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Biomedical subjects

M M Adams

Publications and source records attributed to M M Adams.

At least 55 records · Page 3Linked to original sources
PubMed1991

The Pregnancy Risk Assessment Monitoring System: design, questionnaire, data collection and response rates. PRAMS Working Group.

The birth certificate, the primary tool for population-based surveillance of the condition of infants at birth and maternal status during pregnancy, provides little data about maternal behaviour during pregnancy. To collect data on maternal behaviours that influence pregnancy outcome, we implemented the Pregnancy Risk Assessment Monitoring System in seven states. For this population-based surveillance, new mothers were sampled from birth certificates 2 to 6 months after delivery and contacted by mail; follow-up of nonrespondents was by telephone. Participants completed a 10-page questionnaire. Stratification permitted over-sampling of women with adverse pregnancy outcomes. Among 10,563 women sampled during 1988 and 1989, stratum-specific response rates ranged from 30% to 89%. In 11 of the 28 strata, response rates were greater than 70%. Response rates varied considerably between states. Rates were lower for Black mothers, mothers of low birthweight infants, unmarried mothers and mothers with less than 12 years of education. Active refusal to participate and undelivered mail occurred infrequently. Mail and telephone surveillance of new mothers can yield adequate response rates in selected population groups. Trials of alternative approaches to enhancing response among Black and disadvantaged mothers, such as additional mailings or post-partum in-hospital recruitment, are needed.

Black or African American↗
PubMed1990

Descriptive epidemiology of selected malformations of the aorta, Atlanta, 1970-1983.

To augment available population-based epidemiologic data for obstructive malformations of the aorta, we studied the descriptive epidemiology of coarctation, hypoplasia, and interruption of the aortic arch in Atlanta from 1970 through 1983. The study used data from the Metropolitan Atlanta Congenital Defects Program, a population-based birth defects registry. One hundred seventy infants were identified as having either interruption of the aortic arch (18), coarctation (131), or hypoplasia (21) of the aorta. The prevalence per 10,000 live births was as follows: interruption of the aortic arch, 0.50; coarctation, 3.62; and hypoplasia of the aorta, 0.58. Despite the differences in rates, the descriptive epidemiology for the three malformations was similar. None of the malformations was associated with gender or maternal age. Birth prevalence for whites was higher than that for other races; the increase, however, was statistically significant only for coarctation. Birth prevalence of these malformations increased during the period of observation, with the greatest increase (threefold) seen with interruption of the aortic arch. The rates for all malformation groups also showed a strong inverse association with birthweight.

Adult↗
PubMed1990

Are race and length of gestation related to age at death in the sudden infant death syndrome?

Although race and preterm delivery are known to be associated with sudden infant death syndrome (SIDS), the relationships between age at death from SIDS and these factors have not been well described. To examine these relationships, we used linked infant birth and death records for the cohort of 1,204,375 White and 283,776 Black postneonates who were born from 1979 to 1981 in five states: California, Georgia, Missouri, South Carolina and Tennessee. Deaths attributable to SIDS occurred to 1404 White postneonates and to 696 Black postneonates. Although postneonatal SIDS rate among Black infants was twice that of White infants, the relative risk was smaller among infants with gestations of less than 35 weeks. For White postneonates, the median postneonatal age at death sharply declined for gestations from 28-29 weeks to 36-37 weeks and levelled off for longer gestations. For Black postneonates, the results do not support an association between length of gestation and age at death. The findings suggest that practitioners investigating approaches to avert SIDS need to maintain their interventions to an older age among White preterm infants. Researchers investigating the causes of SIDS need to consider the relationship between length of gestation and age at death from SIDS as well as possible developmental differences between White and Black preterm infants.

Black or African American↗
PubMed1989

Risk factors for conotruncal cardiac defects in Atlanta.

Because the causes of conotruncal cardiac defects are poorly understood, a case-control study was conducted to investigate maternal risk factors for conotruncal cardiac defects. Eligible cases included all infants who were born from 1976 through 1980 to residents of the five county metropolitan Atlanta area and diagnosed with truncus arteriosus, transposition of the great arteries or tetralogy of Fallot. Eligible control infants were a sample of comparable infants without birth defects. Maternal interviews were conducted for 73% (83 of 114) of eligible cases and 72% (1,303 of 1,804) of eligible control infants. The results showed increased risks associated with maternal diabetes (odds ratio 5.6; 90% confidence interval 2.5 to 15.6), maternal stress related to job loss, divorce, separation or death of a close friend or relative (odds ratio 2.4; 90% confidence interval 1.4 to 4.2) and a history of a sibling with a cardiac defect (odds ratio 4.8; 90% confidence interval 2.2 to 10.5). The statistical power of the data was adequate to rule out threefold or greater increases in risk for a wide variety of other exposures, including maternal illnesses other than diabetes, contraceptive use, nonmedicinal drugs (for example, coffee, tea, alcohol, cigarettes, street drugs), employment and education. This population-based study offers no clues that could explain either the high rate of transposition of the great arteries or the temporal trend of an increasing rate of tetralogy of Fallot in Atlanta.

Cross-Sectional Studies↗
PubMed1987

Monitoring for multiple malformations in the detection of epidemics of birth defects.

Although most known human teratogens often produce a combination of birth defects in an affected infant, surveillance programs aimed at detecting epidemics of birth defects usually only monitor rates of individual defects. A drawback to this approach is that an increase in the rate of infants affected with a specific combination of defects may lead to little or no increase in the rates of component defects. Using the Poisson distribution, we show that, compared with monitoring for individual defects, monitoring for combinations of two and three defects may require fewer numbers of births to detect an epidemic. In general, an increase can be detected more rapidly by monitoring the rates of defect combinations than by monitoring the rates of individual defects if most affected infants have combinations of defects rather than isolated defects. For example, in the case of Congenital rubella syndrome (CRS), monitoring for the combination of cataracts with deafness and/or patent ductus arteriosus could have led to earlier detection of an epidemic than could monitoring for cataracts alone. In contrast, in the case of thalidomide embryopathy, monitoring for reduction defects of upper limbs in combination with reduction defects of lower limbs and/or microtia/anotia would not have led to earlier detection of an epidemic than would monitoring for reduction defects of upper limbs alone. This is due mainly to the low frequency of defect combinations among affected cases. When used with regular monitoring for individual defects, surveillance of defect combinations can enhance the ability of monitoring programs to detect epidemics of birth defects.

Abnormalities, Drug-Induced↗
PubMed1985

Trends in clinical characteristics of infants with spina bifida--Atlanta, 1972-1979.

In Atlanta, the birth prevalence of spina bifida declined from 10.1 per 10,000 live births in 1972-1973 to 5.8 per 10,000 live births in 1978-1979. This trend cannot be explained by use of prenatal diagnosis, because it was unavailable in Atlanta until 1976, and even in the late 1970s was not used widely. To determine if this decrease was associated with changes in the distribution of clinical characteristics among infants with spina bifida, we reviewed the medical records of a population-based group of 154 infants with spina bifida, born in Atlanta during the eight-year period from 1972 through 1979. Distribution by the highest level of the defect on the spine did not change during these years. The proportions of infants with isolated spina bifida (ie, no other major malformations) and with open spina bifida (ie, not covered by skin) did, however, decrease. When we examined these two characteristics simultaneously, we found declines in both the proportion of infants with open-isolated spina bifida and the birth prevalence of infants with open-isolated spina bifida. If this trend persists, it will have important implications for workers involved with prenatal alpha-fetoprotein screening and researchers investigating the etiology of spina bifida.

Abnormalities, Multiple↗
PubMed1985

The descriptive epidemiology of sudden infant deaths among natives and whites in Alaska.

From 1976-1980, the incidence of sudden infant deaths among native Alaskans was 2.9 times higher than that for white Alaskans (6.28 per 1,000 live births among natives vs. 2.14 per 1,000 live births among whites). Linked birth and death vital records data were used to compare the age-at-death distributions and relative risks associated with demographic factors for natives and whites. The purpose of the comparisons was to seek clues to the etiology of sudden infant death in natives. The age-at-death distributions for natives and whites were virtually identical (mean age at death 90.4 +/- 7.0 days for natives; 87.8 +/- 6.5 days for whites). The associations between the risk of sudden death and birth weight, marital status, season of birth, and residence were similar for natives and whites. The risk associated with young maternal age (less than 20 years) was significantly higher for whites than for natives (3.20 vs. 1.38). The sex ratio for sudden deaths among whites significantly favored males (relative risk = 1.78; female = reference); a significant sex ratio was not apparent for natives. Vital records data were useful for confirming the native-white difference in sudden infant death incidence, but not for elucidating etiologic differences between natives and whites.

Age Factors↗
PubMed1985

Survival of infants with spina bifida--Atlanta, 1972-1979.

We studied the survival of a population-based cohort of 154 infants with spina bifida who were born during the eight-year period from 1972 through 1979 to residents of Atlanta. Our objectives were to describe the cohort's survival experience and to explore relationships between clinical characteristics and survival. Overall, 57% of the cohort survived one year or more. This figure is misleading, however, because it conceals important differences in survival among subgroups of affected infants. From univariate analyses, we observed significant differences in survival among infants categorized by year of birth, birth weight, the open-closed status of the defect, the highest level of the defect on the spine, the presence of multiple major birth defects, and the presence of hydrocephalus at birth. More infants born in the late 1970s survived their first year of life than infants born in the early 1970s; infants with open defects had lower survival than those with closed defects; and infants whose defects were low on the spine had better survival than those whose defects were higher. When comparing the survival experience of this cohort with that of other groups from other areas or from more recent years, health workers must consider referral biases and differences in the distribution of clinical characteristics.

Abnormalities, Multiple↗
PubMed1984

Cost implications of routine antenatal administration of Rh immune globulin.

Using decision analysis, we estimated the benefits, risks, and costs of a program for routine antepartum administration of Rh immune globulin to Rh-negative primiparous women, who were studied through their second deliveries. The number of births of second-order infants with Rh hemolytic disease of the newborn averted by an antepartum program for 10,000 Rh-negative primiparous women was estimated by race to be white, 14; black, 18; and Asian, 35. For all races, the costs incurred by an antepartum program were more than double the costs averted. Sensitivity analyses showed that the most crucial factor influencing the benefits of routine antepartum administration of Rh immune globulin is the probability of severe chronic disability from hemolytic disease of the newborn. Current data are unavailable for the probability of this event. Another factor affecting the program's benefits is the rate of antepartum Rh sensitization among primiparous women. If the program were restricted to primiparous women at high risk for antepartum Rh sensitization, its benefits might exceed its costs.

Cost-Benefit Analysis↗
PubMed1984

Use of prenatal diagnosis among parents of infants with spina bifida in Atlanta, Georgia, 1976-1979.

A follow-up was made of the parents of a population-based cohort of 154 infants with spina bifida who were born in Atlanta during 1972-1979. We interviewed the parents of these infants and, for pregnancies after the spina bifida-affected birth, the ratio of use of prenatal diagnosis and the rate of recurrence of spina bifida were ascertained. Among 43 pregnancies which occurred in 1976 or later, and which occurred after a spina bifida-affected birth, prenatal diagnosis was used for 27 pregnancies (63%). For whites, among full siblings born after a spina bifida-affected birth, the recurrence rate for spina bifida was 2% (1/51). For blacks, among seven full siblings born after a spina bifida-affected birth, none was affected. Prenatal diagnosis appears to be well accepted among these parents of infants with spina bifida.

Adult↗
PubMed1984

Guidelines for planning home enteral feedings.

Tube feeding at home is a viable option for maintaining optimum nutriture when oral intake is inadequate or impossible. Qualifying patients and their caretakers can be instructed in formula preparation, feeding administration, and related care techniques. Extra hospital support systems, including insurance agencies, home medical suppliers, and public health nurses, are available to facilitate the transition from hospital to home care. For patients who require enteral nutrition but not acute or extended medical care, home tube feeding can promote a less disrupted family unit, improved quality of life, and diminished health care costs.

Enteral Nutrition↗
PubMed1981

Down's syndrome. Recent trends in the United States.

The crude incidence of Down's syndrome (DS) in the United States is currently about 1/1,000 births. Reduction in the proportion of births to women 35 years and older can account for a halving of the estimated percentage of DS births to this age group and a drop in the estimated crude incidence of DS from 1.33/1,000 births in 1960 to 0.99/1,000 births in 1978. Epidemiologic studies suggest that among women 35 years and older, the risk of having a child with DS has not changed. With the present distribution of maternal ages, prenatal diagnosis among women 35 years and older can result in no more than a 20% decrease in the crude incidence of DS. With continued use of prenatal diagnosis among older gravidas, upward of 80% of DS births will occur to younger mothers.

Adolescent↗
PubMed1981

Utilization of prenatal genetic diagnosis in women 35 years of age and older in the United States, 1977 to 1978.

As a measure of access to and acceptability of prenatal chromosomal diagnosis among older gravidas, we determined the ratio of use of prenatal diagnosis among women 35 years of age and older in Alabama, California, Manhattan, and Nebraska for the period 1977-1978. Utilization ratios were higher in 1978. Overall, utilization ratios were between 6% and 28%, well below the adjusted rates of 40% to 50% found in certain United States and British localities. Urban women tended to have higher utilization ratios than had rural women, and white women had higher ratios than had black women. Ratios were extremely low for black and rural residents. The oldest women (those greater than or equal to 40 years), who were at fivefold greater risk than women 35 to 36 years of age, had less than a onefold increase in utilization over the latter groups. The vast majority of older gravidas initiated prenatal care sufficiently early in their pregnancies to receive prenatal diagnosis. Current program strategies need to ensure access to prenatal diagnosis, especially for women greater than or equal to 40 years of age, women who are black, and women who live in rural areas.

Adult↗
PubMed1981

Rh hemolytic disease of the newborn: using incidence observations to evaluate the use of RH immune globulin.

During the 1970s, the crude incidence of Rh hemolytic disease of the newborn (RhHDN) in the United States dropped 65 per cent---from 40.5/10,000 total births in 1970 to 14.3/10,000 total births in 1979. Since the risk of RhHDN is directly associated with birth order, changes both in birth order-specific RhHDN incidence rates and in the birth order distribution would be expected to influence crude RhHDN incidence. Review of birth order-specific incidences ascertained in Connecticut, 1972-1977, shows that incidence was stable for first and second births, whereas it dropped significantly for third and fourth births. Due to the nearly complete use of Rh immune globulin (RhIG) in Connecticut during these years, the drop in these specific rates is best attributed to this prevention strategy. Nationwide, during the 1970s, the annual percentages of fourth and higher order births decreased from 18 per cent to 10 per cent. We estimate that some 30 per cent to 40 per cent of the 1970-1979 drop in the crude rate is attributed to changes in the birth order distribution, whereas 60 per cent to 70 per cent of the drop is attributed to RhIG. However, comparison of pooled incidences for 1972-1974 and 1975-1977 observed in Connecticut for first births and births to 15-19 year olds showed significant increases for both groups in 1975-1977. Further study of specific trends from other areas is needed to confirm these observations. Also needed is investigation of likely causes of sensitization among these teenaged, primiparous women.

Birth Order↗