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Biomedical subjects

E E Ekwo

Publications and source records attributed to E E Ekwo.

At least 19 recordsLinked to original sources
PubMed2000

Maternal age and preterm births in a black population.

Babies born to teenagers aged 15-19 years have a substantial risk of dying within the first year of life. Although associated socio-demographic factors may account for an increase in the risk of adverse reproductive outcomes for teenagers, there is a concern that young maternal age may also be a biological risk factor. We examined the effects of maternal age of primiparous black women on the incidence of preterm births using data from 6,072 black women delivering between 1989 and 1995 at an urban perinatal network of 17 hospitals and health centres serving residents in a well-defined geographical area. Maternal age was grouped as: < or = 15, 16-17, 18-19, 20-24, 25-29 or > or = 30 years age groups. The 20-24 age group with the highest number of births and lowest preterm rate was used as the reference age. Preterm birth was defined as delivery < 37 completed weeks of gestation. Of the 6,072 infants born to the cohort, 1,170 (19.3%) were preterm. The unadjusted odds for a preterm birth for the < or = 15-year-olds (odds ratio [OR] = 0.97; 95% confidence interval [CI], 0.69,1.36), for the 16- to 17-year-olds (OR=1.21; CI=0.94, 1.57) and for the 18- to 19-year olds (OR=1.15, CI = 0.92, 1.43) were not significantly different from that for the reference group. The risk for the 25-to 29-year-old mothers was 1.26 times [CI = 1.05, 1.50] and for the > 30-year-old mothers 1.28 times [CI = 1.07, 1.52] that for the reference group. Adjustments using logistic regression analysis for the effects of maternal smoking, drug abuse during pregnancy, insurance status, having prenatal care and median family income from census tract of residence did not result in a significantly increased risk for preterm birth or low birthweight for the teenage groups compared with the reference group. We conclude that primiparous teenage black mothers do not have an inherent biologically increased risk for preterm births.

Adolescent↗
PubMed1998

The relationship of interpregnancy interval to the risk of preterm births to black and white women.

BACKGROUND: Premature births are of major public health concern. Short interpregnancy intervals may influence the incidence of premature births among black and white women, with blacks conceiving at shorter intervals than whites. DESIGN: Women (293 blacks and 468 whites) with complete obstetric records delivering singleton infants between January 1988 and December 1993 were included. We related the outcome of the second of any pair of consecutive pregnancies to the interval between the pair. RESULTS: Both black and white women conceiving within 3 months or less of their preceding pregnancy had a high risk of premature birth (37.5%). At all other intervals, the risk among blacks was consistently over twice that for whites. Conception within an interval of 6 months or less was significantly associated with increased risk of premature birth for blacks (35.8% versus 25.8% for longer intervals; P = 0.03), but this difference was not significant after controlling for other confounding variables (odds ratio = 1.52, 95% confidence interval [CI]: 0.91-2.55). Whites conceiving within 6 months compared to those conceiving after more than 6 months had no significant increased risk (18.4% versus 9.7%). The risk of preterm birth was 1.67 (CI: 0.42-2.91) for women conceiving at < or =6 months, compared to those who conceived after 6 months, after controlling for confounding variables. CONCLUSIONS: Preterm birth was not significantly associated with short intervals of 6 months or less for both black and white women. A subset of multiparous black women with short interpregnancy intervals, however, may have an increased risk of premature birth.

Adolescent↗
PubMed1993

Coitus late in pregnancy: risk of preterm rupture of amniotic sac membranes.

OBJECTIVES: Coitus with or without orgasm in late pregnancy is inconsistently associated with preterm rupture of amniotic sac membranes. We tested the hypothesis that during late pregnancy sexual behaviors including sexual positioning relate to the occurrence of premature rupture of membranes. STUDY DESIGN: Women aged 15 to 45 years having preterm premature rupture of membranes, term premature rupture of membranes, or preterm delivery without premature rupture of membranes were matched singly by age, race, and parity to control women delivered of term infants. Information about six sexual activities, obstetric history, cervical infections, smoking during pregnancy, and sociodemographic information was obtained by face-to-face interview. RESULTS: Only the male superior position was significantly associated with preterm premature rupture of membranes (odds ratio 2.40, 95% confidence interval 1.16 to 4.97) and preterm delivery without premature rupture of membranes (odds ratio 1.82, confidence interval 1.02 to 3.25) after confounding variables were controlled for. No sexual positioning or sexual activities related significantly to term premature rupture of membranes. CONCLUSION: Most sexual positions and activities during late pregnancy are not associated with adverse pregnancy outcomes.

Adolescent↗
PubMed1993

Risks for premature rupture of amniotic membranes.

The objective of this study was to test the hypothesis that diverse risk variables including infections during the index pregnancy independently increase the risk of preterm premature rupture of amniotic membranes (PROM) and preterm delivery without PROM. A case-control design was used to study women 15-45 years old who had preterm PROM, full-term PROM or preterm without PROM and were singly matched by age race and parity to controls who delivered full-term infants. The odds for preterm PROM was 6.0 times that of controls among women with intra-amniotic infection, 3.7 times among those with urinary tract and 7.6 times among women with gonorrhoea infections after controlling for the effects of exposure to cigarette smoke, having previous preterm and full-term PROM deliveries and antepartum bleeding that independently increased the odds. The odds for preterm births without PROM was 4.8 times that of controls among women with a previous preterm PROM birth, was significantly increased among those exposed to cigarette smoke or having antepartum bleeding, but not among those exposed to chlamydia infection. Even after adjusting for concomitant risk factors, women with preterm PROM births were more likely than their matched controls to have had infections.

Adolescent↗
PubMed1993

Previous pregnancy outcomes and subsequent risk of preterm rupture of amniotic sac membranes.

OBJECTIVE: To test the hypothesis that previous unfavourable pregnancy outcomes increase the risk for premature birth, with (PP) or without (PTB) premature rupture of the amniotic sac (PROM) at the index pregnancy and that multiple undesirable outcomes increase risk. DESIGN: Case control study. SETTING: Two university hospitals. SUBJECTS: Four hundred sixty-three women aged 15 to 45 years who were delivered preterm PROM, full term PROM and preterm without PROM matched with 463 women who delivered full term. All women included in the study had at least one previous pregnancy. OUTCOME MEASURES: Odds ratio of previous adverse pregnancy outcome among index cases. RESULTS: Compared with controls, PP cases had odds ratios of 95 for previous preterm birth, 186 for abortion and prematurity and 158 for fetal loss, abortion/prematurity after controlling for confounding variables. Compared with controls, PTB cases had an odds ratio of 96.5 for previous preterm delivery, 84 for abortion and prematurity, and 320 for fetal loss/abortion and prematurity after controlling for confounding variables. CONCLUSIONS: Previous preterm delivery, abortion and prematurity and fetal loss/abortion and prematurity all increase risk for subsequent preterm birth with or without PROM.

Abortion, Spontaneous↗
PubMed1993

Adequacy of prenatal care and risk of pre term rupture of amniotic sac membranes.

Premature rupture of amniotic membranes (PROM) is associated with perinatal morbidity and mortality. A matched case-control study was undertaken to determine whether adequacy of prenatal care was associated with increased risk for PROM. Three study groups were defined, consisting of women delivering pre term with PROM, full term with PROM, and pre term without PROM. Cases were singly matched by race, age, and parity with women having full term deliveries without PROM. Data were collected by face-to-face structured interviews with eligible subjects and by medical records abstraction. Conditional multiple logistic regression indicated that among women with inadequate levels of prenatal care during pregnancy the risk for pre term PROM was 3.11 (CI = 1.10-8.78) and for pre term without PROM 2.18 (CI = 1.05-4.53) times higher than for their matched controls, even when adjusted for other sociodemographic, behavioral, index pregnancy, and medical history factors. We conclude that inadequate prenatal care may be a marker for less healthy behaviors, lifestyles, and environmental factors among women at increased risk for pre term delivery.

Adolescent↗
PubMed1992

Dietary habits, prepregnancy weight, and weight gain during pregnancy. Risk of pre term rupture of amniotic sac membranes.

BACKGROUND: Premature rupture of amniotic sac membranes (PROM) is associated with perinatal morbidity and mortality. A matched case-control study was undertaken to determine whether dietary habits, prepregnancy weight, and weight gain during pregnancy were associated with increased risks for PROM. METHODS: Three study groups were defined, consisting of women delivering pre term with PROM (PP), full term with PROM (FP), and pre term without PROM (PWP). Cases were singly matched by race, age, and parity with women having full term deliveries without PROM. Data were collected by face-to-face structured interviews with eligible subjects and by medical records abstraction. RESULTS: Conditional multiple logistic regression indicated that during pregnancy, PP cases were significantly more likely to have gained less than 21 pounds (9.5 kg) (OR = 2.7, CI = 1.14-6.36) and were only half as likely as controls to have improved their diet (OR = 0.43, CI = 0.18-0.99) while controlling for cigarette smoking, urinary tract infection, chorioamnionitis, chlamydia, and a history of previous PROM. FP cases were significantly less likely than controls to have gained 31-40 pounds (14-18 kg) while pregnant (OR = 0.56, CI = 0.33-0.94) and were significantly more likely than controls to have a somewhat inadequate pregnancy diet (OR = 2.05, CI = 1.11-3.77) while controlling for a history of previous PROM. PWP cases were significantly less likely to have gained 31-40 pounds (14-18 kg) (OR = 0.42, CI = 0.21-0.84) or greater than 40 pounds (18 kg) (OR = 0.37, CI = 0.17-0.80) while pregnant or to have had adequate dairy products intake (OR = 0.60, CI = 0.36-0.99) while controlling for cigarette usage. CONCLUSION: Maternal dietary habits, weight gain during pregnancy, and supplement intake are associated with the occurrence of both pre term and full term PROM and pre term delivery without PROM.

Adult↗
PubMed1992

Unfavorable outcome in penultimate pregnancy and premature rupture of membranes in successive pregnancy.

OBJECTIVES: Previous adverse obstetric events are known to influence the outcome of the succeeding pregnancy. We tested the hypothesis that preterm premature rupture of membranes (PROM), full-term PROM, and preterm delivery without PROM relate independently to the outcome of the immediately preceding pregnancy. METHODS: In a case-control study, 345 women 15-45 years old with preterm PROM, full-term PROM, or preterm delivery without PROM were singly matched by age, race, and parity to women having full-term delivery. Information about the penultimate pregnancy, household smoking, and sociodemographic variables were obtained during face-to-face interviews. Obstetric history, infections during pregnancy, and pregnancy complications abstracted from medical records were cross-checked with patient interview data. Penultimate pregnancy outcomes included full-term delivery, premature delivery, fetal loss or miscarriage, and planned abortion. RESULTS: Women having preterm PROM or preterm delivery without PROM in the index pregnancy were, respectively, 6.34 and 21.28 times more likely than controls to have had preterm delivery in the preceding pregnancy. A preceding fetal loss or miscarriage also increased 4.39-fold the risk for preterm PROM. Exposure to cigarette smoke, urinary tract infections, and vaginal bleeding during the index pregnancy independently increased the risk for preterm PROM. Women with full-term PROM did not differ significantly from controls in the outcomes of the penultimate pregnancy. CONCLUSION: Preterm delivery in the preceding pregnancy is associated with an increased risk for preterm delivery with or without PROM.

Abortion, Spontaneous↗
PubMed1987

Parental perceptions of the burden of genetic disease.

Parents who are carriers of genes that code for genetic disease face a complex decision regarding procreation. To investigate how parents perceive the potential effects of having a child with congenital defects and how such perceptions influence their reproductive decisions, 202 women accepting and 50 women rejecting amniocentesis after genetic counseling were followed in a 3-year longitudinal study. Using multiple correspondence analysis, we found that perceived burdens associated with hypothetical congenital abnormalities leading to prolonged illness or early death were considered the most serious, those related to physical handicap or facial abnormalities were perceived as least serious, while genetic defects causing mental retardation fell between. The parents were increasingly likely to accept amniocentesis the more they felt they would be unable to cope with the consequences of a genetic disease leading to prolonged illness or mental retardation (R = .23). Overall, the women who accepted amniocentesis were those who perceived the consequences of congenital malformation as most burdensome. The findings suggest that genetic counselors should not only explore parents' attitudes about specific congenital abnormalities, but also their perceptions of how they would cope with the medical and social consequences of the various genetic defects.

Adaptation, Psychological↗
PubMed1985

Factors influencing maternal estimates of genetic risk.

The relationship between the objective and subjective estimates of genetic risk was studied in 202 women accepting and 50 women not accepting amniocentesis. All women were at risk of having a child with congenital anomalies either because of maternal age at pregnancy or family history of Down syndrome (DS) or other congenital anomalies. Only 28.6% of the women rejecting and 44.4% of the women accepting amniocentesis remembered correctly their objective odds. The correlations between the objective risk estimates and the subjective risk estimates were low overall (r = 0.089, p = 0.08); for women rejecting (r = 0.024, p = 0.44) or accepting (r = 0.082, p = 0.12) amniocentesis. The psychosocial and sociodemographic variables relating to either objective or subjective risk estimates were different for both groups of women. The study provides information on variables that should be taken into consideration in formulating a general theory to predict individual perceptions of genetic risk.

Adult↗
PubMed1985

Investigation of a model for the initiation of breastfeeding in primigravida women.

Primigravida women are faced with the decision about how they will feed their infants. Many will decide to breastfeed but the motivation for this choice is unclear. While certain beliefs and worries about breastfeeding appear to predict women who will choose to breastfeed, such concepts are influenced by a combination of other values, support resources and socioeconomic background. The main goal of this research was to demonstrate how multivariate analysis can be applied to the infant-feeding decision and how it can lend a theoretical interpretation to social issues such as the initiation of breastfeeding. One hundred completely breastfeeding and 57 bottle feeding primigravida women were enrolled in the study and completed a pretested Likert-type questionnaire. Three primary predictors for the initiation of breastfeeding were identified: positive maternal beliefs about breastfeeding; the absence of maternal worries about breastfeeding; and higher levels of maternal education. Secondary psychosocial predictors significantly associated with maternal breastfeeding beliefs included maternal beliefs in increased personal satisfaction from breastfeeding and maternal beliefs in preventive health measures. Secondary psychosocial predictors significantly related to maternal worries about breastfeeding before breastfeeding began. Over half of the strength of the direct psychosocial predictors for breastfeeding initiation could be attributed to their respective groups of indirect predictors. Thus, the main contribution of this research has been to shift the emphasis of past research away from differences between groups of bottle feeders and breastfeeders to focus more precisely on the decision-making process involved in the infant feeding choice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Anorectal manometry for the exclusion of Hirschsprung's disease in neonates.

We studied the usefulness of anorectal manometry in excluding Hirschsprung's disease in 25 neonates with signs and symptoms of intestinal obstruction. An intraluminal pressure transducer or perfused side-opening catheters were used to evaluate anal tone, anal rhythmicity, and internal sphincter relaxation during rectal distention. Hirschsprung's disease was diagnosed by rectal biopsy in 16% of the neonates. Studies using anorectal manometry gave one false positive and one false negative diagnosis of Hirschsprung's disease, which resulted in 75% sensitivity, 95% specificity, and a kappa coefficient of 0.7. We found that anorectal manometry, a rapid and atraumatic test, is a reliable screening test for exclusion of neonatal Hirschsprung's disease. By using the combination of manometry and contrast enema, it is possible to eliminate the need for a confirmatory rectal biopsy in many neonates suspected of having Hirschsprung's disease.

Anal Canal↗
PubMed1984

Psychosocial factors influencing the duration of breastfeeding by primigravidas.

We studied factors which influence the duration of breastfeeding by 81 primigravidas by use of a Likert-type questionnaire. Three primary independent variables related inversely to the duration of breastfeeding in a multiple regression analysis. The most important of these variables was maternal perception of difficulties in scheduling breastfeeding on her return to work (p less than 0.01). Also total family income (p less than 0.01) and maternal worries about the demands of breastfeeding (p less than 0.01) inversely related to the duration of breastfeeding. Causal analytical technique was used to identify secondary variables relating to the primary independent variables. Maternal worries about the demands of breastfeeding related strongly to her worries about the lack of family psychosocial support. Maternal age and complications of breastfeeding did not relate to the duration of breastfeeding.

Breast Feeding↗
PubMed1983

Factors influencing initiation of breast-feeding.

We used the critical incidence method to study factors motivating 33 primigravidas and 39 multigravidas to initiate breast-feeding of their infants. Women chose breast-feeding because they believed that it would provide protection to the infant against infection, establish maternal-infant bonding, was convenient, provided better nutrition than cow's milk formula, was emotionally satisfying, and was the natural way to feed infants. The decision to breast-feed was made well in advance of pregnancy by primigravidas and shortly before pregnancy by multigravidas. Friends who had successfully nursed infants were as influential as immediate family members in influencing our study subjects in their decision to breast-feed. Prenatal counseling, though important, may not be the optimal period for motivating women to breast-feed.

Adult↗
PubMed1983

Relationship of parental smoking and gas cooking to respiratory disease in children.

In a survey of 1,355 children six- to 12 years of age, the risk of hospitalization for respiratory illness among children before age two years was increased when gas was used for cooking at home (p less than 0.001) or at least one of the parents smoked (p less than 0.02). The occurrence of cough with colds in children also was significantly increased when one or both parents smoked (p less than 0.001). Small but significant increases (p less than .05) in the mean values of forced expiratory volume at one second, the flow rate at 75 percent of the forced vital capacity, and the forced expiratory flow rate from 25 percent to 75 percent of the vital capacity (FEF25-75) were seen after administering inhaled isoproterenol to children whose parents smoked (n = 94) but not among children whose parents did not smoke (n = 89); this was not seen in association with gas cooking. Thus, exposure of children during the first two years of life to gas cooking or cigarette smoking appears to be associated with an increased risk of hospitalization for respiratory illness, and cigarette smoking appears to be associated with a more consistent response to inhaled bronchodilator among six- to 12-year-old children with no other history of chronic respiratory illness.

Child↗
PubMed1982

Comparison of orally administered metaproterenol and theophylline in the control of chronic asthma.

The efficacy of metaproterenol (orciprenaline) and theophylline given orally at currently recommended doses was examined in 34 children with chronic asthma using a randomized double-blind cross-over evaluation of four weeks' duration for each active regimen. No serious adverse effects were seen with either medication, but tremor occurred more frequently with metaproterenol (P less than 0.01). No significant differences were observed in the frequency of nausea, vomiting, headache, or insomnia (P greater than 0.05). Symptoms of wheezing, coughing, exercise intolerance, and interference with sleep were more frequently associated with the oral metaproterenol regimen; completely asymptomatic days occurred 50% more frequently in association with theophylline therapy (P less than 0.01). Mean peak flows, performed twice daily during each of the four-week study periods, were 86 and 92% of predicted for metaproterenol and theophylline, respectively (P less than 0.05). Pulmonary function decreased significantly less with theophylline than with metaproterenol among those who completed six minutes of treadmill exercise during both regimens (P less than 0.05). Corticosteroids, used for acute symptoms that failed to respond to the addition of inhaled metaproterenol, were required in four patients during both regimens, in ten patients only during the metaproterenol regimen, and in one patient only during the theophylline regimen (P less than 0.02). Thus, theophylline therapy was associated with fewer adverse effects, fewer symptoms of asthma, better pulmonary function, better exercise tolerance, and less requirements for corticosteroids than was treatment with metaproterenol.

Administration, Oral↗
PubMed1980

Monitoring health care: children with bacteriuria.

A program which used a nurse clinician to monitor the health care received by children with bacteriuria is described. We identified 152 patients with significant bacteriuria (greater than or equal to 10(5) organisms/ml) by urine culture from 351 patients who either had symptoms suggestive of urinary tract infections or routine urinalysis during health care visits. Adequate health care was provided to 116 (76%) of the 152 patients and inadequate health care to 31 (24%) of these patients. A significant number of patients who received inadequate therapy (12 of 36, or 37%) compared to 8 (7%) of 116 patients who received adequate therapy failed to clear their bacteriuria (Chi-square = 17, p less than 0.001). Eight patients with recurrent bacteriuria despite adequate therapy were shown to have no urinary tract anomaly by radiography. The use of recurrence of UTI as a criterion for measuring adequacy of therapy and the uniqueness of the program are discussed.

Bacteriuria↗