The joint effect of maternal smoking during pregnancy and maternal pre-pregnancy overweight on infants' term birth weight.

BACKGROUND: It is well known that maternal smoking during pregnancy and maternal pre-pregnancy overweight have opposite effects on the infants' birth weight. We report on the association of the combination between both risk factors and the infants' birth weight. METHODS: We studied 3241 infants born at term in the PIAMA birth cohort. Maternal smoking during pregnancy and pre-pregnancy height and weight were self-reported. Multivariable regression analysis was performed to assess the associations between infants of mothers who only smoked during pregnancy, who only had pre-pregnancy overweight and who had both risk factors simultaneously, on term birth weight and the risk of being SGA or LGA. RESULTS: Of 3241 infants, 421 infants (13%) were born to smoking, non-overweight mothers, 514 (15.8%) to non-smoking, overweight mothers, 129 (4%) to smoking and overweight mothers and 2177 (67%) to non-smoking, non-overweight mothers (reference group). Infants of mothers who smoked and also had pre-pregnancy overweight had similar term birth weight (- 26.6 g, 95%CI: - 113.0, 59.8), SGA risk (OR = 1.06, 95%CI: 0.56, 2.04), and LGA risk (OR = 1.09, 95%CI: 0.61, 1.96) as the reference group. CONCLUSIONS: Our findings suggested that the effects of maternal smoking during pregnancy and maternal pre-pregnancy overweight on infants' birth weight cancel each other out. Therefore, birth weight may not be a good indicator of an infant's health status in perinatal practice because it may mask potential health risks due to these maternal risk factors when both present together.

The Obstetrics and Neonatal Outcomes of Teenage Pregnancy in Naresuan University Hospital.

OBJECTIVE: It is evident that the incidence of teenage pregnancy has been increasing in the past decades and consequently poses significant problems on maternal and child health. The present study was aimed to compare obstetric and neonatal outcomes between teenage and non-teenage pregnancy. MATERIAL AND METHOD: A retrospective cohort study was conducted to investigate 957 singleton pregnant women attending labor rooms in Naresuan University Hospital between October 2006 and September 2013 by comparing the pregnancy outcomes of 268 teenage pregnancy (woman age less than 20 years at the first time of antenatal care visit) with 689 non-teenage pregnancy (woman age 20 to 34 years). The obstetrics and neonatal complication was the main outcome of interest. RESULTS: The incidence of teenage pregnancy was 15.24% during seven years of study. As opposed to non-teenage mothers, complete attending antenatal care visit was less likely to be found among teenage mothers, 66.5% vs. 90.5% respectively (p < 0.001). Higher proportion of normal vaginal delivery was found in teenage mothers (59.7% vs. 36.4%). The occurrence of cephalo-pelvic disproportion (CPD) seemed to be lower in teenage group as compared to non-teenage group, 14.5% vs. 26.4% (p < 0.001). In addition, postpartum hemorrhage was unlikely to occur in teenage group, 3.8% vs. 8.4% (p = 0.016). The proportion of preterm birth was found to be higher in teenage pregnancy compared to non-teenage pregnancy (16.2% vs. 5.5%, p < 0.001). At birth, the higher proportion of infants who had low Apgar scores (< 7) at 1-minute was found in teenage pregnancy, 7.1% vs. 3.1% (p = 0.01). CONCLUSION: Even though obstetric complications were less likely to occur among teenage pregnancies, most of the neonatal untoward consequences were observed in mothers with younger ages. The finding suggests the need of appropriate health care services for teenage mothers as to monitor harmful complications to both mother and her child.

Agreement on grading of normal clivus using magnetic resonance imaging among radiologists.

PURPOSE: The present study was aimed to evaluate the agreement on grading normal clivus on MRI among radiologists. METHODS: A retrospective study included patients who underwent MRI brain during January 1, 2015 to October 31, 2019. Two hundred forty-four patients who had no marrow pathology on MRI were included and divided into 8 age groups by decades. Three radiologists independently reviewed the signal intensity of clivus in mid sagittal T1-weighted image. The signal intensity was classified into three grades (Grade I-III). Fleiss' kappa coefficients (k) were calculated to assess interrater agreement. RESULTS: Of 244 patients, there were 123 (50.4%) males and 121 (49.6%) females. Age ranged from 1 to 79 years old. Clivus Grade II was more frequently reported (> 50%) by radiologists. The agreement (kappa) among all three radiologists on evaluation of clivus irrespective of the grading equals to 0.67 (95%CI: 0.60-0.74). In stratified analyses by the grade of clivus, the kappa values for Grade I to III and were 0.73, 0.62, and 0.69 respectively. CONCLUSION: Interrater agreement of MRI evaluation of normal clivus among radiologists was good. The visual grading criteria to classify the clivus is sufficient to distinguish the marrow maturation. However, the consensus reading should be made whenever normal clivus Grade II is read.

Pain reduction of a pain management regimen in orthopedic patients at Lamphun Hospital.

BACKGROUND: VAS pain score is an effective method to evaluate patients. Pain control regimens are varied and rarely evaluated. The objective of this study is to evaluate the clinical benefit of pain control regimens using a visual analogue scale during hospital stays. MATERIAL AND METHOD: The retrospectively comparative time-series study was used. A total of 509 adult orthopaedic patients admitted between September 2006 and February 2007 were included. The average VAS pain score during the hospital stays and the length of hospital stay for each patient were evaluated. Exact probability tests, rank sum tests were used to compare the two groups. To adjust for any discrepancies in prognostic factors between the two groups, a regression analysis was employed. RESULTS: The VAS average pain score was significantly 33% less in the regimen application group (OR = 0.67, 95% CI = 0.49-0.91, p = 0.015), but length of hospital stays were similar (p = 0.836). After adjusting for the differences in percentage of operative procedures and anxiety, and simultaneously controlling for gender and age, the chance of patients who have moderate pain level or worse was reduced by 40% (OR = 0.60, 95% CI = 0.59-0.61, p < 0.001). CONCLUSION: The pain regimen was found to be effective in pain reduction. However, the length of hospital stays was not reduced by this regimen as it may be affected by many other factors.