This study explores the stability and change in maternal life satisfaction and psychological distress following the birth of a child with a congenital anomaly using 5 assessments from the Norwegian Mother and Child Cohort Study collected from Pregnancy Week 17 to 36 months postpartum. Participating mothers were divided into those having infants with (a) Down syndrome (DS; n = 114), (b) cleft lip/palate (CLP; n = 179), and (c) no disability (ND; n = 99,122). Responses on the Satisfaction With Life Scale and a short version of the Hopkins Symptom Checklist were analyzed using structural equation modeling, including latent growth curves. Satisfaction and distress levels were highly diverse in the sample, but fairly stable over time (retest correlations: .47-.68). However, the birth of a child with DS was associated with a rapid decrease in maternal life satisfaction and a corresponding increase in psychological distress observed between pregnancy and 6 months postpartum. The unique effects from DS on changes in satisfaction (Cohen's d = -.66) and distress (Cohen's d = .60) remained stable. Higher distress and lower life satisfaction at later assessments appeared to reflect a persistent burden that was already experienced 6 months after birth. CLP had a temporary impact (Cohen's d = .29) on maternal distress at 6 months. However, the overall trajectories did not differ between CLP and ND mothers. In sum, the birth of a child with DS influences maternal psychological distress and life satisfaction throughout the toddler period, whereas a curable condition like CLP has only a minor temporary effect on maternal psychological distress.
Renal Research Group, Institute of Medicine, University of Bergen, and The Norwegian Kidney Biopsy Registry, Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway. firstname.lastname@example.org
Strong associations of adverse perinatal outcomes have been identified with later cardiovascular disease in the mother. Few studies have addressed associations with kidney disease. This study investigated whether perinatal outcomes are associated with later clinical kidney disease as diagnosed by kidney biopsy. The Medical Birth Registry of Norway contains data on all childbirths in Norway since 1967. The Norwegian Kidney Biopsy Registry contains data on all kidney biopsies in Norway since 1988. All women with a first singleton delivery from 1967 to 1998 were included. Pregnancy-related predictors of later kidney biopsy were analyzed by Cox regression analyses. A total of 756,420 women were included, and after a mean period of 15.9+/-9.4 yr, 588 had a kidney biopsy. Compared with women without preeclampsia and with offspring with birth weight of >or=2.5 kg, women with no preeclampsia and with offspring with birth weight of 1.5 to 2.5 kg had a relative risk (RR) for a later kidney biopsy of 1.7, women with no preeclampsia and with offspring with birth weight of or=2.5 kg had an RR of 2.5, women with preeclampsia and with offspring with a birth weight of 1.5 to 2.5 kg had an RR of 4.5, and women with preeclampsia and with offspring with a birth weight of
Background. It is unknown whether adverse pregnancy-related outcomes in women with pregestational diabetes are associated with later development of end-stage renal disease (ESRD) or death. Methods. We linked data from the Medical Birth Registry of Norway with data from the Norwegian Renal Registry and the Norwegian Cause of Death Registry. Data from up to three pregnancies for women with a first singleton delivery from 1967 to 1994 were included and analysed in a cohort design using Cox regression. Results. Altogether, 639 018 women were included in the analyses, among whom 2204 women had diabetes mellitus before pregnancy. Their first pregnancy was complicated by pre-eclampsia in 13.2%, low birth weight offspring (
Department of Public Health and Primary Health Care, The Medical Birth Registry of Norway, University of Bergen, N-5018 Bergen, Norway; Division of Military Research and Development, Joint Norwegian Medical Services, N-0753 Oslo, Norway.
Infants born with birth defects have poorer outcomes in terms of mortality and disability, but the long-term intellectual outcome in children with birth defects is generally unknown. We assessed the long-term associations of various birth defects with mortality and disability, and evaluated whether high mortality and disability were reflected in impaired intellectual performance at age 18. In this nationwide cohort study, records of 9,186 males with and 384,384 without birth defects, registered in the Medical Birth Registry of Norway (1967-1979) were linked to the National Conscript Service (1984-1999). Mortality and disability before military draft, and intelligence test score at conscription were the main outcome measures. Males with birth defects had a relative risk for disability of 6.0 compared with males without defects. Disability was low within categories of birth defects associated with low mortality, and high within defect categories associated with high mortality. The relative risk for not being drafted was highest if maternal educational level was low. Heart defects and cleft palate were the only subgroups in which intellectual performance was lower after adjustment for maternal education, maternal age, marital status and birth order. In particular, intellectual performance was not impaired among those with multiple compared with single defects. We conclude that for the majority of birth defect categories in the present birth cohort, our hypothesis that intellectual performance would be impaired was not confirmed. Thus, there seems to be little reason to fear an adverse intellectual outcome in non-disabled surviving infants with birth defects.
OBJECTIVES: To estimate the association between birth weight and hearing impairment among Norwegians born between 1967 and 1993, taking other pregnancy-related conditions into consideration. METHODS: A cohort study was conducted of all Norwegian live births from 1967 to 1993 (n = 1 548 429) linking information of the Medical Birth Registry of Norway and the register for the National Insurance Administration, which covers all Norwegians. The Medical Birth Registry of Norway has recorded information on birth weight and other pregnancy-related conditions as well as diseases of the mother before and during pregnancy. The register of the National Insurance Administration contains information on all Norwegians who have received cash benefits for a disease/disability, including hearing impairment. Data up to 1997 are included; thus, the follow-up period varies between 29 and 3 years. RESULTS: The occurrence of hearing impairment was 11 per 10 000, decreasing from 60 per 10 000 for birth weights 4499 g. Compared with birth weights between 3000 g and 3499 g, the adjusted rate ratio of hearing impairment was 7.55 (95% confidence interval: 4.81-11.87) for birth weights 4499 g. The association did not change substantially with adjustment for other pregnancy-related conditions. Restricting the analyses to term born, the association between hearing impairment and low birth weight became stronger. CONCLUSIONS: Birth weight was a strong predictor of hearing impairment in the Norwegian population. Children who were born at term with a low birth weight seemed to be a particularly vulnerable group.
BACKGROUND: In a number of studies, birthweight has been associated with cognition and educational attainment into adult age. However, the association is not clear between birthweight and work participation in adulthood. We investigated this association assessing to which extent it was influenced by circumstances concerning family background or disease in early life. METHODS: Through linkage between several national registers containing personal information from birth into adult age we established a longitudinal, population-based cohort study. Study participants were all 308 829 singletons born in Norway in 1967-1971 as registered by the Medical Birth Registry of Norway who were national residents at age 29. The study outcome was unemployment defined as a lack of personal income among people who were not under education in the calendar year of their 29th birthday as registered by the National Insurance Administration and Statistics Norway. RESULTS: Birthweight below the standardized mean was associated with unemployment. The risk of unemployment increased by decreasing birthweight for both women and men and also after adjustment for potential confounding factors. The association was evident both in people with or without social disadvantage, as well as people with or without childhood disease. Still, birthweight below the standardized mean explained much less of the unemployment risk than did social disadvantage (attributable fractions 8.0% versus 28.3% for women and 10.0% versus 40.2% for men). CONCLUSION: Birthweight below the standardized mean was independently associated with unemployment at age 29, also in the normal birthweight range.
Comment In: Int J Epidemiol. 2004 Aug;33(4):856-715166198
OBJECTIVE: Long-term intellectual performance in breech-presented infants may be negatively affected by vaginal delivery. We evaluated the effect of presentation at birth and delivery mode on intellectual performance at age 18 years in a nationwide population study. METHODS: We studied 8,738 male infants in breech and 384,832 males in cephalic presentation registered in the Medical Birth Registry of Norway, 1967-1979, and linked to data registered at the National Conscript Service, 1984-1999. Test scores of intelligence testing at conscription were presented as standard nine ("stanine") scores. Mean stanine scores and odds ratios of low score were computed and adjusted for birth order, maternal age, and education. RESULTS: Mean stanine score was slightly higher among breech-presented males than among cephalic-presented males (5.26 versus 5.22, P = .05), whereas after adjustment the difference disappeared (P = .3). Breech-presented infants had lower mean scores if delivered by cesarean compared with vaginal breech delivery (P = .03), and cephalic-presented males scored lower if their mothers had a cesarean delivery instead of a vaginal delivery (P
To assess the association of pre-eclampsia with later cardiovascular death in mothers according to their lifetime number of pregnancies, and particularly after only one child.
Prospective, population based cohort study.
Medical Birth Registry of Norway.
We followed 836,147 Norwegian women with a first singleton birth between 1967 and 2002 for cardiovascular mortality through linkage to the national Cause of Death Registry. About 23,000 women died by 2009, of whom 3891 died from cardiovascular causes. Associations between pre-eclampsia and cardiovascular death were assessed by hazard ratios, estimated by Cox regression analyses. Hazard ratios were adjusted for maternal education (three categories), maternal age at first birth, and year of first birth
The rate of cardiovascular mortality among women with preterm pre-eclampsia was 9.2% after having only one child, falling to 1.1% for those with two or more children. With term pre-eclampsia, the rates were 2.8% and 1.1%, respectively. Women with pre-eclampsia in their first pregnancy had higher rates of cardiovascular death than those who did not have the condition at first birth (adjusted hazard ratio 1.6 (95% confidence interval 1.4 to 2.0) after term pre-eclampsia; 3.7 (2.7 to 4.8) after preterm pre-eclampsia). Among women with only one lifetime pregnancy, the increase in risk of cardiovascular death was higher than for those with two or more children (3.4 (2.6 to 4.6) after term pre-eclampsia; 9.4 (6.5 to 13.7) after preterm pre-eclampsia). The risk of cardiovascular death was only moderately elevated among women with pre-eclamptic first pregnancies who went on to have additional children (1.5 (1.2 to 2.0) after term pre-eclampsia; 2.4 (1.5 to 3.9) after preterm pre-eclampsia). There was little evidence of additional risk after recurrent pre-eclampsia. All cause mortality for women with two or more lifetime births, who had pre-eclampsia in first pregnancy, was not elevated, even with preterm pre-eclampsia in first pregnancy (1.1 (0.87 to 1.14)).
Cardiovascular death in women with pre-eclampsia in their first pregnancy is concentrated mainly in women with no additional births. This association might be due to health problems that discourage or prevent further pregnancies rather than to pre-eclampsia itself. As a screening criterion for cardiovascular disease risk, pre-eclampsia is a strong predictor primarily among women with only one child-particularly with preterm pre-eclampsia.
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Worldwide rising cesarean section rates over the past decades have caused much concern. Studies on the association between cesarean section and maternal social background have reported conflicting results.
A cohort study, comprising 837,312 birth order one deliveries notified to the population-based Medical Birth Registry of Norway during 1967-2004. The relative risk of cesarean section (from 1988 onwards planned and emergency cesarean section) according to maternal educational level was assessed in all deliveries, in an obstetric low-risk group and within groups of medical/obstetric high-risk conditions.
Throughout the study period, the lowest educated had the highest risk of cesarean section, followed by the medium educational group. In all deliveries, the adjusted relative risk of cesarean section for the lowest versus the highest educated increased from 1.16 (95% CI 1.09-1.23) in the 1967-76 period to 1.34 (95% CI 1.27-1.42) in the 1996-2004 period, and in the obstetric low risk group from 1.19 (95% CI 1.10-1.30) to 1.50 (95% CI 1.38-1.63). From 1988 onwards, the lowest educated had the highest risk of both planned and emergency cesarean section, followed by the medium educational group.
The lowest educated had the highest risk of cesarean section, followed by the medium educational group, and the differences gradually increased during 1967-2004. This trend could be accounted for by increasing vulnerability of the lowest educational group due to a strong social migration, and by increased occurrence of cesarean section on maternal request among the lowest educated in recent years.