High gestational weight gain and the risk of preterm birth and low birth weight: a systematic review and meta-analysis.

OBJECTIVE: Many women have high gestational weight gain (GWG), but potential neonatal consequences are not yet well quantified. We sought to determine the relationship between high GWG and preterm birth (PTB) and low birth weight (LBW) in singleton births. DATA SOURCES: We searched Medline and Embase and reference lists. STUDY SELECTION: Two assessors independently performed all steps. We selected studies assessing high total or weekly GWG on PTB (< 37 weeks) and LBW (< 2500 grams). DATA EXTRACTION AND SYNTHESIS: Thirty-eight studies, 24 cohort and 14 case-control, were included involving 2 124 907 women. Most contained unadjusted data. Women with high total GWG had a decreased risk overall of PTB < 37 weeks (relative risk [RR] 0.75; 95% CI 0.60 to 0.96), PTB 32 to 36 weeks (RR 0.70; 95% CI 0.70 to 0.71), and < 32 weeks (RR 0.87; 95% CI 0.85 to 0.90). High GWG was associated with lower risk of LBW (RR 0.64; 95% CI 0.53 to 0.78). Women with the highest GWG had lower risks of LBW (RR 0.55; 95% CI 0.32 to 0.94) than women with moderately high GWG (RR 0.73; 95% CI 0.60 to 0.89). Women with the highest weekly GWG had greater risks of PTB (RR 1.51; 95% CI 1.47 to 1.55) than women with moderately high weekly GWG (RR 1.09; 95% CI 1.05 to 1.13). Women with high weekly GWG were at increased risk of PTB 32 to 36 weeks (RR 1.14; 95% CI 1.10 to 1.17 and < 32 weeks (RR 1.81; 95% CI 1.73 to 1.90). CONCLUSION: Although women with high total GWG have lower unadjusted risks of PTB and LBW, high weekly GWG is associated with increased PTB, and more adjusted studies are needed, as are more studies in obese women. Potential benefits of high GWG for the infant must be balanced against maternal risks and other known infant risks such as high birth weight.

Intention to become pregnant and low birth weight and preterm birth: a systematic review.

Increased stress, psychosocial problems, economic disadvantages, and lack of prenatal care are proposed to explain discrepancies in the outcome of unintended pregnancies. Studies of maternal intention and pregnancy outcomes have yielded varied results. Objective is to review studies of the risk of low birth weight (LBW)/preterm births (PTB) associated with unintended pregnancies ending in a live birth. We reviewed studies reporting on maternal intentions and outcomes from Medline, Embase, CINAHL, and bibliographies of identified articles. An unintended pregnancy was further classified as mistimed (not intended at that time) or unwanted (not desired at any time). Studies reporting an association between pregnancy intention and any of the outcomes were included. Study quality was assessed for biases in selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition. Unadjusted and adjusted data from included studies were extracted by two reviewers. There were significantly increased odds of LBW among unintended pregnancies [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.25, 1.48] ending in a live birth. Within the unintended category, mistimed (OR 1.31, 95% CI 1.13, 1.52) and unwanted (OR 1.51, 95% CI 1.29, 1.78) pregnancies were associated with LBW. There were statistically significantly increased odds of PTB among unintended (OR 1.31, 95% CI 1.09, 1.58), and unwanted (OR 1.50, 95% CI 1.41, 1.61) but not for mistimed (OR 1.36, 95% CI 0.96, 1.93) pregnancies. Unintended, unwanted, and mistimed pregnancies ending in a live birth are associated with a significantly increased risk of LBW and PTB.

Factors influencing women's decisions about timing of motherhood.

OBJECTIVE: To examine the factors that influence women's decisions about the timing of motherhood from a life span perspective. DESIGN: Qualitative. SETTING: Large Western Canadian city with a high rate of infants born to women aged 35 years and older. PARTICIPANTS: 45 Canadian women aged 20 to 48 years. RESULTS: Independence, a stable relationship, and declining fertility influenced women's decisions about the timing of motherhood. Women integrated child developmental transitions into a projected life plan as they considered the timing of motherhood. Partner readiness and family of origin influences played a lesser role. Delayed childbearing has become more socially acceptable, with subsequent negative connotations associated with younger motherhood. Parental benefits have limited influence on the timing of motherhood. CONCLUSIONS: Recognition by nurses of the various and complex factors that influence women's decisions about the timing of motherhood may flag the importance of pregnancy-related counseling for woman across the fertility life span. Policy decision makers must be cognizant of the need for additional high-risk obstetric and neonatal health services when societal norms encourage women to delay childbearing in favor of completing education and establishing a career.

The relationship between self-reported emotional health, demographics, and perceived satisfaction with prenatal care.

Aims to describe pregnant women with poor emotional health and the relationship between self-reported emotional health and prenatal care satisfaction. To this end, 1,265 women who delivered a live-born singleton infant were interviewed and information abstracted from prenatal records. Concludes that patient assessment of satisfaction with prenatal care may be related to both self-reported emotional health and delivery of medical care. Identifying and addressing emotional health of prenatal patients may improve compliance with medical recommendations, ultimately improving health outcomes.

Do maternal characteristics and past pregnancy experiences predict preterm delivery among women aged 20 to 34?

OBJECTIVE: To identify key demographic, lifestyle, and medical indicators for preterm births in women aged 20 to 34. METHODS: A population-based, case-control study consisting of 987 women aged 20 to 34, who delivered a liveborn singleton infant at <37 weeks' gestation in Alberta between May 1999 and August 2000. Controls delivered liveborn infant(s) at > or =37 weeks' gestation. Information was obtained from computer-assisted telephone interviews, and the provincial Physician Notice of Stillbirth/Birth database. Analysis included bivariate and logistic regression techniques. RESULTS: Logistic regression modelling indicated that significant risk factors for preterm delivery included poor past pregnancy outcome (odds ratio [OR] 6.4), poor emotional health (OR 1.8), more than 3 years or less than 1 year between pregnancies (OR 1.4 and 1.9, respectively), polyhydramnios and oligohydramnios (OR 4.1), bleeding at greater than 20 weeks' gestation (OR 10.4), malpresentation (OR 2.9), gestational hyper- tension (OR 2.2), and gestational hypertension with proteinuria (OR 4.4). Women who had fewer than 10 prenatal visits, regardless of attending prenatal classes, were at highest risk of preterm delivery (OR 6.7). CONCLUSIONS: In this population of women aged 20 to 34 years, few prenatal visits, poor emotional health prior to pregnancy, and conditions of the current pregnancy were strongly associated with preterm singleton birth.