the feasibility of using the French Canadian translation of the ASQ in an epidemiological cohort of children from the French general population. Follow-up study by postal questionnaire at 12 and 36 months, using the ASQ. 339 French families recruited at the birth of their child in 2006 in two hospitals in the Paris suburbs. Response rates and French ASQ results at 12 and 36 months. The ASQ was scored as indicated in the manual. A high response rate of 79% was observed at the children's 1st and 3rd birthdays. Parents were enthusiastic about participating; half of them wrote comments on the questionnaires, most of them positive. Low scores at the 12-month assessment were associated with birth characteristics such as prematurity and transfer to the neonatology unit after birth, whereas at 36 months they tended to be associated with both birth and family socio-demographic characteristics. Use of the French ASQ in a research cohort appears feasible as response rates were high. Moreover, known links between child development measured by ASQ and birth and social characteristics were observed. However, further French studies are needed to understand differences observed in 12-month ASQ gross motor scores compared with US norms. For research purposes, further analysis of the ASQ in innovative, quantitative approaches, is needed. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Global contraceptive use improves health.

PubMed

Ross, J A

1988-01-01

Over 40% of all cohabiting women, in Asia and Latin America, are using contraceptives, most of them modern methods. In many countries, upper order births are disappearing, and rural birth rates in some regions have fallen nearly as much as urban ones. The average family size is diminishing sharply. It is close to 2 children in Thailand, and below 2 throughout urban China. 4/5 of the developing world's population live in only 17 countries, in which contraceptive use has risen from 41% to 52% of couples in 10 years. Moreover, family planning programs affect the overall health of the population: fewer births have meant fewer maternal deaths, and fewer orphans, fewer infant and child deaths, fewer high-risk births (especially at short intervals and upper parities), fewer children left unimmunized, and fewer unserved by the health services. The extent of this quiet social revolution has its limits. Mainly in the 50 struggling countries of sub-Saharan Africa, most of them with weak health ministries, as well as, among the largest 8 countries, Nigeria and Pakistan, which have changed little. But both are reactivating their family planning programs, and the concentration of 2/3 of the developing world's population in 8 large countries means that only 8 administrations can control the course of vital rates. The consequence of the great transformation induced by contraceptive use has begun to give developing world's women control over their own child bearing, adding freedom to their lives. Nevertheless, if the contraceptive revolution has enormously advanced the cause of international health, it still has a long way to go.

Atrazine and nitrate in drinking water and the risk of preterm delivery and low birth weight in four Midwestern states.

PubMed

Stayner, Leslie Thomas; Almberg, Kirsten; Jones, Rachael; Graber, Judith; Pedersen, Marie; Turyk, Mary

2017-01-01

Atrazine and nitrate are common contaminants in water, and there is limited evidence that they are associated with adverse birth outcomes. The objective of this study was to examine whether atrazine and nitrate in water are associated with an increased risk of preterm delivery (PTD) and term low birth weight (LBW). The study included a total of 134,258 singletons births born between January 1, 2004 and December 31, 2008 from 46 counties in four Midwestern states with public water systems that were included in the U.S. Environmental Protection Agency (EPA)'s atrazine monitoring program (AMP). Counties with a population of >300,000 were eliminated from the analyses in order to avoid confounding by urbanicity. Monthly child's sex, race and Hispanic ethnicity specific data were obtained from the states for estimating rates of PTD (<37 weeks) and very preterm (VPTD, <32 weeks), term LBW (<2.5kg among infants born at term) and very low birth weight (VLBW, <1.5kg). The rates were linked with county specific monthly estimates of the concentration of atrazine and nitrate in finished water. Multivariable negative binomial models were fitted to examine the association between the exposures and the adverse birth outcomes. Models were fitted with varying restrictions on the percentage of private well usage in the counties in order to limit the degree of exposure misclassification. Estimated water concentrations of atrazine (mean=0.42 ppb) and nitrate (mean=0.95ppm) were generally low. Neither contaminant was associated with an increased risk of term LBW. Atrazine exposure was associated with a significant increased rate of PTD when well use was restricted to 10% and the exposure was averaged over 4-6 months prior to birth (Rate Ratio for 1ppm increase [RR 1ppm ]=1.08, 95%CI=1.05,1.11) or over 9 months prior to birth (RR 1ppm =1.10, 95%CI=1.01,1.20). Atrazine exposure was also associated with an increased rate of VPTD when when well use was restricted to 10% and the exposure was averaged over 7-9 months prior to birth (RR 1ppm =1.19, 95%CI=1.04,1.36). Exposure to nitrate was significantly associated with an increased rate of VPTD (RR 1ppm =1.08, 95%CI=1.02,1.15) and VLBW (RR 1ppm =1.17, 95%CI=1.08,1.25) when well use was restricted to 20% and the exposure was averaged over 9 months prior to birth. The positive and negative findings from our study need to be interpreted cautiously given its ecologic design, and limitations in the data for the exposures and other risk factors. Nonetheless, our findings do raise concerns about the potential adverse effects of these common water contaminants on human development and health, and the adequacy of current regulatory standards. Further studies of these issues are needed with individual level outcome data and more refined estimates of exposure. Copyright © 2016 Elsevier Inc. All rights reserved.

Caesarean birth rates in public and privately funded hospitals: a cross-sectional study.

PubMed

Alonso, Bruna Dias; Silva, Flora Maria Barbosa da; Latorre, Maria do Rosário Dias de Oliveira; Diniz, Carmen Simone Grilo; Bick, Debra

2017-01-01

To examine maternal and obstetric factors influencing births by cesarean section according to health care funding. A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births. The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women's maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system. Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.

Political economy of population growth.

PubMed

Mehta, S; Mehta, H S

1987-01-01

Tracing the origin of political economy as a class-science, this paper focuses on the political economy of population growth. Exposing the limitations of Malthusian ideas and their invalidity even for the capitalist economies, it discusses the subsequent revival of the Malthusian model during the period of de-colonization and the misinterpretation of the relationship between population growth and development in the developing and developed countries. Taking India, China, and Japan as some case studies, the paper examines the relationship between birth rate levels and some correlates. It elaborates on the Indian experience, emphasizing the association of population growth with poverty and unemployment and lays bare some of the hidden causes of these phenomena. The authors examine some interstate variations in India and identify constraints and prospects of the existing population policy. The paper proposes outlines of a democratic population policy as an integral part of India's development strategy which should recognize human beings not simply as consumers but also as producers of material values. It pleads for 1) restructuring of property relations; 2) bringing down the mortality rates and raising of the literacy levels, especially among females; and 3) improving nutritional levels, as prerequisites for bringing down birth rates.

Sociodemographic characteristics of mother’s population and risk of preterm birth in Chile

PubMed Central

2013-01-01

Background Preterm birth is a global problem in Perinatal and infant Health. Currently is gaining a growing attention. Rates of preterm birth have increased in most countries, producing a dramatic impact on public health. Factors of diverse nature have been associated to these trends. In Chile, preterm birth has increased since 90. Simultaneously, the advanced demographic transition has modified the characteristics of woman population related to maternity. The principal objective of this study is to analyze some sociodemographic characteristics of the maternal population over time, and their possible association to rates of preterm birth. The second aim is to identify groups of mothers at high risk of having a preterm child. Methods This population-based study examined all liveborn singletons in Chile from 1991 to 2008; divided in three periods. Preterm birth rates were measured as % births <37 weeks of gestation. Logistic regression assessed the risk of preterm birth associated with mother’s age, parity, and marital status, expressed as crude and adjusted odds ratios. Results Over time, rates of preterm birth increased in overall population, especially during the third period (2001–2008). In the same time, characteristics of maternal population changed: significant increase of extreme reproductive ages, significant decrease in parity and increase in mothers living without a partner. Risk of preterm birth remained higher in groups of mothers: <18 and >38 years of age; without a partner; primiparas and grandmultiparas. However, global increase in preterm birth was not explained by the modification of socio demographics characteristics of maternal population. Conclusions Some socio demographic characteristics remained associated with preterm birth over time. These associations allowed identifying five groups of mothers at higher risk to have a preterm child in the population. Increase in overall preterm birth affected all women, even those considered at “low sociodemographic risk” and the contribution of more recent period (2001–2008) to this increase is greater. Then, studied factors couldn’t explain the increase in preterm birth. Further research will have to consider other factors affecting maternal population that could explain the observed trend of preterm birth. PMID:23680406

Birth seasonality and calf mortality in a large population of Asian elephants.

PubMed

Mumby, Hannah S; Courtiol, Alexandre; Mar, Khyne U; Lummaa, Virpi

2013-10-01

In seasonal environments, many species concentrate their reproduction in the time of year most likely to maximize offspring survival. Asian elephants (Elephas maximus) inhabit regions with seasonal climate, but females can still experience 16-week reproductive cycles throughout the year. Whether female elephants nevertheless concentrate births on periods with maximum offspring survival prospects remains unknown. We investigated the seasonal timing of births, and effects of birth month on short- and long-term mortality of Asian elephants, using a unique demographic data set of 2350 semicaptive, longitudinally monitored logging elephants from Myanmar experiencing seasonal variation in both workload and environmental conditions. Our results show variation in birth rate across the year, with 41% of births occurring between December and March. This corresponds to the cool, dry period and the beginning of the hot season, and to conceptions occurring during the resting, nonlogging period between February and June. Giving birth during the peak December to March period improves offspring survival, as the odds for survival between age 1 and 5 years are 44% higher for individuals born during the high birth rate period than those conceived during working months. Our results suggest that seasonal conditions, most likely maternal workload and/or climate, limit conception rate and calf survival in this population through effects on maternal stress, estrus cycles, or access to mates. This has implications for improving the birth rate and infant survival in captive populations by limiting workload of females of reproductive age. As working populations are currently unsustainable and supplemented through the capture of wild elephants, it is imperative to the conservation of Asian elephants to understand and alleviate the effects of seasonal conditions on vital rates in the working population in order to reduce the pressure for further capture from the wild.

Reducing preterm birth by a statewide multifaceted program: an implementation study.

PubMed

Newnham, John P; White, Scott W; Meharry, Suzanne; Lee, Han-Shin; Pedretti, Michelle K; Arrese, Catherine A; Keelan, Jeffrey A; Kemp, Matthew W; Dickinson, Jan E; Doherty, Dorota A

2017-05-01

A comprehensive preterm birth prevention program was introduced in the state of Western Australia encompassing new clinical guidelines, an outreach program for health care practitioners, a public health program for women and their families based on print and social media, and a new clinic at the state's sole tertiary level perinatal center for referral of those pregnant women at highest risk. The initiative had the single aim of safely lowering the rate of preterm birth. The objective of the study was to evaluate the outcomes of the initiative on the rates of preterm birth both statewide and in the single tertiary level perinatal referral center. This was a prospective population-based cohort study of perinatal outcomes before and after 1 full year of implementation of the preterm birth prevention program. In the state overall, the rate of singleton preterm birth was reduced by 7.6% and was lower than in any of the preceding 6 years. This reduction amounted to 196 cases relative to the year before the introduction of the initiative and the effect extended from the 28-31 week gestational age group onward. Within the tertiary level center, the rate of preterm birth in 2015 was also significantly lower than in the preceding years. A comprehensive and multifaceted preterm birth prevention program aimed at both health care practitioners and the general public, operating within the environment of a government-funded universal health care system can significantly lower the rate of early birth. Further research is now required to increase the effect and to determine the relative contributions of each of the interventions. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

Delayed blastulation, multinucleation, and expansion grade are independently associated with live-birth rates in frozen blastocyst transfer cycles.

PubMed

Desai, Nina; Ploskonka, Stephanie; Goodman, Linnea; Attaran, Marjan; Goldberg, Jeffrey M; Austin, Cynthia; Falcone, Tommaso

2016-11-01

To identify blastocyst features independently predictive of successful pregnancy and live births with vitrified-warmed blastocysts. Retrospective study. Academic hospital. Women undergoing a cycle with transfer of blastocysts vitrified using the Rapid-i closed carrier (n = 358). None. Clinical pregnancy and live-birth rates analyzed using logistic regression analysis. A total of 669 vitrified-warmed blastocysts were assessed. The survival rate was 95%. A mean of 1.7 ± 0.5 embryos were transferred. The clinical pregnancy, live-birth, and implantation rates were 55%, 46%, and 43%, respectively. The odds of clinical pregnancy (odds ratio [OR] 3.08; 95% confidence interval [CI], 1.88-5.12) and live birth (OR 2.93; 95% CI, 1.79-4.85) were three times higher with day-5 blastocysts versus slower-growing day-6 vitrified blastocysts, irrespective of patient age at cryopreservation. Blastocysts from multinucleated embryos were half as likely to result in a live birth (OR 0.46; 95% CI, 0.22-0.91). A four -fold increase in live birth was observed if an expanded blastocyst was available for transfer. The inner cell mass-trophectoderm score correlated to positive outcomes in the univariate analysis. The implantation rate was statistically significantly higher for day-5 versus day-6 vitrified blastocysts (50% vs. 29%, respectively). The blastocyst expansion grade after warming was predictive of successful outcomes independent of the inner cell mass or trophectoderm score. Delayed blastulation and multinucleation were independently associated with lower live-birth rates in frozen cycles. Implantation potential of the frozen blastocysts available should be included in the decision-making process regarding embryo number for transfer. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Contextual determinants of neonatal mortality using two analysis methods, Rio Grande do Sul, Brazil.

PubMed

Zanini, Roselaine Ruviaro; Moraes, Anaelena Bragança de; Giugliani, Elsa Regina Justo; Riboldi, João

2011-02-01

To analyze neonatal mortality determinants using multilevel logistic regression and classic hierarchical models. Cohort study including 138,407 live births with birth certificates and 1,134 neonatal deaths recorded in 2003, in the state of Rio Grande do Sul, Southern Brazil. The Information System on Live Births and mortality records were linked for gathering information on individual-level exposures. Sociodemographic data and information on the pregnancy, childbirth care and characteristics of the children at birth were collected. The associated factors were estimated and compared by traditional and multilevel logistic regression analysis. The neonatal mortality rate was 8.19 deaths per 1,000 live births. Low birth weight, 1- and 5-minute Apgar score below eight, congenital malformation, pre-term birth and previous fetal loss were associated with neonatal death in the traditional model. Elective cesarean section had a protective effect. Previous fetal loss did not remain significant in the multilevel model, but the inclusion of a contextual variable (poverty rate) showed that 15% of neonatal mortality variation can be explained by varying poverty rates in the microregions. The use of multilevel models showed a small effect of contextual determinants on the neonatal mortality rate. There was found a positive association with the poverty rate in the general model, and the proportion of households with water supply among preterm newborns.

Effects of oestradiol for luteal phase support in fresh embryo transfer cycles: A retrospective cohort study.

PubMed

Zhao, Wei; Liu, Yifeng; Xu, Peng; Wu, Yiqing; Chen, Kai; Guo, Xiaoyan; Zhang, Fan; Huang, Yun; Zhu, Linlin; Zhang, Runjv; Zhang, Dan

2018-05-12

Any benefit of oestradiol supplementation with progesterone for luteal support after fresh embryo transfer in in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycles remains controversial. In this study, we further addressed this question in cycles using gonadotropin-releasing hormone (GnRH) agonist for ovarian stimulation. A retrospective cohort study in a tertiary teaching and research hospital. A total of 1602 patients were given oestradiol valerate (E) in addition to progesterone (P) as luteal support. One thousand six hundred and two patients receiving progesterone alone were selected as the control group. Live birth rate. Secondary measures included clinical pregnancy rate, miscarriage rate and premature birth rate. Clinical pregnancy and live birth rates were similar for the P alone vs the P+E group. In cycles with oestradiol (E2) levels less than 5000 pmol/L on the day of hCG trigger, E supplementation resulted in a significantly higher live birth rate (23.44% vs 32.92%, OR = 1.60 [95% CI 1.05 to 2.46]). In cycles with oestradiol levels 5000 to 10 000 pmol/L on the day of hCG trigger, E supplementation did not increase the live birth rate (34.43% vs 35.42%, OR = 0.90 [95% CI 0.80 to 1.01]). In cycles with oestradiol levels over 10 000 pmol/L on the day of hCG trigger, the live birth rate was significantly lower (36.83% vs 31.37%, OR = 0.78 [95% CI 0.62 to 0.99]) and the premature birth rate was significantly higher (19.66% vs 28.73%,OR = 1.65 [95% CI 1.05 to 2.59]) in the E supplementation group. Any benefit of oestradiol supplementation for luteal phase support appears to correlate with the serum oestradiol level on the day of hCG trigger. Oestradiol supplementation is beneficial for improving live birth rate in cycles with oestradiol levels less than 5000 pmol/L, but is not recommended in cycles with oestradiol levels over 10 000 pmol/L. © 2018 John Wiley & Sons Ltd.

Neurodevelopmental Delay Diagnosis Rates Are Increased in a Region with Aerial Pesticide Application.

PubMed

Hicks, Steven D; Wang, Ming; Fry, Katherine; Doraiswamy, Vignesh; Wohlford, Eric M

2017-01-01

A number of studies have implicated pesticides in childhood developmental delay (DD) and autism spectrum disorder (ASD). The influence of the route of pesticide exposure on neurodevelopmental delay is not well defined. To study this factor, we examined ASD/DD diagnoses rates in an area near our regional medical center that employs yearly aerial pyrethroid pesticide applications to combat mosquito-borne encephalitis. The aim of this study was to determine if areas with aerial pesticide exposure had higher rates of ASD/DD diagnoses. This regional study identified higher rates of ASD/DD diagnoses in an area with aerial pesticides application. Zip codes with aerial pyrethroid exposure were 37% more likely to have higher rates of ASD/DD (adjusted RR = 1.37, 95% CI = 1.06-1.78, p  = 0.02). A Poisson regression model controlling for regional characteristics (poverty, pesticide use, population density, and distance to medical center), subject characteristics (race and sex), and local birth characteristics (prematurity, low birthweight, and birth rates) identified a significant relationship between aerial pesticide use and ASD/DD rates. The relationship between pesticide application and human neurodevelopment deserves additional study to develop safe and effective methods of mosquito prevention, particularly as communities develop plans for Zika virus control.

Investigating recent trends in the U.S. teen birth rate.

PubMed

Kearney, Melissa S; Levine, Phillip B

2015-05-01

We investigate trends in the U.S. rate of teen childbearing between 1981 and 2010, focusing specifically on the sizable decline since 1991. We focus on establishing the role of state-level demographic changes, economic conditions, and targeted policies in driving recent aggregate trends. We offer three main observations. First, the recent decline cannot be explained by the changing racial and ethnic composition of teens. Second, the only targeted policies that have had a statistically discernible impact on aggregate teen birth rates are declining welfare benefits and expanded access to family planning services through Medicaid, but these policies can account for only 12.6 percent of the observed decline since 1991. Third, higher unemployment rates lead to lower teen birth rates and can account for 16 percent of the decline in teen birth rates since the Great Recession began. Copyright © 2015 Elsevier B.V. All rights reserved.

Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants Ventilated With Continuous Positive Airway Pressure vs. Mechanical Ventilation

PubMed Central

Thomas, Cameron W.; Meinzen-Derr, Jareen; Hoath, Steven B.; Narendran, Vivek

2012-01-01

OBJECTIVE To compare continuous positive airway pressure (CPAP) vs. traditional mechanical ventilation (MV) at 24 h of age as predictors of neurodevelopmental (ND) outcomes in extremely low birth weight (ELBW) infants at 18-22 mo corrected gestational age (CGA). METHODS Infants ≤ 1000g birth weight born from January 2000 through December 2006 at two hospitals at the Cincinnati site of the National Institute of Child Health and Human Development Neonatal Research Network were evaluated comparing CPAP (N = 198) vs. MV (N = 109). Primary outcomes included the Bayley Score of Infant Development Version II (BSID-II), presence of deafness, blindness, cerebral palsy, bronchopulmonary dysplasia and death. RESULTS Ventilatory groups were similar in gender, rates of preterm prolonged rupture of membranes, antepartum hemorrhage, use of antenatal antibiotics, steroids, and tocolytics. Infants receiving CPAP weighed more, were older, were more likely to be non-Caucasian and from a singleton pregnancy. Infants receiving CPAP had better BSID-II scores, and lower rates of BPD and death. CONCLUSIONS After adjusting for acuity differences, ventilatory strategy at 24 h of age independently predicts long-term neurodevelopmental outcome in ELBW infants. PMID:21853318

Agrichemicals in surface water and birth defects in the United States

PubMed Central

Winchester, Paul D; Huskins, Jordan; Ying, Jun

2009-01-01

Objectives: To investigate if live births conceived in months when surface water agrichemicals are highest are at greater risk for birth defects. Methods: Monthly concentrations during 1996–2002 of nitrates, atrazine and other pesticides were calculated using United States Geological Survey's National Water Quality Assessment data. Monthly United States birth defect rates were calculated for live births from 1996 to 2002 using United States Centers for Disease Control and Prevention natality data sets. Birth defect rates by month of last menstrual period (LMP) were then compared to pesticide/nitrate means using logistical regression models. Results: Mean concentrations of agrichemicals were highest in April–July. Total birth defects, and eleven of 22 birth defect subcategories, were more likely to occur in live births with LMPs between April and July. A significant association was found between the season of elevated agrichemicals and birth defects. Conclusion: Elevated concentrations of agrichemicals in surface water in April–July coincided with higher risk of birth defects in live births with LMPs April–July. While a causal link between agrichemicals and birth defects cannot be proven from this study an association might provide clues to common factors shared by both variables. PMID:19183116

The ex-pat effect: presence of recent Western immigrants is associated with changes in age at first birth and birth rate in a Maya population from rural Guatemala.

PubMed

McKerracher, Luseadra; Collard, Mark; Altman, Rachel; Richards, Michael; Nepomnaschy, Pablo

2017-08-01

Economic transitions expose indigenous populations to a variety of ecological and cultural challenges, especially regarding diet and stress. These kinds of challenges are predicted by evolutionary ecological theory to have fitness consequences (differential reproduction) and, indeed, are often associated with changes in fertility dynamics. It is currently unclear whether international immigration might impact the nature of such an economic transition or its consequences for fertility. To examine measures of fertility, diet and stress in two economically transitioning Maya villages in Guatemala that have been differentially exposed to immigration by Westerners. This study compared Maya women's ages at first birth and birth rates between villages and investigated whether these fertility indicators changed through time. It also explored whether the villages differed in relation to diet and/or a proxy of stress. It was found that, in the village directly impacted by immigration, first births occurred earlier, but birth rate was slower. In both villages, over the sampled time window, age at first birth increased, while birth rate decreased. The villages do not differ significantly in dietary indicators, but the immigration-affected village scored higher on the stress proxy. Immigration can affect fertility in host communities. This relationship between immigration and fertility dynamics may be partly attributable to stress, but this possibility should be evaluated prospectively in future research.

Care in a birth room versus a conventional setting: a controlled trial.

PubMed Central

Klein, M; Papageorgiou, A; Westreich, R; Spector-Dunsky, L; Elkins, V; Kramer, M S; Gelfand, M M

1984-01-01

A controlled clinical trial was carried out to assess whether a birth room setting would influence the care of mothers and newborns. Of the 163 low-risk women enrolled, 49 (30%) manifested some prenatal risk and were excluded. The remaining 114 were allocated by strict alternation to a birth room or a conventional setting. Of the 56 women allocated to the birth room, 63% of the primiparas and 19% of the multiparas were later transferred. The numbers in the two settings who had oxytocin stimulation, epidural anesthesia, forceps delivery or cesarean section did not show statistically significant differences. The episiotomy rates were slightly lower in the birth room than in the conventional setting, and the rates of an intact perineum were higher in the birth room. Neither the Apgar scores nor the morbidity rates of the infants showed statistically significant differences related to the setting to which the mother had been allocated, although more infants from the conventional setting were admitted to a special care unit. Both "experimental" groups of women less often received routine perineal shaving, enemas or intravenous infusions than did an obstetrically similar nonexperimental comparison group. Despite the apparent inability in this setting for the birth room to influence the rate of major obstetric procedures (except for episiotomy) and outcomes, the authors believe that a birth room is desirable in tertiary care centres as well as in community hospitals. PMID:6388776

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.

PubMed

Kent, Shia T; McClure, Leslie A; Zaitchik, Ben F; Gohlke, Julia M

2013-06-10

Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban-rural status. Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991-2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas.

Explaining the Rapid Increase in Nigeria's Sex Ratio at Birth: Factors and Implications.

PubMed

Kaba, Amadu J

2015-06-01

This paper examines the rapid increase in Nigeria's sex ratio at birth from 1.03 boys born for every 1 girl born in each year from 1996-2008 to 1.06 in each year from 2009-2014, second only to Tunisia in Africa at 1.07. The average sex ratio at birth in the world in 2014 was 1.07. In most Black African nations or Black majority nations, it is 1.03 or less. Among the factors presented for this development are: historical fluctuations of sex ratio at birth; geography and ethnicity; male preference/chasing a son; Age of parents; high death rates of male infants and males in general; and wealth/socioeconomic status. Among the potential implications are: young and poor men in Nigeria may not be able to find brides and form families due to a potential shortage of females; emigration of young and poor Nigerian men to West (Africa) and elsewhere to seek brides and form families; immigration of marriage age women from West (Africa) and around the world to Nigeria to seek husbands; and low contraceptive use and high fertility rates in Nigeria.

"Natural family planning": effective birth control supported by the Catholic Church.

PubMed

Ryder, R E

1993-09-18

During 20-22 September Manchester is to host the 1993 follow up to last year's "earth summit" in Rio de Janeiro. At that summit the threat posed by world overpopulation received considerable attention. Catholicism was perceived as opposed to birth control and therefore as a particular threat. This was based on the notion that the only method of birth control approved by the church--natural family planning--is unreliable, unacceptable, and ineffective. In the 20 years since E L Billings and colleagues first described the cervical mucus symptoms associated with ovulation natural family planning has incorporated these symptoms and advanced considerably. Ultrasonography shows that the symptoms identify ovulation precisely. According to the World Health Organisation, 93% of women everywhere can identify the symptoms, which distinguish adequately between the fertile and infertile phases of the menstrual cycle. Most pregnancies during trials of natural family planning occur after intercourse at times recognised by couples as fertile. Thus pregnancy rates have depended on the motivation of couples. Increasingly studies show that rates equivalent to those with other contraceptive methods are readily achieved in the developed and developing worlds. Indeed, a study of 19,843 poor women in India had a pregnancy rate approaching zero. Natural family planning is cheap, effective, without side effects, and may be particularly acceptable to the efficacious among people in areas of poverty.

Annual summary of vital statistics--1995.

PubMed

Guyer, B; Strobino, D M; Ventura, S J; MacDorman, M; Martin, J A

1996-12-01

Recent trends in the vital statistics of the United States continued in 1995, including decreases in the number of births, the birth rate, the age-adjusted death rate, and the infant mortality rate; life expectancy at birth increased to a level equal to the record high of 75.8 years in 1992. Marriages and divorces both decreased. An estimated 3,900,089 infants were born during 1995, a decline of 1% from 1994. The preliminary birth rate for 1995 was 14.8 live births per 1000 total population, a 3% decline, and the lowest recorded in nearly two decades. The fertility rate, which relates births to women in the childbearing ages, declined to 65.6 live births per 1000 women 15 to 44 years old, the lowest rate since 1986. According to preliminary data for 1995, fertility rates declined for all racial groups with the gap narrowing between black and white rates. The fertility rate for black women declined 7% to a historic low level (71.7); the preliminary rate for white women (64.5) dropped just 1%. Fertility rates continue to be highest for Hispanic, especially Mexican-American, women. Preliminary data for 1995 suggest a 2% decline in the rate for Hispanic women to 103.7. The birth rate for teenagers has now decreased for four consecutive years, from a high of 62.1 per 1000 women 15 to 19 years old in 1991 to 56.9 in 1995, an overall decline of 8%. The rate of childbearing by unmarried mothers dropped 4% from 1994 to 1995, from 46.9 births per 1000 unmarried women 15 to 44 years old to 44.9, the first decline in the rate in nearly two decades. The proportion of all births occurring to unmarried women dropped as well in 1995, to 32.0% from 32.6% in 1994. Smoking during pregnancy dropped steadily from 1989 (19.5%) to 1994 (14.6%), a decline of about 25%. Prenatal care utilization continued to improve in 1995 with 81.2% of all mothers receiving care in the first trimester compared with 78.9% in 1993. Preliminary data for 1995 suggests continued improvement to 81.2%. The percent of infants delivered by cesarean delivery declined slightly to 20.8% in 1995. The percent of low birth weight (LBW) infants continued to climb in 1994 rising to 7.3%, from 7.2% in 1993. The proportion of LBW improved slightly among black infants, declining from 13.3% to 13.2% between 1993 and 1994. Preliminary figures for 1995 suggest continued decline in LBW for black infants (13.0%). The multiple birth ratio rose to 25.7 per 1000 births for 1994, an increase of 2% over 1993 and 33% since 1980. Age-adjusted death rates in 1995 were lower for heart disease, malignant neoplasms, accidents, and homicide. Although the total number of human immunodeficiency virus (HIV) infection deaths increased slightly from 42,114 in 1994 to an estimated 42,506 in 1995, the age-adjusted death rate for HIV infection did not increase, which may indicate a leveling off of the steep upward trend in mortality from HIV infection since 1987. Nearly 15,000 children between the ages of 1-14 years died in the United States (US) in 1995. The death rate for children 1 to 4 years old in 1995 was 40.4 per 100,000 population aged 1 to 4 years, 6% lower than the rate of 42.9 in 1994. The 1995 death rate for 5- to 14-year-olds was 22.1, 2% lower than the rate of 22.5 in 1994. Since 1979, death rates have declined by 37% for children 1 to 4 years old, and by 30% for children 5 to 14 years old. For children 1 to 4 years old, the leading cause of death was injuries, which accounted for for an estimated 2277 deaths in 1995, 36% of all deaths in this age group. Injuries were the leading cause of death for 5- to 14-year-olds as well, accounting for an ever higher percentage (41%) of all deaths. In 1995, the preliminary infant mortality rate was 7.5 per 1000live births, 6% lower than 1994, and the lowest ever recorded in the US. The decline occurred for neonatal as well as postneonatal mortality rates, and among white and black infants alike.

Assessing the value of customized birth weight percentiles.

PubMed

Hutcheon, Jennifer A; Walker, Mark; Platt, Robert W

2011-02-15

Customized birth weight percentiles are weight-for-gestational-age percentiles that account for the influence of maternal characteristics on fetal growth. Although intuitively appealing, the incremental value they provide in the identification of intrauterine growth restriction (IUGR) over conventional birth weight percentiles is controversial. The objective of this study was to assess the value of customized birth weight percentiles in a simulated cohort of 100,000 infants aged 37 weeks whose IUGR status was known. A cohort of infants with a range of healthy birth weights was first simulated on the basis of the distributions of maternal/fetal characteristics observed in births at the Royal Victoria Hospital in Montreal, Canada, between 2000 and 2006. The occurrence of IUGR was re-created by reducing the observed birth weights of a small percentage of these infants. The value of customized percentiles was assessed by calculating true and false positive rates. Customizing birth weight percentiles for maternal characteristics added very little information to the identification of IUGR beyond that obtained from conventional weight-for-gestational-age percentiles (true positive rates of 61.8% and 61.1%, respectively, and false positive rates of 7.9% and 8.5%, respectively). For the process of customization to be worthwhile, maternal characteristics in the customization model were shown through simulation to require an unrealistically strong association with birth weight.

Recent Declines in Induction of Labor by Gestational Age

MedlinePlus

... Individual live birth in a singleton (one fetus) pregnancy. Singleton induction rate : Number of labor inductions for singleton births per 100 singleton births. Gestational age categories : Early preterm: Births prior to 34 completed weeks of ...

Where Do You Feel Safest?: Demographic Factors and Place of Birth

PubMed Central

Sperlich, M.; Gabriel, C.; Seng, J.

2016-01-01

Introduction The vast majority of planned out-of-hospital births in the United States occur among white women; no study has addressed whether black women prefer out-of-hospital birth less or whether this racial disparity is due to other causes such as constrained access. This study sought to answer the question of whether white and black women feel safest giving birth in out-of-hospital settings at different rates, and whether this answer is associated with other socioeconomic indicators. Methods An interview of 634 nulliparous women during the third trimester of their pregnancy in Michigan provided data regarding where women felt safest giving birth. Feeling safest giving birth out-of-hospital was examined in relation to socioeconomic factors including race, age, household income, education, residence in a high-crime neighborhood, partnered status, and type of insurance. Results This study found that black and white women say they feel safest giving birth in out-of-hospital settings at similar rates (11.5% and 13.1% respectively). Logistic regression results showed that poverty and having education beyond high school were the only sociodemographic indicators significantly associated with feeling safest giving birth out-of-hospital. Discussion Disparities evident in planned homebirth and birth center rates cannot be explained by racial differences in feelings toward out-of-hospital birth and should be addressed more specifically in public policy and future studies. PMID:27623132

The effects of competition on assisted reproductive technology outcomes.

PubMed

Henne, Melinda B; Bundorf, M Kate

2010-04-01

To evaluate the relationship between competition among fertility clinics and assisted reproductive technology (ART) treatment outcomes, particularly multiple births. Using clinic-level data from 1995 to 2001, we examined the relationship between competition and clinic-level ART outcomes and practice patterns. National database registry. Clinics performing ART. The number of clinics within a 20-mile (32.19-km) radius of a given clinic. Clinic-level births, singleton births, and multiple births per ART cycle; multiple births per ART birth; average number of embryos transferred per cycle; and the proportion of cycles for women under age 35 years. The number of competing clinics is not strongly associated with ART birth and multiple birth rates. Relative to clinics with no competitors, the rate of multiple births per cycle is lower (-0.03 percentage points) only for clinics with more than 15 competitors. Embryo transfer practices are not statistically significantly associated with the number of competitors. Clinic-level competition is strongly associated with patient mix. The proportion of cycles for patients under 35 years old is 6.4 percentage points lower for clinics with more than 15 competitors than for those with no competitors. Competition among fertility clinics does not appear to increase rates of multiple births from ART by promoting more aggressive embryo transfer decisions. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.Published by Elsevier Inc.

[The influence of previous pregnancy terminations, miscarriages and still-births on the incidence of babies with low birth weight and premature births as well as a somatic classification of newborns].

PubMed

Voigt, M; Olbertz, D; Fusch, C; Krafczyk, D; Briese, V; Schneider, K T M

2008-02-01

The influence of previous interruptions, miscarriages and IUFD on the IUGR and preterm rate as well as on the somatic staging (gestational age and birth weight) of the new born is a subject of controversial discussion in the literature. The present paper attempts to quantify these risks of the medical history. 2 282 412 singleton pregnancies of the period 1995 to 2000 were evaluated from the German Perinatal Database. For the analysis 1 065 202 pregnancies (46.7 %) of those mothers without any live birth in the medical history were assessed. To exclude any influence from previous abortions patients with previous miscarriages and IUFDs were excluded. The control collective were new borns whose mothers had suffered neither from miscarriages nor from abortions or IUFD. Previous interruptions, miscarriages and IUFD influence the rate of new borns with low birth weight and increase the rate of prematurity. With increasing numbers of isolated or combined risks in the medical history, the rate of newborns with a low birth weight or with prematurity is increased. The lowest risk was found after one interruption, the highest rate with two or more IUFDs. Interruptions, miscarriages or IUFD are not risk factors for IUGR or SGA. Previous interruptions, miscarriages and IUFD are relevant risk factors for prematurity and are related with low birth weight of the new borns. Pregnant women with such risk factors have to been considered as risk pregnancies and need intensive surveillance.

Planned home birth: the professional responsibility response.

PubMed

Chervenak, Frank A; McCullough, Laurence B; Brent, Robert L; Levene, Malcolm I; Arabin, Birgit

2013-01-01

This article addresses the recrudescence of and new support for midwife-supervised planned home birth in the United States and the other developed countries in the context of professional responsibility. Advocates of planned home birth have emphasized patient safety, patient satisfaction, cost effectiveness, and respect for women's rights. We provide a critical evaluation of each of these claims and identify professionally appropriate responses of obstetricians and other concerned physicians to planned home birth. We start with patient safety and show that planned home birth has unnecessary, preventable, irremediable increased risk of harm for pregnant, fetal, and neonatal patients. We document that the persistently high rates of emergency transport undermines patient safety and satisfaction, the raison d'etre of planned home birth, and that a comprehensive analysis undermines claims about the cost-effectiveness of planned home birth. We then argue that obstetricians and other concerned physicians should understand, identify, and correct the root causes of the recrudescence of planned home birth; respond to expressions of interest in planned home birth by women with evidence-based recommendations against it; refuse to participate in planned home birth; but still provide excellent and compassionate emergency obstetric care to women transported from planned home birth. We explain why obstetricians should not participate in or refer to randomized clinical trials of planned home vs planned hospital birth. We call on obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital. Copyright © 2013 Mosby, Inc. All rights reserved.

Promotion of family-centered birth with gentle cesarean delivery.

PubMed

Magee, Susanna R; Battle, Cynthia; Morton, John; Nothnagle, Melissa

2014-01-01

In this commentary we describe our experience developing a "gentle cesarean" program at a community hospital housing a family medicine residency program. The gentle cesarean technique has been popularized in recent obstetrics literature as a viable option to enhance the experience and outcomes of women and families undergoing cesarean delivery. Skin-to-skin placement of the infant in the operating room with no separation of mother and infant, reduction of extraneous noise, and initiation of breastfeeding in the operating room distinguish this technique from traditional cesarean delivery. Collaboration among family physicians, obstetricians, midwives, pediatricians, neonatologists, anesthesiologists, nurses, and operating room personnel facilitated the provision of gentle cesarean delivery to families requiring an operative birth. Among 144 gentle cesarean births performed from 2009 to 2012, complication rates were similar to or lower than those for traditional cesarean births. Gentle cesarean delivery is now standard of care at our institution. By sharing our experience, we hope to help other hospitals develop gentle cesarean programs. Family physicians should play an integral role in this process. © Copyright 2014 by the American Board of Family Medicine.

A closer look at the increase in suicide rates in South Korea from 1986-2005.

PubMed

Kwon, Jin-Won; Chun, Heeran; Cho, Sung-il

2009-02-27

Suicide rates have recently been decreasing on average among OECD countries, but increasing trends have been detected in South Korea, particularly since the 1997 economic crisis. There have been no detailed analyses about the changes of the suicide rates over time periods in Korea. We examined trends in both absolute and proportional suicide rates over the time period of economic development, crisis, and recovery (1986 - 2005) as well as in birth cohorts from 1924 to 1978. We used data on total mortality and suicide rates from 1986 to 2005 published online by the Korean National Statistical Office (NSO) and extracted data for individuals under 80 years old. The analyses of the trends for 1) the sex-age-specific total mortality rate, 2) the sex-age-specific suicide rate, and 3) the sex-age-specific proportional suicide rate in 1986-2005 were conducted. To demonstrate the birth cohort effect on the proportional suicide rate, the synthetic birth cohort from 1924 to 1978 from the successive cross-sectional data was constructed. Age standardized suicide rates in South Korea increased by 98% in men (from 15.3 to 30.3 per 100,000) and by 124% in women (from 5.8 to 13.0 per 100,000). In both genders, the proportional increase in suicide rates was more prominent among the younger group aged under 45, despite the absolute increase being attributed to the older group. There were distinct cohort effects underlying increasing suicide rates particularly among younger age groups. Increasing suicide rates in Korea was composed of a greater absolute increase in the older group and a greater proportional increase in the younger group.

A closer look at the increase in suicide rates in South Korea from 1986–2005

PubMed Central

Kwon, Jin-Won; Chun, Heeran; Cho, Sung-il

2009-01-01

Background Suicide rates have recently been decreasing on average among OECD countries, but increasing trends have been detected in South Korea, particularly since the 1997 economic crisis. There have been no detailed analyses about the changes of the suicide rates over time periods in Korea. We examined trends in both absolute and proportional suicide rates over the time period of economic development, crisis, and recovery (1986 – 2005) as well as in birth cohorts from 1924 to 1978. Methods We used data on total mortality and suicide rates from 1986 to 2005 published online by the Korean National Statistical Office (NSO) and extracted data for individuals under 80 years old. The analyses of the trends for 1) the sex-age-specific total mortality rate, 2) the sex-age-specific suicide rate, and 3) the sex-age-specific proportional suicide rate in 1986–2005 were conducted. To demonstrate the birth cohort effect on the proportional suicide rate, the synthetic birth cohort from 1924 to 1978 from the successive cross-sectional data was constructed. Results Age standardized suicide rates in South Korea increased by 98% in men (from 15.3 to 30.3 per 100,000) and by 124% in women (from 5.8 to 13.0 per 100,000). In both genders, the proportional increase in suicide rates was more prominent among the younger group aged under 45, despite the absolute increase being attributed to the older group. There were distinct cohort effects underlying increasing suicide rates particularly among younger age groups. Conclusion Increasing suicide rates in Korea was composed of a greater absolute increase in the older group and a greater proportional increase in the younger group. PMID:19250535

Temporal trends in Inuit, First Nations and non-Aboriginal birth outcomes in rural and northern Quebec

PubMed Central

Simonet, Fabienne; Wilkins, Russell; Luo, Zhong-Cheng

2012-01-01

Objectives The objective was to assess trends in Inuit, First Nations and non-Aboriginal birth outcomes in the rural and northern regions of Quebec. Study design and methods In a birth cohort-based study of all births to residents of rural and northern Quebec from 1991 through 2000 (n = 177,193), we analyzed birth outcomes and infant mortality for births classified by maternal mother tongue (Inuit, First Nations or non-Aboriginal) and by community type (predominantly First Nations, Inuit or non-Aboriginal). Results From 1991–1995 to 1996–2000, there was a trend of increasing rates of preterm birth for all 6 study groups. In all rural and northern areas, low birth weight rates increased significantly only for the Inuit mother tongue group [RR1.45 (95% CI 1.05–2.01)]. Stillbirth rates showed a non-significant increase for the Inuit mother tongue group [RR1.76 (0.64–4.83)]. Neonatal mortality rates decreased significantly in the predominantly non-Aboriginal communities and in the non-Aboriginal mother tongue group [RR0.78 (0.66–0.92)], and increased non-significantly for the First Nations mother tongue group [RR2.17 (0.71–6.62)]. Perinatal death rates increased for the First Nations mother tongue grouping in northern areas [RR2.19 (0.99–4.85)]. Conclusion There was a disconcerting rise of some mortality outcomes for births to First Nations and Inuit mother tongue women and to women in predominantly First Nations and Inuit communities, in contrast to some improvements for births to non-Aboriginal mother tongue women and to women in predominantly non-Aboriginal communities in rural or northern Quebec, indicating a need for improving perinatal and neonatal health for Aboriginal populations in rural and northern regions. PMID:22973566

Association between preterm birth and its subtypes and maternal sociodemographic characteristics during the post-transitional phase in a developing country with a very high human development index.

PubMed

Araya, B M; Díaz, M; Paredes, D; Ortiz, J

2017-06-01

Chile is a post-transitional country evolving towards a stationary population pyramid, which may be associated with increasing preterm birth (PTB) rates. This study aimed to compare maternal sociodemographic characteristics between the start of the post-transition phase (1994) and an established stage (2013) and to evaluate associations between these characteristics and PTB. An observational analytic design was conducted using national birth records (n = 4,956,311). Variables analysed in the 20 birth cohorts from 1994 to 2013 were: length of gestation (preterm <37 weeks) subdivided by gestational age (extreme, moderate/severe and late); maternal age (≤19, 20-35 and >35 years); education level (<8, 8-12 and >12 years of education); employment; marital status; area of residence; and type of birth (singleton, twins, and triplets or higher order). The prevalence of PTB was expressed as a percentage, and associations between PTB and predictor variables were analysed using logistic regression models. Education level, age >35 years, maternal employment, unmarried status, twin delivery and urban residency rates increased between 1994 and 2013. According to the adjusted models, age >35 years and delivery of more than two foetuses were risk factors for all PTB subtypes. Maternal employment was a risk factor for moderate/severe, late and total PTB, and a low level of education was a risk factor for late and total PTB. On the other hand, age ≤19 years was protective against all PTB subtypes. All maternal characteristics changed between 1994 and 2013. Furthermore, the prevalence of PTB increased for all predictor variables studied over this period. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

An Update on Teen Pregnancy.

PubMed

Ahern, Nancy R; Bramlett, Traci

2016-02-01

After years of high teen birth rates, there is currently a decline in U.S. pregnancy and birth rates among teens. Nevertheless, these rates continue to be higher than those of most global counterparts, and psychosocial and physical adversities still occur for pregnant teens and their children. The declining birth rates may be due to teens making better choices about contraceptive use and sexual behaviors. Psychiatric-mental health nurses are in key positions to enhance pregnancy prevention for teens. [Journal of Psychosocial Nursing and Mental Health Services, 54(2), 25-28.]. Copyright 2016, SLACK Incorporated.

Testing survey-based methods for rapid monitoring of child mortality, with implications for summary birth history data.

PubMed

Brady, Eoghan; Hill, Kenneth

2017-01-01

Under-five mortality estimates are increasingly used in low and middle income countries to target interventions and measure performance against global development goals. Two new methods to rapidly estimate under-5 mortality based on Summary Birth Histories (SBH) were described in a previous paper and tested with data available. This analysis tests the methods using data appropriate to each method from 5 countries that lack vital registration systems. SBH data are collected across many countries through censuses and surveys, and indirect methods often rely upon their quality to estimate mortality rates. The Birth History Imputation method imputes data from a recent Full Birth History (FBH) onto the birth, death and age distribution of the SBH to produce estimates based on the resulting distribution of child mortality. DHS FBHs and MICS SBHs are used for all five countries. In the implementation, 43 of 70 estimates are within 20% of validation estimates (61%). Mean Absolute Relative Error is 17.7.%. 1 of 7 countries produces acceptable estimates. The Cohort Change method considers the differences in births and deaths between repeated Summary Birth Histories at 1 or 2-year intervals to estimate the mortality rate in that period. SBHs are taken from Brazil's PNAD Surveys 2004-2011 and validated against IGME estimates. 2 of 10 estimates are within 10% of validation estimates. Mean absolute relative error is greater than 100%. Appropriate testing of these new methods demonstrates that they do not produce sufficiently good estimates based on the data available. We conclude this is due to the poor quality of most SBH data included in the study. This has wider implications for the next round of censuses and future household surveys across many low- and middle- income countries.

A comparative study of breastfeeding during pregnancy: impact on maternal and newborn outcomes.

PubMed

Madarshahian, Farah; Hassanabadi, Mohsen

2012-03-01

Despite widespread cultural vilification, lactation-pregnancy overlap remains common. Its actual adverse effects remain uncertain. This study compared rates of success in reaching full-term delivery and newborn birth weights between two groups of multiparous pregnant women: those who breast-fed during pregnancy and those who did not. This was a comparative study conducted over 9 months, which examined two groups of women in the maternity units of two hospitals in Birjand, Iran. The first group comprised 80 women who breast-fed for 30 days or more during pregnancy; the second group comprised 240 women who did not. The two groups had similar distributions in terms of maternal age, parity, medical/midwifery problems, and nutritional changes during pregnancy. Two trained nurses used a self-developed questionnaire to collect data. Results found no significant difference in full-term or non-full-term births rates and mean newborn birth weight between the two groups. We further found no significant difference between full-term or non-full-term births and mean newborn birth weight for those who continued and discontinued breastfeeding during pregnancy in the overlap group. Results suggest that breastfeeding during normal pregnancy does not increase chance of untoward maternal and newborn outcomes. Nurses and midwives should give expectant mothers appropriate evidence-based guidance and focus attention on promoting proper nutritional intake based on lactation status during pregnancy.

In vivo T-cell activation by a monoclonal αCD3ε antibody induces preterm labor and birth

PubMed Central

Gomez-Lopez, Nardhy; Romero, Roberto; Arenas-Hernandez, Marcia; Ahn, Hyunyoung; Panaitescu, Bogdan; Vadillo-Ortega, Felipe; Sanchez-Torres, Carmen; Salisbury, Katherine S; Hassan, Sonia S.

2016-01-01

PROBLEM Activated/effector T cells seem to play a role in the pathological inflammation associated with preterm labor. The aim of this study was to determine whether in vivo T-cell activation by a monoclonal αCD3ε antibody induces preterm labor and birth. METHOD OF STUDY Pregnant B6 mice were intraperitoneally injected with a monoclonal αCD3ε antibody or its isotype control. The gestational age and the rates of preterm birth and pup mortality at birth, as well as the fetal heart rate and umbilical artery pulsatility index, were determined. RESULTS Injection of a monoclonal αCD3ε antibody led to preterm labor/birth [αCD3ε 83 ± 16.97% (10/12) vs. isotype 0% (0/8)], and increased the rate of pup mortality at birth [αCD3ε 87.30 ± 8.95% (77/85) vs. isotype 4.91 ± 4.34% (3/59)]. In addition, injection of a monoclonal αCD3ε antibody decreased the fetal heart rate and increased the umbilical artery pulsatility index when compared to isotype controls. CONCLUSION In vivo T-cell activation by a monoclonal αCD3ε antibody in late gestation induces preterm labor and birth. PMID:27658719

Perinatal mortality and adverse pregnancy outcomes in a low-income rural population of women who smoke.

PubMed

McElroy, Jane A; Bloom, Tina; Moore, Kelly; Geden, Beth; Everett, Kevin; Bullock, Linda F

2012-04-01

We describe adverse pregnancy outcomes, including congenital anomalies, fetal, neonatal, and infant mortality among a Missouri population of low-income, rural mothers who participated in two randomized smoking cessation trials. In the Baby BEEP (BB) trial, 695 rural women were recruited from 21 WIC clinics with 650 women's pregnancy outcomes known (93.5% retention rate). Following the BB trial, 298 women who had a live infant after November 2004 were recruited again into and completed the Baby Beep for Kids (BBK) trial. Simple statistics describing the population and perinatal and postneonatal mortality rates were calculated. Of the adverse pregnancy outcomes (n = 79), 29% were spontaneous abortions of less than 20 weeks' gestation, 23% were premature births, and 49% were identified birth defects. The perinatal mortality rate was 15.9 per 1000 births (BB study) compared with 8.6 per 1000 births (state of Missouri) and 8.5 per 1000 births (United States). The postneonatal infant mortality rate was 13.4 per 1000 live births (BBK) compared with 2.1 per 1000 live births (United States). The health disparity in this population of impoverished, rural, pregnant women who smoke, particularly in regard to perinatal and infant deaths, warrants attention. Copyright © 2012 Wiley Periodicals, Inc.

Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth.

PubMed

Suri, Rita; Altshuler, Lori; Hellemann, Gerhard; Burt, Vivien K; Aquino, Ana; Mintz, Jim

2007-08-01

The authors evaluated the effects of prenatal antidepressant exposure and maternal depression on infant gestational age at birth and risk of preterm birth. Ninety women were followed in a prospective, naturalistic design through pregnancy with monthly assessments of symptoms of depression and anxiety using the Structured Clinical Interview for DSM-IV mood module for depression, the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Perceived Stress Scale. Participants included 49 women with major depressive disorder who were treated with antidepressants during pregnancy (group 1), 22 women with major depressive disorder who were either not treated with antidepressants or had limited exposure to them during pregnancy (group 2), and 19 healthy comparison subjects (group 3). The primary outcome variables were the infants' gestational age at birth, birth weight, 1- and 5-minute Apgar scores, and admission to the special care nursery. Groups 1, 2, and 3 differed significantly in gestational age at birth (38.5 weeks, 39.4 weeks, 39.7 weeks, respectively), rates of preterm birth (14.3%, 0%, 5.3%, respectively), and rates of admission to the special care nursery (21%, 9%, 0%, respectively). Birth weight and Apgar scores did not differ significantly between groups. Mild to moderate depression during pregnancy did not affect outcome measures. Prenatal antidepressant use was associated with lower gestational age at birth and an increased risk of preterm birth. Presence of depressive symptoms was not associated with this risk. These results suggest that medication status, rather than depression, is a predictor of gestational age at birth.

Effect of Embryo Banking on U.S. National Assisted Reproductive Technology Live Birth Rates.

PubMed

Kushnir, Vitaly A; Barad, David H; Albertini, David F; Darmon, Sarah K; Gleicher, Norbert

2016-01-01

Assisted Reproductive Technology (ART) reports generated by the Centers for Disease Control and Prevention (CDC) exclude embryo banking cycles from outcome calculations. We examined data reported to the CDC in 2013 for the impact of embryo banking exclusion on national ART outcomes by recalculating autologous oocyte ART live birth rates. Inflation of reported fresh ART cycle live birth rates was assessed for all age groups of infertile women as the difference between fresh cycle live births with reference to number of initiated fresh cycles (excluding embryo banking cycles), as typically reported by the CDC, and fresh cycle live births with reference to total initiated fresh ART cycles (including embryo banking cycles). During 2013, out of 121,351 fresh non-donor ART cycles 27,564 (22.7%) involved embryo banking. The proportion of banking cycles increased with female age from 15.5% in women <35 years to 56.5% in women >44 years. Concomitantly, the proportion of thawed cycles decreased with advancing female age (P <0.0001). Exclusion of embryo banking cycles led to inflation of live birth rates in fresh ART cycles, increasing in size in parallel to advancing female age and utilization of embryo banking, reaching 56.3% in women age >44. The inflation of live birth rates in thawed cycles could not be calculated from the publically available CDC data but appears to be even greater. Utilization of embryo banking increased during 2013 with advancing female age, suggesting a potential age selection bias. Exclusion of embryo banking cycles from national ART outcome reports significantly inflated national ART success rates, especially among older women. Exclusion of embryo banking cycles from US National Assisted Reproductive Technology outcome reports significantly inflates reported success rates especially in older women.

Effect of Embryo Banking on U.S. National Assisted Reproductive Technology Live Birth Rates

PubMed Central

Kushnir, Vitaly A.; Barad, David H.; Albertini, David F.; Darmon, Sarah K.; Gleicher, Norbert

2016-01-01

Background Assisted Reproductive Technology (ART) reports generated by the Centers for Disease Control and Prevention (CDC) exclude embryo banking cycles from outcome calculations. Methods We examined data reported to the CDC in 2013 for the impact of embryo banking exclusion on national ART outcomes by recalculating autologous oocyte ART live birth rates. Inflation of reported fresh ART cycle live birth rates was assessed for all age groups of infertile women as the difference between fresh cycle live births with reference to number of initiated fresh cycles (excluding embryo banking cycles), as typically reported by the CDC, and fresh cycle live births with reference to total initiated fresh ART cycles (including embryo banking cycles). Results During 2013, out of 121,351 fresh non-donor ART cycles 27,564 (22.7%) involved embryo banking. The proportion of banking cycles increased with female age from 15.5% in women <35 years to 56.5% in women >44 years. Concomitantly, the proportion of thawed cycles decreased with advancing female age (P <0.0001). Exclusion of embryo banking cycles led to inflation of live birth rates in fresh ART cycles, increasing in size in parallel to advancing female age and utilization of embryo banking, reaching 56.3% in women age >44. The inflation of live birth rates in thawed cycles could not be calculated from the publically available CDC data but appears to be even greater. Conclusions Utilization of embryo banking increased during 2013 with advancing female age, suggesting a potential age selection bias. Exclusion of embryo banking cycles from national ART outcome reports significantly inflated national ART success rates, especially among older women. Précis Exclusion of embryo banking cycles from US National Assisted Reproductive Technology outcome reports significantly inflates reported success rates especially in older women. PMID:27159215

State policy and teen childbearing: a review of research studies.

PubMed

Beltz, Martha A; Sacks, Vanessa H; Moore, Kristin A; Terzian, Mary

2015-02-01

Teen childbearing is affected by many individual, family, and community factors; however, another potential influence is state policy. Rigorous studies of the relationship between state policy and teen birth rates are few in number but represent a body of knowledge that can inform policy and practice. This article reviews research assessing associations between state-level policies and teen birth rates, focusing on five policy areas: access to family planning, education, sex education, public assistance, and access to abortion services. Overall, several studies have found that measures related to access to and use of family planning services and contraceptives are related to lower state-level teen birth rates. These include adolescent enrollment in clinics, minors' access to contraception, conscience laws, family planning expenditures, and Medicaid waivers. Other studies, although largely cross-sectional analyses, have concluded that policies and practices to expand or improve public education are also associated with lower teen birth rates. These include expenditures on education, teacher-to-student ratios, and graduation requirements. However, the evidence regarding the role of public assistance, abortion access, and sex education policies in reducing teen birth rates is mixed and inconclusive. These conclusions must be viewed as tentative because of the limited number of rigorous studies that examine the relationship between state policy and teen birth rates over time. Many specific policies have only been analyzed by a single study, and few findings are based on recent data. As such, more research is needed to strengthen our understanding of the role of state policies in teen birth rates. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

[Statistical surveys].

PubMed

1980-01-01

Tables are included on territory and population of Czechoslovakia; population development, 1869-1970; mortality by selected causes, 1960-1978; life expectancy by age, 1920-1978; live birth, death, abortion, marriage, and divorce rates, 1975-1980; and natural movement of the population, 1975-1980

Falling caesarean section rate and improving intra-partum outcomes: a prospective cohort study.

PubMed

Amin, Pina; Zaher, Summia; Penketh, Richard; Cherian, Sobha; Collis, Rachel E; Sanders, Julia; Bhal, Kiron

2018-02-19

To evaluate caesarean section (CS) rates and moderate to severe hypoxaemic ischaemic encephalopathy (HIE) rates with other core intra-partum outcomes following reconfiguration of maternity services in Cardiff, South Wales, UK. Cohort study of births from 2006 to 2015. A University tertiary referral centre for foetal and maternal medicine with 6000 births/year, University Hospital of Wales, United Kingdom. Data relating to births from 1 January 2006 to 31 December 2015 were extracted from the computerized maternity database on a yearly basis. Case notes of all mothers and babies for the same duration were hand searched for documentation of HIE. HIE data was also collected prospectively by neonatologist (SC) and obstetrician (PA). Incidence of caesarean section births, babies with moderate to severe HIE, instrumental vaginal births, obstetric anal sphincter injuries (OASIS) associated with instrumental delivery, and major post-partum haemorrhage (MPPH) of 2500 mL or more. During this 10-year period, a downward trend in emergency CS rate was seen from 15.6% in 2006 to 10.5% in 2015, reducing total CS rate from 25.5% in 2006 to 21.2% in 2015. A downward trend in the incidence of moderate and severe HIE was seen over the same period. There was an increase in operative vaginal births (OVB) from 12.8% to 15%. The rate of spontaneous vaginal births (SVB) remained stable. The incidence of OASIS remained constant and MPPH rate has fallen. Following amalgamation of two medium sized obstetric units and the opening of a Midwifery Led Unit (MLU), core intrapartum outcomes have improved. Contributing factors are the introduction of regular multidisciplinary training with enhanced team working, compulsory education for obstetricians and midwives on cardiotocograph (CTG) interpretation, increased consultant presence on delivery suite, robust risk management systems and broad multidisciplinary agreement on clinical guidelines promoting vaginal birth.

Blood transfusion during pregnancy, birth, and the postnatal period.

PubMed

Patterson, Jillian A; Roberts, Christine L; Bowen, Jennifer R; Irving, David O; Isbister, James P; Morris, Jonathan M; Ford, Jane B

2014-01-01

To identify risk factors for transfusion and trends in transfusion rates across pregnancy and the postnatal period. Linked hospital and birth data on all births in hospitals in New South Wales, Australia, between 2001 and 2010 were used to identify blood transfusions for women during pregnancy, at birth, and in the 6 weeks postpartum. Poisson regression was used to identify risk factors for red cell transfusion in the birth admission. Separate models were fitted for cesarean and vaginal births. Between 2001 and 2010, there were 12,147 transfusions across 891,914 pregnancies, with a transfusion rate of 1.4%. The transfusion rate increased steadily from 1.2% in 2001 to 1.6% in 2010. The majority of transfusions (91%) occurred during the birth admission, and 81% of these transfusions were associated with a diagnosis of hemorrhage. Women with bleeding or platelet disorders (vaginal: number transfused 529, relative risk [RR] 7.8, 99% confidence interval [CI] 6.9-8.7, cesarean: n=592, RR 8.7, CI 7.7-9.7) and placenta previa: (vaginal n=73, RR 4.6, CI 3.4-6.3, cesarean: n=875, RR 5.7, CI 5.1-6.4) were at highest risk of transfusion. Among vaginal births, increased risk was evident for forceps (n=1,036, RR 2.8, CI 2.5-3.0) or vacuum births (n=1,073, RR 1.9, CI 1.7-2.0) compared with nonoperative births. Rates of obstetric blood product transfusion have increased by 33% since 2001, with the majority of this associated with hemorrhage. Women with bleeding or platelet disorders and placenta previa are at increased risk of transfusion and should be treated accordingly. II.

Trends and differentials in higher-birthweight infants at 28-31 weeks of gestation, by race and Hispanic origin, United States, 1990-2002.

PubMed

Kirmeyer, Sharon E W; Martin, Joyce A

2007-09-01

Birth certificate gestational age data based on the date of the mother's last menstrual period (LMP) are considered problematic. Of particular concern are birthweight distributions for infants reported on the birth certificate as having been delivered at 28-31 weeks' gestation; these distributions have been shown to be distinctly bimodal. The 'second curve' of the birthweight distribution at 28-31 weeks includes implausible birthweight/gestational age combinations and, thus, has been hypothesised to represent erroneous gestational ages due to misidentification of the date of LMP. It has been suggested that such 'misclassification' has declined in recent years and that this change can affect trends in preterm birth rates (<37 weeks' gestation), particularly rates among non-Hispanic black infants. This present study used primarily simple and multivariable analyses to review trends and differentials in birthweight distributions at 28-31 weeks by race and Hispanic origin of the mother. It aggregated data for the years 1990-92 and 2000-02 from the US vital statistics Natality files. Over the decade, the percentage of births in the second curve declined for all births and for each racial and Hispanic origin group studied. The largest decline was observed for non-Hispanic blacks; the smallest for Hispanic births. Later initiation of prenatal care, younger maternal age, lower educational attainment, higher birth order and vaginal and singleton delivery were positively associated with a larger second curve, suggesting misclassification of gestational age. Declines in the second curve over the study period were suggested to contribute significantly to the observed decrease in overall preterm birth rates for non-Hispanic black births. Further analysis is needed to estimate the influence of reporting error on preterm birth rates by race and Hispanic origin.

Linking a pharmaceutical claims database with a birth defects registry to investigate birth defect rates of suspected teratogens.

PubMed

Colvin, Lyn; Slack-Smith, Linda; Stanley, Fiona J; Bower, Carol

2010-11-01

Data linkage of population administrative data is being investigated as a tool for pharmacovigilance in pregnancy in Australia. Records of prescriptions of known or suspected teratogens dispensed to pregnant women have been linked to a birth defects registry to determine if defects associated with medicine exposure can be detected. The Pharmaceutical Benefits Scheme is a national claims database that has been linked with population-based data to extract linkages for women with a pregnancy event in Western Australia from 2002 to 2005 (n = 106 074). Records of births to the women who were dispensed medicines in categories D or X of the Australian ADEC pregnancy risk category were linked to the Birth Defects Registry of Western Australia. Population rates of registered birth defects per 1000 births were calculated for each medicine. There were 47 medicines dispensed at least once during pregnancy with 23 associated with a registered birth defect to a woman dispensed the medicine. When the birth defect rate for each medicine was compared with the rate for all other women not dispensed that medicine, most medicines showed an increased risk. Medicines with the higher risks were medroxyprogesterone acetate (OR: 1.8; 95%CI: 1.4-2.3), follitropin alfa (OR: 2.5; 95%CI: 1.2-5.0), carbamazepine (OR: 3.1; 95%CI: 1.7-5.6) and enalapril maleate (OR: 8.1; 95%CI: 1.6-41.7). Many known associations between medicines and birth defects were identified, suggesting that linked administrative data could be an important means of pharmacovigilance in pregnancy in Australia. Copyright © 2010 John Wiley & Sons, Ltd.

Socioeconomic and geographical disparities in under-five and neonatal mortality in Uttar Pradesh, India.

PubMed

Dettrick, Zoe; Jimenez-Soto, Eliana; Hodge, Andrew

2014-05-01

As a part of the Millennium Development Goals, India seeks to substantially reduce its burden of childhood mortality. The success or failure of this goal may depend on outcomes within India's most populous state, Uttar Pradesh. This study examines the level of disparities in under-five and neonatal mortality across a range of equity markers within the state. Estimates of under-five and neonatal mortality rates were computed using five datasets, from three available sources: sample registration system, summary birth histories in surveys, and complete birth histories. Disparities were evaluated via comparisons of mortality rates by rural-urban location, ethnicity, wealth, and districts. While Uttar Pradesh has experienced declines in both rates of under-five (162-108 per 1,000 live births) and neonatal (76-49 per 1,000 live births) mortality, the rate of decline has been slow (averaging 2 % per annum). Mortality trends in rural and urban areas are showing signs of convergence, largely due to the much slower rate of change in urban areas. While the gap between rich and poor households has decreased in both urban and rural areas, trends suggest that differences in mortality will remain. Caste-related disparities remain high and show no signs of diminishing. Of concern are also the signs of stagnation in mortality amongst groups with greater ability to access services, such as the urban middle class. Notwithstanding the slow but steady reduction of absolute levels of childhood mortality within Uttar Pradesh, the distribution of the mortality by sub-state populations remains unequal. Future progress may require significant investment in quality of care provided to all sections of the community.

Exact Bayesian Inference for Phylogenetic Birth-Death Models.

PubMed

Parag, K V; Pybus, O G

2018-04-26

Inferring the rates of change of a population from a reconstructed phylogeny of genetic sequences is a central problem in macro-evolutionary biology, epidemiology, and many other disciplines. A popular solution involves estimating the parameters of a birth-death process (BDP), which links the shape of the phylogeny to its birth and death rates. Modern BDP estimators rely on random Markov chain Monte Carlo (MCMC) sampling to infer these rates. Such methods, while powerful and scalable, cannot be guaranteed to converge, leading to results that may be hard to replicate or difficult to validate. We present a conceptually and computationally different parametric BDP inference approach using flexible and easy to implement Snyder filter (SF) algorithms. This method is deterministic so its results are provable, guaranteed, and reproducible. We validate the SF on constant rate BDPs and find that it solves BDP likelihoods known to produce robust estimates. We then examine more complex BDPs with time-varying rates. Our estimates compare well with a recently developed parametric MCMC inference method. Lastly, we performmodel selection on an empirical Agamid species phylogeny, obtaining results consistent with the literature. The SF makes no approximations, beyond those required for parameter quantisation and numerical integration, and directly computes the posterior distribution of model parameters. It is a promising alternative inference algorithm that may serve either as a standalone Bayesian estimator or as a useful diagnostic reference for validating more involved MCMC strategies. The Snyder filter is implemented in Matlab and the time-varying BDP models are simulated in R. The source code and data are freely available at https://github.com/kpzoo/snyder-birth-death-code. kris.parag@zoo.ox.ac.uk. Supplementary material is available at Bioinformatics online.

Targeting regional pediatric congenital hearing loss using a spatial scan statistic.

PubMed

Bush, Matthew L; Christian, Warren Jay; Bianchi, Kristin; Lester, Cathy; Schoenberg, Nancy

2015-01-01

Congenital hearing loss is a common problem, and timely identification and intervention are paramount for language development. Patients from rural regions may have many barriers to timely diagnosis and intervention. The purpose of this study was to examine the spatial and hospital-based distribution of failed infant hearing screening testing and pediatric congenital hearing loss throughout Kentucky. Data on live births and audiological reporting of infant hearing loss results in Kentucky from 2009 to 2011 were analyzed. The authors used spatial scan statistics to identify high-rate clusters of failed newborn screening tests and permanent congenital hearing loss (PCHL), based on the total number of live births per county. The authors conducted further analyses on PCHL and failed newborn hearing screening tests, based on birth hospital data and method of screening. The authors observed four statistically significant (p < 0.05) high-rate clusters with failed newborn hearing screenings in Kentucky, including two in the Appalachian region. Hospitals using two-stage otoacoustic emission testing demonstrated higher rates of failed screening (p = 0.009) than those using two-stage automated auditory brainstem response testing. A significant cluster of high rate of PCHL was observed in Western Kentucky. Five of the 54 birthing hospitals were found to have higher relative risk of PCHL, and two of those hospitals are located in a very rural region of Western Kentucky within the cluster. This spatial analysis in children in Kentucky has identified specific regions throughout the state with high rates of congenital hearing loss and failed newborn hearing screening tests. Further investigation regarding causative factors is warranted. This method of analysis can be useful in the setting of hearing health disparities to focus efforts on regions facing high incidence of congenital hearing loss.

Satisfaction with caregivers during labour among low risk women in the Netherlands: the association with planned place of birth and transfer of care during labour.

PubMed

Geerts, Caroline C; van Dillen, Jeroen; Klomp, Trudy; Lagro-Janssen, Antoine L M; de Jonge, Ank

2017-07-14

The caregiver has an important influence on women's birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care. It is speculated that satisfaction with care is affected in particular for women who need to be transferred from home to hospital. We examined the level of satisfaction with the caregiver among women with planned home versus planned hospital birth in midwife-led care. We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Women filled in a postpartum questionnaire which contained elements of the Consumer Quality index. This instrument measures 'general rate of  satisfaction with the caregiver' (scale from 1 to 10, with cut-off of below 9) and 'quality of treatment by the caregiver' (containing 7 items on a 4 point Likert scale, with cut-off of mean of 4 or lower). Women who planned a home birth (n = 1372) significantly more often rated 'quality of treatment by caregiver' high than women who planned a hospital birth (n = 829). Primiparous women who planned a home birth significantly more often had a high rate (9 or 10) for 'general satisfaction with caregiver' (adj.OR 1.48; 95% CI 1.1, 2.0). Also, primiparous women who planned a home birth and had care transferred during labour (331/553; 60%) significantly more often had a high rate (9 or 10) for 'general satisfaction' compared to those who planned a hospital birth and who had care transferred (1.44; 1.0-2.1). Furthermore, they significantly more often rated 'quality of treatment by caregiver' high, than 276/414 (67%) primiparous women who planned a hospital birth and who had care transferred (1.65; 1.2-2.3). No differences were observed for multiparous women who had planned home or hospital birth and who had care transferred. Planning home birth is associated to a good experience of quality of care by the caregiver. Transferred planned home birth compared to a transferred planned hospital birth does not lead to a more negative experience of care received from the caregiver.

Fetal Heart Rate and Variability: Stability and Prediction to Developmental Outcomes in Early Childhood

ERIC Educational Resources Information Center

DiPietro, Janet A.; Bornstein, Marc H.; Hahn, Chun-Shin; Costigan, Kathleen; Achy-Brou, Aristide

2007-01-01

Stability in cardiac indicators before birth and their utility in predicting variation in postnatal development were examined. Fetal heart rate and variability were measured longitudinally from 20 through 38 weeks gestation (n = 137) and again at age 2 (n = 79). Significant within-individual stability during the prenatal period and into childhood…

The sub-stellar birth rate from UKIDSS

NASA Astrophysics Data System (ADS)

Day-Jones, A. C.; Marocco, F.; Pinfield, D. J.; Zhang, Z. H.; Burningham, B.; Deacon, N.; Ruiz, M. T.; Gallardo, J.; Jones, H. R. A.; Lucas, P. W. L.; Jenkins, J. S.; Gomes, J.; Folkes, S. L.; Clarke, J. R. A.

2013-04-01

We present a new sample of mid-L to mid-T dwarfs with effective temperatures of 1100-1700 K selected from the UKIDSS Large Area Survey (LAS) and confirmed with infrared spectra from X-shooter/Very Large Telescope. This effective temperature range is especially sensitive to the formation history of Galactic brown dwarfs and allows us to constrain the form of the sub-stellar birth rate, with sensitivity to differentiate between a flat (stellar like) birth rate and an exponentially declining form. We present the discovery of 63 new L and T dwarfs from the UKIDSS LAS DR7, including the identification of 12 likely unresolved binaries, which form the first complete sub-set from our programme, covering 495 square degrees of sky, complete to J = 18.1. We compare our results for this sub-sample with simulations of differing birth rates for objects of masses 0.10-0.03 M⊙ and ages 1-10 Gyr. We find that the more extreme birth rates (e.g. a halo type form) can likely be excluded as the true form of the birth rate. In addition, we find that although there is substantial scatter we find a preference for a mass function, with a power-law index α in the range -1 < α < 0 that is consistent (within the errors) with the studies of late T dwarfs.

Long and spatially variable Neolithic Demographic Transition in the North American Southwest

PubMed Central

Kohler, Timothy A.; Reese, Kelsey M.

2014-01-01

In many places of the world, a Neolithic Demographic Transition (NDT) is visible as a several-hundred-year period of increased birth rates coupled with stable mortality rates, resulting in dramatic population growth that is eventually curtailed by increased mortality. Similar processes can be reconstructed in particular detail for the North American Southwest, revealing an anomalously long and spatially variable NDT. Irrigation-dependent societies experienced relatively low birth rates but were quick to achieve a high degree of sociopolitical complexity, whereas societies dependent on dry or rainfed farming experienced higher birth rates but less initial sociopolitical complexity. Low birth rates after A.D. 1200 mark the beginning of the decline of the Hohokam. Overall in the Southwest, birth rates increased slowly from 1100 B.C. to A.D. 500, and remained at high levels with some fluctuation until decreasing rapidly beginning A.D. 1300. Life expectancy at 15 increased slowly from 900 B.C. to A.D. 700, and then increased rapidly for 200 y before fluctuating and then declining after A.D. 1400. Life expectancy at birth, on the other hand, generally declined from 1100 B.C. to A.D. 1100/1200, before rebounding. Farmers took two millennia (∼1100 B.C. to ∼A.D. 1000) to reach the carrying capacity of the agricultural niche in the Southwest. PMID:24982134

Temporal trends of infant and birth outcomes in Minamata after severe methylmercury exposure.

PubMed

Yorifuji, Takashi; Kashima, Saori; Suryadhi, Made Ayu Hitapretiwi; Abudureyimu, Kawuli

2017-12-01

Severe methylmercury poisoning occurred in Minamata and neighboring communities in Japan during the 1950s and 1960s, causing what is known as Minamata disease. Although an increase in stillbirths and a reduced male proportion at birth (i.e., reduced sex ratio) have been reported, no studies have evaluated the impact of exposure on an entire set of infant and birth outcomes. We therefore evaluated the temporal trends of these outcomes in the Minamata area from 1950 to 1974. We focused on the spontaneous/artificial stillbirth rate, crude fertility rate, male proportion at birth, male proportion among stillbirths, and infant mortality. We obtained the number of stillbirths, live births, and infant deaths in Minamata City and Kumamoto Prefecture (as a reference) from 1950 to 1974. After plotting annual figures for each outcome, we divided the study period into five intervals and compared them between Minamata City and Kumamoto Prefecture using the chi-squared test. We observed a slightly increased spontaneous stillbirth rate and decreased artificial stillbirth rate in Minamata City, followed by a reduced crude fertility rate. The crude fertility rates in Minamata City during the period 1955-1965 were significantly lower compared with those in Kumamoto Prefecture (p < 0.001). An increase in the male proportion among stillbirths was observed, corresponding to a reduction in the proportion of males at birth in the late 1950s. The impact on infant mortality was equivocal. These descriptive analyses demonstrate a severe regional impact of methylmercury exposure on a series of birth outcomes in the Minamata area. Copyright © 2017 Elsevier Ltd. All rights reserved.

Decreases in Smoking-Related Cancer Mortality Rates Are Associated with Birth Cohort Effects in Korean Men.

PubMed

Jee, Yon Ho; Shin, Aesun; Lee, Jong-Keun; Oh, Chang-Mo

2016-12-05

Background: This study aimed to examine trends in smoking-related cancer mortality rates and to investigate the effect birth cohort on smoking-related cancer mortality in Korean men. Methods: The number of smoking-related cancer deaths and corresponding population numbers were obtained from Statistics Korea for the period 1984-2013. Joinpoint regression analysis was used to detect changes in trends in age-standardized mortality rates. Birth-cohort specific mortality rates were illustrated by 5 year age groups. Results: The age-standardized mortality rates for oropharyngeal decreased from 2003 to 2013 (annual percent change (APC): -3.1 (95% CI, -4.6 to -1.6)) and lung cancers decreased from 2002 to 2013 (APC -2.4 (95% CI -2.7 to -2.2)). The mortality rates for esophageal declined from 1994 to 2002 (APC -2.5 (95% CI -4.1 to -0.8)) and from 2002 to 2013 (APC -5.2 (95% CI -5.7 to -4.7)) and laryngeal cancer declined from 1995 to 2013 (average annual percent change (AAPC): -3.3 (95% CI -4.7 to -1.8)). By the age group, the trends for the smoking-related cancer mortality except for oropharyngeal cancer have changed earlier to decrease in the younger age group. The birth-cohort specific mortality rates and age-period-cohort analysis consistently showed that all birth cohorts born after 1930 showed reduced mortality of smoking-related cancers. Conclusions: In Korean men, smoking-related cancer mortality rates have decreased. Our findings also indicate that current decreases in smoking-related cancer mortality rates have mainly been due to a decrease in the birth cohort effect, which suggest that decrease in smoking rates.

Decreases in Smoking-Related Cancer Mortality Rates Are Associated with Birth Cohort Effects in Korean Men

PubMed Central

Jee, Yon Ho; Shin, Aesun; Lee, Jong-Keun; Oh, Chang-Mo

2016-01-01

Background: This study aimed to examine trends in smoking-related cancer mortality rates and to investigate the effect birth cohort on smoking-related cancer mortality in Korean men. Methods: The number of smoking-related cancer deaths and corresponding population numbers were obtained from Statistics Korea for the period 1984–2013. Joinpoint regression analysis was used to detect changes in trends in age-standardized mortality rates. Birth-cohort specific mortality rates were illustrated by 5 year age groups. Results: The age-standardized mortality rates for oropharyngeal decreased from 2003 to 2013 (annual percent change (APC): −3.1 (95% CI, −4.6 to −1.6)) and lung cancers decreased from 2002 to 2013 (APC −2.4 (95% CI −2.7 to −2.2)). The mortality rates for esophageal declined from 1994 to 2002 (APC −2.5 (95% CI −4.1 to −0.8)) and from 2002 to 2013 (APC −5.2 (95% CI −5.7 to −4.7)) and laryngeal cancer declined from 1995 to 2013 (average annual percent change (AAPC): −3.3 (95% CI −4.7 to −1.8)). By the age group, the trends for the smoking-related cancer mortality except for oropharyngeal cancer have changed earlier to decrease in the younger age group. The birth-cohort specific mortality rates and age-period-cohort analysis consistently showed that all birth cohorts born after 1930 showed reduced mortality of smoking-related cancers. Conclusions: In Korean men, smoking-related cancer mortality rates have decreased. Our findings also indicate that current decreases in smoking-related cancer mortality rates have mainly been due to a decrease in the birth cohort effect, which suggest that decrease in smoking rates. PMID:27929405

Does duration of abstinence affect the live-birth rate after assisted reproductive technology? A retrospective analysis of 1,030 cycles.

PubMed

Periyasamy, Anurekha J; Mahasampath, Gowri; Karthikeyan, Muthukumar; Mangalaraj, Ann M; Kunjummen, Aleyamma T; Kamath, Mohan S

2017-12-01

To study influence of abstinence period on the live-birth rate after assisted reproductive technology (ART). Retrospective cohort study. Reproductive medicine unit, university-level hospital. A total 1,030 ART cycles evaluated from 2011 to 2015. Group I, abstinence period 2-7 days, and group II, abstinence period >7 days, were compared. Two subgroups Ia (2-4 days) and Ib (5-7 days) were also compared with group II. Primary outcome was live birth per ET. Secondary outcomes included implantation, clinical pregnancy, and miscarriage rates. The live-birth rate (34.1 % vs. 24.1%; odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), clinical pregnancy rate (44.4 % vs. 32.7%; OR, 1.6; 95% CI, 1.1-2.3), and implantation rate (26.4% vs. 18.2%) were significantly higher in group I compared with group II. Other secondary outcomes of fertilization rate and miscarriage rate did not differ between groups I and II. The adjusted odds ratio (aOR) for live birth (aOR, 1.6; 95% CI, 1.1-2.5) and clinical pregnancy rates (aOR, 1.7; 95% CI, 1.2-2.5) were significantly higher for group I compared with group II. The live-birth rate was significantly higher in group Ia (36.1% vs. 24.1%) compared with group II. An abstinence period of more than 7 days may impact ART outcomes adversely when compared with an abstinence period of 2-7 days. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Toward a New Model of Fertility: The Effects of the World Economic System and the Status of Women on Fertility Behavior.

ERIC Educational Resources Information Center

Ward, Kathryn B.

A relationship exists between high birth rates and the lowered status of women in developing nations, resulting from their country's economic development. Research was based on data from various sources on 34 developed nations and 92 developing nations throughout the world. Variables included income inequality, foreign trade structure and…

Stochastic Forecasting of Labor Supply and Population: An Integrated Model.

PubMed

Fuchs, Johann; Söhnlein, Doris; Weber, Brigitte; Weber, Enzo

2018-01-01

This paper presents a stochastic model to forecast the German population and labor supply until 2060. Within a cohort-component approach, our population forecast applies principal components analysis to birth, mortality, emigration, and immigration rates, which allows for the reduction of dimensionality and accounts for correlation of the rates. Labor force participation rates are estimated by means of an econometric time series approach. All time series are forecast by stochastic simulation using the bootstrap method. As our model also distinguishes between German and foreign nationals, different developments in fertility, migration, and labor participation could be predicted. The results show that even rising birth rates and high levels of immigration cannot break the basic demographic trend in the long run. An important finding from an endogenous modeling of emigration rates is that high net migration in the long run will be difficult to achieve. Our stochastic perspective suggests therefore a high probability of substantially decreasing the labor supply in Germany.

Reproductive Health of Women in Rural Areas of East Azerbaijan - Iran, before and after Implementation of rural Family Physician Program: an Ecologic Study.

PubMed

Alizadeh, Mahasti; Jabbari Birami, Hossein; Moradi, Siavash

2015-12-01

Implementation of rural family physician program in Iran in 2005 has been evaluated and shown that this program has been led to some improvements in health indicators. In this study, some reproductive health (RH) indicators were compared before and after implementation of this program in rural areas of East Azerbaijan, Iran. In this ecologic- time trend study, the data of 191075 births of rural women of East Azerbaijan from 2001 to 2010 was extracted from vital horoscope (ZIJ) and used for calculation of 20 important RH indicators. The paired t-test and correlation analysis wear used for data analysis. Some indicators such as adolescent marriage rate, adolescent birth and over 35 year olds birth rate were increased after rural family physician program implementation in 2005. Also stillbirth rate and unsafe delivery were decreased during this period. There was a significant correlation between increasing adolescent birth rate and increasing low birth weight deliveries (r= 0.911, P= 0.031) and also between increasing over 35 year olds birth rate and increasing neonatal mortality rate in term of prematurity and congenital malformations (r= 0.912, P= 0.031) after program implementation. Perinatal care and safe delivery even for pregnancies outside the typical child-bearing ages are promoting after implementation of rural family physician program in East Azerbaijan. Also decreasing unsafe delivery and stillbirth rate can be considered as achievements of running this program in this province.

Infant abusive head trauma in a military cohort.

PubMed

Gumbs, Gia R; Keenan, Heather T; Sevick, Carter J; Conlin, Ava Marie S; Lloyd, David W; Runyan, Desmond K; Ryan, Margaret A K; Smith, Tyler C

2013-10-01

Evaluate the rate of, and risk factors for, abusive head trauma (AHT) among infants born to military families and compare with civilian population rates. Electronic International Classification of Diseases data from the US Department of Defense (DoD) Birth and Infant Health Registry were used to identify infants born to military families from 1998 through 2005 (N = 676 827) who met the study definition for AHT. DoD Family Advocacy Program data were used to identify infants with substantiated reports of abuse. Rates within the military were compared with civilian population rates by applying an alternate AHT case definition used in a civilian study. Applying the study definition, the estimated rate of substantiated military AHT was 34.0 cases in the first year of life per 100 000 live births. Using the alternate case definition, the estimated AHT rate was 25.6 cases per 100 000 live births. Infant risk factors for AHT included male sex, premature birth, and a diagnosed major birth defect. Parental risk factors included young maternal age (<21 years), lower sponsor rank or pay grade, and current maternal military service. This is the first large database study of AHT with the ability to link investigative results to cases. Overall rates of AHT were consistent with civilian populations when using the same case definition codes. Infants most at risk, warranting special attention from military family support programs, include infants with parents in lower military pay grades, infants with military mothers, and infants born premature or with birth defects.

Clinic access and teenage birth rates: Racial/ethnic and spatial disparities in Houston, TX.

PubMed

Wisniewski, Megan M; O'Connell, Heather A

2018-03-01

Teenage motherhood is a pressing issue in the United States, and one that is disproportionately affecting racial/ethnic minorities. In this research, we examine the relationship between the distance to the nearest reproductive health clinic and teenage birth rates across all zip codes in Houston, Texas. Our primary data come from the Texas Department of State Health Services. We use spatial regression analysis techniques to examine the link between clinic proximity and local teenage birth rates for all females aged 15 to 19, and separately by maternal race/ethnicity. We find, overall, limited support for a connection between clinic distance and local teenage birth rates. However, clinics seem to matter most for explaining non-Hispanic white teenage birth rates, particularly in high-poverty zip codes. The racial/ethnic and economic variation in the importance of clinic distance suggests tailoring clinic outreach to more effectively serve a wider range of teenage populations. We argue social accessibility should be considered in addition to geographic accessibility in order for clinics to help prevent teenage pregnancy. Copyright © 2018. Published by Elsevier Ltd.

Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients.

PubMed

Goldman, R H; Racowsky, C; Farland, L V; Munné, S; Ribustello, L; Fox, J H

2017-04-01

Can a counseling tool be developed for women desiring elective oocyte cryopreservation to predict the likelihood of live birth based on age and number of oocytes frozen? Using data from ICSI cycles of a population of women with uncompromised ovarian reserve, an evidence-based counseling tool was created to guide women and their physicians regarding the number of oocytes needed to freeze for future family-building goals. Elective oocyte cryopreservation is increasing in popularity as more women delay family building. By undertaking elective oocyte freezing at a younger age, women hope to optimize their likelihood of successful live birth(s) using their thawed oocytes at a future date. Questions often arise in clinical practice regarding the number of cryopreserved oocytes sufficient to achieve live birth(s) and whether or not additional stimulation cycles are likely to result in a meaningful increase in the likelihood of live birth. As relatively few women who have electively cryopreserved oocytes have returned to use them, available data for counseling patients wishing to undergo fertility preservation are limited. A model was developed to determine the proportion of mature oocytes that fertilize and then form blastocysts as a function of age, using women with presumably normal ovarian reserve based on standard testing who underwent ICSI cycles in our program from January, 2011 through March, 2015 (n = 520). These included couples diagnosed exclusively with male-factor and/or tubal-factor infertility, as well as cycles utilizing egg donation. Age-specific probabilities of euploidy were estimated from 14 500 PGS embryo results from an external testing laboratory. Assuming survival of thawed oocytes at 95% for women <36 y and for egg donors, and 85% for women ≥36 y, and 60% live birth rate per transferred euploid blastocyst, probabilities of having at least one, two or three live birth(s) were calculated. First fresh male-factor and/or tubal-factor only autologous ICSI cycles (n = 466) were analyzed using Poisson regression to calculate the probability that a mature oocyte will become a blastocyst based on age. Egg donation cycles (n = 54) were analyzed and incorporated into the model separately. The proportion of blastocysts expected to be euploid was determined using PGS results of embryos analyzed via array comparative genomic hybridization. A counseling tool was developed to predict the likelihood of live birth, based on individual patient age and number of mature oocytes. This study provides an evidence-based model to predict the probability of a woman having at least one, two or three live birth(s) based on her age at egg retrieval and the number of mature oocytes frozen. The model is derived from a surrogate population of ICSI patients with uncompromised ovarian reserve. A user-friendly counseling tool was designed using the model to help guide physicians and patients. The data used to develop the prediction model are, of necessity, retrospective and not based on patients who have returned to use their cryopreserved oocytes. The assumptions used to create the model, albeit reasonable and data-driven, vary by study and will likely vary by center. Centers are therefore encouraged to consider their own blastocyst formation and thaw survival rates when counseling patients. Our model will provide a counseling resource that may help inform women desiring elective fertility preservation regarding their likelihood of live birth(s), how many cycles to undergo, and when additional cycles would bring diminishing returns. None. Not applicable. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Correcting haemoglobin cut-offs to define anaemia in high-altitude pregnant women in Peru reduces adverse perinatal outcomes.

PubMed

Gonzales, Gustavo F; Tapia, Vilma; Gasco, Manuel

2014-07-01

To determine if correction of cut-offs of haemoglobin levels to define anaemia at high altitudes affects rates of adverse perinatal outcomes. Data were obtained from 161,909 mothers and newborns whose births occurred between 1,000 and 4,500 m above sea level (masl). Anaemia was defined with or without correction of haemoglobin (Hb) for altitude as Hb <11 g/dL. Correction of haemoglobin per altitude was performed according to guidelines from the World Health Organization. Rates of stillbirths and preterm births were also calculated. Stillbirth and preterm rates were significantly reduced in cases of anaemia calculated after correction of haemoglobin for altitude compared to values obtained without Hb correction. At high altitudes (3,000-4,500 masl), after Hb correction, the rate of stillbirths was reduced from 37.7 to 18.3 per 1,000 live births (p < 0.01); similarly, preterm birth rates were reduced from 13.1 to 8.76 % (p < 0.01). The odds ratios for stillbirths and for preterm births were also reduced after haemoglobin correction. At high altitude, correction of maternal haemoglobin should not be performed to assess the risks for preterm birth and stillbirth. In fact, using low altitude Hb cut-off is associated with predicting those at risk.

Population policy: do we need it? Prospects and problems.

PubMed

Moyo, N P

1986-01-01

A 1983 report by the Whitsun Foundation called upon the Government of Zimbabwe to recognize the urgent nature of that country's population problem and to devise and implement a comprehensive population policy aimed at reducing morbidity and mortality among women and children, reducing the population growth rate, and reducing the fertility level. This article challenges the Whitsun Foundation's view that population pressure is the primary cause of poverty in Zimbabwe and that family planning is a feasible remedy. It is argued instead that poverty in Zimbabwe can be traced to capitalist development policies that have removed from rural people the means to produce their own subsistence. More important that large-scale birth control programs are radical structural and institutional changes aimed at achieving social and economic progress and directly attacking poverty, unemployment, and inequality. Those countries where marked declines in birth rates have been achieved have usually been those that spread the benefits of development throughout their populations. Moreover, the Whitsun report implies that there is no family planning program in Zimbabwe. In fact, in 1982, an estimated 200,000 people received contraception through the Child Spacing and Fertility Association of Zimbabwe's program. It is unlikely that an expanded birth control program and educational campaign to persuade the rural and urban poor to practice family planning will be effective. Policy makers will have to address the cynicism brought about by the colonial regimes' genocidal efforts in the 1960s and 1970s to introduce birth control measures.

Evaluation of growth performance of abergele goats under traditional management systems in Sekota District, Ethiopia.

PubMed

Deribe, Belay; Taye, Mengistie

2013-07-15

The study was conducted at Abergele in the semi arid parts of Sekota district to evaluate growth performance of Abergele goats managed under traditional management systems. Data on growth and growth rates were collected from 724 kids for two years. The least squares mean birth, three months, six months and yearling weight of kids obtained were 1.91 +/- 0.04, 6.84 +/- 0.19, 9.13 +/- 0.31 and 16.42 +/- 1.20 kg, respectively. Parity of doe and birth type of kid significantly affected birth weight and three months weight while sex of kid and season of birth of kid affected birth, three months, six months and yearling weight consistently. Kids from first parity does were lighter at birth, three months and six months of age than kids from higher parity does. Twin born kids were lower in weight at birth and three months of ages than their single born counterparts. Female kids and kids born during the dry season had lower weight at all ages considered. The least squares mean pre-weaning and post-weaning growth rates obtained were 53.4 +/- 2.30 and 29.3 +/- 4.32 g day(-1), respectively. Parity of doe, type of birth and season birth of kid affected pre-weaning growth rate. Kids from first parity does, twin born kids and kids born during the dry season had lower growth rate. The significant effect of fixed factors needs to be considered in an effort to improve productivity of goats in the study areas.

Vitamins and perinatal outcomes among HIV-negative women in Tanzania.

PubMed

Fawzi, Wafaie W; Msamanga, Gernard I; Urassa, Willy; Hertzmark, Ellen; Petraro, Paul; Willett, Walter C; Spiegelman, Donna

2007-04-05

Prematurity and low birth weight are associated with high perinatal and infant mortality, especially in developing countries. Maternal micronutrient deficiencies may contribute to these adverse outcomes. In a double-blind trial in Dar es Salaam, Tanzania, we randomly assigned 8468 pregnant women (gestational age of fetus, 12 to 27 weeks) who were negative for human immunodeficiency virus infection to receive daily multivitamins (including multiples of the recommended dietary allowance) or placebo. All the women received prenatal supplemental iron and folic acid. The primary outcomes were low birth weight (<2500 g), prematurity, and fetal death. The incidence of low birth weight was 7.8% among the infants in the multivitamin group and 9.4% among those in the placebo group (relative risk, 0.82; 95% confidence interval [CI], 0.70 to 0.95; P=0.01). The mean difference in birth weight between the groups was modest (67 g, P<0.001). The rates of prematurity were 16.9% in the multivitamin group and 16.7% in the placebo group (relative risk, 1.01; 95% CI, 0.91 to 1.11; P=0.87), and the rates of fetal death were 4.3% and 5.0%, respectively (relative risk, 0.87; 95% CI, 0.72 to 1.05; P=0.15). Supplementation reduced both the risk of a birth size that was small for gestational age (<10th percentile; 10.7% in the multivitamin group vs. 13.6% in the placebo group; relative risk, 0.77; 95% CI, 0.68 to 0.87; P<0.001) and the risk of maternal anemia (hemoglobin level, <11 g per deciliter; relative risk, 0.88; 95% CI, 0.80 to 0.97; P=0.01), although the difference in the mean hemoglobin levels between the groups was small (0.2 g per deciliter, P<0.001). Multivitamin supplementation reduced the incidence of low birth weight and small-for-gestational-age births but had no significant effects on prematurity or fetal death. Multivitamins should be considered for all pregnant women in developing countries. (ClinicalTrials.gov number, NCT00197548 [ClinicalTrials.gov].). Copyright 2007 Massachusetts Medical Society.

The socioeconomic consequences of teenage childbearing: findings from a natural experiment.

PubMed

Grogger, J; Bronars, S

1993-01-01

A study based on census data from 1970 and 1980 examines the socioeconomic effects of unplanned teenage childbearing by comparing teenage mothers whose first birth was to twins with those whose first birth was to a single infant. Among black women, an unplanned teenage birth--represented by the secondborn twin--results in significantly lower rates of high school graduation and labor-force participation and significantly higher rates of poverty and welfare recipiency. Ten years after giving birth, black women who have an unplanned child are also significantly less likely than women who have not to be currently married, but are not less likely to have ever been married. Like black women, white women who have an unplanned teenage birth have significantly higher rates of poverty and welfare recipiency; they also have significantly lower family earnings and household income.

Effects of anticoagulant therapy on pregnancy outcomes in patients with thrombophilia and previous poor obstetric history.

PubMed

Mutlu, Ilknur; Mutlu, Mehmet Firat; Biri, Aydan; Bulut, Berk; Erdem, Mehmet; Erdem, Ahmet

2015-04-01

This study investigates the effects of anticoagulant therapy on pregnancy outcomes in 204 patients with thrombophilia and previous poor obstetric outcomes. Patients with poor obstetric history (pre-eclampsia, intrauterine growth retardation, fetal death, placental abruption, recurrent pregnancy loss) and having hereditary thrombophilia were included in this study. Poor obstetric outcomes were observed more frequently in patients who had not taken anticogulant therapy compared with treated group. Live birth rate, gestational age at birth and Apgar scores were significantly higher in the treated group when compared with the untreated group. There were no significant differences in terms of birthweight, mode of delivery and admission rates to the neonatal intensive care unit (NICU). Low-molecular-weight heparin (LMWH) plus acetylsalicylic acid (ASA) had higher gestational age at birth, Apgar scores, live birth rate and a lower abortion rates when compared with controls; in contrast, no significant difference was observed in terms of birthweight, mode of delivery, obstetric complications and admission rates to NICU. There were no significant differences between control group and both LMWH only and ASA only groups in terms of gestational age at birth, Apgar scores, birthweight, mode of delivery, obstetric complications and admission rates to NICU. Only LMWH group had higher live birth rate as compared with control group. The use of only ASA did not seem to affect the perinatal complication rates and outcomes. In conclusion, anticoagulant therapy with both LMWH and ASA seems to provide better obstetric outcomes in pregnant women with thrombophilia and previous poor obstetric outcomes.

Increasing skilled birth attendance through midwifery workforce management.

PubMed

Rosskam, Ellen; Pariyo, George; Hounton, Sennen; Aiga, Hirotsugu

2013-01-01

Policy makers and development partners struggle to help find solutions to the high rates of maternal and newborn mortality in many low and middle income countries. Increasing access to midwives and health workers skilled in midwifery can help to alleviate the situation. We aim to contribute to the debate on strategies to increase access to skilled birth attendance by sharing our views, illustrated with as yet unpublished case stories that were recognized with Awards of Excellence at the Second Global Forum on Human Resources for Health, 2011, held in Bangkok, Thailand. The correlation between access to skilled birth attendance and the density of midwives, nurses and doctors has been well established in the literature. How to cost-effectively scale up skilled birth attendance in low and middle income countries, however, remains a matter of debate. This article is based on a review of success stories in midwifery workforce management and innovations in increasing population access to midwives and other health workers skilled in midwifery. We draw on case stories from three low resource settings: Bangladesh, Sri Lanka and Nigeria. Addressing the problem of access to skilled birth attendance, some countries are making good progress towards achieving Millennium Development Goals 4 and 5. Unshakeable political will and financial commitment are fundamental. Copyright © 2012 John Wiley & Sons, Ltd.

Schizophrenia and season of birth: relationship to geomagnetic storms.

PubMed

Kay, Ronald W

2004-01-01

An excess pattern of winter and spring birth, of those later diagnosed as schizophrenic, has been clearly identified in most Northern Hemisphere samples with none or lesser variation in Equatorial or Southern Hemisphere samples. Pregnancy and birth complications, seasonal variations in light, weather, temperature, nutrition, toxins, body chemistry and gene expression have all been hypothesized as possible causes. In this study, the hypothesis was tested that seasonal variation in the geomagnetic field of the earth primarily as a result of geomagnetic storms (GMS) at crucial periods in intrauterine brain development, during months 2 to 7 of gestation could affect the later rate of development of schizophrenia. The biological plausibility of this hypothesis is also briefly reviewed. A sample of eight representative published studies of schizophrenic monthly birth variation were compared with averaged geomagnetic disturbance using two global indices (AA*) and (aa). Three samples showed a significant negative correlation to both geomagnetic indices, a further three a significant negative correlation to one of the geomagnetic indices, one showed no significant correlation to either index and one showed a significant positive correlation to one index. It is suggested that these findings are all consistent with the hypothesis and that geomagnetic disturbance or factors associated with this disturbance should be further investigated in birth seasonality studies.

Integrated approaches to improve birth outcomes: perinatal periods of risk, infant mortality review, and the Los Angeles Mommy and Baby Project.

PubMed

Chao, Shin Margaret; Donatoni, Giannina; Bemis, Cathleen; Donovan, Kevin; Harding, Cynthia; Davenport, Deborah; Gilbert, Carol; Kasehagen, Laurin; Peck, Magda G

2010-11-01

This article provides an example of how Perinatal Periods of Risk (PPOR) can provide a framework and offer analytic methods that move communities to productive action to address infant mortality. Between 1999 and 2002, the infant mortality rate in the Antelope Valley region of Los Angeles County increased from 5.0 to 10.6 per 1,000 live births. Of particular concern, infant mortality among African Americans in the Antelope Valley rose from 11.0 per 1,000 live births (7 cases) in 1999 to 32.7 per 1,000 live births (27 cases) in 2002. In response, the Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs partnered with a community task force to develop an action plan to address the issue. Three stages of the PPOR approach were used: (1) Assuring Readiness; (2) Data and Assessment, which included: (a) Using 2002 vital records to identify areas with the highest excess rates of feto-infant mortality (Phase 1 PPOR), and (b) Implementing Infant Mortality Review (IMR) and the Los Angeles Mommy and Baby (LAMB) Project, a population-based study to identify potential factors associated with adverse birth outcomes. (Phase 2 PPOR); and (3) Strategy and Planning, to develop strategic actions for targeted prevention. A description of stakeholders' commitments to improve birth outcomes and monitor infant mortality is also given. The Antelope Valley community was engaged and ready to investigate the local rise in infant mortality. Phase 1 PPOR analysis identified Maternal Health/Prematurity and Infant Health as the most important periods of risk for further investigation and potential intervention. During the Phase 2 PPOR analyses, IMR found a significant proportion of mothers with previous fetal loss (45%) or low birth weight/preterm (LBW/PT) birth, late prenatal care (39%), maternal infections (47%), and infant safety issues (21%). After adjusting for potential confounders (maternal age, race, education level, and marital status), the LAMB case-control study (279 controls, 87 cases) identified additional factors associated with LBW births: high blood pressure before and during pregnancy, pregnancy weight gain falling outside of the recommended range, smoking during pregnancy, and feeling unhappy during pregnancy. PT birth was significantly associated with having a previous LBW/PT birth, not taking multivitamins before pregnancy, and feeling unhappy during pregnancy. In response to these findings, community stakeholders gathered to develop strategic actions for targeted prevention to address infant mortality. Subsequently, key funders infused resources into the community, resulting in expanded case management of high-risk women, increased family planning services and local resources, better training for nurses, and public health initiatives to increase awareness of infant safety. Community readiness, mobilization, and alignment in addressing a public health concern in Los Angeles County enabled the integration of PPOR analytic methods into the established IMR structure and [the design and implementation of a population-based l study (LAMB)] to monitor the factors associated with adverse birth outcomes. PPOR proved an effective approach for identifying risk and social factors of greatest concern, the magnitude of the problem, and mobilizing community action to improve infant mortality in the Antelope Valley.

Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection

PubMed Central

Vitek, Wendy S.; Galárraga, Omar; Klatsky, Peter C.; Robins, Jared C.; Carson, Sandra A.; Blazar, Andrew S.

2015-01-01

Objective To determine the cost-effectiveness of split IVF-intracytoplasmic sperm injection (ICSI) for the treatment of couples with unexplained infertility. Design Adaptive decision model. Setting Academic infertility clinic. Patient(s) A total of 154 couples undergoing a split IVF-ICSI cycle and a computer-simulated cohort of women <35 years old with unexplained infertility undergoing IVF. Intervention(s) Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes. Main Outcome Measure(s) Live birth rate, incremental cost-effectiveness ratio (ICER). Result(s) In a single cycle, all IVF is preferred as the ICER of split IVF-ICSI or all ICSI ($58,766) does not justify the increased live birth rate (3%). If two cycles are needed, split IVF/ICSI is preferred as the increased cumulative live birth rate (3.3%) is gained at an ICER of $29,666. Conclusion(s) In a single cycle, all IVF was preferred as the increased live birth rate with split IVF-ICSI and all ICSI was not justified by the increased cost per live birth. If two IVF cycles are needed, however, split IVF/ICSI becomes the preferred approach, as a result of the higher cumulative live birth rate compared with all IVF and the lesser cost per live birth compared with all ICSI. PMID:23876534

Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection.

PubMed

Vitek, Wendy S; Galárraga, Omar; Klatsky, Peter C; Robins, Jared C; Carson, Sandra A; Blazar, Andrew S

2013-11-01

To determine the cost-effectiveness of split IVF-intracytoplasmic sperm injection (ICSI) for the treatment of couples with unexplained infertility. Adaptive decision model. Academic infertility clinic. A total of 154 couples undergoing a split IVF-ICSI cycle and a computer-simulated cohort of women <35 years old with unexplained infertility undergoing IVF. Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes. Live birth rate, incremental cost-effectiveness ratio (ICER). In a single cycle, all IVF is preferred as the ICER of split IVF-ICSI or all ICSI ($58,766) does not justify the increased live birth rate (3%). If two cycles are needed, split IVF/ICSI is preferred as the increased cumulative live birth rate (3.3%) is gained at an ICER of $29,666. In a single cycle, all IVF was preferred as the increased live birth rate with split IVF-ICSI and all ICSI was not justified by the increased cost per live birth. If two IVF cycles are needed, however, split IVF/ICSI becomes the preferred approach, as a result of the higher cumulative live birth rate compared with all IVF and the lesser cost per live birth compared with all ICSI. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

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

PubMed

Thyrian, Jochen René; Fendrich, Konstanze; Lange, Anja; Haas, Johannes-Peter; Zygmunt, Marek; Hoffmann, Wolfgang

2010-08-01

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. (c) 2010 Elsevier Ltd. All rights reserved.

Persisting behavior problems in extremely low birth weight adolescents.

PubMed

Taylor, H Gerry; Margevicius, Seunghee; Schluchter, Mark; Andreias, Laura; Hack, Maureen

2015-04-01

To describe behavior problems in extremely low birth weight (ELBW, <1000 g) adolescents born 1992 through 1995 based on parent ratings and adolescent self-ratings at age 14 years and to examine changes in parent ratings from ages 8-14. Parent ratings of behavior problems and adolescent self-ratings were obtained for 169 ELBW adolescents (mean birth weight 815 g, gestational age 26 wk) and 115 normal birth weight (NBW) controls at 14 years. Parent ratings of behavior at age 8 years were also available. Behavior outcomes were assessed using symptom severity scores and rates of scores above DSM-IV symptom cutoffs for clinical disorder. The ELBW group had higher symptom severity scores on parent ratings at age 14 years than NBW controls for inattentive attention-deficit hyperactivity disorder (ADHD), anxiety, and social problems (all p's < .01). Rates of parent ratings meeting DSM-IV symptom criteria for inattentive ADHD were also higher for the ELBW group (12% vs. 1%, p < .01). In contrast, the ELBW group had lower symptom severity scores on self-ratings than controls for several scales. Group differences in parent ratings decreased over time for ADHD, especially among females, but were stable for anxiety and social problems. Extremely low birth weight adolescents continue to have behavior problems similar to those evident at a younger age, but these problems are not evident in behavioral self-ratings. The findings suggest that parent ratings provide contrasting perspectives on behavior problems in ELBW youth and support the need to identify and treat these problems early in childhood.

Islamic Republic of Iran provides fresh data.

PubMed

1998-01-01

This article presents a demographic statistical profile of the Islamic Republic of Iran, based on 1996 census data. The discussion also focused on the government actions taken since the 1994 International Conference on Population and Development. Total population was 60.1 million. 61% of population lived in urban areas. 51.4% of the population were aged under 20 years of age. 4.3% were aged over 65 years. The annual rate of population growth was 2.7% during 1976-86, and 3.2% during 1986-96. Growth was accounted for by an increase in refugee flow, decreased mortality, and a higher birth rate. The Government in 1987, enacted the Family Planning Law as a measure to reduce the rapid population growth rate. The 1994-98 Five Year Plan integrates population issues with sustainable development strategies. The aim for 1998, is to reduce population growth to 1.5%, fertility to 2.5 children/woman, maternal mortality to 35/100,000 live births, and infant mortality to under 22/1000 live births. Islamic principles address gender issues having to do with equality, equity, and the empowerment of women. A Bureau of Women's Affairs, which was established under the President's Office, aims to promote the status of women and ensure their active participation within the development process. The government has advanced women's position by improving reproductive health and family planning programs. In late 1994, the government began to promote the activities of 70 nongovernmental organizations, many of which are concerned with women's issues. A high council for youth was set up in the President's Office.

Trends in Canadian Birth Weights, 1971 to 1989

PubMed Central

Wadhera, S.; Millar, W. J.; Nimrod, Carl

1992-01-01

This paper outlines levels and trends in birth weights of singleton birth weights of singleton births in Canada between 1971 and 1989. It relates these birth weights to maternal age, marital status, and parity and to gestational age. From 1971 to 1989, the median birth weight of all singletons increased by 104g, or 3.1%. The proportion of low birth weight babies declined, probably contributing to improved infant mortality rates. PMID:21221364

Prevalence of and risk factors associated with cesarean section in Lebanon - A retrospective study based on a sample of 29,270 women.

PubMed

Zgheib, Sandy M; Kacim, Mohammad; Kostev, Karel

2017-12-01

During the last decades, there has been an alarming and dramatic increase in the number of cesarean births in both developed and undeveloped countries. This increase has not been clinically justified but, nevertheless, has raised an important number of issues. The aim of this study was to determine the risk factors associated with the high cesarean section rates in Lebanon. This study is based on a sample of 29,270 Lebanese women who were pregnant between 2000 and 2015. Among these, 14,327 gave birth by cesarean section and 14,943 gave birth vaginally. To identify the risk factors of cesarean section, logistic regression was applied as a statistical method using the SPSS statistical package. Of the 29,270 pregnant women included in the study, 49% had cesarean sections while 51% gave birth vaginally. Repeat cesarean section accounted for 23% while vaginal birth after cesarean accounted for only 0.2% of deliveries. In addition, weekdays were associated with a preference of providers to carry out more cesarean sections. According to an analysis of our data using logistic regression, the risk factors associated with the increase in cesarean section rates were advanced maternal age, elective cesarean section, malpresentation of fetus, multiple birth, prolonged pregnancy, prolonged labor, and fetal distress. Based on these results, it is recommended that a new health policy be implemented to reduce the number of unnecessary cesarean deliveries in Lebanon. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Effects of Birth Month on Child Health and Survival in Sub-Saharan Africa

PubMed Central

Dorélien, Audrey M.

2015-01-01

Birth month is broadly predictive of both under-five mortality rates and stunting throughout most of sub-Saharan Africa (SSA). Observed factors, such as mother's age at birth and educational status, are correlated with birth month but are not the main factors underlying the relationship between birth month and child health. Accounting for maternal selection via a fixed-effects model attenuates the relationship between birth month and health in many SSA countries. In the remaining countries, the effect of birth month may be mediated by environmental factors. Birth month effects on mortality typically do not vary across age intervals; the differential mortality rates by birth month were evident in the neonatal period and continued across age intervals. The male-to-female sex-ratio at birth did not vary by birth month, which suggests that in utero exposures are not influencing fetal loss, and therefore, the birth month effects are not likely due to selective survival during the in utero period. In one-third of the sample, the birth month effects on stunting diminished after the age of two years; therefore, some children were able to catch-up. Policies to improve child health should target pregnant women and infants and must take seasonality into account. PMID:26266973

Association between oocyte number retrieved with live birth rate and birth weight: an analysis of 231,815 cycles of in vitro fertilization

PubMed Central

Baker, Valerie L.; Brown, Morton B.; Luke, Barbara; Conrad, Kirk P.

2015-01-01

Objective To determine if number of oocytes correlates with live birth rate and incidence of low birthweight (LBW). Design Retrospective cohort. Setting N/A. Patients Women undergoing fresh embryo transfer utilizing either autologous (n=194,627) or donor (n=37,188) oocytes whose cycles were reported to the Society for Assisted Reproductive Technology 2004–2010. Main outcome measures Live birth rate, birthweight, birth weight z-score, LBW. Interventions None. Results For both autologous and donor oocyte cycles, increasing number of oocytes retrieved paralleled live birth rate and embryos available for cryopreservation in most analyses performed with all models adjusted for age and prior births. For cycles achieving singleton pregnancy using autologous oocytes via transfer of 2 embryos, a higher number of oocytes retrieved was associated with lower mean birth weight, lower birthweight z-score, and greater incidence of LBW. In contrast, for cycles using donor oocytes, there was no association of oocyte number retrieved with measures of birthweight. Conclusions A higher number of oocytes retrieved was associated with an increased incidence of LBW in autologous singleton pregnancies resulting from transfer of 2 embryos but not in donor oocyte cycles. Although the effect of high oocyte number on the incidence of LBW in autologous cycles was of modest magnitude, further study is warranted to determine if a subgroup of women may be particularly vulnerable. PMID:25638421

Evaluation of the product ratio coherent model in forecasting mortality rates and life expectancy at births by States

NASA Astrophysics Data System (ADS)

Shair, Syazreen Niza; Yusof, Aida Yuzi; Asmuni, Nurin Haniah

2017-05-01

Coherent mortality forecasting models have recently received increasing attention particularly in their application to sub-populations. The advantage of coherent models over independent models is the ability to forecast a non-divergent mortality for two or more sub-populations. One of the coherent models was recently developed by [1] known as the product-ratio model. This model is an extension version of the functional independent model from [2]. The product-ratio model has been applied in a developed country, Australia [1] and has been extended in a developing nation, Malaysia [3]. While [3] accounted for coherency of mortality rates between gender and ethnic group, the coherency between states in Malaysia has never been explored. This paper will forecast the mortality rates of Malaysian sub-populations according to states using the product ratio coherent model and its independent version— the functional independent model. The forecast accuracies of two different models are evaluated using the out-of-sample error measurements— the mean absolute forecast error (MAFE) for age-specific death rates and the mean forecast error (MFE) for the life expectancy at birth. We employ Malaysian mortality time series data from 1991 to 2014, segregated by age, gender and states.

A Dynamic Model for C3 Information Incorporating the Effects of Counter C3

DTIC Science & Technology

1980-12-01

birth and death rates exactly cancel one another and H = 0. Although this simple first order linear system is not very sophisti- cated, we see...per hour and refer to the average behavior of the entire system ensemble much as species birth and death rates are typically measured in births (or...unit time) iii) VTX, VIY ; Uncertainty Death Rates resulting from data inputs (bits/bit per unit time) 3 -1 iv) YYV» YvY > Counter C

Simple stochastic birth and death models of genome evolution: was there enough time for us to evolve?

PubMed

Karev, Georgy P; Wolf, Yuri I; Koonin, Eugene V

2003-10-12

The distributions of many genome-associated quantities, including the membership of paralogous gene families can be approximated with power laws. We are interested in developing mathematical models of genome evolution that adequately account for the shape of these distributions and describe the evolutionary dynamics of their formation. We show that simple stochastic models of genome evolution lead to power-law asymptotics of protein domain family size distribution. These models, called Birth, Death and Innovation Models (BDIM), represent a special class of balanced birth-and-death processes, in which domain duplication and deletion rates are asymptotically equal up to the second order. The simplest, linear BDIM shows an excellent fit to the observed distributions of domain family size in diverse prokaryotic and eukaryotic genomes. However, the stochastic version of the linear BDIM explored here predicts that the actual size of large paralogous families is reached on an unrealistically long timescale. We show that introduction of non-linearity, which might be interpreted as interaction of a particular order between individual family members, allows the model to achieve genome evolution rates that are much better compatible with the current estimates of the rates of individual duplication/loss events.

Men’s Migration and Women’s Fertility in Rural Mozambique

PubMed Central

Yabiku, Scott T.; Cau, Boaventura

2012-01-01

Labor migration profoundly affects households throughout rural Africa. This study looks at how men’s labor migration influences marital fertility in a context where such migration has been massive while its economic returns are increasingly uncertain. Using data from a survey of married women in southern Mozambique, we start with an event-history analysis of birth rates among women married to migrants and those married to nonmigrants. The model detects a lower birth rate among migrants’ wives, which tends to be partially compensated for by an increased birth rate upon cessation of migration. An analysis of women’s lifetime fertility shows that it decreases as the time spent in migration by their husbands accrues. When we compare reproductive intentions stated by respondents with migrant and nonmigrant husbands, we find that migrants’ wives are more likely to want another child regardless of the number of living children, but the difference is significant only for women who see migration as economically benefiting their households. Yet, such women are also significantly more likely to use modern contraception than other women. We interpret these results in light of the debate on enhancing versus disrupting effects of labor migration on families and households in contemporary developing settings. PMID:21691931

Single-embryo transfer versus multiple-embryo transfer.

PubMed

Gerris, Jan

2009-01-01

Despite the progress made in assisted reproductive technology, live birth rates remain disappointingly low. Multiple-embryo transfer has been an accepted practice with which to increase the success rate. This has led to a higher incidence of multiple-order births compared with natural conception, which not only increase the risk of mortality and morbidity to both mother and children but are also associated with social and economic consequences. Elective single-embryo transfer (eSET) was developed in an effort to increase singleton pregnancies in assisted reproduction. Studies comparing eSET with multiple-embryo transfer highlight the benefit of this approach and suggest that, with careful patient selection and the transfer of good-quality embryos, the risk of a multiple-order pregnancy can be reduced without significantly decreasing live birth rates. Although the use of eSET has gradually increased in clinical practice, its acceptance has been limited by factors such as availability of funding and awareness of the procedure. An open discussion of eSET is warranted in an effort to enable a broader understanding by physicians and patients of the merits of this approach. Ultimately, eSET may provide a more cost-effective, potentially safer approach to patients undergoing assisted reproduction technology.

Birth position and obstetric anal sphincter injury: a population-based study of 113 000 spontaneous births.

PubMed

Elvander, Charlotte; Ahlberg, Mia; Thies-Lagergren, Li; Cnattingius, Sven; Stephansson, Olof

2015-10-09

The association between birth position and obstetric anal sphincter injury (OASIS) in spontaneous vaginal deliveries is unclear. The study was based on the Stockholm-Gotland Obstetric Database (Sweden) from Jan 1(st) 2008 to Oct 22(nd) 2014 and included 113 279 singleton spontaneous vaginal births with no episiotomy. We studied risk of OASIS with respect to the following birth positions: a) sitting, b) lithotomy, c) lateral, d) standing on knees, e) birth seat, f) supine, g) squatting, h) standing and i) all fours. All analyses were stratified for parity. General linear models were used to calculate risk ratios (RR) adjusted for maternal, pregnancy and fetal characteristics. The rates of OASIS among nulliparous women, parous women and women undergoing vaginal birth after a caesarean (VBAC) were 5.7%, 1.3% and 10.6%, respectively. The rates varied by birth position: from 3.7 to 7.1% in nulliparous women, 0.6% to 2.6% in parous women and 5.6% to 18.2% in women undergoing VBAC. Regardless of parity, the lowest rates were found among women giving birth in standing position and the highest rates among women birthing in the lithotomy position. Compared with sitting position, the lithotomy position involved an increased risk of OASIS among nulliparous (adjusted RR 1.17, 95% CI 1.06-1.29) and parous women (adjusted RR 1.66, 95% CI 1.35-2.05). Birth seat and squatting position involved an increased risk of OASIS among parous women (adjusted RR [95% CI] 1.36 [1.03-1.80] and 2.16 [1.15-4.07], respectively). Independent risk factors for OASIS were maternal age, head circumference ≥35 cm, birth weight ≥4000 g, length of gestation ≥ 40 weeks, prolonged second stage of labour, non-occiput anterior presentation and oxytocin augmentation. Compared with sitting position, lateral position has a slightly protective effect in nulliparous women whilst an increased risk is noted among women in the lithotomy position, irrespective of parity. Squatting and birth seat position involve an increase in risk among parous women.

Contribution of maternal age to preterm birth rates in Denmark and Quebec, 1981-2008.

PubMed

Auger, Nathalie; Hansen, Anne V; Mortensen, Laust

2013-10-01

We sought evidence to support the hypothesis that advancing maternal age is potentially causing a rise in preterm birth (PTB) rates in high-income countries. We assessed maternal age-specific trends in PTB using all singleton live births in Denmark (n = 1 674 308) and Quebec (n = 2 291 253) from 1981 to 2008. We decomposed the country-specific contributions of age-specific PTB rates and maternal age distribution to overall PTB rates over time. PTB rates increased from 4.4% to 5.0% in Denmark and from 5.1% to 6.0% in Quebec. Rates increased the most in women aged 20 to 29 years, whereas rates decreased or remained stable in women aged 35 years and older. The overall increase over time was driven by age-specific PTB rates, although the contribution of younger women was countered by fewer births at this age in both Denmark and Quebec. PTB rates increased among women aged 20 to 29 years, but their contribution to the overall PTB rates was offset by older maternal age over time. Women aged 20 to 29 years should be targeted to reduce PTB rates, as potential for prevention may be greater in this age group.

Hispanic Teen Pregnancy and Birth Rates: Looking Behind the Numbers. Child Trends Research Brief. Publication #2005-01

ERIC Educational Resources Information Center

Ryan, Suzanne; Franzetta, Kerry; Manlove, Jennifer

2005-01-01

This research brief focuses on the birth, pregnancy, contraceptive, and relationship behaviors of Hispanic teens because they represent an important risk group. Teen pregnancy and birth rates for U.S. teens have declined dramatically in recent years. Yet for Hispanic teens, reductions in teen pregnancy and childbearing have lagged behind that of…

The role of under-employment and unemployment in recent birth cohort effects in Australian suicide.

PubMed

Page, Andrew; Milner, Allison; Morrell, Stephen; Taylor, Richard

2013-09-01

High suicide rates evident in Australian young adults during an epidemic period in the 1990s appear to have been sustained in older age-groups in the subsequent decade. This period also coincides with changes in employment patterns in Australia. This study investigates age, period, and birth cohort effects in Australian suicide over the 20th century, with particular reference to the period subsequent to the 1990s youth suicide epidemic in young males. Period- and cohort-specific trends in suicide were examined for 1907-2010 based on descriptive analysis of age-specific suicide rates and a series of age-period-cohort (APC) models using Poisson regression. Under-employment rates (those employed part-time seeking additional hours of work) and unemployment rates (those currently seeking employment) for the latter part of this time series (1978-2010) were also examined and compared with period- and cohort-specific trends in suicide. A significant increasing birth cohort effect in male suicide rates was evident in birth cohorts born after 1970-74, after adjusting for the effects age and period. An increasing birth cohort effect was also evident in female suicide rates, but was of a lesser magnitude. Increases in male cohort-specific suicide rates were significantly correlated with increases in cohort-specific under-employment and unemployment rates. Birth cohorts that experienced the peak of the suicide epidemic during the 1990s have continued to have higher suicide rates than cohorts born in earlier epochs. This increase coincides with changes to a labour force characterised by greater 'flexibility' and 'casualised' employment, especially in younger aged cohorts. Copyright © 2013 Elsevier Ltd. All rights reserved.

Labor management evidence update: potential to minimize risk of cesarean birth in healthy women.

PubMed

Simpson, Kathleen Rice

2014-01-01

New evidence regarding normal parameters of labor progress for healthy women has the potential to minimize risk of cesarean birth and thereby enhance current and future maternal well-being if clinicians apply the research findings to obstetric practice. The economic and reproductive health consequences of the increasing cesarean birth rate in the United States are considerable; therefore, action on this issue by all stakeholders is necessary. Review and integration of the recent recommendations for labor management from experts convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine are required to make maternity care in the United States as safe as possible.

Correlation of sex ratio at birth with health and socioeconomic indicators.

PubMed

Grech, Victor

2018-03-01

The sex ratio at birth (male divided by total live births: M/T) has been mooted as a potential sentinel health indicator. Several metrics indicate individual countries' health and socioeconomic status. In this study, in all available countries (where such data was accessible), M/T and these indicators were compared in order to ascertain whether better (vis-à-vis health and socioeconomic status) levels of these indicators were associated with higher M/T in available countries. The following were obtained (by country) from various sources: M/T, infant mortality rate, under 5 years mortality rate, fertility rate, Human Development Index, gross domestic product per capita, life expectancy for both sexes, females, males, as well as both sexes Health Adjusted Life Expectancy (HALE). Pearson correlation was performed comparing M/T and these indicators. Despite weak correlation values, all except for the Human Development Index (HDI) correlated with M/T at statistically significant levels. A decrease in mortality and an increase in life expectancy and GDP/capita are indicators of socioeconomic wellbeing. In this study, mortality was negatively correlated with M/T. Life expectancy and GDP/capita were both positively correlated with M/T, indicating that M/T may also serve as a surrogate health indicator, and incidentally, also supporting the Trivers-Willard hypothesis. Improving economies lead to increasing education, which in turns tends to lower fertility rate in association with a declining M/T. In conclusion, the global correlation of health and socioeconomic indicators with M/T suggests that M/T may be a useful sentinel health indicator. Copyright © 2018 Elsevier B.V. All rights reserved.

The Effect of Minimum Wages on Adolescent Fertility: A Nationwide Analysis.

PubMed

Bullinger, Lindsey Rose

2017-03-01

To investigate the effect of minimum wage laws on adolescent birth rates in the United States. I used a difference-in-differences approach and vital statistics data measured quarterly at the state level from 2003 to 2014. All models included state covariates, state and quarter-year fixed effects, and state-specific quarter-year nonlinear time trends, which provided plausibly causal estimates of the effect of minimum wage on adolescent birth rates. A $1 increase in minimum wage reduces adolescent birth rates by about 2%. The effects are driven by non-Hispanic White and Hispanic adolescents. Nationwide, increasing minimum wages by $1 would likely result in roughly 5000 fewer adolescent births annually.

Smoke-Free Legislation in Spain and Prematurity.

PubMed

Simón, Lorena; Pastor-Barriuso, Roberto; Boldo, Elena; Fernández-Cuenca, Rafael; Ortiz, Cristina; Linares, Cristina; Medrano, María José; Galán, Iñaki

2017-06-01

Spain implemented a partial smoking ban in 2006 followed by a comprehensive ban in 2011. The objective was to examine the association between these smoke-free policies and different perinatal complications. Cross-sectional study including all live births between 2000 and 2013. Selected adverse birth outcomes were: preterm births (<37 gestational weeks), small for gestational age (SGA; <10th weight percentile according to Spanish reference tables), and low birth weight (<2500 g). We estimated immediate and gradual rate changes after smoking bans by using overdispersed Poisson models with different linear trends for 2000 to 2005 (preban), 2006 to 2010 (partial ban), and 2011 to 2013 (comprehensive ban). Models were adjusted for maternal sociodemographics, health care during the delivery, and smoking prevalence during pregnancy. The comprehensive ban was associated with preterm birth rate reductions of 4.5% (95% confidence interval [CI]: 2.9%-6.1%) and 4.1% (95% CI: 2.5%-5.6%) immediately and 1 year after implementation, respectively. The low birth weight rate also dropped immediately (2.3%; 95% CI: 0.7%-3.8%) and 1 year after the comprehensive ban implementation (3.5%; 95% CI: 2.1%-5.0%). There was an immediate reduction in the SGA rate at the onset of the partial ban (4.9%; 95% CI: 3.5%-6.2%), which was sustained 1 year postimplementation. Although not associated with the comprehensive ban at the onset, the SGA rate declined by 1.7% (95% CI: 0.3%-3.1%) 1 year postimplementation. The implementation of the Spanish smoke-free policies was associated with a risk reduction for preterm births and low birth weight infants, especially with the introduction of the more restrictive ban. Copyright © 2017 by the American Academy of Pediatrics.

What does it take to have a strong and independent profession of midwifery? Lessons from the Netherlands.

PubMed

De Vries, Raymond; Nieuwenhuijze, Marianne; Buitendijk, Simone E

2013-10-01

In the 1970s, advocates of demedicalising pregnancy and birth 'discovered' Dutch maternity care. The Netherlands presented an attractive model because its maternity care system was characterised by a strong and independent profession of midwifery, close co-operation between obstetricians and midwives, a very high rate of births at home, little use of caesarean section, and morbidity and mortality statistics that were among the best in the developed world. Over the course of the following 40 years much has changed in the Netherlands. Although the home birth rate remains quite high when compared to other modern countries, it is half of what it was in the 1970s. Midwifery is still an independent medical profession, but a move toward 'integrated care' threatens to bring midwives into hospitals under the direction of medical specialists, more women are interested in medical pain relief, and there is a growing concern that current, albeit slight, increases in rates of intervention in physiological births foreshadow the end of the unique approach to birth in the Netherlands. The story of Dutch maternity care thus offers an ideal opportunity to examine the social, organisational, and cultural factors that work to support, and to diminish, the independent practice of midwifery in high-resource countries. We may wish to believe that providing ample and convincing evidence of the value of midwifery care will be enough to promote more and better use of midwifery, but the lessons from the Netherlands make clear that an array of social forces play a critical role determining the place of midwives in the health care system and how the care they provide is deployed. © 2013 Elsevier Ltd. All rights reserved.