Factors influencing childbearing decisions and knowledge of perinatal risks among Canadian men and women.

BACKGROUND: Women age 35 and older account for an increasing proportion of births and are at increased risk of having difficulties conceiving and of delivering a multiple birth, low birth weight infant, and/or preterm infant. Little is known about men's and women's understanding of the maternal age related risks to pregnancy. OBJECTIVES: 1) To determine the factors influencing the timing of childbearing for non-parenting men and women, 2) to determine knowledge among non-parenting men and women about maternal age-related reproductive risks, the consequences of low birth weight and multiple birth, and issues related to infertility, and 3) to determine characteristics associated with limited knowledge of these reproductive risks. METHODS: An age-stratified random sample of individuals, aged 20-45 years and without children, completed a computer-assisted telephone interview from two urban regions of Alberta, Canada (1006 women and 500 men). RESULTS: Factors that influenced timing of childbearing for both men and women included: financial security (85.8%) and partner suitability to parent (80.2%). Over 70% of men and women recognized the direct relationship between older maternal age and conception difficulties. Less than half knew that advanced maternal age increased the risk of stillbirth, caesarean delivery, multiple birth and preterm delivery. CONCLUSIONS: Poor understanding of the links between childbearing after age 35, pregnancy complications and increased risk of adverse infant outcomes limits adults' ability to make informed decisions about timing of childbearing.

What do women know about the risks of delayed childbearing?

BACKGROUND: Women aged 35 and older account for an increasing proportion of births and are at increased risk of pregnancy complications and poor infant outcomes. The objectives of the study were: 1) to determine what women know about delayed childbearing, including pregnancy complications and outcomes associated with low birthweight (LBW, < 2500 grams), preterm delivery (< 37 weeks) and multiple birth, and 2) to assess the characteristics of women with limited knowledge of risks. METHODS: A computer-assisted telephone interview survey was conducted with 1,044 randomly selected women who delivered their first live-born infant, between July 2002 and September 2003, in two urban centres, Calgary and Edmonton, in Alberta, Canada. RESULTS: The proportion of women aware of specific childbearing risks associated with advanced maternal age were as follows: conception difficulties (85.3%), multiple birth (24.0%), caesarean section (18.8%), preterm delivery (21.8%), and LBW (11.2%). Knowledge of specific developmental and health-related risks of suboptimal infant outcomes ranged between 18.0% and 46.5%. Logistic regression revealed that limited knowledge of maternal age-related pregnancy risks were associated with unplanned pregnancy (OR, 1.48; 95% CI, 1.03-2.14), smoking (OR, 1.83; 95% CI, 1.29-2.60) and non-use of fertility treatment (OR, 2.15; 95% CI, 1.44-3.19). Characteristics associated with limited knowledge of the risks associated with suboptimal birth outcomes were: age 35-39 years (OR, 2.98; 95% CI, 1.35-6.58), less than post-graduate education (< or = high school OR, 2.14; 95% CI, 1.20-3.82), and not currently enrolled as a student (OR, 1.75; 95% CI, 1.02-3.00). CONCLUSIONS: Many women are generally unaware of the potential consequences of delayed childbearing. There are missed opportunities in preconception counselling and education, which should be addressed to allow for more informed decision-making about family planning.

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.

Do women change their drinking behaviors while trying to conceive? An opportunity for preconception counseling.

BACKGROUND: Prenatal alcohol exposure is a leading cause of preventable mental retardation and developmental disabilities, including fetal alcohol syndrome. Current medical guidelines recommend that no alcohol should be consumed over the period of conception and throughout pregnancy. Although the majority of women reduce alcohol consumption when they realize they are pregnant, this recognition may not occur until well into the first trimester, potentially impacting embryonic development. OBJECTIVES: To describe and assess changes in patterns of women's alcohol use between the preconception, pre-pregnancy recognition and post-pregnancy recognition time periods. Secondly, to describe characteristics of women consuming any alcohol and those binge drinking during pre- and post-pregnancy recognition periods. METHODS: Computer assisted telephone interviews were conducted with 1042 women who had recently delivered a baby in urban Alberta, Canada. Differences in consumption patterns between time periods were analyzed using analysis of variance and Chi-square tests. Characteristics of those drinking both before and after pregnancy recognition were analyzed using logistic regression. RESULTS: Eighty percent of women reported alcohol consumption pre-conceptually, 50% pre-pregnancy recognition and 18% post-pregnancy recognition. Binge drinking was reported by 32%, 11% and 0% for preconception, pre-pregnancy recognition and post-pregnancy recognition periods, respectively. Alcohol consumption patterns (i.e., the mean number of drinks per drinking day and week) did not differ significantly between preconception and pre-pregnancy recognition periods but did significantly drop after pregnancy recognition (p<0.001). Alcohol use during the period of pre-pregnancy recognition was higher among those not planning a pregnancy, not using assisted reproductive technology, of higher income, without a history of miscarriage, who were Caucasian, and who used tobacco. Binge drinking was higher among women not planning a pregnancy, those who used tobacco, and those with low self-esteem. Women continuing to drink small amounts of alcohol after pregnancy recognition were more likely to be between the ages of 30-39 years, be Caucasian and use tobacco. CONCLUSION: Preconception and "well-women" counseling strategies would be improved by increasing the emphasis on the risks of alcohol use during periods when pregnancy can occur.

Maternal and umbilical cord blood levels of mercury, lead, cadmium, and essential trace elements in Arctic Canada.

Maternal and umbilical cord blood levels of mercury (Hg), lead (Pb), cadmium (Cd), and the trace elements copper (Cu), zinc (Zn), and selenium (Se) are reported for Inuit, Dene/Métis, Caucasian, and Other nonaboriginal participants from Arctic Canada. This is the first human tissue monitoring program covering the entire Northwest Territories and Nunavut for multiple contaminants and establishes a baseline upon which future comparisons can be made. Results for chlorinated organic pesticides and PCBs for these participants have been reported elsewhere. Between May 1994 and June 1999, 523 women volunteered to participate by giving their written informed consent, resulting in the collection of 386 maternal blood samples, 407 cord samples, and 351 cord:maternal paired samples. Geometric mean (GM) maternal total mercury (THg) concentrations ranged from 0.87 microg/L (SD = 1.95) in the Caucasian group of participants (n = 134) to 3.51 microg/L (SD = 8.30) in the Inuit group (n = 146). The GM of the Inuit group was 2.6-fold higher than that of the Dene/Métis group (1.35 microg/L, SD = 1.60, n = 92) and significantly higher than those of all other groups (P<0.0001). Of Inuit women participants, 3% (n = 4) were within Health Canada's level of concern range (20-99 microg/L) for methylmercury (MeHg) exposure. Of Inuit and Dene/Métis cord samples, 56% (n = 95) and 5% (n = 4), respectively, exceeded 5.8 microg/L MeHg, the revised US Environmental Protection Agency lower benchmark dose. GM maternal Pb was significantly higher in Dene/Métis (30.9 microg/L or 3.1 microg/dL; SD = 29.1 microg/L) and Inuit (31.6 microg/L, SD = 38.3) participants compared with the Caucasian group (20.6 microg/L, SD = 17.9) (P < 0.0001). Half of all participants were smokers. GM blood Cd in moderate smokers (1-8 cigarettes/day) and in heavy smokers (> 8 cigarettes/day) was 7.4-fold higher and 12.5-fold higher, respectively, than in nonsmokers. The high percentage of smokers among Inuit (77%) and Dene/Métis (48%) participants highlights the need for ongoing public health action directed at tobacco prevention, reduction, and cessation for women of reproductive age. Pb and THg were detected in more than 95% of all cord blood samples, with GMs of 21 microg/L and 2.7 microg/L, respectively, and Cd was detected in 26% of all cord samples, with a GM of 0.08 microg/L. Cord:maternal ratios from paired samples ranged from 0.44 to 4.5 for THg, from 0.5 to 10.3 for MeHg, and 0.1 to 9.0 for Pb. On average, levels of THg, MeHg, and Zn were significantly higher in cord blood than in maternal blood (P < 0.0001), whereas maternal Cd, Pb, Se, and Cu levels were significantly higher than those in cord blood (P < 0.0001). There was no significant relationship between methylmercury and selenium for the range of MeHg exposures in this study. Ongoing monitoring of populations at risk and traditional food species, as well as continued international efforts to reduce anthropogenic sources of mercury, are recommended.

Organochlorine levels in maternal and umbilical cord blood plasma in Arctic Canada.

A baseline for exposure to organochlorine and metal contaminants has been established for mothers and newborns in the Northwest Territories and Nunavut areas of Arctic Canada. Maternal and umbilical cord blood plasma organochlorine levels are described for Inuit, Dene, Métis, Caucasian and Other non-Aboriginal participants. Overall, 523 women volunteered to participate by giving their written informed consent between May 1994 and June 1999, resulting in the collection of 386 maternal blood samples, 407 cord blood samples and 351 maternal/cord pairs. Nearly half of all the participants regularly smoked cigarettes, including 77% of the Inuit participants. Maternal and cord results are presented for PCBs (as Aroclor 1260 and 14 congeners) and organochlorine pesticides, including p,p'-DDT, p,p'-DDE, beta-hexachlorocyclohexane (beta-HCH), hexachlorobenzene (HCB), cis and trans nonachlor, heptachlor epoxide, oxychlordane, mirex, dieldrin and toxaphene. Maternal PCB levels (as Aroclor 1260) averaged 4.42 (+/-9.03) microg/l in Inuit, which was 3.3 times higher than those found in Dene/Métis, and 3.4 times higher than levels in Caucasians. Mean DDE levels were 2.8 times higher in the Other non-Aboriginal group (Chinese, Filipino, East Indian and multiple ethnicity) than in the Inuit group, at 3.99 microg/l and 1.42 microg/l, respectively. Cord blood PCB levels (as Aroclor 1260) averaged 1.16 (+/-2.42) microg/l for Inuit participants, which was 3.3-4 fold higher than the other ethnic groups. PCBs, p,p'-DDE and hexachlorobenzene were detected in all maternal samples, and p,p'-DDE was detected in all cord samples. Regression coefficients for maternal/cord pairs are presented for selected organochlorines. Other results from this study, including maternal and cord metals data, will be presented elsewhere.