Intergenerational teen pregnancy: a population-based cohort study.

OBJECTIVE: To estimate the intergenerational association in teenage pregnancy, and whether there is a coupling tendency between a mother and daughter in how their teen pregnancies end, such as a termination of pregnancy (TOP) versus a live birth. DESIGN: Population-based cohort study. SETTING: Ontario, Canada. POPULATION: A total of 15 097 mothers and their 16 177 daughters. METHODS: Generalised estimating equations generated adjusted odds ratios (aOR) of a daughter experiencing a teen pregnancy in relation to the number of teen pregnancies her mother had. Multinomial logistic regression estimated the odds that a teen pregnancy ended with TOP among both mother and daughter. All models were adjusted for maternal age and world region of origin, the daughter's socio-demographic characteristics and comorbidities, mother-daughter cohabitation, and neighbourhood-level teen pregnancy rate. MAIN OUTCOME MEASURES: Teen pregnancy in the daughter, between ages 15 and 19 years, and also the nature of the daughter's teen pregnancy, categorised as (1) no teen pregnancy, (2) at least one teen pregnancy, all exclusively ending with a live birth, and (3) at least one teen pregnancy, with at least one teen pregnancy ending with a TOP. RESULTS: The proportion of daughters having a teen pregnancy among those whose mother had zero, one, two, or at least three teen pregnancies was 16.3, 24.9, 33.5 and 36.3%, respectively. The aOR of a daughter having a teen pregnancy was 1.42 (95% CI 1.25-1.61) if her mother had one, 1.97 (95% CI 1.71-2.26) if she had two, and 2.17 (95% CI 1.84-2.56) if her mother had three or more teen pregnancies, relative to none. If a mother had at least one teen pregnancy ending with TOP, then her daughter had an aOR of 2.12 (95% CI 1.76-2.56) for having a teen pregnancy also ending with TOP; whereas, if a mother had at least one teen pregnancy, all ending with a live birth, then her daughter had an aOR of 1.73 (95% CI 1.46-2.05) for that same outcome. CONCLUSION: There is a strong intergenerational occurrence of teenage pregnancy between a mother and daughter, including a coupling tendency in how the pregnancy ends. TWEETABLE ABSTRACT: Strong intergenerational association for teenage pregnancy between mother and daughter.

Disparities in pre-eclampsia and eclampsia among immigrant women giving birth in six industrialised countries.

OBJECTIVE: To assess disparities in pre-eclampsia and eclampsia among immigrant women from various world regions giving birth in six industrialised countries. DESIGN: Cross-country comparative study of linked population-based databases. SETTING: Provincial or regional obstetric delivery data from Australia, Canada, Spain and the USA and national data from Denmark and Sweden. POPULATION: All immigrant and non-immigrant women delivering in the six industrialised countries within the most recent 10-year period available to each participating centre (1995-2010). METHODS: Data was collected using standardised definitions of the outcomes and maternal regions of birth. Pooled data were analysed with multilevel models. Within-country analyses used stratified logistic regression to obtain odds ratios (OR) with 95% confidence intervals (95% CI). MAIN OUTCOME MEASURES: Pre-eclampsia, eclampsia and pre-eclampsia with prolonged hospitalisation (cases per 1000 deliveries). RESULTS: There were 9,028,802 deliveries (3,031,399 to immigrant women). Compared with immigrants from Western Europe, immigrants from Sub-Saharan Africa and Latin America & the Caribbean were at higher risk of pre-eclampsia (OR: 1.72; 95% CI: 1.63, 1.80 and 1.63; 95% CI: 1.57, 1.69) and eclampsia (OR: 2.12; 95% CI: 1.61, 2.79 and 1.55; 95% CI: 1.26, 1. 91), respectively, after adjustment for parity, maternal age and destination country. Compared with native-born women, European and East Asian immigrants were at lower risk in most industrialised countries. Spain exhibited the largest disparities and Australia the smallest. CONCLUSION: Immigrant women from Sub-Saharan Africa and Latin America & the Caribbean require increased surveillance due to a consistently high risk of pre-eclampsia and eclampsia.

Immigrants' duration of residence and adverse birth outcomes: a population-based study.

OBJECTIVE: This study aimed to examine preterm and small-for-gestational-age (SGA) births among immigrants, by duration of residence, and to compare them with the Canadian-born population. DESIGN: Population-based cross-sectional study with retrospective assessment of immigration. SETTING: Metropolitan areas of Ontario, Canada. POPULATION: A total of 83 233 singleton newborns born to immigrant mothers and 314 237 newborns born to non-immigrant mothers. METHODS: We linked a database of immigrants acquiring permanent residence in Ontario, Canada, in the period 1985-2000 with mother-infant hospital records (2002-2007). Duration of residence was measured as completed years from arrival to Canada to delivery/birth. Logistic regression models were used to estimate the effects of duration of residence with adjusted odds ratios and 95% confidence intervals. In analyses restricted to immigrants only, hierarchical models were used to account for the clustering of births into maternal countries of birth. MAIN OUTCOME MEASURES: Preterm birth (PTB) and SGA birth. RESULTS: Recent immigrants (<5 years) had a lower risk of PTB (4.7%) than non-immigrants (6.2%), but those with > or =15 years of stay were at higher risk (7.4%). Among immigrants, a 5-year increase in Canadian residence was associated with an increase in PTB (AOR 1.14, 95% CI 1.10-1.19), but not in SGA birth (AOR 0.99, 95% CI 0.96-1.02). CONCLUSIONS: Time since migration was associated with increases in the risk of PTB, but was not associated with an increase in SGA births. Ignoring duration of residence may mask important disparities in preterm delivery between immigrants and non-immigrants, and between immigrant subgroups categorised by their duration of residence.

Somali women and their pregnancy outcomes postmigration: data from six receiving countries.

OBJECTIVE: This study aimed to investigate pregnancy outcomes in Somali-born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden. DESIGN: Meta-analyses of routinely collected data on confinements and births. SETTING: National or regional perinatal datasets spanning 3-6 years between 1997 and 2004 from six countries. SAMPLE: A total of 10 431 Somali-born women and 2 168 891 receiving country-born women. METHODS: Meta-analyses to compare outcomes for Somali-born and receiving country-born women across the six countries. MAIN OUTCOME MEASURES: Events of labour (induction, epidural use and proportion of women using no analgesia), mode of birth (spontaneous vaginal birth, operative vaginal birth and caesarean section) and infant outcomes (preterm birth, birthweight, Apgar at 5 minutes, stillbirths and neonatal deaths). RESULTS: Compared with receiving country-born women, Somali-born women were less likely to give birth preterm (pooled OR 0.72, 95% CI 0.64-0.81) or to have infants of low birthweight (pooled OR 0.89, 95% CI 0.82-0.98), but there was an excess of caesarean sections, particularly in first births (pooled OR 1.41, 95% CI 1.25-1.59) and an excess of stillbirths (pooled OR 1.86, 95% CI 1.38-2.51). CONCLUSIONS: This analysis has identified a number of disparities in outcomes between Somali-born women and their receiving country counterparts. The disparities are not readily explained and they raise concerns about the provision of maternity care for Somali women postmigration. Review of maternity care practices followed by implementation and careful evaluation of strategies to improve both care and outcomes for Somali women is needed.

Preterm preeclampsia in relation to country of birth.

OBJECTIVE: To examine the association between maternal country of birth and the risk of preeclampsia+preterm birth (PTB). STUDY DESIGN: We completed a population-based study in the entire province of Ontario, where there is universal access to obstetrical care. We included 881 700 singleton livebirths among Canadian-born mothers and 305 547 births among immigrant mothers. Adjusted risk ratios (aRRs) were adjusted for maternal age, parity and income quintile. RESULTS: Compared with a rate of preeclampsia+PTB of 4.0 per 1000 among Canadian-born mothers, the aRR of preeclampsia+PTB at 24 to 36 weeks was significantly higher for immigrant women from Nigeria (1.79, 95% confidence interval (CI) 1.12 to 2.84), the Philippines (1.54, 95% CI 1.30 to 1.86), Colombia (1.68, 95% CI 1.04 to 2.73), Jamaica (2.06, 95% CI 1.66 to 2.57) and Ghana (2.12, 95% CI 1.40 to 3.21). The aRRs generally followed a similar pattern for secondary outcomes. Specifically, women from Ghana were at highest risk of preeclampsia+very PTB (4.55, 95% CI 2.57 to 8.06), and women from Jamaica at the highest risk of preeclampsia+indicated PTB (1.89, 95% CI 1.43 to 2.50). CONCLUSION: The risk of preeclampsia+PTB is highest among women from a select number of countries. This information can enhance initiatives aimed at reducing the risk of PTB related to preeclampsia.

[Limited reserve of corticotropic hormone (ACTH)]. / Reserva limitada de hormona corticotropa (ACTH).

Chronic deterioration of the glucocorticoid function may result from a primary disorder of the suprarenal glands; from a deficit of the corticotropic hormone (ACTH) due in most cases to an extended hypophyseal affection with reduced secretion of other hypophyseal hormones and from the lack of corticotropin releasing hormone (CRH) at the hypothalamic level. Isolated ACTH deficiency is a rare clinical entity. A subgroup within this pathology is the limited reserve of ACTH which would constitute a mild form of dysfunction in the corticotropic cells, with enough secretion of ACTH to maintain a normal adrenal function in the absence of stress-inducing situations, but unable to show an appropriate reaction in such situations. The difference between these two entities lies in the normal levels of 17-OH-corticosteroids in the limited reserve of ACTH. We describe the case of a patient with acute severe hyponatremia in whom this rare affection was diagnosed and we make some considerations regarding this entity.

[Endogenous opioid peptides and the immune system]. / Péptidos opioides endógenos y sistema inmunitario.

Several studies have demonstrated that endogenous opioid peptides produced by the neuroendocrine system can modulate several immunological functions. Immune system cells have also been shown to have the ability to synthesize and release such peptides. This would mean that the neuroendocrine and immunological systems share molecules and opioid receptors and it may be that peptides produced by the neuroendocrine system modify immunocompetence and that these same substances released by macrophages that infiltrate inflamed tissue also act on the pain response in the zone of lesions. We aimed to investigate the immunoregulatory function of endogenous opioid peptides and their effects on the complement system's natural "killer" cell activity, chemotaxis, phagocytosis and oat cell activity.

Risk of stillbirth at extremes of birth weight between 20 to 41 weeks gestation.

OBJECTIVE: To determine the risk of stillbirth between 20 to 41 weeks gestation, at highly detailed weight percentiles, including extreme degrees of small (SGA) and large (LGA) for gestational age birth weight. STUDY DESIGN: We completed a population-based study of all births in Ontario, Canada between 2002 and 2007. We included 767, 016 liveborn and 4,697 stillborn singletons delivered between 20 and 41 weeks gestation. Smoothed birthweight percentile curves were generated for males and females, combining livebirths and stillbirths. Quantile regression was used to calculate sex-specific absolute birthweight differences and 95% confidence intervals (CI) between stillborns vs liveborns at various gestational ages. Logistic regression was used to calculate the odds ratios (OR) for stillbirth at various sex-specific birthweight percentiles, including <1st and ≥ 99th percentile. OR were adjusted for maternal age and parity. RESULT: At the 10th percentile, stillborns weighed significantly less than liveborns starting at 24 weeks gestation. By 32 weeks, this difference was 590 g (95% CI 430 to 750) for males and 551 g (95% CI 345 to 448) for females. A reverse J-shaped association was observed between birthweight percentile and risk of stillbirth across all gestational ages. Relative to the 40th to 60th percentile referent, the adjusted OR for stillbirth was 9.63 (95% CI 8.39 to 11.06) at a birth weight <1st percentile. At ≥ 99th percentile, the adjusted OR was 2.24 (95% CI 1.76 to 2.86). The risk of stillbirth at extreme birthweight percentiles was robustly observed across gestational ages. CONCLUSION: Substantial birthweight differences exist between stillborns and newborns. As a possible hallmark of impending intrauterine death, severe SGA and LGA may each be potential targets for future stillbirth prevention initiatives.

Declining sexually transmitted infections among female sex workers: the results of an HIV and sexually transmitted infection prevention strategy in Honduras, 2006-08.

In 2006, we implemented an HIV and sexually transmitted infection (STI) prevention programme for female sex workers (FSWs) in three Honduran cities. All FSW attending STI clinics underwent regular examinations and STI testing. Information on condom use with different partners was collected at each visit. After three years, we detected a significant decline in the prevalence of syphilis from 2.3% at the first screening to 0.0% at the third screening (P = 0.05), and of chlamydia, from 6.1% to 3.3% (P = 0.01). No changes were observed in the prevalence of gonorrhoea or trichomoniasis. The cumulative HIV prevalence remained constant (P = 0.44). Reports of condom use with clients increased from 93.8% to 98.9% (P < 0.001). The implementation of an HIV/STI prevention programme in FSW has contributed to increases in condom use with clients and the reduction in syphilis and chlamydia prevalence. The intervention should be strengthened and considered as part of a national health policy strategy.

Estimating gestational age at birth: a population-based derivation-validation study.

INTRODUCTION: Information on newborn gestational age (GA) is essential in research on perinatal and infant health, but it is not always available from administrative databases. We developed and validated a GA prediction model for singleton births for use in epidemiological studies. METHODS: Derivation of estimated GA was calculated based on 130 328 newborn infants born in Ontario hospitals between 2007 and 2009, using linear regression analysis, with several infant and maternal characteristics as the predictor (independent) variables. The model was validated in a separate sample of 130 329 newborns. RESULTS: The discriminative ability of the linear model based on infant birth weight and sex was reasonably approximate for infants born before the 37th week of gestation (r2 = 0.67; 95% CI: 0.65-0.68), but not for term births (37-42 weeks; r2 = 0.12; 95% CI: 0.12-0.13). Adding other infant and maternal characteristics did not improve the model discrimination. CONCLUSION: Newborn gestational age before 37 weeks can be reasonably approximated using locally available data on birth weight and sex.