International comparison of common risk factors of preterm birth between the U.S. and Canada, using PRAMS and MES (2005-2006).

Preterm birth (PTB) is a leading cause of newborn deaths and morbidities. The pregnancy risk assessment monitoring system (PRAMS) from the U.S., and the maternity experiences survey (MES) from Canada, which was modeled from PRAMS, were used to examine between-country differences in risk factors of preterm birth. The adjusted risk ratio and population attributable fraction (PAF) were calculated for modifiable and semi-modifiable risk factors of PTB, and all measures were compared between the U.S. and Canada. PTB was defined here as a live singleton birth between 28 and 37 completed weeks gestation (using the clinical gestational age estimate) where the baby was living with the mother at the time of the survey. The PTB risk was 7.6 % (SE = 0.2) in the U.S. and 4.9 % (SE = 0.3) in Canada. The a priori high risk category of factors was almost always more prevalent in the U.S. than Canada, suggesting broad social differences, but individually most of these differences were not associated with PTB. The underlying risk of PTB was generally higher in the U.S. in both the higher risk and referent categories, and the risk ratios for most risk factors were similar between the countries. The primary exception was for recurrence of PTB, where the risk ratio (RR) and PAF were much higher in Canada. We observed between-country differences in both the prevalence of risk factors and the adjusted RR. Further between-country comparisons may lead to important inferences as to the influence of modifiable risk factors contributing to PTB.

Characteristics of women who consume alcohol before and after pregnancy recognition in a Canadian sample: a prospective cohort study.

BACKGROUND: High levels of alcohol consumption during pregnancy are teratogenic to fetal development, yet less is known about the effects of low levels of consumption. Only a few studies have reported on the predictors and maternal characteristics associated with different alcohol consumption patterns prior to and following pregnancy recognition. METHODS: The All Our Babies longitudinal study in Alberta, Canada was used to analyze the association of maternal characteristics with binge drinking prior to pregnancy recognition and low to moderate levels after pregnancy recognition among 2,246 women who consumed alcohol 1 year prior to pregnancy. Bivariate and multivariable analyses were conducted. RESULTS: Thirteen percent of women reported binge drinking prior to pregnancy recognition. Forty-six percent reported drinking after pregnancy recognition, almost all at low to moderate levels. Significant, independent predictors (odds ratio, 95% confidence interval) of binge drinking in early pregnancy included high school or less education (3.61, 1.81 to 7.19), some or completed university/college (2.23, 1.16 to 4.27), nulliparity (1.62, 1.19, 2.20), not trying to get pregnant (1.92, 1.37 to 2.69), smoked in the year prior to pregnancy (1.98, 1.43 to 2.73), binge drinking in the year prior to pregnancy (10.83, 6.71 to 17.46), and low dispositional optimism (1.73, 1.23 to 2.42). Independent predictors of low to moderate average levels of consumption after pregnancy recognition included not trying to get pregnant (1.91, 1.45 to 2.52), prepregnancy body mass index <25.0 kg/m(2) (1.41, 1.61 to 1.72), smoking in the year before pregnancy (1.90, 1.43 to 2.53), and binge drinking in the year before pregnancy (2.62, 2.16 to 3.18). CONCLUSIONS: Common risk factors for different alcohol consumption patterns are unintended pregnancy and substance use behaviors prior to pregnancy. Other risk factors were specific to the different patterns. Targeted strategies that address the needs of alcohol or nicotine using women and that can reduce the risk of unintended pregnancy may be beneficial.

Breastfeeding difficulties and exclusivity among late preterm and term infants: results from the all our babies study.

OBJECTIVE: To compare breastfeeding difficulties attributable to the baby and mother/milk and exclusive breastfeeding between a group of late preterm (LP) infants and term infants. METHODS: We utilized data from a prospective community-based cohort (n=2977) in Calgary, Alberta, and performed bivariate and multivariable analyses to identify demographic, obstetric, maternal and infant health indicators that were independently associated with term status and breastfeeding outcomes. RESULTS: Multivariable analyses found that LP status was an independent risk factor for breastfeeding difficulties attributable to the baby (OR 1.72, 95% CI 1.24-2.38), but not for difficulties due to mother/milk (defined as not producing enough milk or having flat or inverted nipples). Among women who were breastfeeding at hospital discharge, mothers of LP infants were less likely to report exclusive breastfeeding at 4 months (OR 0.67, 95% CI 0.46-0.97), after controlling for household income level, mode of delivery and postpartum maternal physical health. CONCLUSIONS: Mothers of LP infants need increased support to establish successful breastfeeding outcomes and to ensure that these infants receive the full benefits of breast milk.

Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies.

OBJECTIVE: To assess the effect of 25-hydroxyvitamin D (25-OHD) levels on pregnancy outcomes and birth variables. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline (1966 to August 2012), PubMed (2008 to August 2012), Embase (1980 to August 2012), CINAHL (1981 to August 2012), the Cochrane database of systematic reviews, and the Cochrane database of registered clinical trials. STUDY SELECTION: Studies reporting on the association between serum 25-OHD levels during pregnancy and the outcomes of interest (pre-eclampsia, gestational diabetes, bacterial vaginosis, caesarean section, small for gestational age infants, birth weight, birth length, and head circumference). DATA EXTRACTION: Two authors independently extracted data from original research articles, including key indicators of study quality. We pooled the most adjusted odds ratios and weighted mean differences. Associations were tested in subgroups representing different patient characteristics and study quality. RESULTS: 3357 studies were identified and reviewed for eligibility. 31 eligible studies were included in the final analysis. Insufficient serum levels of 25-OHD were associated with gestational diabetes (pooled odds ratio 1.49, 95% confidence interval 1.18 to 1.89), pre-eclampsia (1.79, 1.25 to 2.58), and small for gestational age infants (1.85, 1.52 to 2.26). Pregnant women with low serum 25-OHD levels had an increased risk of bacterial vaginosis and low birthweight infants but not delivery by caesarean section. CONCLUSION: Vitamin D insufficiency is associated with an increased risk of gestational diabetes, pre-eclampsia, and small for gestational age infants. Pregnant women with low 25-OHD levels had an increased risk of bacterial vaginosis and lower birth weight infants, but not delivery by caesarean section.

Neonatal tetanus elimination in Pakistan: progress and challenges.

Pakistan is one of the 34 countries that have not achieved the neonatal tetanus (NT) global elimination target set by the World Health Organization (WHO). NT, caused by Clostridium tetani, is a highly fatal infection of the neonatal period. It is one of the most underreported diseases and remains a major but preventable cause of neonatal and infant mortality in many developing countries. In 1989, the World Health Assembly called for the elimination of NT by 1995, and since then considerable progress has been made using the following strategies: clean delivery practices, routine tetanus toxoid (TT) immunization of pregnant women, and immunization of all women of childbearing age with three doses of TT vaccine in high-risk areas during supplementary immunization campaigns. This review presents the activities, progress, and challenges in achieving NT elimination in Pakistan. A review of the literature found TT vaccination coverage in Pakistan ranged from 60% to 74% over the last decade. Low vaccination coverage, the main driver for NT in Pakistan, is due to many factors, including demand failure for TT vaccine resulting from inadequate knowledge of TT vaccine among reproductive age females and inadequate information about the benefits of TT provided by health care workers and the media. Other factors linked to low vaccination coverage include residing in rural areas, lack of formal education, poor knowledge about place and time to get vaccinated, and lack of awareness about the importance of vaccination. A disparity exists in TT vaccination coverage and antenatal care between urban and rural areas due to access and utilization of health care services. NT reporting is incomplete, as cases from the private sector and rural areas are underreported. To successfully eliminate NT, women of reproductive age must be made aware of the benefits of TT vaccine, not only to themselves, but also to their families. Effective communication strategies for TT vaccine delivery and health education focusing on increasing awareness of NT are strongly suggested. It is imperative that the private and government sectors work cooperatively to report NT cases and improve routine TT vaccination coverage.