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Objectives. The purpose of this study was to expand the search for risk factors for low birthweight and to find new explanations for the ethnic-group disparities in birth outcomes. Methods. The subjects were 1150 pregnant women from six ethnic groups (African American, Chinese, Dominican, Puerto Rican, Mexican, and White) who received prenatal care at clinics in New York and Chicago between December 1987 and December 1989. Two interviews were conducted during the second and third trimesters of pregnancy. Results. The study, after controlling for poverty and other birthweight correlates, showed that living in public housing and believing that chance plays a major role in determining one's health status were negatively associated with birthweight. Having a stable residence was positively related to birthweight. Material hardship, social adversity, perceived racial discrimination, physical abuse, anxiety, and depression were not associated with birthweight. Conclusions. The negative role of an impoverished living environment and feelings of helplessness, as well as the positive role of having a stable form of social support, suggest new directions for research on the causes of low birthweight and the ethnic disparities in US birth outcomes. [ABSTRACT FROM AUTHOR]

Abstract: A prospective survey of maternal employment and breast-feeding initiation and duration was conducted among 668 Black and 511 White women who delivered their first child in Washington, DC. Ninety-one percent of White women (n = 511) and 80 percent of Black women (n = 668) reported working during pregnancy. Black women who planned to return to work part time vs full time were more likely to breast-feed rather than formula-feed (adjusted odds ratio, 2.3; 95% confidence intervals (CI) = 1.4, 3.7). Using Cox regression, Black women who returned to work had a shorter duration of breast-feeding than those not returning to work (hazard ratio = 0.5 (CI = 0.3, 0.9)). Black and White women returning to professional occupations had a longer duration of breast-feeding compared to women returning to sales or technical positions (hazard ratio for Black women = 2.4 (CI = 1.4, 4.4); hazard ratio for White women = 1.6 (CI = 1.0, 2.5)). In addition, White women in professional occupations had a longer duration of breastfeeding than women in clerical positions (hazard ratio = 1.7 (CI = 1.1, 2.6)). Until employers in the United States develop a maternity policy which does not discourage breast-feeding, the recommended six months of breast-feeding will be difficult to achieve for most employed women. (Am J Public Health 1989; 79:1247-1250). [ABSTRACT FROM AUTHOR]

Abstract: Ethnic differences in preterm (<37 weeks) and very preterm (<33 weeks) delivery were evaluated in a prospective cohort of 28,330 women. Blacks had the highest rate of preterm and very preterm delivery, followed by Mexican-Americans, Asians, and Whites. Adjustment for maternal age, education, marital status, employment, parity, number of previous spontaneous or induced abortions, smoking and drinking during pregnancy, infant sex, and gestational age at initiation of prenatal care resulted in the following odds ratios for preterm delivery: 1.79 (1.55-2.08) for Blacks, 1.40 (1.19-1.63) for Mexican-Americans, 1.40 (1.16-1.69) for Asians, and 1.00 for Whites. The corresponding odds ratios for very preterm delivery were 2.35 (1.72-3.22) for Blacks, 1.31 (0.88-1.94) for Mexican-Americans, 1.10 (0.67-1.83) for Asians, and 1.00 for Whites. Exclusion of cases of premature rupture of membranes, placenta previa, and abruptio placenta did not explain the large ethnic differences. Although Whites and Mexican-Americans had similar birthweight distributions, Mexican-Americans had an increased risk for preterm delivery. Fifty-five per ¢ of low birthweight babies in Kaiser were preterm and this fraction did not vary substantially by ethnic group. [ABSTRACT FROM AUTHOR]

Presents a study that compared spontaneous and induced abortions in a nationally representative sample of female medical school graduates and of the sexual partners of their male classmates. Patients and methods; Results; Conclusion.

Abstract. Factors influencing early formula supplementation in breast-fed neonates were examined among 726 women who were delivered of their first child in one of three metropolitan Washington, DC, hospitals. Thirty-seven percent of breast-fed neonates were given supplementary formula in the hospital. Mothers who gave birth at a university hospital were more likely to breast-feed exclusively (adjusted odds ratio 3.5; 95% confidence limit 2.1 to 5.9), after adjustment for maternal demographics, hospital factors (such as time of first breast-feed, demand feeding, delivery type, and rooming-in), and the maternal breast-feeding commitment. Aside from delivery hospital, a strong predictor of formula use was the time between birth and initiation of the first breast-feed. The longer a mother waited to initiate breast-feeding the more likely she was to use formula; the adjusted odds ratios for women who initiated breast-feeding 2 to 6 hours, 7 to 11 hours, and 12 or more hours postpartum were 1.1, 0.5, and 0.2, respectively. Feeding the baby on demand, having a vaginal delivery, deciding to breast-feed before pregnancy, having a college education, and being married also were moderately, though significantly, predictive of exclusive breast-feeding. The findings suggest that hospital influences can promote formula use and indirectly shorten breast-feeding duration, particularly those hospital practices that delay early initiation of breast-feeding. [ABSTRACT FROM AUTHOR]

The influence of sociodemographic factors on the incidence and duration of breast-feeding was evaluated in 668 black and 511 white women delivering their first child in the metropolitan Washington, DC, area. Breast-feeding rates were 84% among white and 49% among black women. Maternal educational level was strongly associated with breast-feeding, whereas the effect of ethnicity was moderate. Women with some college or some graduate school education had adjusted odds of breast-feeding that were 2.6 (95% confidence limit 1.9 to 3.7) and 5.2 (95% confidence limit 2.7 to 10.2) times higher than women with a high school education or less. In contrast, the adjusted odds of breast-feeding were 2.0 (95% confidence limit 1.4 to 3.1) times higher for white women compared with black women. The odds of breast-feeding increased among black women if they attended childbirth classes, were married, or were older. Among black women, the frequency of breast-feeding decreased sharply by I month postpartum. Breast-feeding duration for black v white women was 74% v 90% at 1 month, 44% v 72% at 4 months, and 26% v 50% at 7 months postpartum. The majority of black women (53%) used formula supplements in the hospital, which was the only factor significantly related to a shortened duration in this group (P < .01). The high rate of formula supplementation among black women and its strong association with shortened duration of breast-feeding point to a need for more advice and support and less reliance on formula during the hospital stay. [ABSTRACT FROM AUTHOR]

Examines the effects of maternal anemia on the pathogenesis of preterm birth. Incidence of preterm birth among women with and without anemia; Dose-response effect for anemia; Comparison of hematocrits from women who are in preterm and term labor.

In a population of about 300,000 Northern California women aged 15-44, the age-adjusted incidence of ectopic pregnancy rose from 55.5 to 84.2/100,000 women. 1972-1978. The ratio of ectopics to 1,000 deliveries-plus spontaneous abortions rose from 9.4 to 14.8. The change occurred mainly in women under age 30, and was observed in seven of the eight hospitals in the area. There was no alteration in the frequency of hospitalized pelvic inflammatory disease (PID): salpingitis decreased over the years studied; and tubal sterilization events remained constant at around 0.9 per cent per year of women aged 15-44. [ABSTRACT FROM AUTHOR]

Presents a study that developed a voluntary, anonymous, Internet-based reporting of medical errors in neonatal intensive care. Methods; Results; Discussion.

Background: Two recent studies have found that infants who received intramuscular vitamin K were at twice the expected risk for cancer during childhood. Since nearly all newborns in the United States receive this drug, the public health implications of this association, if confirmed, would be substantial. Methods: We examined the relation between vitamin K and cancer in a nested case-control study that used data from the Collaborative Perinatal Project, a multicenter, prospective study of pregnancy, delivery, and childhood. Among 54,795 children born from 1959 through 1966, 48 cases of cancer were diagnosed after the first day of life and before the eighth birthday. Each case child was matched with five randomly selected controls whose last study visit occurred at or after the age when the case child's cancer was diagnosed. Exposure to vitamin K was determined from study forms and medical records. Results: Vitamin K had been administered to 68 percent of the 44 case children and 71 percent of the 226 controls for whom data were available (matched odds ratio, 0.84; 95 percent confidence interval, 0.41 to 1.71). The odds ratio was 0.47 (95 percent confidence interval, 0.14 to 1.55) for leukemia and 1.08 (95 percent confidence interval, 0.45 to 2.61) for other cancers. Sequential adjustment for potential confounding factors did not change the results substantially. Conclusions: We found no association between exposure to vitamin K and an increased risk of any childhood cancer or of all childhood cancers combined, although a slightly increased risk could not be ruled out. The benefits of neonatal vitamin K prophylaxis against hemorrhagic disease have been well described. Unless other evidence supporting an association between vitamin K and cancer appears, there is no reason to abandon the routine administration of vitamin K to newborns. (N Engl J Med 1993;329:905-8.) [ABSTRACT FROM AUTHOR]