During a four year period, 60 patients with premature rupture of membranes (PROM) met the inclusion criteria of having a single living fetus with gestational age between 25 to 36 weeks and more than 24 hours between PROM and delivery were admitted in Karolinska Hospital, Sweden. These cases were reviewed retrospectively. Five neonates died postnatally and the total survival rate was 91.7%. Three of them had major malformations and one died of hyaline membrane disease with 29 weeks of gestational age. In only one case the immediate cause of death was due to infection. The present protocol of expectant treatment for PROM in this hospital tends to be a minimum of unnecessary intervention for obtaining a high survival rate.
To compare the rates of low birth weight, preterm delivery and small for gestational age (SGA), in pregnancy outcomes among women who were exposed and nonexposed to antidepressants during pregnancy.
At The Motherisk Program, we analyzed pregnancy outcomes of 1,243 women in our database who took various antidepressants during their pregnancy. Nine hundred and twenty-eight of these women and 928 nonexposed women who delivered a live born infant were matched for age, (+/-2 years), smoking and alcohol use and specific pregnancy outcomes were compared between the two groups.
There were 82 (8.8%) preterm deliveries in the antidepressant group and 50 (5.4%) in the comparison group. OR: 1.7 (95% CI: 1.18-2.45). There were 89 (9.6%) in the antidepressant group and 76 (8.2%) in the comparison group who delivered babies evaluated as SGA; OR: 1.19 (95% CI: 0.86-1.64). The mean birth weight in the antidepressant group was 3,449+/-591 g and 3,455+/-515 g in the comparison group (P=.8).
The use of antidepressants in pregnancy appears to be associated with a small, but statistically significant increased rate in the incidence of preterm births, confirming results from several other studies. It is difficult to ascertain whether this small increased rate of preterm births is confounded by depression, antidepressants, or both. However, we did not find a statistically significant difference in the incidence of SGA or lower birth weight. This information adds to limited data available in the literature regarding these outcomes following the use of antidepressants in pregnancy.
Division of Epidemiology, Statistics, and Prevention Research, Department of Health and Human Services, National Institute of Child Health and Human Development, Bethesda, MD 20892, USA. firstname.lastname@example.org
OBJECTIVE: The purpose of the study was to evaluate the effects of smokeless tobacco use during pregnancy. STUDY DESIGN: We examined birth weight, preterm delivery, and preeclampsia in women who were delivered of singleton, live-born infants in Sweden from 1999 through 2000. For each snuff user, 10 cigarette smokers and 10 tobacco nonusers were selected randomly. RESULTS: After exclusions, 789 snuff users, 11,240 smokers, and 11,495 nonusers remained. Compared with nonusers, adjusted mean birth weight was reduced in snuff users by 39 g (95% CI, 6-72 g) and in smokers by 190 g (95% CI, 178-202 g). Preterm delivery was increased in snuff users and smokers (adjusted odds ratios, 1.98 [95% CI, 1.46-2.68] and 1.57 [95% CI, 1.38-1.80], respectively). Preeclampsia was reduced in smokers (adjusted odds ratio, 0.63; 95% CI, 0.53-0.75) but increased in snuff users (adjusted odds ratio, 1.58; 95% CI, 1.09-2.27). CONCLUSION: Snuff use was associated with increased risk of preterm delivery and preeclampsia. Snuff does not appear to be a safe alternative to cigarettes during pregnancy.
OBJECTIVES: The aim of the study was to investigate reproductive outcomes such as birthweight, preterm births, and postterrm births among women working in research laboratories while pregnant. METHODS: Female university personnel were identified from a source cohort of Swedish laboratory employees, and the database was linked to the medical birth register. The first births of the women were included in the analysis, 249 pregnancies among the women with laboratory work and 613 pregnancies among the women without laboratory tasks. Information about exposure to various laboratory agents was obtained from a previous questionnaire investigation at the research group level according to a specific definition. The ponderal index and ratio between observed and expected birthweights were calculated. Logistic regression models were used for analyses of dichotomous outcomes (preterm, postterrm and birthweight). RESULTS: Exposure to laboratory work with solvents was associated with an increased risk of preterm births, the estimated odds ratio (OR) being 3.4 (1.0
Agricultural activity on Prince Edward Island poses a potential hazard to groundwater, which is the sole source of drinking water on the island. This study investigates the potential impact of groundwater nitrate exposure on prematurity and intrauterine growth restriction on Prince Edward Island. A total of 210 intrauterine growth restriction cases, 336 premature births, and 4098 controls were abstracted from a database of all Island births. An ecological measure of groundwater nitrate level was used to gauge potential exposure to agriculturally contaminated drinking water. The higher nitrate exposure categories were positively associated with intrauterine growth restriction and prematurity, and significant dose-response trends were seen, even after adjustment for several important covariates. Nevertheless, these risks must be interpreted cautiously because of the ecological nature of this exposure metric. An investigation using nitrate levels for individual study subjects is needed to confirm this association.
Our aim was to explore the association between alcohol consumption, before and during pregnancy, and the risk of preterm birth among 46,252 primiparous mothers.
We obtained information on alcohol consumption from questionnaire responses at pregnancy week 15 from the prospective, observational Norwegian Mother and Child Cohort Study. Data on preterm birth, categorized as delivery before gestation week 37, were retrieved from the Medical Birth Registry of Norway.
Among the participants, 91% consumed alcohol before pregnancy and fewer than 20% reported consuming alcohol during pregnancy. The adjusted odds ratio (aOR) for preterm birth associated with prepregnancy alcohol consumption was 0.81 (95% confidence interval [CI], 0.70-0.95). We did not find a risk reduction for overall drinking during pregnancy, aOR = 1.03 (95% CI, 0.90-1.19). However, dose-response analyses showed tendencies toward adverse effects when drinking 1-3 times per month during the first 15 weeks of pregnancy, aOR = 1.51 (95% CI, 1.14-2.00).
We did not find any effects of alcohol consumption during pregnancy, whereas pre-pregnancy drinking was associated with reduced risk of preterm birth. Residual confounding may have influenced the risk estimates, especially before pregnancy, as nondrinkers have lower socioeconomic status and well-being than drinkers.
The adverse effects of amphetamine addiction during pregnancy and the neonatal period were studied in 69 Swedish women. Almost one-third of the women (Group I) succeeded in overcoming their addiction in early pregnancy. The women in Group I (n = 17), unlike those in Group II (n = 53), received the same amount of prenatal care as the average Swedish woman. An increased rate of preterm deliveries (25%) as well as a higher perinatal mortality (7.5%) was found in Group II. During the neonatal period an increased incidence of mother-infant separation was found since many of the infants (46%) were transferred to pediatric wards for medical and social reasons. All newborns in Group I and 74% of infants born to mothers with continuous amphetamine addiction throughout pregnancy remained in their mother's custody following discharge from the maternity clinic.
OBJECTIVES: To examine the incidence and temporal trends of hospitalization during pregnancy, and provide additional information on maternal morbidity among Canadian women. METHODS: A population-based cohort study was conducted using the Canadian Institute for Health Information's Discharge Abstract Database between fiscal year 1991/92 and 2002/03. This database included antenatal hospitalizations for all hospital deliveries (N=3,103,365) in Canada except for those occurring in Manitoba and Quebec. Temporal trends, and variations in the non-delivery antenatal hospitalization ratio (per 100 deliveries) by maternal age and province or territory were quantified. Primary causes for antenatal hospitalization, the lengths of in-hospital stay, and changing pattern by maternal age and time period were compared. RESULTS: The overall antenatal hospitalization ratio declined by 43%, from 24.0 per 100 deliveries in 1991/92 to 13.6 in 2002/03. Younger women tended to be hospitalized more frequently than older women: 27.1 per 100 deliveries for women aged less than 20 years and 21.5 per 100 deliveries for 20-24 years, respectively, compared to 11.5 per 100 for women aged 35-39 years. The antenatal hospitalization ratio varied greatly by province/territory--from 12.2 per 100 deliveries in Ontario to 30.7 in the Yukon. Threatened preterm labour, antenatal hemorrhage, hypertensive disorders, severe vomiting and diabetes remained the five most common causes for antenatal hospitalization, although the trends for the first four declined dramatically from 1991/92 to 2002/03. Younger women were more likely to be admitted for threatened preterm labour and severe vomiting, while older women were more likely to be admitted for antenatal hemorrhage and hypertensive disorders. CONCLUSIONS: The decline in antenatal hospitalization may reflect changes in management of pregnancy complications, e.g., transition from in-hospital care to out-of-hospital care, and introduction of antepartum home care programs. Information on interprovincial/territorial variations in antenatal hospitalization may be helpful in directing future maternal health care.
To assess the risk factors for preterm birth in twin pregnancies, particularly monochorionicity.
A cohort study of 767 sets of twins, each twin weighing more than 500 g, born between January 1, 1992, and December 31, 2001, at St. Joseph's Health Care in London, Ontario. Statistical analysis was performed using forward stepwise logistic regression models, with gestational age at birth less than 28 or 32 weeks as the outcome.
Polyhydramnios and chorioamnionitis were significant risk factors for preterm birth prior to 28 or 32 weeks' gestation. Monochorionicity was a risk factor for preterm birth prior to 32 weeks' gestation. Past term birth and maternal age over 30 years were associated with reduced risk for preterm birth.
Monochorionic placentation is a significant risk factor for preterm twin birth.
BACKGROUND: To investigate how mean birthweight has changed in the past decade, and to describe changes in the proportion of infants with a birthweight above 4000 grams (g). METHODS: We analyzed data on 43,561 singleton infants born between 1990 and 1999 at Aarhus University Hospital, Denmark. Information on birthweight, gestational age, stillbirths, malformations, mode of delivery, prelabor intervention, and maternal diabetes was obtained from birth registration forms. RESULTS: For all infants mean birthweight increased by 45 g (95% CI: 20-70 g) from 3474 g in 1990 to 3519 g in 1999. For infants born at term the mean increase was 62 g (95% CI: 41-83 g). During the same period the percentage of infants born with a birthweight above 4000 g increased from 16.7% in 1990 to 20.0% in 1999 (p