Children of drug-addicted mothers are at an increased risk of premature birth, neonatal complications, developmental delay, understimulation, deprivation, neglect, abuse and even premature death. Research results from four Danish centres are presented and discussed. The material covers the period from 1970-1983. The studies clearly show a need for more coordinated support and services for these families and their children in order to prevent a new generation of 'social losers'.
To evaluate the association between maternal body mass index and neonatal outcomes in adolescents and to compare neonatal outcomes between overweight and obese adolescents and obstetric low-risk adult women.
Retrospective cohort study using data from the Swedish Medical Birth Register.
All 31,386 primiparous adolescents younger than 20 years of age and 178,844 "standard" women, defined as normal weight, obstetric low-risk adult women who delivered between 1992 and 2013. The adolescents were categorized according to weight and height in early pregnancy into body mass index groups according to the World Health Organization classification. Logistic regression models were used.
Neonatal outcomes in relation to maternal body mass index groups.
In the adolescents, 6109/31,386 (19.5%) and 2287/31,386 (7.3%) were overweight and obese, respectively. Compared with normal weight adolescents, overweight adolescents had a lower risk of having small for gestational age neonates, and higher risks for having neonates with macrosomia, and being large for gestational age and with Apgar score less than 7 at 5 minutes. The obese adolescents had increased risk for having neonates being large for gestational age (3.8% vs 1.3%; adjusted odds ratio [aOR], 2.97 [95% confidence interval (CI), 2.30-3.84]), with macrosomia (>4500 g) (4.6% vs 1.4%; aOR, 2.95 [95% CI, 2.33-3.73]), and with Apgar score less than 7 at 5 minutes (2.2% vs 1.1%; aOR, 1.98 [95% CI, 1.43-2.76]) than normal weight adolescents. Compared with the standard women, overweight and obese adolescents had overall more adverse neonatal outcomes.
Overweight and obese adolescents had predominantly increased risks for adverse neonatal outcomes compared with normal weight adolescents and standard women.
Physical and genital status of 2473 girls aged 12-16 was studied and factors of risk of development of the reproductive system in puberty detected. A scale for individual prediction of the reproductive function development, based on the girls' health status, body mass, exercise, was derived.
Since 2007 the Danish Health and Medicines Authority has advised total alcohol abstinence from the time of trying to conceive and throughout pregnancy. The prevalence of binge drinking among pregnant Danish women has nevertheless been reported to be up to 48 % during early pregnancy. Since the introduction of the recommendation of total abstinence, no studies have examined pre-pregnancy lifestyle and reproductive risk factors associated with this behaviour in a Danish context. The aims of this study were therefore to describe the prevalence of weekly alcohol consumption and binge drinking in early pregnancy among women living in the capital of Denmark. Secondly to identify pre-pregnancy lifestyle and reproductive risk factors associated with binge drinking during early pregnancy.
Data were collected from September 2012 to August 2013 at the Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark. Self-reported information on each woman's socio-demographic characteristics, medical history, and lifestyle factors including alcohol habits was obtained from an electronic questionnaire filled out as part of the individual medical record. Descriptive analysis was conducted and multivariate logistic regression analysis was used to assess the potential associated risk factors (adjusted odds ratio (aOR)).
Questionnaires from 3,238 women were included. A majority of 70 %, reported weekly alcohol consumption before pregnancy. The prevalence decreased to 3 % during early pregnancy. The overall proportion of women reporting binge drinking during early pregnancy was 35 % (n?=?1,134). The following independent risk factors for binge drinking in early pregnancy were identified: lower degree of planned pregnancy, smoking and alcohol habits before pregnancy ((1 unit/weekly aOR 4.48, CI: 3.14 - 6.40), (2-7 units aOR 10.23, CI: 7.44-14.06), (=8 units aOR 33.18, CI: 19.53-56.36)). Multiparity and the use of assisted reproductive technology were associated with lower odds of binge drinking in early pregnancy.
The prevalence of weekly alcohol consumption decreased considerably during early pregnancy compared with pre-pregnancy levels. Nevertheless one third of the pregnant women engaged in binge drinking. Identification of risk factors for this behaviour renders it possible not only to design prevention strategies, but also to target those most at risk.
Cites: J Epidemiol Community Health. 2001 Oct;55(10):738-4511553658
Cites: Am J Epidemiol. 2001 Oct 15;154(8):777-8211590091
Cites: Scand J Public Health. 2003;31(1):5-1112623518
Cites: J Epidemiol Community Health. 2004 May;58(5):426-3315082745
Both cigarette smoking and alcohol consumption during pregnancy remain an important concern for the practicing obstetrician, who should provide current information on the potential detrimental effects of these habits. There appears to be a wide spectrum of fetal phenotypic response to the effects of alcohol. This phenotypic variability may be partially explained by the dose, timing, and pattern of gestational exposure, the metabolism of mother or fetus, or other environmental and genetic factors. At the most severe end of the spectrum are infants with the unique combination of anomalies termed the fetal alcohol syndrome (FAS). The abnormalities most typically associated with alcohol teratogenicity can be grouped into 4 categories: central nervous system (CNS) dysfunctions; growth deficiencies; a characteristic cluster of facial abnormalites, and variable major and minor malformations. To make a diagnosis of fullblown FAS, abnormalities in all 4 categories must be present. Along the continuum toward normal are infants with various combinations of FAS anomalies. One of the most common and serious defects associated with ethanol teratogenicity is mental retardation. Recent evidence supports the concept of a prenatal origin to the problem. At birth infants with FAS are deficient for both length and weight, usually at or below the 3rd percentile for both parameters. Growth and mental deficiency are seen in many conditions, but the rather striking facial appearance of children with FAS secures the diagnosis. The characteristic face in small children includes short palpebral fissures, short upturned nose, hypoplastic philtrum, hypoplastic maxilla, and thinned upper vermilion. A table lists the variety of malformations that may be found in other organ systems in patients with FAS. The likelihood of miscarriage increases directly with alcohol consumption. Risk of abortion is twice as high in women consuming 1 ounce of absolute alcohol (AA) as infrequently as twice a week. Alcohol has severe effects on a wide variety of animal species, and these effects are reviewed. FAS has been estimated to occur between 1 in 600 and 1 in 1000 live births in the US, France, and Sweden. Possible interference with placentation or implantation has been suggested by the observed increased frequency of spontaneous abortion of a chromosomally normal conceptus for women who smoke. On average, infants born to women who smoke during pregnancy are 200 gm lighter than babies born to comparable women who do not smoke. From a review of these studies, the relationship between smoking and reduced birth weight is independent of all other factors that influence birth weight. The finding of antepartum bleeding of unknown cause has consistently been found more often in smokers, compared with nonsmokers. In almost all studies, the incidence of preeclampsia has been found to be reduced in smokers. Sudden infant death syndrome has been found to be closely associated with both the frequency and level of maternal smoking during pregnancy.
Risk of stillbirth evaluated by Poisson regression.
Mean (SD) length of follow-up was 5.5 (3.5) years. In analyses adjusting for baseline age and length of follow-up, =3 hours of baseline past-year vigorous physical activity per week (resulting in shortness of breath/sweating) was associated with increased risk of stillbirth compared with 18.5?and
The aims of this follow-up study were: (a) to evaluate the role of ECT technology as a risk factor for several diseases; and (b) to determine if the effects of these diseases on cows' reproductive performance and as risk factors for culling are influenced by exposure to ECTs. Diseases considered were retained placenta, metritis, ketosis, cystic ovaries, silent heat, milk fever, clinical mastitis, and foot and leg problems. We used historical and contemporary controls (with control herds selected to match the experimental herds for size and location). Data consisted of 10,264 Swedish Red and White (SRB) and 5461 Swedish Friesian (SLB) lactation records in 150 herds of which 33 used cow-trainers. Logistic regression was used to estimate the effects of parity and exposure to electric cow-trainers on the risks of diseases and the effects of diseases and exposure to electric cow-trainers on risk of culling. The least-squares procedure was used to estimate the effects of diseases on reproductive performance. The dominant effects associated with use of electric cow-trainers were an increased risk for silent heat, clinical mastitis, ketosis and culling relative to cows in herds not using cow-trainers. Diseases had negative effects on reproductive performance and the effects were larger for cows in herds using cow-trainers. In herds using electric cow-trainers, the largest increase in the interval from first service to conception (58 days) was caused by the occurrences of silent heat, cystic ovaries and the combination of two or more diseases. Retained placenta, metritis, cystic ovaries, clinical mastitis and a combination of two or more diseases increased the risk of culling about two times relative to healthy primiparous cows with the increase being greater for cows in herds using cow-trainers. Silent heat did not increase risk of culling in control groups, but was the largest risk factor for culling in the exposed group. We concluded that exposure to electric cow-trainers increased the incidence risk of silent heat, clinical mastitis, and ketosis and changed silent heat from a neutral disease with respect to culling to a major risk factor. Finally, exposure to cow-trainers increased the general negative effect of diseases on the cows' reproductive performance and risk for culling.
This paper describes weight gain during pregnancy in Sweden in relation to guidelines from the United States. These guidelines take into consideration the fact that optimal weight gain during pregnancy is related to the woman's prepregnant weight in relation to her height. Almost 50 per cent of women delivering babies in Sweden during the year 2000 were obese or overweight. In the three populations studied, less than 50 per cent gained weight in accordance with the US guidelines, while more than 20 per cent gained less weight than recommended. The results indicate that, in Sweden, more attention should be paid to the body weight of women who bear children.
Early labour is the very first phase of the labour process and is considered to be a period of time when no professional attendance is needed. However there is a high frequency of women who seek care at the delivery wards during this phase. When a woman is admitted to the delivery ward, one role for midwives is to determine whether the woman is in established labour or not. If the woman is assessed as being in early labour she will probably then be advised to return home. This recommendation is made due to past research that found that the longer a woman is in hospital the higher the risk for complications for her and her child. Women have described how this situation leaves them in a vulnerable situation where their preferences are not always met and where they are not always included in the decision-making process.
The aim of this study was to generate a theory based on where a woman chooses to be during the early labour process and to increase our understanding about how experiences can differ from place to place.
The method was a secondary analysis with grounded theory. The data used in the analysis was from two qualitative interview studies and 37 transcripts.
The findings revealed a substantive theory that women needed to be in a safe and thus secure place during early labour. This theory also describes the interplay between how women ascribed their meaning of childbirth as either a natural live event or a medical one, how this influenced where they wanted to be during early labour, and how that chosen place influenced their experiences of labour and birth.