He Tamariki Kokoti Tau: Tackling preterm incidence and outcomes of preterm births by ethnicity in Aotearoa New Zealand 2010-2014.

OBJECTIVE: To explore preterm birth among Maori indigenous peoples through Kaupapa Maori research of preterm birth in Aotearoa New Zealand. METHODS: Linked maternity, mortality, and hospital data were analyzed for women and their infants born between January 1, 2010 and December 31, 2014. Relative risks (RR) were calculated for each ethnic group for preterm birth, small for gestational age (SGA), and mortality. RESULTS: Adjusted rates showed that compared with Maori women, European women were at significantly less risk of having extremely and very preterm infants (RR 0.86, 95% confidence interval [CI] 0.76-0.95). Preterm infants of European women had a significantly lower adjusted RR of early neonatal death (RR 0.65, 95% CI 0.45-0.93) or post-neonatal death (RR 0.41, 95% CI 0.26-0.64). In addition to ethnicity, preterm rates were influenced by maternal age, body mass index, smoking status, and SGA status. CONCLUSION: This study demonstrates that the Aotearoa New Zealand maternity system privileges whiteness, suggesting that clinical pathways for evidence-based medical care are not delivered systemically and equitably for all. Health pathways that focus on equity as a fundamental right will enhance health outcomes for Maori women and their infants.

Perinatal arterial ischemic stroke in northern Queensland.

OBJECTIVES: Our objective was to review the occurrence, presentation, and associated risk factors of stroke in infants at a tertiary neonatal intensive care unit. STUDY DESIGN: Inpatient electronic records identified infants between March 2002 and March 2011 who had perinatal arterial ischemic stroke. RESULTS: Ten infants had perinatal arterial ischemic stroke, 50% were outborn, 20% were indigenous, and mortality was 30%. Median birth weight was 2970 g (range 1699 to 3443 g), and median gestation was 36 weeks (range 32 to 41 weeks). Perinatal arterial ischemic stroke were left sided in three, right sided in three, and bilateral in four. Presentation included four with seizures, four with apnea/sepsis, one with thrombosis, and one without symptoms. In 4 of 10 cases reported in this series, there was a maternal history of gestational diabetes, although the incidence of gestational diabetes in Australia is only 4.5%. CONCLUSION: The incidence of gestational diabetes mellitus in our cases appears to be very much higher than the average population. Larger studies are needed to determine if gestational diabetes mellitus is a risk factor for perinatal arterial ischemic stroke.