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1.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1414-1419, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838814

RESUMO

Objective: To explore the spatial distribution of low birth weight (LBW) and the potential environmental risk factors and provide the evidence for the prevention and intervention of LBW. Methods: Data were from a surveillance system for newly born population and adverse pregnancy outcome between 2007 and 2012 in Pingding county, Shanxi province. The data from 313 villages were analyzed. Spatial hierarchical Bayesian model was used to adjust the risk of LBW at village level, Moran's I and Getis-Ord Gi* were used to analyze the difference in distribution of LBW risk area. Spatial negative binomial model was used to evaluate the association between the risk of LBW and chemical fertilizer application. Results: A total of 18 749 new births were recorded between 2007 and 2012, including 911 LBW cases, the total incidence of LBW was 4.86%. The result of the spatial hierarchical Bayesian model showed that high-risk area of LBW was in the southeast of Pingding and low-risk area was in the middle west of Pingding. The result of Moran's I showed that there was a clustering pattern of LBW risk, and Getis-Ord Gi* found a high risk (hot spot) area in the south area. Moreover, the findings of association analysis showed that the risk of LBW increased with the increased chemical fertilizer application at village level. Conclusions: There were area specific differences in the risk of LBW, and dose-response relationship between chemical fertilizer application and the risk of LBW. Our findings suggest that maternal exposure to chemical fertilizer during pregnancy might be a potential risk factor for LBW in rural area.


Assuntos
Exposição Ambiental/efeitos adversos , Fertilizantes/efeitos adversos , Recém-Nascido de Baixo Peso , Exposição Materna/efeitos adversos , Nascimento Prematuro/induzido quimicamente , Teorema de Bayes , Feminino , Sistemas de Informação Geográfica , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez/etnologia , Nascimento Prematuro/epidemiologia , Fatores de Risco , Análise Espacial
2.
BMC Pregnancy Childbirth ; 19(1): 194, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164095

RESUMO

BACKGROUND: Studies have shown differences in the risk of caesarean section (CS) between ethnic minority groups. This could be a marker of unequal health care. The aim of this study was to investigate differences in the risk of CS between immigrants of various origins in Denmark, where all health care is free and easy to access, and Danish-born women. A further aim was to determine the possible influence of known risk factors for CS. METHODS: The design was a population-based register study using national Danish registers and included all live- and stillborn singleton deliveries by primiparous women in Denmark from 2004 to 2015. The total study population consisted of 298,086 births, including 25,198 births to women from the 19 largest immigrant groups in Denmark. Multinomial logistic regression analysis was used to estimate relative risk ratios (RRR) of emergency and planned CS, using vaginal delivery (VD) as reference, in immigrant women compared to Danish-born women. A number of known risk factors were included separately. RESULTS: Women from Turkey, the Philippines, Thailand, Somalia, Vietnam, Iran and Afghanistan had a statistically significant elevated risk ratio of emergency CS vs. VD compared to Danish-born women; adjusted RRR's ranging 1.15-2.19. The risk ratio of planned CS vs. VD was lower among the majority of immigrant groups, however higher among women from Poland, Thailand and Iran, when compared to Danish-born women. None of the studied explanatory variables affected the risk ratio of planned CS vs. VD, whereas maternal height contributed with varying strength to the risk ratio of emergency CS vs. VD for all immigrant groups. CONCLUSION: Substantial variations in CS risks by maternal country of birth were documented. Some of the disparities in emergency CS seem to be explained by maternal height.


Assuntos
Cesárea/estatística & dados numéricos , Emigrantes e Imigrantes/classificação , Disparidades em Assistência à Saúde/etnologia , Resultado da Gravidez/etnologia , Medição de Risco , Adulto , Dinamarca/epidemiologia , Feminino , Humanos , Grupos Minoritários , Gravidez , Sistema de Registros/estatística & dados numéricos , Medição de Risco/etnologia , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos
3.
Sex Reprod Healthc ; 20: 42-45, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31084817

RESUMO

OBJECTIVES: To assess the pregnancy outcome of low-risk pregnancies for women originating from non-Western countries compared with ethnic Norwegian women. STUDY DESIGN: A retrospective population-based observational cohort study with prospectively registered data. Conducted at Stavanger University Hospital, Norway, with approximately 4800 deliveries annually, from 2009 to 2015. We included women with low-risk pregnancies of non-Western origin (n = 1413), born in Africa (n = 224), Asia (n = 439), Eastern Europe (n = 499), Middle East (n = 138), South America (n = 85), Western (n = 979), and ethnic Norwegian women (n = 7028). MAIN OUTCOME MEASURES: The relative risk of emergency cesarean section or postpartum hemorrhage by country of origin was estimated by odds ratios with 95% confidence intervals using logistic multiple regression. RESULTS: In total, the pregnancy outcomes of 9392 women were analyzed. Risk of emergency cesarean section was significantly higher for women originating from Asia (aOR: 1.887), followed by Africans (aOR: 1.705). Lowest risk was found in women originating from South America (aOR: 0.480). Risk of postpartum hemorrhage was significantly higher in women originating from Asia (aOR: 1.744) compared to Norwegians. CONCLUSION: Even in a low-risk population, women originating from Asia and Africa had an elevated risk of adverse pregnancy outcome compared to the Norwegian group. The elevated risk should be considered by obstetric care providers, and we suggest that women originating from Asia and Africa would benefit from a targeted care during pregnancy and childbirth.


Assuntos
Cesárea/estatística & dados numéricos , Complicações do Trabalho de Parto/etnologia , Hemorragia Pós-Parto/etnologia , Resultado da Gravidez/etnologia , Adolescente , Adulto , África/etnologia , Europa Oriental/etnologia , Feminino , Humanos , Pessoa de Meia-Idade , Oriente Médio/etnologia , Noruega/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , América do Sul/etnologia , Adulto Jovem
4.
Pregnancy Hypertens ; 15: 195-200, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30825922

RESUMO

BACKGROUND: Renal insufficiency is associated with pregnancy complications including fetal growth restriction, preterm birth (PTB), and pre-eclampsia. OBJECTIVE: To determine the effect of preconception kidney function within the normal range on pregnancy outcome. METHOD: 1043 (50% black, 50% white) women who participated in the CARDIA study who had kidney function and biochemical analyses measured before at least one pregnancy delivered during the 20 years post-baseline period were included in analysis. Kidney function estimated as glomerular filtration rate (eGFR) via modified CKD-EPI equations, serum creatinine, and urinary albumin/creatinine ratio were evaluated as predictors of infant birthweight, gestational age, birthweight-for-gestational-age, and hypertensive disorders of pregnancy via self-report, using multiple regression with adjustment for confounders (age, race, smoking, BMI, center, parity, systolic blood pressure at baseline). Serum uric acid was also examined at both baseline and year 10. RESULTS: Unadjusted pre-pregnancy eGFR (baseline) was associated with lower average birthweight-for-gestational-age, but this disappeared after adjustment for confounders. A decline in GFR from baseline to year 10 was associated with lower birthweight (adjusted estimate -195 g, p = 0.03 overall), especially among whites. After adjustment for confounders, no association was found with gestational age or hypertensive disorders. CONCLUSIONS: No strong evidence for an association between preconception kidney function in the normal range and birthweight or gestational age was found. Possible racial differences in these relationships warrant further examination.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Recém-Nascido Pequeno para a Idade Gestacional , Rim/fisiologia , Nascimento Prematuro , Adulto , Creatina/sangue , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Estudos Longitudinais , Gravidez , Resultado da Gravidez/etnologia , Fatores de Risco , Autorrelato , Adulto Jovem
5.
Health Care Women Int ; 40(4): 365-385, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30742558

RESUMO

Pregnancy-related metrics vary by race/ethnicity, yet most gestational weight gain (GWG) guidelines are ethnicity-blind. We estimated small-for-gestational age (SGA) risk in a Japanese population, examining GWG adequacy categorized by Institute of Medicine (IOM) and Japanese guidelines in male (N = 192) and female (N = 191) full-term singleton infants. For predicting SGA, IOM guidelines had high sensitivity ( ≥ 0.75), but low specificity ( ≤ 0.25); Japanese guidelines had high specificity ( ≥ 0.80) but low sensitivity ( ≤ 0.50). GWG guidelines' implicit notions of Caucasian-Americans as optimal may lead to 'One Size Fits All' recommendations that can obscure important biocultural factors contributing to maternal child health outcomes.


Assuntos
Ganho de Peso na Gestação/etnologia , Recém-Nascido Pequeno para a Idade Gestacional , Resultado da Gravidez/etnologia , Ganho de Peso/fisiologia , Adulto , Feminino , Guias como Assunto , Humanos , Recém-Nascido , Japão , Masculino , Gravidez
6.
BMC Health Serv Res ; 19(1): 60, 2019 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-30674306

RESUMO

BACKGROUND: Preconception care has been acknowledged as an intervention to reduce perinatal mortality and morbidity. However, utilization of preconception care is low because of low awareness of availability and benefits of the service. An outreach strategy was employed to promote uptake of preconception care consultations. Its effect on the uptake of preconception care consultations was evaluated within the Healthy Pregnancy 4 All study. METHODS: We conducted a community-based intervention study. The outreach strategy for preconception care consultations included four approaches: (1) letters from municipal health services; (2) letters from general practitioners; (3) information leaflets by preventive child healthcare services and (4) encouragement by peer health educators. The target population was set as women aged 18 to 41 years in 14 Dutch municipalities with relatively high perinatal morbidity and mortality rates. We evaluated the effect of the outreach strategy by analyzing uptake of preconception care consultations between February 2013 and December 2014. Registration data of applications for preconception care as well as participant questionnaires were obtained for analysis. RESULTS: The outreach strategy led to 587 applications for preconception care consultations. The majority of applications (n = 424; 72%) were prompted by the invitation letters (132,129) from the municipalities and general practitioners. The effect of the municipal letter seemed to fade out after 3 months. CONCLUSIONS: Outreach strategies amongst the general population promote uptake of preconception care consultations, although on a small scale and with a temporary effect.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Concepcional/estatística & dados numéricos , Adolescente , Adulto , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Utilização de Instalações e Serviços , Feminino , Clínicos Gerais/estatística & dados numéricos , Promoção da Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Países Baixos/etnologia , Gravidez , Complicações na Gravidez/etnologia , Complicações na Gravidez/prevenção & controle , Resultado da Gravidez/etnologia , Serviços Preventivos de Saúde/estatística & dados numéricos , Estudos Prospectivos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
7.
J Matern Fetal Neonatal Med ; 32(23): 4022-4028, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29852821

RESUMO

Purpose: Racial disparities in preterm birth have been long recognized, but the social and biological mechanisms for these differences are unclear. Our analysis had three goals: (1) to determine the relation between race and other social risk factors and cervical structure; (2) to determine whether social factors mediate the relation between race and cervical structure; and (3) to determine whether racial disparities in preterm birth (PTB) are mediated through changes in cervical structure observed earlier in pregnancy. Materials and methods: Data from the Maternal Fetal Medicine Unit network Preterm Prediction Study were used to examine the relation between race and other social factors and cervical properties throughout pregnancy in 2920 black and white women. Outcomes included cervical length and dilation; cervical score (cervical length-internal dilation); and whether membranes protruded at 22-24 and 26-29 weeks. Race, education, income, insurance type, and marital status were examined as predictors of the outcomes using linear and logistic regression, adjusting for age, BMI, parity, and smoking. Mediation analysis was used to examine whether (a) any social factors explained racial differences in cervical properties, and (b) whether cervical properties mediated racial differences in risk for preterm birth. Results: Shorter cervical length, especially at a subject's first visit, was associated with black race (adjusted beta -1.56 mm, p < .01) and lower income (adjusted beta -1.48, p =.05). External dilation was not associated with social factors, while internal dilation was associated with black race and lower education. Black race and marital status were associated with lower cervical score. There was no evidence of mediation of the racial effect on cervical properties by any social factor. Shorter cervical length, dilation, and score were all associated with preterm birth (p < .01). Mediation analysis indicated that each of these mediated the effect of race, but explained a small proportion of the total effect (15-25%). Conclusions: Race, and, to a lesser extent, other social factors are correlated with adverse cervical properties. This pathway could explain a proportion of the racial disparity in preterm birth.


Assuntos
Medida do Comprimento Cervical , Colo do Útero/patologia , Grupos de Populações Continentais/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Medida do Comprimento Cervical/métodos , Medida do Comprimento Cervical/normas , Medida do Comprimento Cervical/estatística & dados numéricos , Colo do Útero/diagnóstico por imagem , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez/etnologia , Segundo Trimestre da Gravidez/etnologia , Terceiro Trimestre da Gravidez/etnologia , Nascimento Prematuro/patologia , Cuidado Pré-Natal/estatística & dados numéricos , Prognóstico , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
8.
Ultrasound Obstet Gynecol ; 53(5): 638-648, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29380922

RESUMO

OBJECTIVES: Raised vascular function measures are associated with adverse maternal and perinatal outcomes in low-risk pregnancy. This study aimed to evaluate the association between longitudinal vascular function parameters and adverse outcome in pregnant women with chronic hypertension, and to assess whether these measures vary according to baseline parameters such as black ethnicity. METHODS: This was a nested cohort study of women with chronic hypertension and a singleton pregnancy recruited to the PANDA (Pregnancy And chronic hypertension: NifeDipine vs lAbetalol as antihypertensive treatment) study at one of three UK maternity units. Women had serial pulse-wave analyses performed using the Arteriograph®, while in a sitting position, from 12 weeks' gestation onwards. Statistical analysis was performed using random-effects logistic regression models. Longitudinal vascular parameters were compared between women who developed superimposed pre-eclampsia (SPE) and those who did not, between women who delivered a small-for-gestational-age (SGA) infant (birth weight < 10th centile) and those who delivered an infant with birth weight ≥ 10th centile and between women of black ethnicity and those of non-black ethnicity. RESULTS: The cohort included 97 women with chronic hypertension and a singleton pregnancy, of whom 90% (n = 87) were randomized to antihypertensive treatment and 57% (n = 55) were of black ethnicity, with up to six (mean, three) longitudinal vascular function assessments. SPE was diagnosed in 18% (n = 17) of women and 30% (n = 29) of infants were SGA. In women who developed subsequent SPE, compared with those who did not, mean brachial systolic blood pressure (SBP) (148 mmHg vs 139 mmHg; P = 0.002), mean diastolic blood pressure (DBP) (87 mmHg vs 82 mmHg; P = 0.01), mean central aortic pressure (139 mmHg vs 128 mmHg; P = 0.001) and mean augmentation index (AIx-75) (29% vs 22%; P = 0.01) were significantly higher across gestation. In women who delivered a SGA infant compared to those who delivered an infant with birth weight ≥ 10th centile, mean brachial SBP (146 mmHg vs 138 mmHg; P = 0.001), mean DBP (86 mmHg vs 82 mmHg; P = 0.01), mean central aortic pressure (137 mmHg vs 127 mmHg; P < 0.0001) and mean pulse-wave velocity (9.1 m/s vs 8.5 m/s; P = 0.02) were higher across gestation. No longitudinal differences were found in vascular function parameters in women of black ethnicity compared with those of non-black ethnicity. CONCLUSION: There were persistent differences in vascular function parameters and brachial blood pressure throughout pregnancy in women with chronic hypertension who later developed adverse maternal or perinatal outcome. Further investigation into the possible clinical use of these findings is warranted. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Pressão Sanguínea , Hipertensão/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Análise de Onda de Pulso/estatística & dados numéricos , Adulto , Anti-Hipertensivos/uso terapêutico , Peso ao Nascer , Doença Crônica , Estudos de Coortes , Estudos de Viabilidade , Feminino , Idade Gestacional , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etnologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Labetalol/uso terapêutico , Estudos Longitudinais , Nifedipino/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/etnologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/etnologia , Resultado da Gravidez/etnologia , Análise de Regressão , Resultado do Tratamento
9.
Int J Epidemiol ; 48(1): 275-286, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30357348

RESUMO

BACKGROUND: Studies on immigrants revealed an epidemiological paradox whereby low-socioeconomic status (SES) immigrant mothers exhibit favourable birth outcomes compared with native-born mothers. We tested the epidemiological paradox in a context of forced migration, comparing associations of low birthweight (LBW) and maternal SES between Syrian and Lebanese newborns in Lebanon. METHODS: We used data from the National Collaborative Perinatal Neonatal Network (NCPNN) of 31 Lebanese hospitals, including 45 442 Lebanese and 4910 Syrian neonates born 2011-13. We assessed associations between LBW and maternal SES for both groups. Logistic regression models examined interactions between maternal origin and SES. RESULTS: Syrian births increased exponentially between 2011 and 2013, along with the group's forced migration into Lebanon. Although Syrian mothers are more socioeconomically disadvantaged compared with Lebanese mothers, Syrian LBW (6.2%) was only marginally higher than Lebanese LBW (5.6%; P = 0.059). Only 20-24-years-old Syrian women [odds ratio (OR) = 1.70 (1.22-2.36)] and those with ≥ university education [OR = 2.02 (0.98-4.16)] exhibited higher odds of delivering an LBW baby compared with Lebanese women of the same age and education. CONCLUSIONS: The findings do not provide strong evidence for the epidemiological paradox in a forced migration context. However, the relatively advantageous LBW profile among Syrian neonates, despite their mothers' low SES and exposure to acute and chronic psychological stress, points to protective mechanisms. One of these mechanisms may be a collective response by the displaced population to improve neonatal outcomes as a way of recovering from loss and death.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Recém-Nascido de Baixo Peso , Mães/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Classe Social , Peso ao Nascer , Escolaridade , Feminino , Humanos , Recém-Nascido , Líbano/epidemiologia , Modelos Logísticos , Mães/psicologia , Gravidez , Resultado da Gravidez/etnologia , Fatores de Risco , Estresse Psicológico/etnologia , Síria/etnologia , Adulto Jovem
10.
BMC Pregnancy Childbirth ; 18(1): 422, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30367602

RESUMO

BACKGROUND: Understanding and tackling perinatal health inequities in industrialized countries requires analysing the socioeconomic determinants of adverse pregnancy outcomes among immigrant populations. Studies show that among certain migrant groups, education is not associated with adverse pregnancy outcomes. We aim to extend this analysis to further dimensions of socioeconomic status (SES) and to other settings. The objective of this study is to identify sociodemographic characteristics associated with adverse pregnancy outcomes, according to the origin of mothers residing in Brussels. METHODS: We analysed all singleton live births in Brussels between 2005 and 2010 (n = 97,844). The data arise from the linkage between three administrative databases. Four groups of women were included according to their place of birth: Belgium, EU, North Africa, and Sub-Saharan Africa. For each group, logistic regression was carried out to estimate the odds ratios of low birthweight (LBW) and small for gestational age (SGA) according to SES indicators (household income, maternal employment status, maternal education) and single parenthood. RESULTS: Three key findings emerge from this study: 1) 25% of children were born into a household under the poverty threshold. This proportion was much higher for mothers born outside of the EU. 2) For North African immigrants, SES indicators didn't influence the pregnancy outcomes, whereas their risk of LBW increased with single parenthood. 3) For Sub-Saharan Africans the risk of LBW increased with low household income. CONCLUSION: In a region where immigrant mothers are at high poverty risk, we observe a classic social gradient in perinatal outcomes only for mothers born in Belgium or the EU. In the other groups, SES influences perinatal outcomes less systematically. To develop interventions to reduce inequities from birth, it's important to identify the determinants of perinatal health among immigrants and to understand the underlying mechanisms in different contexts.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Mães/estatística & dados numéricos , Resultado da Gravidez/etnologia , Classe Social , Adulto , África ao Sul do Saara , África do Norte , Bélgica , Grupos Étnicos , União Europeia , Feminino , Humanos , Recém-Nascido , Masculino , Pobreza , Gravidez , Sistema de Registros , Fatores de Risco
11.
BMC Med ; 16(1): 153, 2018 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-30165842

RESUMO

BACKGROUND: The association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions. METHODS: Systematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes. RESULTS: Overall, 5874 studies were identified and 23 were included (n = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe. GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes. CONCLUSIONS: Women in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia.


Assuntos
Peso Fetal/etnologia , Resultado da Gravidez/etnologia , Ganho de Peso/etnologia , Ganho de Peso/fisiologia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez
12.
Can J Public Health ; 109(5-6): 692-699, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30242635

RESUMO

OBJECTIVE: Studies of perinatal health outcomes in Canadian First Nations populations have largely focused on limited geographical areas and have been unable to examine outcomes by registered status and community residence. In this study, we compare rates of adverse birth outcomes among First Nations individuals living within vs. outside of First Nations communities and those with vs. without registered status. METHODS: Data included 13,506 singleton pregnancies from the 2006 Canadian Birth-Census Cohort. Outcomes examined included preterm birth (PTB), small- and large-for-gestational-age birth (SGA, LGA), stillbirth, overall infant mortality, and neonatal and postneonatal mortality. Risk ratios (RRs) were estimated with adjustment for maternal age, education, parity, and paternal education. RESULTS: Mothers living in First Nations communities and those with status had elevated adjusted risks of LGA (RR for First Nations community residence = 1.22, 95% CI = 1.09-1.35; RR for status = 1.50, 95% CI = 1.16-1.93). Rates of SGA were significantly lower among mothers with status (adjusted RR = 0.62, 95% CI = 0.44-0.86). Rates of PTB did not vary substantially by residence or by status. Adjusted differences in fatal outcomes could not be estimated, owing to small cell sizes. However, mothers living in First Nations communities had higher crude rates of infant mortality (10.9 vs. 7.7 per 1000), particularly for neonatal mortality (6.1 vs. 2.9). CONCLUSION: Future investigations should explore risk factors, including food security and access to health care services, that may explain disparities in SGA and LGA by status and residence within First Nations populations.


Assuntos
Disparidades nos Níveis de Saúde , Índios Norte-Americanos/estatística & dados numéricos , Mortalidade Infantil/etnologia , Resultado da Gravidez/etnologia , Características de Residência/estatística & dados numéricos , Adulto , Canadá/epidemiologia , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Sistema de Registros , Fatores de Risco , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-30189649

RESUMO

Background: Immigration into Europe has reached an all-time high. Provision of coordinated healthcare, especially to refugee women that are at increased risk for adverse pregnancy outcomes, is a challenge for receiving health care systems. Methods: We assessed pregnancy rates and associated primary healthcare needs in three refugee cohorts in Northern Germany during the current crisis. Results: Out of n = 2911 refugees, 18.0% were women of reproductive age, and 9.1% of these were pregnant. Pregnancy was associated with a significant, 3.7-fold increase in primary health care utilization. Language barrier and cultural customs impeded healthcare to some refugee pregnant women. The most common complaints were demand for pregnancy checkup without specific symptoms (48.6%), followed by abdominal pain or urinary tract infections (in 11.4% of cases each). In 4.2% of pregnancies, severe complications such as syphilis or suicide attempts occurred. Discussion: We present data on pregnancy rates and pregnancy associated medical need in three current refugee cohorts upon arrival in Germany. Healthcare providers should be particularly aware of the requirements of pregnant migrants and should adapt primary caretaking strategies accordingly.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Resultado da Gravidez/etnologia , Gestantes , Refugiados , Adulto , Características Culturais , Feminino , Alemanha/epidemiologia , Humanos , Linguagem , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Fatores Socioeconômicos
14.
Zhonghua Fu Chan Ke Za Zhi ; 53(7): 452-458, 2018 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-30078254

RESUMO

Objective: To investigate the influence of maternal age on the health status of pregnant women and the pregnant outcomes. Methods: Data obtained from "Beijing perinatal health management registration system" was analyzed, 263 157 pregnant women with age information were included from October 1st, 2015 to September 30th, 2016, in which 43 594 women delivered at the age of 35 or above (advanced age) . According to the age of maternal age, there were 5 groups. (1) Proper age: 219 563 (83.43%, 219 563/263 157) cases of the age of 18-34 years, including 122 735 cases (46.64%, 122 735/263 157) in the ≤29 years old group and 96 828 cases (36.79%, 96 828/263 157) in 30-34 years old group. (2) Advanced age: there were 43 594 cases (16.57%, 43 594/263 157) ≥35 years old, including 37 395 cases (14.21%, 37 395/263 157) in the 35-39 years old group, 5 790 cases (2.20%, 5 790/263 157) in the 40-44 years old group and 409 cases (0.16%, 409/263 157) in the ≥45 years old group. The trend-based chi-square test and logistic regression were used to analyze the effects of different age groups on maternal complications and pregnant outcomes. Results: (1) The total incidence of high risk pregnancy (HRP) : in advanced age women, the incidence of HRP was 67.83% (29 571/43 594) which was 56.73% (124 550/219 563) in proper age women, the difference was statistically significant (χ(2)=1 848.91, P<0.000) . In advanced age women, the incidence of severe HRP was 7.64% (3 329/43 594) which was 6.18% (13 571/219 563) in proper age women, the difference was statistically significant (χ(2)=128.211, P<0.000) . In advanced age women, the incidence of very severe HRP was 1.76% (769/43 594) which was 0.84% (1 838/219 563) in proper age women, the difference was statistically significant (χ(2)=318.58, P<0.000) . (2) Comparison of the incidence of HRP in 5 groups:the total incidence of HRP increased through the following age group ≤29 years, 30-34 years, 35-39 years, 40-44 years, ≥45 years (53.28%, 61.09%, 67.41%、70.09%, 74.57% respectively) , the difference was statistically significant (linear by linear χ(2)=3 165.72, P<0.000) . The incidence of very severe HPR increased (0.66%, 1.06%, 1.66%, 2.35%, 2.93% respectively) , the difference was statistically significant (linear by linear χ(2)=218.31, P<0.000) . The incidence of severe HPR increased (5.77%, 6.70%, 7.48%, 8.34%, 11.49% respectively) , the difference was statistically significant (linear by linear χ(2)=422.20, P<0.000) . The incidence of general HPR increased (46.84%, 53.34%, 58.26%, 59.40%, 60.15% respectively) , the difference was statistically significant (linear by linear χ(2)=1 947.51, P<0.000) . (3) As the maternal age group increased, the incidence of adverse pregnancy outcomes increased (5.54%, 6.85%, 8.77%, 9.90%, 18.09%, linear by linear χ(2)=674.57, P<0.000) . The incidence of perinatal death, premature birth and low birth weight also presented the above trends (perinatal death: linear by linear χ(2)=34.79, P<0.000; premature birth: linear by linear χ(2)=692.87, P<0.000; low birth weight: linear by linear χ(2)=379.20, P<0.000) . (4) Logistic regression analysis with the assisted reproductive technology and multiple pregnancy considered showed the same trend (P<0.000) . Conclusion: The maternal age has an impact on the maternal health status and pregnancy outcomes, and the risk of various types of pregnancy complications and adverse pregnancy outcomes increase with the maternal age group, antenatal care and management should be emphasized in women with advanced maternal age, especially for women ≥40 years old.


Assuntos
Nível de Saúde , Idade Materna , Complicações na Gravidez/etnologia , Resultado da Gravidez/etnologia , Gravidez de Alto Risco/etnologia , Pequim/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez Múltipla , Nascimento Prematuro , Cuidado Pré-Natal
15.
Matern Child Health J ; 22(12): 1797-1804, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30062651

RESUMO

Objectives Nationwide, African American women report higher stress levels and less access to pre- and postnatal resources. Wisconsin mirrors national infant mortality trends that show a persistent four-decade gap in infant survival between African American and White populations. The objective of the Milwaukee Birthing Project (MBP) was to implement a community-based health promotion intervention to improve birth outcomes for pregnant, low-income African American women, evaluate its effectiveness, and document its usefulness to inform development of future interventions. The project involved a mentoring and supportive relationship between 28 volunteer mentors (Sister Friends) and 20 pregnant women (Little Sisters). Methods The project implementation and evaluation were informed by the lifecourse perspective and a postcolonial feminist framework. Thematic analysis was used to analyze ethnographic data from monthly meetings and interviews with pregnant Little Sisters and Sister Friends. Results Our findings showed patterns both in community spaces and spaces created during the MBP. Program spaces contrasted with everyday life spaces and allowed women to experience community support. Based on our analysis, we classify these spaces as: (1) community spaces lacking support, (2) safe spaces of belonging and understanding, (3) spaces that foster meaningful interaction, and (4) safe, supportive spaces for other women in the future. Conclusions for Practice Future interventions should consider intentionally developing safe spaces to attain health goals. From a postcolonial feminist perspective, the voices of women who are at greatest risk for experiencing poor birth outcomes are crucial to the development of effective policies.


Assuntos
Afro-Americanos/estatística & dados numéricos , Promoção da Saúde/métodos , Disparidades em Assistência à Saúde , Pobreza , Resultado da Gravidez/etnologia , Gestantes/etnologia , Nascimento Prematuro/etnologia , Cuidado Pré-Natal/métodos , Adulto , Participação da Comunidade , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Gravidez , Gestantes/psicologia , Avaliação de Programas e Projetos de Saúde , Características de Residência , Fatores Socioeconômicos , Wisconsin/epidemiologia , Adulto Jovem
16.
Hawaii J Med Public Health ; 77(8): 188-198, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30083431

RESUMO

The objective of this study is to examine the relationship between maternal nativity status and preterm birth (PTB) or low birth weight (LBW) for Hawai'i resident mothers, to compare these relationships across different maternal race/ethnicity groups, and to identify other potential risk and protective factors related to PTB and LBW. Using the 2004 Natality Birth Data from the National Vital Statistic System of the National Center for Health Statistics, crude and adjusted odds ratios were calculated using logistic regression to determine maternal racial/ethnic-specific nativity effects on PTB and LBW. Other Asian or Pacific Islander foreign-born mothers had higher unadjusted rates of PTB, and Samoan foreign-born mothers had lower rates of LBW after adjusting for the socio-demographic covariates compared to their native-born counterparts. Given the limitation of this study particularly relating to data quality, further research is needed to identify socio-contextual factors that are involved in the relationship between nativity status and PTB/LBW.


Assuntos
Grupos de Populações Continentais/etnologia , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Hawaii/epidemiologia , Hawaii/etnologia , Humanos , Recém-Nascido de Baixo Peso , Modelos Logísticos , Gravidez , Resultado da Gravidez/etnologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etnologia , Fatores de Risco , Fatores Socioeconômicos
17.
BMC Pregnancy Childbirth ; 18(1): 339, 2018 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-30126351

RESUMO

BACKGROUND: Racial disparities in birth outcomes are mirrored in cardiovascular health. Recently there have been calls for more attention to preconception and interconceptional health in order to improve birth outcomes, including as a strategy to reduce black-white disparities. METHODS: As part of a larger study of cardiovascular and reproductive health ("Bogalusa Babies"), female participants were linked to their children's birth certificates for Louisiana, Mississippi, and Texas births from 1982 to 2009. Three thousand and ninety-five women were linked to birth certificate data. Birth outcomes were defined as low birthweight (LBW) birthweight < 2500 g; preterm birth (PTB), > 3 weeks early; small for gestational age (SGA), <10th percentile for gestational age (percentiles based on study population); large for gestational age (LGA) >90th percentile for gestational age]. Cardiovascular measures (blood pressure, lipids, glucose, insulin) at the visit closest in time but prior to the pregnancy was examined as predictors of birth outcomes using logistic models adjusted for covariates. RESULTS: Only a few cardiovascular risk factors were associated with birth outcomes. Triglycerides were associated with higher risk of LBW among whites (aOR 1.05, 95% 1.01-1.10). Higher glucose was associated with a reduction in risk of SGA for black women (aOR 0.85, 95% CI 0.76-0.95), but not whites (p for interaction = 0.02). Clear racial disparities were found, but they were reduced modestly (LBW/SGA) or not at all (PTB/LGA) after CVD risk factors were adjusted for. CONCLUSIONS: This analysis does not provide evidence for preconception cardiovascular risk being a strong contributor to racial disparities.


Assuntos
Doenças Cardiovasculares/etiologia , Disparidades nos Níveis de Saúde , Complicações na Gravidez/etiologia , Resultado da Gravidez/etnologia , Adolescente , Adulto , Peso ao Nascer , Glicemia/análise , Pressão Sanguínea , Doenças Cardiovasculares/complicações , Criança , Pré-Escolar , Grupos de Populações Continentais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Lipídeos/sangue , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Estados Unidos , Adulto Jovem
18.
Reprod Biol Endocrinol ; 16(1): 77, 2018 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-30097043

RESUMO

BACKGROUND: Appropriate classification of obesity is vital for risk assessment and complication prevention during pregnancy. We aimed to explore which pre-pregnancy BMI cut-offs of obesity, either BMI ≥ 25 kg/m2 as recommended by the WHO for Asians or BMI ≥ 28 kg/m2 as suggested by the Working Group on Obesity in China (WGOC), best predicts the risk of adverse maternal and perinatal outcomes. METHODS: We retrospectively reviewed 11,494 medical records for live singleton deliveries in a tertiary center in Guangzhou, China, between January 2013 and December 2016. The primary outcomes included maternal obesity prevalence, adverse maternal and perinatal outcomes. Data were analyzed using the Chi-square test, logistic regression, and diagnostics tests. RESULTS: Among the study population, 824 (7.2%) were obese according to the WHO criteria for Asian populations, and this would be reduced to 198 (1.7%) based on the criteria of WGOC. Obesity-related adverse maternal and perinatal outcomes were gestational diabetes mellitus, preeclampsia, cesarean section, and large for gestational age (P < 0.05). Compared to the WGOC criterion, the WHO for Asians criterion had a higher Youden index in our assessment of its predictive value in identifying risk of obesity-related adverse outcomes for Chinese pregnant women. Women in the BMI range of 25 to 28 kg/m2 are at high risks for adverse maternal and perinatal outcomes, which were similar to women with BMI ≥ 28 kg/m2. CONCLUSIONS: A lower pre-pregnancy BMI cutoff at 25 kg/m2 for defining obesity may be appropriate for pregnant women in South China. If WGOC standards are applied to pregnant Chinese populations, a significant proportion of at-risk patients may be missed.


Assuntos
Índice de Massa Corporal , Obesidade/fisiopatologia , Complicações na Gravidez/fisiopatologia , Adulto , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Feminino , Humanos , Obesidade/epidemiologia , Obesidade/etnologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etnologia , Resultado da Gravidez/epidemiologia , Resultado da Gravidez/etnologia , Prevalência , Estudos Retrospectivos
19.
J Perinat Med ; 47(1): 22-29, 2018 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29870393

RESUMO

Background Anthropometric parameters such as birth weight (BW) and adult body height vary between ethnic groups. Ethnic-specific percentile charts are currently being used for the assessment of newborns. However, due to globalization and interethnic families, it is unclear which charts should be used. A correlation between a mother's height and her child's BW (1 cm accounts for a 17 g increase in BW) has been observed. The study aims to test differences in small for gestational age (SGA) and large for gestational age (LGA) rates, employing BW percentile charts based on maternal height between ethnic groups. Methods This retrospective study of 2.3 million mother/newborn pairs analyzed BW, gestational age, sex, maternal height and ethnicity from the German perinatal survey (1995-2000). These data were stratified for maternal height (≤157, 158-163, 164-169, 170-175, ≥176 cm) and region of origin (Germany, Central and Northern Europe, North America, Mediterranean region, Eastern Europe, Middle East and North Africa, and Asia excluding Middle East). Percentile charts were calculated for each maternal height group. Results The average BW and maternal height differ significantly between ethnic groups. On current percentile charts, newborns of taller mothers (≥176 cm) have a low rate of SGA and a high rate of LGA, whereas newborns of shorter mothers (≤157 cm) have a high rate of SGA and a low rate of LGA. When the BW data are stratified based on the maternal height, mothers of similar height from different ethnic groups show similar average BWs, SGA and LGA rates. Conclusion Maternal body height has a greater influence on BW than maternal ethnicity. The use of BW percentile charts for maternal height should be considered.


Assuntos
Peso ao Nascer , Estatura , Parto/etnologia , Adulto , Grupos Étnicos , Feminino , Alemanha/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Gravidez , Resultado da Gravidez/etnologia , Estudos Retrospectivos
20.
Matern Child Health J ; 22(10): 1519-1525, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29936660

RESUMO

Objectives High infant mortality rates among American Indians in North Dakota contribute to a 20-year gap in average age at death compared to whites. Geographic- and race-specific health disparities data to drive policy making and interventions are not well disseminated. The current study examines prenatal risk factors and birth outcomes between American Indian and whites in North Dakota. Methods A retrospective descriptive analysis of North Dakota live births from 2007 to 2012 was conducted. Period prevalence and prevalence ratios were calculated. Results The infant mortality rate from 2010 to 2012 for infants born to American Indian women was 3.5 times higher than whites. Racial disparities existed in education, teen births, tobacco use during pregnancy, and breastfeeding initiation. Disparities widened for inadequate prenatal care, illegal drug use during pregnancy, and infant mortality from 2007-2009 to 2010-2012 and narrowed for sexually transmitted infections and alcohol use during pregnancy. Conclusions for Practice American Indians are disproportionately affected by poor pregnancy and birth outcomes in North Dakota. Future geographic-specific American Indian research is warranted to aid current and future public health interventions.


Assuntos
Grupo com Ancestrais do Continente Europeu , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Mortalidade Infantil , Resultado da Gravidez/epidemiologia , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , North Dakota/epidemiologia , Gravidez , Resultado da Gravidez/etnologia , Cuidado Pré-Natal , Estudos Retrospectivos , Fatores de Risco
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