Teenage pregnancies in Western Greece: experience from a university hospital setting.

PURPOSE: Teenage pregnancies have consistently been associated with preterm labor in a wide range of studies. Evidence regarding the incidence and potential complications of teenage pregnancies in Greece is at present scarce. The aim of this study was to evaluate the perinatal outcomes as well as the risk of perinatal and obstetric complications of teenage pregnancies. METHODS: This retrospective study was conducted at the Department of Obstetrics and Gynecology of the University Hospital of Patras, Greece, and all data recorded concerned the year 2019 (January-December). We retrospectively reviewed 643 cases of singleton pregnancies divided into two groups, as follows: Group A included women of average maternal age (AMA) (20-34 years old), and Group B included teenagers, defined as women less than 20 years old. Data regarding demographic and pregnancy characteristics as well as obstetric and neonatal complications were collected. RESULTS: Teenage pregnancies accounted for 6.7% of all deliveries. We detected significantly higher rates of preterm births (p = 0.025), primiparity (p < 0.001), and negative marital status (p < 0.001) in teenage mothers compared to pregnant women of AMA. There were no significant differences concerning other factors between the two groups. CONCLUSIONS: The findings of the present study raise concern regarding the perinatal, obstetric, and social consequences of teenage pregnancies in Greece. Extended studies that will include further information on antenatal care and detailed socioeconomic factors (i.e., level of education, income, and ethnicity) are required to formulate reliable conclusions concerning teenage pregnancies and their effect on maternal and neonatal health.

Effect of Social Factors on Cesarean Birth in Primiparous Women: A Cross Sectional Study (Social Factors and Cesarean Birth).

BACKGROUND: P Cesarean delivery rates have been increasing throughout the world. Parallel to the developments in the world the cesarean rate in Turkey has risen to 48.1% in 2013. Some of the social factors were related with cesarean births. The purpose of this study was to determine cesarean birth rates and to find out social factors affecting the cesarean birth in primiparous women. METHODS: This study was conducted in Burdur Province, Turkey between the dates of 1 Jan 2012-31 Dec 2012 on 223 primiparous women. The data was collected with data collection form prepared by the researchers by using face-to-face interview technique. In these analyses, chi-square and Backward Logistic regression analyses were used. RESULTS: In multivariate analyses, the place of delivery (OR: 11.2 [2.9-42.46] in private hospital and OR: 6.1 [2.6-14.1] in university hospital); time of the birth (OR: 7.1 [3.1-16.0]); doctor's effect (OR: 4.0 [1.8-8.95]) and husband's employment status (OR: 2.23 [1.0-4.7]) have been identified as factors affecting the caesarean delivery in primiparous women. CONCLUSION: Although the results do not show all of the factors affecting the caesarean delivery in primiparous women, they reveal that medical reasons are not the only reason in this increase trend. Health policy makers and health professionals are required to identify the causes of this increase and to take measures.

Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price?

OBJECTIVES: In light of the potential physical and emotional costs to both woman and child, this study was conducted to assess pregnancy complications and birth outcomes in primiparae at very advanced maternal age (VAMA, aged ≥45) compared to younger primiparae. METHODS: Retrospective cohort study comparing 222 VAMA primiparae and a reference group of 222 primiparae aged 30-35, delivering at Sheba Medical Center from 2008 through 2013. RESULTS: VAMA primiparae were more likely than younger primiparae to be single, to have chronic health conditions, and higher rates of gestational diabetes mellitus (GDM), gestational-hypertension (GHTN) and preeclampsia-eclampsia. VAMA primiparae conceived mostly by oocyte donation. They were more likely to be hospitalized during pregnancy, to deliver preterm and by cesarean birth. Infants of VAMA primiparae were at greater risk for low birthweight and Neonatal Intensive Care Unit admission. There were no differences in outcomes between VAMA primiparae with or without preexisting chronic conditions, or between those aged 45-49 and ≥50. In multivariable analysis VAMA was an independent risk factor for GDM, GHTN and preeclamsia-eclampsia, with adjusted odds ratio of 2.38 (95 % CI 1.32, 4.29), 5.80 (95 % CI 2.66, 12.64) and 2.45 (95 % CI 1.03, 5.85); respectively. The effect of age disappeared in multiple pregnancies. CONCLUSIONS: Primiparity at VAMA holds a significant risk for adverse pregnancy and birth outcomes. The absence of chronic medical conditions or the use of a young oocyte donor does not improve these outcomes. Multiple pregnancies hold additional risk and may diminish the effect of age. Primiparity at an earlier age should be encouraged.

Age-specific cost of first reproduction in female southern elephant seals.

When to commence breeding is a crucial life-history decision that may be the most important determinant of an individual's lifetime reproductive output and can have major consequences on population dynamics. The age at which individuals first reproduce is an important factor influencing the intensity of potential costs (e.g. reduced survival) involved in the first breeding event. However, quantifying age-related variation in the cost of first reproduction in wild animals remains challenging because of the difficulty in reliably recording the first breeding event. Here, using a multi-event capture-recapture model that accounts for both imperfect detection and uncertainty in the breeding status on an 18-year dataset involving 6637 individuals, we estimated age and state-specific survival of female elephant seals (Mirounga leonina) in the declining Macquarie Island population. We detected a clear cost of first reproduction on survival. This cost was higher for both younger first-time breeders and older first-time breeders compared with females recruiting at age four, the overall mean age at first reproduction. Neither earlier primiparity nor delaying primiparity appear to confer any evolutionary advantage, rather the optimal strategy seems to be to start breeding at a single age, 4 years.

Estonian medical birth registry 1992-1994: association of risk factors with perinatal mortality.

OBJECTIVE: To investigate the association of different maternal sociodemographic characteristics and infant sex with perinatal mortality among primiparas and multiparas. STUDY DESIGN: Analysis of routine data from the Estonian Medical Birth Registry covering the whole of Estonia. A total of 47 358 infants (including stillborns) with a birth weight 1000 g or more from 1992 through 1994 were studied. Perinatal mortality rate, crude odds ratio (OR) and adjusted OR (calculated by a logistic regression model) were used to evaluate the association. OR values were adjusted for maternal age at delivery, maternal ethnicity, educational level, residence, marital status, smoking status, history of previous abortion and infant sex. RESULTS: The perinatal mortality rate was 12.2 per 1000 total births among primiparous and 14.3 among multiparous women. The highest adjusted ORs of perinatal deaths were found in older (35 years and over) primiparas (1.78; 95% confidence interval (CI 0.88-3.57)) and multiparas (1.81; 95% CI 1.29-2.55), in unmarried (single) primiparas (1.59; 95% CI 1.14-2.20) and multiparas (1.98; 95% CI 1.29-3.05), in smoking primiparas (1.69; 95% CI 1.09-2.63) and multiparas (1.51; 95% CI 1.02-2.25), and in multiparas with unknown smoking status (1.98; 95% CI 1.18-3.33). CONCLUSION: The study provides further evidence that perinatal mortality is positively associated with increased maternal age, unmarried (single) status and smoking.

PIP: This study was conducted to investigate the association of different maternal sociodemographic characteristics and infant sex with perinatal mortality among primiparas and multiparas. The data were based on the Estonian Medical Birth Registry (EMBR) which maintains a database of all infants born in hospitals and of the few home deliveries. From 1992 to 1994, 47,022 live births and 336 stillbirths were recorded in the EMBR. Of mothers younger than 20 years old, 26.5% were primiparous and 2.8% were multiparous; among mothers aged 35 years and older, 1.8% were primiparous and 12.0% were multiparous. Results showed that the perinatal mortality rate was 12.2%/1000 total births among primiparous and 14.3% among multiparous women. The highest adjusted odds ratios of perinatal deaths were found in older (35 years and up) primiparas (79%) and multiparas (1.8%); in unmarried primiparas (1.5%) and multiparas (2.0%); in smoking primiparas (1.7%) and multiparas (1.5%); and in multiparas with unknown smoking status (2.0)%. Therefore, perinatal mortality in Estonia was positively associated with increased maternal age, unmarried (single) status, and smoking.

Delaying the introduction of complementary food until 6 months does not affect appetite or mother's report of food acceptance of breast-fed infants from 6 to 12 months in a low income, Honduran population.

Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to one of three groups: 1) continued exclusive breast-feeding to 6 mo (EBF), 2) introduction of complementary foods at 4 mo, with ad libitum nursing 4-6 mo (SF), and 3) introduction of complementary foods at 4 mo, with maintenance of base-line nursing frequency 4-6 mo (SF-M). After the intervention phase (4-6 mo; n= 141), home visits were conducted for a subsample at 9 (n = 60) and 12 (n = 123) mo. At each visit, an observer recorded infant food intake at the midday meal and interviewed the mother regarding usual feeding patterns and the infant's acceptance of 20 common food items. All but two infants (1.5%) were breast-fed to 9 mo and all but eight (6%) to 12 mo. There were no significant differences among groups in breast-feeding frequency, amount or number of foods consumed at the midday meal, percentage of food offered that was consumed, usual daily number of meals and snacks, number of food groups consumed, or overall food acceptance score. Frequency of consumption of foods from eight different food groups (dairy, meats, eggs, grains, beans, fruits, vegetables, tubers) was not significantly different among groups except that, at 9 mo only, the SF group (but not the SF-M group) consumed more vegetables than did the EBF group. These results indicate that delaying the introduction of complementary foods until 6 mo does not adversely affect appetite or food acceptance among breast-fed infants.

PIP: Low-income primiparous mothers who had breast fed exclusively for 4 months were randomly assigned to one of three groups: 1) continued exclusive breast feeding (EBF) to 6 months; 2) introduction of complementary foods at 4 months with ad libitum nursing 4-6 months (SF); and 3) introduction of complementary foods at 4 months with maintenance of baseline nursing frequency 4-6 months (SF-M). After the intervention phase (4-6 months; n = 141), home visits were conducted for a subsample at 9 (n = 60) and 12 (n = 123) months. At each visit, an observer recorded infant food intake at the midday meal and interviewed the mother regarding usual feeding patterns and the infant's acceptance of 20 common food items. All but two infants (1.5%) were breast fed to 9 months and all but eight (6%) to 12 months. There were no significant differences among groups in breast-feeding frequency, amount or number of foods consumed at the midday meal, percentage of food offered that was consumed, usual daily number of meals and snacks, number of food groups consumed, or overall food acceptance score. Frequency of consumption of foods from eight different food groups (dairy, meats, eggs, grains, beans, fruits, vegetables, tubers) was not significantly different among groups except that, at 9 months only, the SF group (but not the SF-M group) consumed more vegetables than did the EBF group. The SF groups initially accepted carrots more readily than did the other two groups (p .05), and the SF and SF-M groups initially accepted potato more readily than did the EBF group (p .05). The average number of food groups from which foods were consumed at least twice per week was significantly higher in the SF group (but not the Sf-M group) than in EBF group at 9 months, but not at 12 months. Delaying the introduction of complementary foods until 6 months does not adversely affect appetite or food acceptance among breast-fed infants.

The influence of socio-biological factors on perinatal mortality in a rural area of Bangladesh.

"The present study considers data on all pregnancies that ended in a stillbirth or live birth in a rural area of Bangladesh during the years 1982 to 1984. It considers the relationships of both biological and socio-economic factors to perinatal mortality....[Results show a] lack of association with any measure of socio-economic status.... Our study has confirmed that survival of the perinatal period is separately related to both maternal age and primiparity. Once maternal age is taken into account, high parity shows no evidence of decreasing survival chances."

The myth about contraceptives and breast cancer.

PIP: Science and modern medicine accord us many advantages, e.g., contraceptive drugs, but many people still do not use them. Contraceptive drugs include oral contraceptives and injectables. OCs are very effective and are associated with minor side effects (e.g., mood changes, breast tenderness, nausea, and changes in weight, mild headache, and spotting between periods), perhaps explaining why they are one of the most often used contraceptive in essentially every country. Women who smoke; are 35 years old; or either have or have a family history of hypertension, diabetes, cardiovascular disease and use OCs are at higher risk of a cardiovascular episode. On the other hand, OCs protect against ovarian and endometrial cancers. Research does not yet confirm or disprove their effect on breast cancer development. OCs appear not to be linked to breast cancer through age 59. Yet, studies of women 45 years old suggest that OCs increases the breast cancer risk in these women who had their first menses before age 13 and used OCs for a long time before their first pregnancy. OCs may facilitate growth of breast tumors that other causes activated, and therefore, do not likely increase the overall risk. Researchers recognize the death of knowledge about breast cancer development, so they call for more research, including basic molecular, cellular, and biochemical studies. In Nigeria, breast cancer is rare, while deaths due to pregnancy and childbirth are common, indicating that OC use can prevent many female deaths. Prolonged breast feeding; later age at first menses; earlier age at menopause; earlier age at first full-term pregnancy larger families; low fat, high fiber diets; and thinness, all of which are common in developing countries, have a protective effect against breast cancer. Further, women in developing countries begin OC use later than women in developed countries.^ieng

Risk factors for preterm and term low birthweight in Ahmedabad, India.

To identify and quantify risk factors for preterm and term low birthweight (LBW) we conducted a hospital-based case-control study, linked with a population survey in Ahmedabad, India. The case-control study of 673 term LBW, 644 preterm LBW cases and 1465 controls showed that low maternal weight, poor obstetric history, lack of antenatal care, clinical anaemia and hypertension were significant independent risk factors for both term and preterm LBW. Short interpregnancy interval was associated with an increased risk of preterm LBW birth while primiparous women had increased risk of term LBW. Muslim women were at a reduced risk of term LBW, but other socioeconomic factors did not remain significant after adjusting for these more proximate factors. Estimates of the prevalence of risk factors from the population survey was used to calculate attributable risk. This analysis suggested that a substantial proportion of term and preterm LBW births may be averted by improving maternal nutritional status, anaemia and antenatal care.

PIP: In 1987-1988, researchers compared data on 1317 low birth weight (LBW) infants and 1465 control infants born in 3 teaching hospitals in Ahmedabad, India to calculate attributable risk (AR) for factors contributing to low birth weight. 673 of the infants were full term yet LBW due to intrauterine growth retardation. 644 of LBW infants were preterm births. They also conducted a population survey in Ahmedabad to estimate the prevalence of risk factors. LBW prevalence stood at 30%. Low maternal weight, poor pregnancy history, lack of prenatal care, clinical anemia, and hypertension were all significant independent risk factors for term and preterm LBW infants (p.05). Primiparous women were more likely to have a term LBW infant than other women (p.05). Interpregnancy intervals =or 6 months was more likely to result in delivery of a preterm LBW infant than longer interpregnancy intervals (p.05). Muslim women were at a much lower risk of delivering a term LBW infant than were Hindu women (p.05). Other than primiparity for term LBW infants (AR=21.9%), maternal weight between 41-45 kg was the single greatest risk factor for LBW (AR=21.5% for term and 19.8% for preterm). Yet low maternal weight had greater adjusted odds ratios (OR) than did maternal weight between 41-45 kg (OR=6.9 and 6.2 vs. OR=3.1 and 2.9). Maternal weight was used to measure nutritional status. Clinical anemia also carried a high Ar, especially for term LBW infants (3.7-8.2% vs. 2.8-7.3% for preterm infants). Another risk factor with considerable AR was no prenatal care (5.8% for term and 14.4% for preterm). These results emphasized the need for health and nutrition interventions to reduce the incidence of both preterm and term LBW infants in urban India.

Safe childbirth needs more than medical services.

This article reviews nonmedical factors contributing to maternal mortality in Indonesia, the Philippines, and Thailand. In general, countries or regions should define their own priorities for intervention strategies designed to diminish the influence of such factors.

PIP: Obstetrician-gynecologists analyzed maternal mortality data from at least 1 rural area of Indonesia, the Philippines, and Thailand to determine nonmedical factors contributing to maternal deaths. They also gathered data from Brunei and Singapore but the data were insufficient (only 3 deaths in Brunei and 0 in Singapore). Overall the leading causes of death were in order eclampsia/intracranial hemorrhage, postpartum hemorrhage, and sepsis. 33% of decreased mothers were 20 or 35 years old. Most mothers had lived in rural areas where there were few health care facilities, inadequate transportation, and much delay between emergence of a problem and medical attention. Lack of education was a risk factor, e.g., 40% of Thai mothers had no education. Most women in the Philippines and Indonesia worked long hours and hauled heavy loads. There was a considerable link between primiparae and grand multiparae and maternal mortality. 90%, 68%, and 59% of maternal deaths in Thailand, the Philippines, and Indonesia, respectively, were of these parities. Almost 66% of the women had not used contraceptives. Overall 33% of the women lived near medical facilities. In Indonesia, this figure was as high as 62%. 40%, 13%, and 9% in Thailand, Indonesia, and the Philippines, respectively, had no access to transportation to take them to a facility. 21%, 46%, and 30% in Indonesia, the Philippines, and Thailand did not receive any prenatal care and 50% of mothers in Indonesia did not feel they needed prenatal care. Inappropriate delivery techniques also contributed to maternal deaths. 90% of deaths occurred after delivery. Considerable bleeding was a contributing factor in 62%, 55%, and 40% of maternal deaths in Indonesia, the Philippines, and Thailand, respectively. A blood transfusion would have saved many of them.