Maternal survival: more research is needed.
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Developing Countries↗
Biomedical subjects
Pierre Buekens
Publications and source records attributed to Pierre Buekens.
Birth weight and infant growth: optimal infant weight gain versus optimal infant weight.
OBJECTIVE: Infant growth assessment often focuses on "optimal" infant weights and lengths at specific ages, while de-emphasizing infant weight gain. Objective of this study was to examine infant growth patterns by measuring infant weight gain relative to birth weight. METHODS: We conducted this study based on data collected in a prospective cohort study including 3,302 births with follow up examinations of infants between the ages of 8 and 18 months. All infants were participants in the Louisiana State Women, Infant and Children Supplemental Food Program between 1999 and 2001. Growth was assessed by infant weight gain percentage (IWG%, defined as infant weight gain divided by birth weight) as well as by mean z-scores and percentiles for weight-for-age, length-for-age, and weight-for-length calculated based on growth charts published by the U.S. Centers for Disease Control (CDC). RESULTS: An inverse relationship was noted between birth weight category and IWG% (from 613.9% for infants with birth weights <1500 g to 151.3% for infants with birth weights of 4000 g or more). In contrast, low birth weight infants had lower weight-for-age, weight-for-length z-scores and percentiles compared to normal birth weight infants according to CDC growth charts. CONCLUSIONS: Although low birth weight infants had lower anthropometric measures compared to a national reference population, they had significant catch-up growth; High birth weight infants had significant slow-down growth. We suggest that growth assessments should compare infants' anthropometric data to their own previous growth measures as well as to a reference population. Further studies are needed to identify optimal ranges of infant weight gain.
Aid to Families with Dependent Children↗
Pregnancy-related deaths in four regions of Europe and the United States in 1999-2000: characterisation of unreported deaths.
OBJECTIVE: We compared official maternal mortality statistics with those from a special study covering all pregnancy-associated deaths in two European countries (Finland and France) and in two US states (Massachusetts and North Carolina) in 1999-2000 to characterize pregnancy-related deaths that are not included in official statistics. STUDY DESIGN: We linked the official ICD-10-based maternal mortality data for 84 deaths with study data on 404 pregnancy-associated deaths. RESULTS: Of the pregnancy-associated deaths, 151 were pregnancy-related. We found 69 pregnancy-related deaths that had not been included as maternal deaths, and two deaths coded as maternal deaths that did not meet our definition for a pregnancy-related death. In total, 58 of these 69 deaths were from medical causes and 11 were from external causes or injuries (10 postpartum depression-related suicides and one accidental drug poisoning). The unreported deaths due to medical causes included 27 direct, 15 indirect, and two direct/indirect pregnancy-related deaths and 14 possibly pregnancy-related deaths. The most common causes of the unreported deaths due to medical causes were intracerebral hemorrhage (7 deaths), peripartum cardiomyopathy (4), pulmonary embolism (4) and pregnancy-induced hypertension (4). CONCLUSIONS: The collection of data on pregnancy-related and pregnancy-associated deaths is useful for countries with low maternal mortality figures. The use of various data-collection methods may substantially increase the quality of maternal mortality statistics.
Female↗
Periodontal disease and gestational diabetes mellitus.
OBJECTIVE: We examined the relationship between periodontal disease and different types of diabetes in pregnant and nonpregnant women. STUDY DESIGN: This study was based on the data from the third National Health and Nutrition Examination Survey (NHANES III), including 256 pregnant and 4234 nonpregnant women. Women were classified into those with gestational diabetes mellitus (GDM) in current pregnancy, with GDM in previous pregnancy, and with type 1 or 2 diabetes. RESULTS: In pregnant women, the prevalence of periodontitis was 44.8% in women with GDM and 13.2% in nondiabetic women, with adjusted odds ratio (aOR) of 9.11 (95% confidence interval [CI] 1.11-74.9). In nonpregnant women, the prevalence of periodontitis was 40.3% in women with type 1 or 2 diabetes, 25.0% in women with previous history of GDM, and 13.9% in nondiabetic women, with aOR of 2.76 (1.03-7.35) for women with type 1 or 2 diabetes. CONCLUSION: We found an association between periodontal disease and GDM.
Adolescent↗
Effect of pethidine administered during the first stage of labor on the acid-base status at birth.
OBJECTIVE: To evaluate the association between the use of pethidine during the first stage of labor and the presence, type and timing of acidosis in the newborn at birth. STUDY DESIGN: Secondary data analysis of a randomized controlled trial, which included term singleton pregnancies diagnosed with dystocia and requiring active management of labor. Women were randomized to receive either 100 mg of pethidine or placebo. Statistical analyses were performed using chi(2) or Fisher's exact tests for proportions and multiple linear regression for continuous outcomes. RESULTS: Three hundred and eighty-three pregnant women with a valid arterial blood cord sample were included in the final analysis. Lower pH and bicarbonate levels, as well as higher pCO(2) levels were found in the pethidide group. A higher incidence of acidosis was found in the pethidine group (pH<7.12 OR: 8.59 95% C.I. 3.29, 22.46). The highest frequency of acidosis was encountered when pethidine-delivery interval was 5 h. CONCLUSION: Pethidine use during the first stage of labor was associated with an increased risk of acidosis at birth.
Acid-Base Equilibrium↗
State-specific trends in preterm delivery: are rates really declining among non-Hispanic African Americans across the United States?
OBJECTIVES: This study sought to examine state-specific trends in preterm delivery rates among non-Hispanic African Americans and to assess whether these rates are influenced by misclassification of gestational age. METHODS: The sample population consisted of singleton non-Hispanic White and non-Hispanic African-American infants born in 1991 and 2001 to U.S. resident mothers. For both time periods, state-specific and national preterm delivery rates were calculated for all infants, stratified by infant race/ethnicity. Next, birth-weight distributions within strata of gestational age were studied to explore possible misclassifications of gestational age. Lastly, state-specific and national preterm delivery rates among infants who weighed less than 2,500 g were separately computed. RESULTS: National analyses showed that the frequency of preterm delivery increased by 15.8% among non-Hispanic Whites but declined by 10.3% among non-Hispanic African Americans over the same period. For both subgroups, a bimodal distribution of birth weights was apparent among preterm births at 28-31 weeks of gestation. The second peak with its cluster of normal-weight infants was more prominent among non-Hispanic African Americans in 1991 than in 2001. After excluding preterm infants who weighed 2,500 g or more, the national trends persisted. State-specific analyses showed that preterm delivery rates increased for both subgroups in 13 states during this period. Of these 13, 6 states had a number of non-Hispanic African-American births classified as preterm that were apparently term births mistakenly assigned short gestational ages. Such misclassification was more frequent in 1991 than in 2001 and inflated 1991 rates. CONCLUSION: There is heterogeneity in state-specific preterm delivery rates. Such differences are often overlooked when aggregate results are presented.
Adolescent↗
Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000.
BACKGROUND: Only few studies have been carried out on the relationship between pregnancy and deaths from external causes. METHODS: Information on deaths from external causes among women aged 15-49 years in Finland in 1987-2000 (n = 5299) was linked to three national health registers to identify pregnancy-associated deaths (n = 212). RESULTS: The mortality rate for women during pregnancy and within 1 year of pregnancy termination from external causes was lower than mortality from external causes among non-pregnant women (relative risk 0.79; 95% confidence interval 0.69-0.91). Owing to elevated suicide and homicide rates, however, an increased risk was observed for women after abortions, especially in the age group of 15-24 years. CONCLUSIONS: The low rate of deaths from external causes suggests the protective effect of childbirth, but the elevated risk after a terminated pregnancy needs to be recognized in the provision of health care and social services.
Adolescent↗
Pregnancy-induced hypertension and infant growth at 28 and 42 days postpartum.
BACKGROUND: No previous studies have examined the effect of pregnancy-induced hypertension (PIH) on early infant growth. The objective was to study infant growth patterns of babies born to mothers with PIH at 28 and 42 days postpartum. METHODS DESIGN: We conducted a population-based retrospective cohort study of 16,936 pregnancies delivered between January 1, 1989 through December 31, 1990 in Suzhou, China. PIH was classified as gestational hypertension, preeclampsia and severe preeclampsia. Infant Growth Percentage (IGP) was calculated as the weight gain from birth to infant weight at 28 or 42 days postpartum divided by the birth weight. Univariate analysis and multivariate linear regression were performed to compare the infant weight as well as IGP at 28 and 42 days postpartum between various types of PIH and the normotensive group. RESULTS: Infant weights at 28 and 42 days postpartum were significantly lower in severe preeclampsia (e.g., 4679.9 g at 42 days) and preeclampsia (e.g., 4763.8 g at 42 days) groups than in the normotensive group (e.g., 4869.1 g at 42 days, p < 0.01). However, there were no differences in IGP between groups. After stratifying by intrauterine growth restriction (IUGR) status, if babies were not intrauterine growth restricted, none of the PIH types showed a significantly lower weight at 28 and 42 days postpartum and their IGPs were similar to those of the reference group. When babies were growth restricted, all PIH groups showed significantly lower weights but higher IGP at 28 and 42 days postpartum as compared to the normotensive group. CONCLUSION: Infants born to mothers with PIH but without IUGR have normal early infant growth. IUGR secondary to PIH is associated with significant catch-up growth at 28 and 42 days postpartum.
Journal Article↗
A cluster randomized controlled trial of a behavioral intervention to facilitate the development and implementation of clinical practice guidelines in Latin American maternity hospitals: the Guidelines Trial: Study protocol [ISRCTN82417627].
BACKGROUND: A significant proportion of the health care administered to women in Latin American maternity hospitals during labor and delivery has been demonstrated to be ineffective or harmful, whereas effective interventions remain underutilized. The routine use of episiotomies and the failure to use active management of the third stage of labor are good examples. METHODS/DESIGN: The aim of this trial is to evaluate the effect of a multifaceted behavioral intervention on the use of two evidence-based birth practices, the selective use of episiotomies and active management of the third stage of labor (injection of 10 International Units of oxytocin). The intervention is based on behavioral and organizational change theories and was based on formative research. Twenty-four hospitals in three urban districts of Argentina and Uruguay will be randomized. Opinion leaders in the 12 intervention hospitals will be identified and trained to develop and implement evidence-based guidelines. They will then disseminate the guidelines using a multifaceted approach including academic detailing, reminders, and feedback on utilization rates. The 12 hospitals in the control group will continue with their standard in-service training activities. The main outcomes to be assessed are the rates of episiotomy and oxytocin use during the third stage of labor. Secondary outcomes will be perineal sutures, postpartum hemorrhages, and birth attendants' opinions.
Journal Article↗
Global maternal and child health.
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Adolescent↗
Underreporting of pregnancy-related mortality in the United States and Europe.
OBJECTIVE: Available maternal mortality statistics do not allow valid international comparisons. Our objective was to uniformly measure underreporting of mortality from pregnancy in official statistics from selected regions within the U.S. and Europe, and to provide comparable revised profiles of pregnancy-related mortality. METHODS: We developed a standardized enhanced method to uniformly identify and classify pregnancy-associated deaths from 2 U.S. states, Massachusetts and North Carolina, and 2 European countries, Finland and France, for the years 1999-2000. Identification method included the use of all data available from the death certificate as well as computerized linkage of births and deaths registers. All cases were reviewed and classified by an international panel of experts. RESULTS: Four-hundred-and-four pregnancy-associated deaths were identified and reviewed. Underestimation of mortality causally related to pregnancy based on International Classification of Diseases cause-of-death codes alone varied from 22% in France to 93% in Massachusetts. Underreporting was greater in the regions with lower initial maternal mortality ratios. The distribution of causes of pregnancy-related mortality was specific to each region. The leading causes of death were cardiovascular conditions in Massachusetts; hemorrhage, pregnancy-induced hypertension, and peripartum cardiomyopathy in North Carolina; noncardiovascular medical conditions in Finland; and hemorrhage in France. CONCLUSION: This study shows the limitations of maternal mortality statistics based on International Classification of Diseases cause-of-death codes alone. Linkage of births and deaths registers should routinely be used in the ascertainment of pregnancy-related deaths. In addition, extension of the definition of a maternal death should be considered. Beyond pregnancy-related mortality ratios, considering the specific distribution of causes-of-death is important to define prevention strategies.
Adult↗
Evidence-based global health.
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Evidence-Based Medicine↗
Preterm delivery rates in North Carolina: are they really declining among non-Hispanic African Americans?
The preterm delivery rate in North Carolina is consistently higher than the national average. However, recent reports suggest that singleton preterm delivery rates for non-Hispanic Whites are increasing while those for non-Hispanic African Americans are decreasing. To study this pattern further, the authors examined data on singleton non-Hispanic White and non-Hispanic African-American births in 1989 and 1999 by using North Carolina vital statistics data. They found that the frequency of preterm delivery rose 1.1% (8.5% to 9.6%) among non-Hispanic Whites but declined 1.4% (17.9% to 16.5%) among non-Hispanic African Americans over the same time period. For both subgroups, a bimodal distribution of birth weights was apparent among preterm births at 28-31 weeks of gestation. The second peak with its cluster of normal-weight infants was more prominent among non-Hispanic African Americans in 1989 than in 1999. To reduce the potential for bias due to misclassification of infant gestational age, frequencies of preterm delivery of infants who weighed less than 2,500 g were calculated. Unlike the original analysis, this calculation showed that preterm delivery increased for both subgroups. A number of non-Hispanic African-American births classified as preterm were apparently term births mistakenly assigned short gestational ages. Such misclassification was more frequent in 1989 than in 1999, inflating 1989 preterm delivery rates.
Adult↗
Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000.
OBJECTIVE: To test the hypothesis that pregnant and recently pregnant women enjoy a "healthy pregnant women effect," we compared the all natural cause mortality rates for women who were pregnant or within 1 year of pregnancy termination with all other women of reproductive age. STUDY DESIGN: This is a population-based, retrospective cohort study from Finland for a 14-year period, 1987 to 2000. Information on all deaths of women aged 15 to 49 years in Finland (n=15,823) was received from the Cause-of-Death Register and linked to the Medical Birth Register (n=865,988 live births and stillbirths), the Register on Induced Abortions (n=156,789 induced abortions), and the Hospital Discharge Register (n=118,490 spontaneous abortions) to identify pregnancy-associated deaths (n=419). RESULTS: The age-adjusted mortality rate for women during pregnancy and within 1 year of pregnancy termination was 36.7 deaths per 100,000 pregnancies, which was significantly lower than the mortality rate among nonpregnant women, 57.0 per 100,000 person-years (relative risk [RR] 0.64, 95% CI 0.58-0.71). The mortality was lower after a birth (28.2/100,000) than after a spontaneous (51.9/100,000) or induced abortion (83.1/100,000). We observed a significant increase in the risk of death from cerebrovascular diseases after delivery among women aged 15 to 24 years (RR 4.08, 95% CI 1.58-10.55). CONCLUSION: Our study supports the healthy pregnant woman effect for all pregnancies, including those not ending in births.
Abortion, Induced↗
Development and testing of interview questions to determine last menstrual period in Mexican immigrant populations.
The last menstrual period is used to estimate gestational age. This paper examines sources of measurement error related to the recall of last menstrual period among Mexican immigrant women living in the United States. Qualitative analyses (focus groups and cognitive interviews) suggest that last menstrual period recall does not seem to be a large source of measurement error in the calculation of gestational age and the impact of this type of error on the misclassification of preterm births appears to be minimal. Questions for querying about last menstrual period in this population are offered.
Adult↗
Birthweight differences among infants of North African immigrants and Belgians in Belgium.
BACKGROUND: Infants of North African immigrants are reported to have higher birthweights than their Belgian counterparts. It is unclear what mechanism contributes to this difference. METHODS: Analyses were based on a hospital-based cohort of 1,162 women. RESULTS: Infants of North African immigrants were less likely to be born preterm, compared to infants of Belgian women. After adjusting for sociodemographic and maternal factors, the estimated difference in mean birthweight was 74 g (p=0.05). When limited to term births, this difference was 28 g (p=0.42). CONCLUSION: The difference in mean birthweight between North African and Belgian infants was explained by differences in preterm birth and other risk factors.
Adult↗
Methods for identifying pregnancy-associated deaths: population-based data from Finland 1987-2000.
To find maternal and pregnancy-related deaths, it is important that all pregnancy-associated deaths are identified. This article examines the effect of data linkages between national health care registers and complete death certificate data on pregnancy-associated deaths. All deaths among women of reproductive age (15-49 years) in Finland during the period 1987-2000 (n = 15 823) were identified from the Cause-of-Death Register and linked to the Medical Birth Register (n = 865 988 births), the Register on Induced Abortions (n = 156 789 induced abortions), and the Hospital Discharge Register (n = 118 490 spontaneous abortions) to determine whether women had been pregnant within 1 year before death. The death certificates of the 419 women thus identified were reviewed to find whether the pregnancy or its termination was coded or mentioned. In total, 405 deaths (96.7%) were identified in registers other than the Cause-of-Death Register. Without data linkages, 73% of all pregnancy-associated deaths would have been missed; the percentage after induced and spontaneous abortions was even higher. Data linkages to national health care registers provide better information on maternal deaths and pregnancy-associated deaths than death certificates alone. If possible, pregnancies not ending in a live birth should be included in the data linkages.
Abortion, Induced↗
Psychosocial factors and preterm birth among African American and White women in central North Carolina.
OBJECTIVES: We assessed associations between psychosocial factors and preterm birth, stratified by race in a prospective cohort study. METHODS: We surveyed 1898 women who used university and public health prenatal clinics regarding various psychosocial factors. RESULTS: African Americans were at higher risk of preterm birth if they used distancing from problems as a coping mechanism or reported racial discrimination. Whites were at higher risk if they had high counts of negative life events or were not living with a partner. The association of pregnancy-related anxiety with preterm birth weakened when medical comorbidities were taken into account. No association with preterm birth was found for depression, general social support, or church attendance. CONCLUSIONS: Some associations between psychosocial variables and preterm birth differed by race.
Adaptation, Psychological↗