RESUMEN
In this critical commentary, we describe the many limitations of the pregnancy planning paradigm as applied to pregnant and parenting teens. We describe how this paradigm, in characterizing pregnancies as intended or unintended, has shaped campaigns to prevent teen pregnancy and remains largely embedded in formal sex education and family planning programs in the United States. We argue that a paradigm shift is long overdue and describe how the reproductive justice framework addresses the limitations of the pregnancy planning paradigm. Although reproductive justice is endorsed by a growing number of organizations, recommended policies face formidable obstacles given that comprehensive sex education, contraception, and legal abortion are increasingly at risk in a post-Dobbs world.
Asunto(s)
Servicios de Planificación Familiar , Embarazo en Adolescencia , Humanos , Femenino , Embarazo , Adolescente , Embarazo en Adolescencia/prevención & control , Servicios de Planificación Familiar/métodos , Estados Unidos , Educación Sexual/métodos , Justicia Social , Anticoncepción/métodosRESUMEN
OBJECTIVE: The similarity in size among siblings has implications for neonatal death, but research in this area is lacking in the United States. We examined the association between small-for-gestational age (SGA), defined as a birthweight <10th percentile for gestational age, and neonatal death, defined as death within the first 28 days of life, among second births who had an elder sibling with SGA ("repeaters") versus those whose elder sibling did not have SGA ("nonrepeaters"). STUDY DESIGN: We conducted a population-based retrospective cohort study including 179,436 women who had their first two nonanomalous singleton live births in Missouri (1989-2005). Logistic regression was used to evaluate the association between SGA and neonatal death among second births, stratified by whether the elder sibling was SGA. RESULTS: Out of 179,436 second births, 297 died in the neonatal period. There was a significant interaction between birthweight-for-gestational age of first and second births in relation to neonatal death (p = 0.001). Second births with SGA had increased odds of neonatal death by 2.15-fold if they were "repeaters," and 4.44-fold if they were "nonrepeaters," as compared with non-SGA second births. CONCLUSION: Our findings suggest that referencing sibling birthweight may be warranted when evaluating infant size in relation to neonatal death.
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Peso al Nacer , Recién Nacido Pequeño para la Edad Gestacional , Muerte Perinatal , Hermanos , Femenino , Edad Gestacional , Humanos , Recién Nacido , Modelos Logísticos , Masculino , Análisis Multivariante , Estudios RetrospectivosRESUMEN
BACKGROUND: Women who smoke cigarettes while pregnant are at elevated risk of having low birth weight infants (LBW, < 2500 g) which increases risks of infant mortality and morbidity, including chronic conditions later in life. OBJECTIVE: Smoking cessation during pregnancy can reduce the risk of poor birth outcomes. However, the effect that timing of smoking cessation has on the reduction of poor birth outcomes in term pregnancies is unknown. STUDY DESIGN: This retrospective cohort study used birth certificate data from Missouri singleton, full-term, live births from 2010 to 2012 (N = 179,653) to examine the rates and timing of smoking cessation during pregnancy on birthweight. Smoking exposure was categorized as non-smoker, preconception cessation, first trimester cessation, second trimester cessation, and smoker. The outcome was low birth weight (LBW). Covariates included maternal race/ethnicity, age, education level, type of payment for the delivery, marital status, paternal acknowledgement, prenatal sexually transmitted infection (STI), comorbidities, and body mass index. Bivariate and multivariable analyses were used to assess relationships between smoking and LBW status. RESULTS: Preconception cessation did not have a statistically higher risk for LBW than mothers who never smoked (aOR 1.12; 95% CI 0.98, 1.28). First trimester cessation (aOR 1.26; 95% CI 1.05, 1.52), second trimester cessation (aOR 2.00; 95% CI 1.60, 2.67), and smoker (aOR 2.46; 95% CI 2.28, 2.67) had increasing odds for LBW relative to mothers who did not smoke. All covariates had significant relationships with the smoking exposure. CONCLUSION: Preconception cessation yielded LBW rates comparable to non-smokers. The risk for LBW increased as smoking continued throughout pregnancy among full term births, an important new finding in contrast with other studies.
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Recién Nacido de Bajo Peso/metabolismo , Conducta de Reducción del Riesgo , Cese del Hábito de Fumar/estadística & datos numéricos , Factores de Tiempo , Adolescente , Adulto , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Humanos , Recién Nacido de Bajo Peso/fisiología , Modelos Logísticos , Missouri , Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: There has been a call for customized rather than population-based birthweight standards that would classify smallness based on an infant's own growth potential. Thus, this study aimed to examine the association between the difference in sibling birthweight and the likelihood of neonatal death among second births in a U.S. STUDY DESIGN: This was a population-based cohort study including 179,300 women who delivered their first two nonanomalous singleton live births in Missouri (1989-2005). We performed binary logistic regression to evaluate the association between being relatively smaller than the elder full- or half-sibling (i.e., smaller by at least 500 g) and neonatal death (i.e., deaths in the first 28 days of life) among second births after controlling for sociodemographic and pregnancy-related variables in the second pregnancy. RESULTS: The adjusted odds of neonatal death were 2.54-times higher among second births who were relatively smaller than their elder sibling. Among relatively small second births, every 100-g increase in the difference in sibling birthweight was associated with a 13% increase in the odds of neonatal death. CONCLUSION: The deviation from the elder sibling's birthweight predicts neonatal death. Taking into consideration the elder sibling's birthweight may be warranted in clinical and research settings.
Asunto(s)
Peso al Nacer , Recién Nacido Pequeño para la Edad Gestacional , Muerte Perinatal , Hermanos , Adulto , Estudios de Cohortes , Femenino , Humanos , Recién Nacido , Masculino , Missouri/epidemiología , Sistema de Registros , Factores SocioeconómicosRESUMEN
Sleep disorders often co-occur with autism spectrum disorder. They further exacerbate autism spectrum disorder symptoms and interfere with children's and parental quality of life. This study examines whether gastrointestinal dysfunctions increase the odds of having sleep disorders in 610 children with idiopathic autism spectrum disorder, aged 2-18 years, from the Autism Genetic Resource Exchange research program. The adjusted odds ratio for sleep disorder among those with gastrointestinal dysfunctions compared to those without was 1.74 (95% confidence interval: 1.22-2.48). In addition, the odds of having multiple sleep disorder symptoms among children with gastrointestinal dysfunctions, adjusted for age, gender, behavioral problems, bed wetting, current and past supplements, and current and past medications for autism spectrum disorder symptoms were 1.75 (95% confidence interval: 1.10-2.79) compared to children without gastrointestinal dysfunctions. Early detection and treatment of gastrointestinal dysfunctions in autism spectrum disorder may be means to reduce prevalence and severity of sleep problems and improve quality of life and developmental outcomes in this population.
Asunto(s)
Trastorno del Espectro Autista/complicaciones , Enfermedades Gastrointestinales/complicaciones , Trastornos del Sueño-Vigilia/complicaciones , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de RiesgoRESUMEN
It is recognized that prenatal care plays an important role in reducing adverse birth. Chinese pregnant women with medical condition were required to seek additional health care based on the recommended at least 5 times health care visits. This study was to estimate the association between prenatal care utilization (PCU) and preterm birth (PTB), and to investigate if medical conditions during pregnancy modified the association. This population-based case control study sampled women with PTB as cases; one control for each case was randomly selected from women with term births. The Electronic Perinatal Health Care Information System (EPHCIS) and a questionnaire were used for data collection. The PCU was measured by a renewed Prenatal Care Utilization (APNCU) index. Logistic regression models were used to estimate odds ratios (OR) and the 95% confidence interval (95% CI). Totally, 2393 women with PTBs and 4263 women with term births were collected. In this study, 695 (10.5%) women experienced inadequate prenatal care, and 5131 (77.1%) received adequate plus prenatal care. Inadequate PCU was associated with PTB (adjusted OR: 1.41, 95% CI: 1.32-1.84); the similar positive association was found between adequate plus PCU and PTB. Among women with medical conditions, these associations still existed; but among women without medical conditions, the association between inadequate PCU and PTB disappeared. Our data suggests that women receiving inappropriate PCU are at an increased risk of having PTB, but it does depend on whether the woman has a medical condition during pregnancy.
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Pueblo Asiatico , Nacimiento Prematuro/epidemiología , Atención Prenatal/estadística & datos numéricos , Adulto , Estudios de Casos y Controles , Factores de Confusión Epidemiológicos , Femenino , Humanos , Factores de RiesgoRESUMEN
BACKGROUND: Gestational Weight Gain (GWG) below or above the Institute of Medicine (IOM) recommendations increases the risk of adverse pregnancy outcomes. However, it remains unknown whether the risk of adverse outcomes is affected by GWG in a previous pregnancy. We examined associations between GWG in the index (second) pregnancy and pregnancy outcomes, including preterm delivery and small for gestational age (SGA), while taking into consideration GWG in the first pregnancy. METHODS: In a population-based cohort study (n = 210 564), using the Missouri maternally-linked birth registry (1989-2005), we used multivariable Poisson regression with robust error variance stratified by prepregnancy body mass index (BMI) to evaluate associations between GWG in the index pregnancy and a composite indicator of GWG in the first and second pregnancies and our outcomes of interest, after controlling for sociodemographic and pregnancy-related confounders. RESULTS: Associations between GWG in the index pregnancy and pregnancy outcomes were moderated by GWG in the first pregnancy. Despite having GWG within recommendations in the index pregnancy, women had increased risk of preterm delivery and SGA if they had suboptimal GWG in their first pregnancy. Also, women having suboptimal GWG in the index pregnancy had increased risk of preterm delivery only if their GWG in the first pregnancy was also suboptimal. CONCLUSIONS: The observation that women who have GWG within recommendations in a current pregnancy may still have increased risk of adverse outcomes if they had suboptimal GWG in the first pregnancy has considerable clinical and public health implications.
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Complicaciones del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Aumento de Peso , Adulto , Índice de Masa Corporal , Femenino , Humanos , Missouri/epidemiología , Paridad , Distribución de Poisson , EmbarazoRESUMEN
Objectives Children born large for gestational age (LGA) are at risk of numerous adverse outcomes. While the racial/ethnic disparity in LGA risk has been studied among women with Gestational Diabetes Mellitus (GDM), the independent effect of race on LGA risk by maternal prepregnancy BMI is still unclear among women without GDM. Therefore, the objective of this study was to assess the association between maternal race/ethnicity and LGA among women without GDM. Methods This was a population-based cohort study of 2,842,278 singleton births using 2012 U.S. Natality data. We conducted bivariate and multivariate logistic regression analyses to assess the association between race and LGA. Due to effect modification by maternal prepregnancy BMI, we stratified our analysis by four BMI subgroups. Results The prevalence of LGA was similar across the different racial/ethnic groups at about 9%, but non-Hispanic Asian Americans had slightly higher prevalence of 11%. After controlling for potential confounders, minority women had higher odds of birthing LGA babies compared to non-Hispanic white women. Non-Hispanic Asian Americans had the highest odds of LGA babies across all BMI categories: underweight (aOR = 2.67; 95% CI: 2.24, 3.05); normal weight (aOR = 2.53; 2.43, 2.62); overweight (aOR = 2.45; 2.32, 2.60) and obese (aOR = 2.05; 1.91, 2.20). Conclusions for practice Racial/ethnic disparities exist in LGA odds, particularly among women with underweight or normal prepregnancy BMI. Most minorities had higher LGA odds than non-Hispanic white women regardless of prepregnancy BMI category. These racial/ethnic disparities should inform public health policies and interventions to address this problem.
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Peso al Nacer , Índice de Masa Corporal , Etnicidad/estadística & datos numéricos , Macrosomía Fetal/etnología , Complicaciones del Embarazo/etnología , Adulto , Pueblo Asiatico , Población Negra , Estudios de Cohortes , Femenino , Macrosomía Fetal/epidemiología , Edad Gestacional , Hispánicos o Latinos , Humanos , Recién Nacido , Obesidad/epidemiología , Obesidad/etnología , Vigilancia de la Población , Embarazo , Complicaciones del Embarazo/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología , Población BlancaRESUMEN
BACKGROUND: Autism spectrum disorder (ASD) is a heterogeneous disorder characterized not only by deficits in communication and social interactions but also a high rate of co-occurring disorders, including metabolic abnormalities, gastrointestinal and sleep disorders, and seizures. Seizures, when present, interfere with cognitive development and are associated with a higher mortality rate in the ASD population. METHODS: To determine the relative prevalence of non-febrile seizures in children with idiopathic ASD from multiplex and simplex families compared with the unaffected siblings in a cohort of 610 children with idiopathic ASD and their 160 unaffected siblings, participating in the Autism Genetic Resource Exchange project, the secondary analysis was performed comparing the life-time prevalence of non-febrile seizures. Statistical models to account for non-independence of observations, inherent with the data from multiplex families, were used in assessing potential confounding effects of age, gender, and history of febrile seizures on odds of having non-febrile seizures. RESULTS: The life-time prevalence of non-febrile seizures was 8.2% among children with ASD and 2.5% among their unaffected siblings. In a logistic regression analysis that adjusted for familial clustering, children with ASD had 5.27 (95%CI: 1.51-18.35) times higher odds of having non-febrile seizures compared to their unaffected siblings. In this comparison, age, presence of gastrointestinal dysfunction, and history of febrile seizures were significantly associated with the prevalence of non-febrile seizures. CONCLUSION: Children with idiopathic ASD are significantly more likely to have non-febrile seizures than their unaffected siblings, suggesting that non-febrile seizures may be ASD-specific. Further studies are needed to determine modifiable risk factors for non-febrile seizures in ASD.
Asunto(s)
Trastorno del Espectro Autista/epidemiología , Sistema de Registros , Convulsiones/epidemiología , Hermanos , Adolescente , Trastorno del Espectro Autista/genética , Niño , Preescolar , Comorbilidad , Femenino , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Convulsiones/genéticaRESUMEN
Objectives Few studies focus on the symptoms of common mental disorders during pregnancy (CMDP) and risk of preterm birth subtypes (PTB). The purpose of this study was to estimate the association between CMDP and PTB, and to examine whether or not the association between CMDP and PTB varies with the subtype of PTB in Chinese. Methods This population-based case control study, conducted in Wuhan, China, defined cases as every pregnant woman who had a PTB among all births in Wuhan, from June 10, 2011, to June 9, 2013. The same number of pregnant women who had term births was randomly selected as controls. The Electronic Perinatal Health Care Information System, a questionnaire designed for the study, provided data about the participants. Logistic regression analyses were used to model associations between CMDP and PTB, and to test associations between CMDP and two subtypes of PTB. Results The study recruited 8616 cases and an equal number of controls. We successfully collected maternal information on 6656 cases and controls for a response rate of 77.3 %. The incidence of PTB in Wuhan was 4.5 %. Spontaneous preterm births (SPTB) accounted for 60.1 %, and medically induced preterm births (IPTB) accounted for 39.9 % of preterm births. The prevalence rate of CMDP was 15.8 %. CMDP was slightly associated with PTB (crude OR 1.16, 95 % CI 1.01-1.32; adjusted OR 1.15, 95 % CI 1.00-1.32), further analyses showed CMDP was associated with IPTB (aOR 1.25, 95 % CI 1.04-1.50), but not with SPTB. Conclusion Our data suggest that CMDP is related to an increased risk of PTB, and that this association is primarily due to IPTB rather than SPTB.
Asunto(s)
Ansiedad/etnología , Pueblo Asiatico/estadística & datos numéricos , Depresión/etnología , Mujeres Embarazadas/psicología , Nacimiento Prematuro/etnología , Adulto , Ansiedad/diagnóstico , Ansiedad/psicología , Pueblo Asiatico/etnología , Estudios de Casos y Controles , China/epidemiología , Estudios de Cohortes , Depresión/diagnóstico , Depresión/psicología , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Vigilancia de la Población , Embarazo , Mujeres Embarazadas/etnología , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Young maternal age at first birth has been associated with poor mental health. However, few studies directly compared the prevalence of psychiatric disorders among adolescent versus adult mothers at first birth using a comprehensive diagnostic tool. This study examined the association between age at first birth and 22 current and lifetime psychiatric disorders in a cohort of low-income pregnant women. METHODS: The sample consisted of 744 low-income currently pregnant women who were Medicaid-eligible and enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Saint Louis City and 5 rural counties in Southeastern Missouri. Current (previous 12 months) and lifetime psychiatric disorders were assessed using the Diagnostic Interview Schedule IV (DIS-IV). Logistic regression analyses tested the association between women's age at first birth and psychiatric disorders, controlling for potential confounders, including relative poverty. RESULTS: When adjusting for confounders, mothers giving birth in their teens had 2.5 times the odds of having a lifetime behavior disorder (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.35-5.24) and current posttraumatic stress disorder (PTSD) (OR 2.54, 95% CI 1.38-4.70) and almost twice the odds of having at least one anxiety disorder compared to older women at first birth (OR 1.78, 95% CI 1.10-2.85). CONCLUSION: Low-income women who have their first birth in adolescence have higher odds of psychiatric disorders and should be the target of psychiatric screening during their pregnancy. Mothers beginning childbearing before age 19 should be screened during pregnancy for anxiety disorders, including PTSD, and behavior disorders.
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Edad Materna , Trastornos Mentales/epidemiología , Madres/psicología , Pobreza/psicología , Complicaciones del Embarazo/psicología , Trastornos por Estrés Postraumático/epidemiología , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Renta , Trastornos Mentales/psicología , Missouri/epidemiología , Análisis Multivariante , Paridad , Pobreza/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/epidemiología , Prevalencia , Población Rural , Bienestar Social , Trastornos por Estrés Postraumático/etiología , Población Blanca/estadística & datos numéricos , Adulto JovenRESUMEN
Objectives To examine correlates of lifetime mental health services (MHS) use among pregnant women reporting prenatal depressive symptoms by race/ethnicity. Methods This cross-sectional population-based study included 81,910 pregnant women with prenatal depressive symptoms using data from the Florida Healthy Start prenatal screening program (2008-2012). Multivariable logistic regression was conducted to ascertain adjusted odds ratios and corresponding 95 % confidence intervals for racial/ethnic differences in the correlates of lifetime MHS use. Results Findings of this study revealed racial/ethnic differences in MHS use among women with prenatal depressive symptoms, the highest rates being among non-Hispanic Whites and the lowest rates among Mexicans and other Hispanics. Most need for care factors, including illness, tobacco use, and physical or emotional abuse, consistently predicted MHS use across racial/ethnic groups after adjusting for covariates. Adjusted associations between predisposing and enabling/restricting factors and MHS use were different for different racial/ethnic groups. Conclusions Racial/ethnic differences in MHS use were found, with pregnant Hispanic women reporting prenatal depressive symptoms being the least likely to use MHS. Our study findings have significant public health implications for targeted intervention for pregnant women with prenatal depressive symptoms.
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Depresión/etnología , Disparidades en Atención de Salud , Hispánicos o Latinos/psicología , Servicios de Salud Mental/estadística & datos numéricos , Mujeres Embarazadas/psicología , Población Blanca/psicología , Adolescente , Adulto , Estudios Transversales , Depresión/psicología , Femenino , Florida/epidemiología , Encuestas de Atención de la Salud , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Edad Materna , Embarazo , Mujeres Embarazadas/etnología , Atención Prenatal , Prevalencia , Factores Socioeconómicos , Población Blanca/estadística & datos numéricos , Adulto JovenRESUMEN
Background: Several recent studies have suggested that maternal exposures to air pollution and temperature extremes might contribute to low birth weight (LBW), preterm birth (PTB), and other outcomes that can adversely affect infant health. At the time the current study began, most other studies had been conducted in the United States or Europe. Dr. Zhengmin Qian proposed to extend work he had done on ambient particulate air pollution and daily mortality in Wuhan, China (Qian et al. 2010), as part of the HEIsponsored Public Health and Air Pollution in Asia program, to study adverse birth outcomes. Wuhan is the capital city of Hubei province, has a large population of about 6.4 million within the urban study area, experiences temperature extremes, and generally has higher air pollution levels than those observed in the United States and Europe, thus providing a good opportunity to explore questions about air pollution and health. Approach: Qian and colleagues planned a cohort and nested casecontrol design with four specific aims, examining whether increased exposures to air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) during vulnerable pregnancy periods were associated with increased rates of PTB, LBW (<2500 g), or intrauterine growth retardation (IUGR, defined as having a birth weight below the 10th percentile of singleton live births in Wuhan) after adjusting for major risk factors and whether the associations were confounded by copollutant exposures, affected by residual confounding, or modified by temperature extremes, socioeconomic status (SES), or secondhand smoke (SHS) exposure. The cohort study included 95,911 births that occurred from June 10, 2011, to June 9, 2013, and met typical prespecified inclusion criteria used in other birth outcome studies. The casecontrol study included 3146 cases (PTB, LBW, or both, but not IUGR) and 4263 controls (matched to the cases by birth month) for whom investigators were able to complete home visits and questionnaires. The investigators obtained air pollution and daily weather data for August 2010 to June 2013 from nine monitoring stations representing background air pollution sites in seven Wuhan inner-city districts. Only two of these stations provided PM2.5 data. For the cohort study, the investigators assigned exposures to mothers according to the daily mean concentrations from the monitor nearest the residential community in which the mother lived at the time of the birth. For the casecontrol study, they assigned exposures based on the inverse distance weighted average of daily mean concentrations from the three nearest monitors, for all but PM2.5 for which the method was not specified. They also collected data on various factors that might confound or modify the impact of the pollutants on the adverse outcomes, including data collected in the cohort from mothers at the time of delivery and, in the casecontrol study, from questionnaires administered to mothers. In the casecontrol study, covariates representing SES (as indicated by the mother's educational attainment and household income) and SHS exposures were of particular interest. The primary statistical analyses of the pollutant associations with PTB, LBW, and IUGR were conducted using logistic regression models. In the cohort study, exposures during the pregnancy period of interest (full term, trimesters, and selected months) were included as continuous variables. In the casecontrol study, the exposures were modeled as binary variables (i.e., above or below the median pollutant concentrations). Numerous sensitivity analyses were conducted. Results and interpretation: Although originally planning a nested casecontrol study, the investigators encountered challenges that led them to analyze the cohort and casecontrol studies using different ways of assigning exposures and characterizing them in their statistical models. These decisions precluded direct comparisons between the sets of results, making it difficult to answer the questions about residual confounding that nested casecontrol studies are designed to answer. The odds ratios from the two study designs using different exposures also have different interpretations. Still, one can ask whether the sets of findings were qualitatively consistent with each other or with those of similar studies. There were some similarities. Both studies suggested that increased PM(2.5), PM(10), CO, and O(3) exposures over the full pregnancy were associated with small increases in the odds of PTB (the casecontrol study also showed an association with NO2) and that increased PM(2.5) exposures were associated with significantly increased odds of LBW. However, most of the other pollutants had no effect on LBW, except CO in the cohort study and O(3) in the casecontrol study, both of which increased the odds of LBW. The exposures over the entire pregnancy were generally associated with decreased odds of IUGR. Adjustments for potential confounders were greatest for the delivery covariates. The investigators found no systematic association of any of these outcomes with particular trimesters or months, another result that differed from those of some other studies. They found little evidence that their main results were confounded or modified by the presence of copollutants, although with the exception of O3, most of the pollutants were highly correlated, making it difficult to disentangle the effects of individual pollutants. Could the two sets of data be analyzed in a more comparable way, as in a standard nested casecontrol study? At the Committee's request, the investigators reanalyzed the casecontrol data using the same exposures and models as in the cohort study. The results were strikingly different from those using the inverse distance weighted exposures, modeled as binary variables the pollutants had either no effect or an apparent beneficial effect on PTB and LBW. The Committee was not convinced by the explanations offered for these differences, leaving the reasons for them unresolved. Conclusions: This study set out to answer important questions about the effects of air pollution exposure on three measures of adverse birth outcomes LBW, PTB, and IUGR in a large cohort of mothers and newborns in Wuhan, China. Given the cohort size, high pollution levels and temperatures, and detailed covariate data, the investigators were well poised to address these questions. They sought to pattern their work on other studies of birth outcomes, were very responsive to Committee questions, and provided many additional analyses and explanations. In the Committee's view, however, the study was unable to address with confidence several of its specific aims. Most important, the differences in results when the casecontrol data were analyzed with different exposure metrics remain unexplained, raising concerns about the ability to draw conclusions from subsequent analyses assessing residual confounding and effect modification by temperature extremes, SES, and SHS exposure. Consequently, any individual findings from the cohort and casecontrol studies should be considered suggestive rather than conclusive, and should be interpreted carefully together.
Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Monitoreo del Ambiente/métodos , Resultado del Embarazo/epidemiología , Adulto , China/epidemiología , Factores de Confusión Epidemiológicos , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Embarazo , Nacimiento PrematuroRESUMEN
OBJECTIVE: This study examined the effect of body mass index (BMI) before a first uncomplicated pregnancy on maternal and fetal outcomes in a subsequent pregnancy, including preterm births, preeclampsia, cesarean delivery, small for gestational age, large for gestational age, and neonatal deaths. STUDY DESIGN: We conducted a population-based cohort study (n = 121,092) using the Missouri maternally linked birth registry (1989 through 2005). Multivariable binary logistic regression models were fit to estimate odds ratios and 95% confidence intervals for the parameters of interest after controlling for sociodemographic and pregnancy-related confounders in the second pregnancy. RESULTS: Compared to women with a normal BMI in their first pregnancy, those who were underweight prepregnancy had increased odds for preterm birth by 20% and small for gestational age by 40% in their second pregnancy, while those with prepregnancy obesity had increased odds for large for gestational age, preeclampsia, cesarean delivery, and neonatal deaths in their second pregnancy by 54%, 156%, 85%, and 37%, respectively. CONCLUSION: Women starting a first pregnancy with suboptimal BMI may be at risk of adverse maternal and fetal outcomes in a subsequent pregnancy, even if their first pregnancy was uncomplicated or if they reached a normal weight by their second pregnancy. The long-term consequences of suboptimal BMI carry considerable public health implications.
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Obesidad/epidemiología , Complicaciones del Embarazo/epidemiología , Sistema de Registros , Delgadez/epidemiología , Adulto , Índice de Masa Corporal , Cesárea/estadística & datos numéricos , Estudios de Cohortes , Femenino , Macrosomía Fetal/epidemiología , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Modelos Logísticos , Masculino , Oportunidad Relativa , Preeclampsia/epidemiología , Embarazo , Resultado del Embarazo , Nacimiento Prematuro/epidemiología , Estudios Retrospectivos , Adulto JovenRESUMEN
Patients with multiple sclerosis (MS) experience a myriad of symptoms. There is some evidence that symptoms may co-occur, or happen in particular combinations. Yet most existing studies focus on single symptoms and practitioners make a priori care decisions based on individual symptoms alone. We examined symptom co-occurrences in patients with relapsing-remitting MS (RRMS), collecting qualitative and quantitative data (mixed methods; N = 140). Content analysis revealed fatigue, heat intolerance, numbness, balance problems, and leg weakness as the most common symptoms. Factor analysis revealed the following factors: urinary, problems with balance, vision, heat, depression, and sleep. These preliminary findings indicate co-occurrence of several disabling symptoms from the overall self-report MS-Related Symptom Scale and 3-month recall. This information will guide health care professionals in developing targeted interventions and improve outcomes.
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Esclerosis Múltiple/fisiopatología , Adaptación Fisiológica , Adulto , Estudios Transversales , Análisis Factorial , Fatiga , Femenino , Calor , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Recent research indicates that sexual minority women are at increased risk for cardiovascular disease (CVD) compared with heterosexual women; however, few studies of CVD risk exist for sexual minority men (SMM). This study aimed to determine whether disparities in CVD risk exist for SMM and if CVD risk is consistent across subgroups of SMM. METHODS: This study utilised publicly available data from the National Health and Nutrition Examination Survey (NHANES), pooled from 2001 to 2010. CVD risk was calculated using the Framingham General CVD Risk Score and operationalised as the ratio of a participant's vascular and chronological age. Differences in this ratio were examined between heterosexual and SMM as a whole, and within subgroups of SMM. RESULTS: SMM had vascular systems that were, on average, 4% (95% CI -7.5% to -0.4%) younger than their heterosexual counterparts; however, adjustment for education and history of hard drug use rendered this difference statistically insignificant. Analysis of SMM subgroups revealed increased CVD risk for bisexual men and decreased CVD risk for both gay and homosexually experienced heterosexual men when compared with heterosexual men. Differences in CVD risk persisted for only bisexual and homosexually experienced heterosexual men after adjustment for education and history of hard drug use. CONCLUSIONS: Subgroups of SMM are at increased risk for CVD compared with heterosexual men, and this increased risk cannot be completely attributed to differences in demographic characteristics or negative health behaviours.
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Bisexualidad/estadística & datos numéricos , Enfermedades Cardiovasculares/etiología , Heterosexualidad/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupos Minoritarios/estadística & datos numéricos , Análisis Multivariante , Encuestas Nutricionales , Vigilancia de la Población , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiologíaRESUMEN
Multiple sclerosis is a chronic neurological disease with a myriad of symptoms. Because most work has been quantitative, it is important to capture symptoms as described by patients who experience them, using a qualitative approach. The purpose of our study was to describe and identify symptoms, with emphasis on co-occurrence, using focus groups. Three focus groups were conducted (N = 16) with relapsing-remitting multiple sclerosis patients. Common symptoms, described as both singular and co-occurring, were problems with balance, cognition, vision, and heat intolerance. These findings augment past characterizations of symptoms experienced in persons with relapsing-remitting multiple sclerosis and provide evidence for future studies.
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Trastornos del Conocimiento , Fatiga , Fiebre , Grupos Focales/métodos , Esclerosis Múltiple Recurrente-Remitente , Adolescente , Adulto , Anciano , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/enfermería , Trastornos del Conocimiento/fisiopatología , Evaluación de la Discapacidad , Progresión de la Enfermedad , Fatiga/etiología , Fatiga/enfermería , Fatiga/fisiopatología , Femenino , Fiebre/etiología , Fiebre/enfermería , Fiebre/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Esclerosis Múltiple Recurrente-Remitente/enfermería , Esclerosis Múltiple Recurrente-Remitente/fisiopatología , Adulto JovenRESUMEN
Asian American women have not benefited from the decline in breast cancer mortality and have lower rates of mammography use. Understanding mammography behaviors among these Asian American women requires culturally specific measures. Champion's belief scale was translated into Thai and cultural items were added. The Thai breast cancer belief scale (TBCBS), the Suinn-Lew self-identification acculturation, and the Asian values scale-revised were administered to 250 Thai immigrants. The TBCBS was tested for face validity, construct validity, and internal consistency. Factor analysis reflected the 4 constructs of the health belief model and accounted for 45.8% of the variance. Cronbach's alpha ranged from .77 to .90. Modest correlations were observed between TBCBS subscales and acculturation scales. Results indicate that the TBCBS measures breast cancer beliefs among Thai immigrant population.
Asunto(s)
Asiático/psicología , Neoplasias de la Mama/etnología , Cultura , Emigrantes e Inmigrantes/psicología , Conocimientos, Actitudes y Práctica en Salud , Mamografía/psicología , Modelos Psicológicos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Tailandia/etnología , Estados Unidos/epidemiologíaRESUMEN
AIMS: This study estimated the prevalence of twenty-two 12-month and lifetime psychiatric disorders in a sample of 744 low-income pregnant women and the frequency that women with psychiatric disorders received treatment. METHOD: To identify psychiatric disorders, the Diagnostic Interview Schedule (DIS) was administered to Medicaid or Medicaid-eligible pregnant women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The sample was stratified by the rural or urban location of the WIC sites in southeastern Missouri and the city of St. Louis. Eligible women were enrolled at each site until their numbers were proportional to the racial distribution of African American and Caucasian pregnant women served there. RESULTS: The 12-month prevalence of one or more psychiatric disorders was 30.9%. Most common were affective disorders (13.6%), particularly major depressive disorder (8.2%) and bipolar I disorder (5.2%). Only 24.3% of those with a psychiatric disorder reported that they received treatment in the past year. Lifetime prevalence of at least one disorder was 45.6%, with affective disorders being the most frequent (23.5%). Caucasian women were more likely than African Americans to have at least one 12-month disorder, with the difference largely accounted for by nicotine dependence. Higher prevalence of lifetime disorders was also found in Caucasian women, particularly affective disorders and substance use disorders. There were no differences in the prevalence of 12-month or lifetime psychiatric disorders by the urban or rural residence of subjects. CONCLUSIONS: With nearly one third of pregnant women meeting criteria for a 12-month psychiatric disorder and only one fourth receiving any type of mental health treatment, comprehensive psychiatric screening during pregnancy is needed along with appropriate treatment.
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Trastornos Mentales/epidemiología , Complicaciones del Embarazo/epidemiología , Adulto , Femenino , Humanos , Entrevistas como Asunto , Medicaid , Missouri/epidemiología , Pobreza , Embarazo , Prevalencia , Población Rural , Factores Socioeconómicos , Estados Unidos , Población UrbanaRESUMEN
BACKGROUND: The prevalence of both unintended pregnancy and psychiatric disorders in pregnancy is high. Each is associated with compromised birth outcomes and challenges in child-rearing. This study examines the relationship between mental illness and unintended pregnancy in seeking to improve the care provided to women and our ability to minimize the number of children born unwanted or ill-cared for. METHODS: The sample consisted of 744 pregnant Women, Infants, and Children (WIC) participants with a stratified enrollment design by residence and representative by race for each WIC county. Analysis consisted of post-stratification by developmental age group with logistic regression models estimating odds of unintended pregnancy among women with and without a psychiatric disorder. Covariates included race, education, and marital status. FINDINGS: Almost one third (30.9%) had at least one psychiatric disorder with over two thirds (67.3%) reporting their pregnancy as unintended. No grouped psychiatric disorder was associated with unintended pregnancy with all ages combined. However, adolescents (ages 15-19) with a substance disorder were less likely to have an unintended pregnancy (adjusted odds ratio [aOR], 0.3; 95% confidence interval [CI], 0.1-0.7) than women without a substance disorder and emerging adult women (ages 20-23) with an anxiety disorder were less likely to have an unintended pregnancy (aOR, 0.4; 95% CI, 0.2-1.0) compared with those without the targeted disorder. CONCLUSION: The prevalence of unintended pregnancy is not associated with having a psychiatric disorder, although substance use disorders and anxiety disorders were associated with a decreased likelihood for an unintended pregnancy in a specific age group. Importantly, targeted efforts are needed to identify and counsel women with mental illness about pregnancy planning.