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The tick-borne condition Lyme borreliosis, commonly known as Lyme Disease, is an emerging problem in the U.K. Thus media coverage highlighting clinical features and measures to prevent tick bites is welcome. How well does the news media provide this information? Here, reports from the British Public Service Broadcaster, the BBC, were examined. BBC coverage of Lyme Disease was classed depending on media type as 'television', 'radio' or 'web page'. Keywords related to symptoms and prevention techniques were recorded. Images of ticks or the characteristic EM rashes were also noted. More reports occurred in the spring and summer months than autumn and winter (Q2, 31.7%: Q3, 29.1%). Early diagnostic features such as a 'rash' (53.3%) and reference to tick bites (68.9%) were frequently mentioned. Other symptoms were well covered; including fever or 'flu-like' symptoms (43.6%), malaise (35.9%) and joint pain (43.6%). Less often mentioned were focal symptoms; including arthritis (8.7%) or facial palsy (6.7%). Prevention techniques were mentioned in 32% of all media reports, with tick removal (26.2%) and body checking (20.3%) being most often mentioned. Tick images were frequently provided (40.7%), but those of EM rashes less often (16.5%). Overall, coverage of early symptoms was high. However, symptoms indicative of later infection were less well covered. Increased use of EM images, and more appropriate tick images, could aid Lyme Disease identification amongst the general public. [ABSTRACT FROM AUTHOR]

This article seeks to provide a unified explanation to two profound challenges to Christian belief: the existence of evil and Darwin’s theory of natural selection. It is argued that an understanding of the full implications of our evolutionary past in conjunction with the Irenaean theodicy provides us with the best answer to these challenges. The traditional Irenaean theodicy emphasizes the importance of education for soul building. Soul building can benefit from technologically enhancing the biological superstructure of our humanity. In particular, genetic engineering can enhance human virtue. The biological basis of our moral natures can be improved using genetic technologies, including (possibly) somatic and germline engineering. To plan for virtue-first enhancement—the Genetic Virtue Project, which focuses on genetic improvements to our moral natures—is of paramount importance for the neo-Irenaean theodicy. [ABSTRACT FROM AUTHOR]

This is the sequel to my paper 'Against One Form of Judgment-Determinism' (IJPS, May 2001), wherein I argued that theoretical rationalization, that is, the forming of judgments by way of inference from other judgments, cannot simply be identified with any kind of predetermination of conclusion-judgments by premise-judgments. Taking 'free' to mean 'neither mechanistically explicable nor random' (where something is mechanistically explicable if and only if it is either predetermined or probabilified in a certain way, and is random if and only if it is not why-explicable at all) I attempt here to establish that all judgments, whether rationalized or not, are necessarily free. [ABSTRACT FROM AUTHOR]

Taking 'rationalized judgments' to be those formed by inference from other judgments, I argue against 'Extreme Determinism': the thesis that theoretical rationalization just is a kind of predetermination of 'conclusion-judgments' by 'premise-judgments'. The argument rests upon two key lemmas: firstly, that a deliberator - in this case, his/her assent to some proposition - to be predetermined (I call this the 'Openness Requirement'): secondly, that a subject's logical insight into his/her premise-judgments must enter into the explanation of any judgment s/he forms that is rationalized by those judgments. My contention is that, given the Openness Requirement, no version of Extreme Determinsim can allow for the role played by logical insight in the rationalization of judgment. I end by indicating briefly how this result might figure in a wider argument against any form of determinism about rationalized judgment, and by explaining why I have focused specifically upon rebutting a deterministic view of theoretical as opposed to 'practical' rationalization. [ABSTRACT FROM AUTHOR]

I have maintained that judgments must be voluntary since, as truth-aimed, they may be represented as responses to practical reasons. Christian Stein has objected that this argument cannot apply to judgments which are not the outcomes of theoretical reasoning. Furthermore, he contends that I have not succeeded in overcoming an argument of H. H. Price's to the effect that judgments which are such outcomes cannot be voluntary. I argue below that neither of these objections can be sustained. [ABSTRACT FROM AUTHOR]

Exposure to suicidal behavior (ESB) through social networks is often associated with an increased risk of suicidality, but empirical research—largely limited to the Western populations—has produced mixed results. Using survey data, we examined (a) the association between ESB and suicide attempt, and (b) the exacerbating role of ESB on gender differences in suicide attempt risk among Turkish adolescents (N = 2035). ESB was significantly associated with increased risk of suicide attempt, and it contributed to the higher attempt risk among girls. Suicidal behaviors spread through social networks via ESB, and suicide contagion exacerbates the existing gender differences. [ABSTRACT FROM AUTHOR]

Low-dose aspirin is recommended for pregnant individuals at high-risk of developing preeclampsia, but less is known about those that develop preeclampsia even while using prophylactic aspirin for preeclampsia prevention as the best course of treatment. The objective of this study is to investigate the risk factors with the highest risk of developing preeclampsia among pregnant individuals already using aspirin from high-risk obstetrical centers across five countries. This is a secondary analysis of pregnant individuals from the Folic Acid Clinical Trial (FACT) who were using prophylactic aspirin before 16 weeks gestation. The FACT randomized control trial took place in 70 high risk obstetrical centers in Canada, United Kingdom, Australia, Jamaica, and Argentina between 2011–2015. Participants were included if they had any of the risk factors for preeclampsia: diabetes, chronic hypertension, twin pregnancy, history of preeclampsia, and/or obesity (Body Mass Index ≥35). The outcomes of interest were preeclampsia and preterm preeclampsia (<37 weeks). Log binomial regressions assessed factors significantly associated with any preeclampsia or preterm-preeclampsia (<37 weeks) using adjusted risk ratios (ARR) and 95% confidence intervals (CI). There were 2296 pregnant individuals with complete information on aspirin included in this study. At baseline, all patients were at high risk of preeclampsia and were eligible for aspirin prophylaxis, however, only 660 (28.7%) were taking aspirin. Among the 660 pregnant individuals taking aspirin, 132 (20%) developed preeclampsia and 60 (9.09%) preterm preeclampsia. Among pregnant individuals using aspirin, the risks of preeclampsia were highest for twins (ARR:2.62, 95% CI: 1.68–4.11), history of preeclampsia (ARR: 2.42, 95% CI: 1.74–3.38), and hypertension (ARR:1.92, 95% CI: 1.37–2.69). Similar trends were found for preterm-preeclampsia for twins (ARR:4.10, 95% CI:2.15–7.82), history of preeclampsia (ARR:2.75, 95% CI:1.62–4.67), and hypertension (ARR:2.18, 95% CI:1.28–3.72). No significant differences were found for obesity or diabetes. These findings suggest that individuals with twin pregnancies, a history of preeclampsia, or hypertension may not benefit from aspirin to the same extent as those with other complications such as obesity or diabetes. Careful clinical monitoring for these risks factors is recommended and future research into the effectiveness in these populations would increase our understanding of the current best practice of prophylactic aspirin use to prevent preeclampsia. TRIAL REGISTRATION: Current Controlled Trials ISRCTN23781770 and ClinicalTrials.gov NCT01355159 [ABSTRACT FROM AUTHOR]

Background: Education is considered one of the most robust determinants of health. However, it is unclear whether maternal education and paternal education have differential impacts on perinatal health outcomes. We assess maternal and paternal education differences and their association with adverse birth outcomes in a large birth cohort from Ontario, Canada. Methods: The OaK Birth Cohort recruited patients from Ontario, Canada, between October 2002 and April 2009. We recruited mothers were recruited between 12 and 20 weeks’ gestation and collected both mother and infant data. The final sample size of the cohort was 8,085 participants. We use logistic regression to model the probability of preterm birth (less than 34 and 37 weeks’ gestation), small-for-gestational-age (SGA), or stillbirth as a function of maternal and paternal educational attainment. We adjust for household-level income, maternal and paternal race and ethnicity, and compare the strength of the association between maternal and paternal education on outcomes using Wald tests. Results: 7,928 mother-father-offspring triads were available for the current analysis. 75% of mothers and fathers had college or university level education, and 8.7% of mothers experienced preterm delivery. Compared to mothers with college or university education, mothers with a high school education had an odds ratio of 1.37 (95% CI: 1.01–1.87) for SGA. Paternal education was not associated with infant outcomes. Comparing the odds ratios for maternal education and paternal education showed a stronger association than paternal education at the high school level for SGA birth (difference in odds ratio: 1.95, 95% CI: 1.13–3.36, p = .016) among women at least 25 years old. Conclusion: Maternal education was associated with SGA, and this effect was more robust than paternal education, but both associations were weaker than previously reported. [ABSTRACT FROM AUTHOR]

Abstract Objective Results Conclusion Benign spinal intradural tumors are rare entities and there have been relatively few case series describing the epidemiology and characteristics of these tumors. Here, we evaluate the presentation, demographics, pathology and outcomes associated with the surgical management of spinal meningioma in our unit over a 6-year period.A total of 68 cases presented to the operating surgeon during a 6-year period. Of these, over 80% (n = 55) were in females. Seventy-nine percent of the meningiomas were observed in the thoracic region (n = 54). Weakness and gait disturbance were the most common presenting complaints. Surgery significantly improved both motor outcome (p < 0.001) and health related qualities of life (SF36, p < 0.01).Seventeen percent of spinal meningioma cases (n = 12) had a preceding cancer diagnosis. Of these 75% (n = 9/12) were attributable to breast cancer. Overall, breast cancer preceded a diagnosis of a spinal meningioma in 16.4% of female cases (9/55). This is higher than expected number of breast cancer based on UK population and those reported in literature for breast cancer and intracranial meningioma.Spinal meningioma is disproportionately over-represented in females. Patients present with neurological deficits and surgery improved both neurology and patient reported quality of life. Relative to the known UK prevalence of breast cancer, there is a significantly higher than expected association between spinal meningioma and a preceding history of breast cancer. [ABSTRACT FROM AUTHOR]

To determine the efficacy of high-dose folic acid for the prevention of preeclampsia in twin pregnancies. Secondary analysis of a randomized controlled trial in 70 obstetrical sites in Argentina, Australia, Canada, Jamaica, and the UK between 2011 and 2015. Eligible women pregnant with twins who were aged 18 y or older and between 8 and 16 completed weeks' gestation were randomized between to receive daily high-dose folic acid (4.0–5.1 mg) or placebo. The primary outcome was preeclampsia, presenting as hypertension after 20 weeks' gestation with significant proteinuria. Secondary outcomes included severe preeclampsia, preterm birth, and adverse fetal and neonatal outcomes. Of 2464 participants randomized between 18 April 2011 and 14 December 2015, 462 (18.8%) had a confirmed twin pregnancy. Thirty-four of these participants withdrew consent or did not have primary outcome data available, and 428 women were analyzed. The rate of preeclampsia was significantly higher in the folic acid group compared to the placebo group in crude analyses (17.2 versus 9.9%; relative risk 1.75 [95% CI 1.06–2.88], p =.029). Multivariable analyses attenuated this effect, rendering it not statistically significant (RR 1.58 [95% CI 0.95–2.63], p =.079). High-dose folic acid supplementation was not significantly associated with preeclampsia in a subgroup of twin pregnancies. Although a suggested elevated risk cannot be confirmed, these results may help to gain novel insights in the etiology of preeclampsia, which continues to be poorly understood. ClinicalTrials.gov NCT01355159. [ABSTRACT FROM AUTHOR]

This paper proposes incorporating the concept of the ‘observing eye/I’, from cognitive analytic therapy (CAT), to Hawkins and Shohet's seven modes of supervision, comprising their transtheoretical model of supervision. Each mode is described alongside explicit examples relating to CAT. This modification using a key idea from CAT (in the form of the addition of a Mode 8 ‘observing us’) enhances the model's utility in supervisory practice. With this adaptation, the model could also be used, with greater breadth and depth, in therapies where the primary focus is not relational. The collaboratively reflexive ‘observing us’ ensures that the very process of supervision is effectively monitored and attended to. The inclusion of this eighth level leads to more formal emphasis on the meta communication and meta commentary levels in supervision. [ABSTRACT FROM AUTHOR]

This paper proposes incorporating the concept of the ‘observing eye/I’, from cognitive analytic therapy (CAT), to Hawkins and Shohet's seven modes of supervision, comprising their transtheoretical model of supervision. Each mode is described alongside explicit examples relating to CAT. This modification using a key idea from CAT (in the form of the addition of a Mode 8 ‘observing us’) enhances the model's utility in supervisory practice. With this adaptation, the model could also be used, with greater breadth and depth, in therapies where the primary focus is not relational. The collaboratively reflexive ‘observing us’ ensures that the very process of supervision is effectively monitored and attended to. The inclusion of this eighth level leads to more formal emphasis on the meta communication and meta commentary levels in supervision. [ABSTRACT FROM PUBLISHER]

It is estimated that close to 30% of all pregnancies end in spontaneous abortion. Although about 60% of spontaneous abortions are thought to be due to genetic, infectious, hormonal, and immunological factors, the role of the environment remains poorly understood. Pregnancy involves a delicate balance of hormonal and immunological functions, which may be affected by environmental substances. Many toxic substances that are persistent in the environment and accumulate in the fatty tissues may disrupt this equilibrium. This overview addresses known risk factors for spontaneous abortions and examines the role, if any, that environmental factors (chemical and physical) may play in the etiology of this adverse health outcome. [ABSTRACT FROM AUTHOR]

This retrospective pilot study examined the relationship between psychological status at the time of breast cancer diagnosis and ratings of cosmetic outcome later. Sixty-three patients completed measures of depression, anxiety, and quality of life at the time of diagnosis. Following lumpectomy and radiation therapy, these patients and their radiation oncologists completed ratings of the quality of the cosmetic outcome (Cosmesis). The results indicated that both psychological distress and quality of life were related to patients' ratings of Cosmesis, while only patients' quality of life was related to physicians' ratings of Cosmesis. We conclude that Cosmesis is a multifaceted construct that incorporates both physical and psychological factors. [ABSTRACT FROM AUTHOR]

The human fetus, child, and adult may experience adverse health outcomes from parental or childhood exposures to environmental toxicants. The fetus and infant are especially vulnerable to toxicants that disrupt developmental processes during relatively narrow time windows. This review summarizes knowledge of associations between child health and development outcomes and environmental exposures, including lead, methylmercury, polychlorinated biphenyls (PCBs), dioxins and related polyhalogenated aromatic hydrocarbons (PHAHs), certain pesticides, environmental tobacco smoke (ETS), aeroallergens, ambient air toxicants (especially particulate matter [PM] and ozone), chlorination disinfection by-products (DBPs), sunlight, power-frequency magnetic fields, radiofrequency (RF) radiation, residential proximity to hazardous waste disposal sites, and solvents. The adverse health effects linked to such exposures include fetal death, birth defects, being small for gestational age (SGA), preterm birth, clinically overt cognitive, neurologic, and behavioral abnormalities, subtle neuropsychologic deficits, childhood cancer, asthma, other respiratory diseases, and acute poisoning. Some environmental toxicants, notably lead, ionizing radiation, ETS, and certain ambient air toxicants, produce adverse health effects at relatively low exposure levels during fetal or child developmental time windows. For the many associations supported by limited or inadequate epidemiologic evidence, major sources of uncertainty include the limited number of studies conducted on specific exposure-outcome relationships and methodologic limitations. The latter include (1) crude exposure indices, (2) limited range of exposure levels, (3) small sample sizes, and (4) limited knowledge and control of potential confounders. Important knowledge gaps include the role of preconceptual paternal exposures, a topic much less studied than maternal or childhood exposures. Large longitudinal studies beginning before or during early pregnancy are urgently needed to accurately measure and assess the relative importance of parental and childhood exposures and evaluate relatively subtle health outcomes such as neuropsychologic and other functional deficits. Large case-control studies are also needed to assess the role of environmental exposures and their interactions with genetic factors in relatively uncommon outcomes such as specific types of birth defects and childhood cancers. There is also an urgent need to accelerate development and use of biomarkers of exposure and genetic susceptibility in epidemiologic studies. This review supports the priority assigned by international agencies to relationships between child health and air quality (indoor and outdoor), lead, pesticides, water contaminants, and ETS. To adequately address such priorities, governments and agencies must strengthen environmental health research capacities and adopt policies to reduce parental and childhood exposures to proven and emerging environmental threats. [ABSTRACT FROM AUTHOR]

A research-to-practice gap was identified in a study on knowledge sharing regarding future cardiovascular disease (CVD) risk associated with a previous diagnosis of pre-eclampsia (PE) during pregnancy, where 41% of healthcare practitioners did not inform patients of increased risk more than 50% of the time. Employing an empirical, sociological lens, we conducted interviews with women and healthcare providers from the same sample as that study. In this article, we analyse participants' perceptions of and attitudes towards the relationship between PE and CVD risk, assessing how relationships between research findings, risk, pregnancy, and women's health are understood and acted upon in Canadian healthcare. Relating empirical observations to larger debates surrounding knowledge sharing practices, we argue that structural, practical, and ideological barriers impede knowledge sharing between healthcare practitioners and patients. Patient perceptions and experiences of the knowledge sharing gap must be addressed in practical and structural changes to healthcare. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of folic acid supplementation during pregnancy on the risk of gestational hypertension/preeclampsia.Methods: A systematic review and meta-analysis were conducted. Medline, Embase, Scopus, and the Web of Science were searched from inception to December 2014.Results: Out of 1224 potentially relevant studies, 13 studies met our inclusion criteria (2 randomized controlled trials (RCTs), 10 cohort studies, and 1 case-control study). The pooled relative risk (RR) and 95% confidence interval (CI) of the two RCTs were 0.62 (0.45-0.87) in the trial arm as compared with the placebo arm. The pooled RR was 0.92 (95% CI: 0.79-1.08) for nine cohort studies with available data on folic acid supplementation in pregnancy and gestational hypertension/preeclampsia. Pooled RR was 0.88 (95% CI: 0.76-1.02) for eight cohort studies with available data on folic acid supplementation and preeclampsia.Conclusion: Whether folic acid supplementation in pregnancy can prevent the occurrence of gestational hypertension/preeclampsia remains uncertain. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to review the maternal and neonatal morbidity and mortality associated with six or more caesarean section (CS).Methods: We conducted a retrospective chart review, at King Abdulaziz University Hospital (KAUH) in Jeddah, for all patients admitted between 2000 through 2010 and identified five patients having more than six CS deliveries.Results: Deliveries occurred in the ranges of 31-38 weeks, from which four cases required emergency CS. There were two cases in the series with a placenta previa. There was a single case of uterine dehiscence. Only one case required a blood transfusion and was complicated with a placenta accreta, bladder injury, urinary tract infection, and prolonged maternal hospital stay with neonatal intensive care unit (NICU) admission. All cases had moderate to severe adhesion intra-operatively. Operative time was long in all cases with a range 55-106 min. One of the five cases had a postoperative wound infection. Finally, none of the current series showed fetal or maternal mortalities.Conclusions: The long-term complications associated with CS should be discussed with patients in the first and subsequent pregnancies. This case series highlighted the outcomes in these unique cases of higher order caesareans. [ABSTRACT FROM AUTHOR]

Background: Carbon monoxide (CO) is one of the main substances contained in fireworks. Previous studies suggested that CO may have protective effect on the development of hypertension of pregnancy. Method: The authors conducted a prospective cohort study in Liuyang, Hunan, China between January 2010 and December 2011. Demographic and life-style variables of the participating pregnant women were obtained through structured interview with the women and clinical data were retrieved from antenatal medical records. Density of fireworks factories was defined as the number of fireworks factories per 1000 residents in the township where the mothers resided during pregnancy. Multiple logistic regression analysis was used to analyze the independent association between maternal exposure to the production of fireworks and new onset hypertension in pregnancy. Results: A total of 5976 pregnant women were included in the final analysis. Density of fireworks factories was inversely correlated with incidence of new onset hypertension in pregnancy (Pearson correlation coefficient = −0.29, p < 0.001). Multiple logistic regression analysis showed that, compared with women who resided during pregnancy in a township with 0-0.25 fireworks factories per 1000 residents, the rates of new onset hypertension in pregnancy in women who resided in a township with 0.26-1.00 fireworks factories per 1000 residents (Odds Ratio = 0.66, 95% confidence interval: 0.46, 0.96) and >1.5 fireworks factories per 1000 residents (Odds Ratio = 0.65, 95% confidence interval: 0.44, 0.97) were reduced by more than 30%. Conclusion: Maternal exposure to the high density of fireworks factories is associated with reduced risk of developing new onset hypertension in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between overweight and obesity and breastfeeding behaviors, a cohort study was conducted among 22,131 women who delivered in Ontario hospitals between April 1 2008 and March 31 2010. Methods: Data regarding maternal characteristics, maternal body mass index (BMI), infant characteristics, and breastfeeding practices were obtained through the Better Outcomes Registry & Network birth records Database. Multivariate linear regression analysis was used to determine the rates of three outcome measures - intention to breastfeed, exclusive breastfeeding in hospital, and exclusive breastfeeding upon discharge from hospital - between non-obese, overweight and obese patients. Results: While overweight mothers have similar intentions to breastfeed compared to non-overweight mothers (OR 1.03 (0.87-1.21), obese mothers were less likely to intend to breastfeed (OR 0.84 (0.70-0.99). Overweight and obese mothers were less likely to exclusively breastfeed in hospital compared to non-overweight mothers (aOR 0.67 (0.60-0.75) and 0.67 (0.60-0.75), respectively), and overweight and obese mothers were less likely to exclusively breastfeed on discharge (aOR 0.68 (0.61-0.76) and 0.68 (0.61-0.76), respectively). Conclusions: This study highlights that while overweight and obese women may benefit more from exclusive breastfeeding compared to non-overweight women, they are less likely to exclusively breastfeed in the immediate post-partum period. [ABSTRACT FROM AUTHOR]

Objectives: To compare outcomes of neonates born from women with Class III obesity with those whose mothers were of normal body weight. Methods: A retrospective cohort study of live-born singleton infants was undertaken. Maternal prepregnancy body mass index (BMI) defined matched normal and Class III obese cohorts. Multivariable regression models were used to determine adjusted relative odds ratios (aOR) and 95% confidence intervals (CI) for selected adverse neonatal outcomes. Results: Newborns exposed to maternal Class III obesity had greater risks of fetal overgrowth and low cord artery pH. Class III obesity was protective against small for gestational age and low birthweight. There was no difference in the risk of preterm delivery, meconium in the amniotic fluid or breastfeeding initiation. Conclusions: The new knowledge generated by this study provides further information on unique challenges faced by newborns of women with Class III obesity, suggesting more specialized care in the intrapartum and neonatal periods may be beneficial. [ABSTRACT FROM AUTHOR]

Objective: To assess the association of intrauterine insemination, in vitro fertilization (IVF) and ovulation induction with the risk of preeclampsia. Methods: We conducted a population based retrospective cohort study of pregnancies conceived by assisted reproductive technology (1357 exposure subjects, 5190 controls) based on 2005 Niday Perinatal Database for Ontario, Canada. All pregnancies conceived by assisted reproductive technology were identified as exposure group. Four controls were randomly matched for each exposure subject by maternal age, parity, plurality, and delivery hospital level and residence area. The risks for preeclampsia associated with intrauterine insemination, IVF, and ovulation induction were evaluated through conditional logistic regression models compared with their corresponding controls. Results: With adjustment of maternal age, smoking during pregnancy and initiating time of prenatal care, in vitro fertilization was associated with an increased risk for preeclampsia (OR = 1.78, 95% CI: 1.05, 3.06), whereas intrauterine insemination (OR = 2.44, 95% CI: 0.74, 8.06) and ovulation induction (OR = 1.34, 95% CI: 0.31, 5.75) was not associated with the risk for preeclampsia. Conclusion: There was a higher incidence of preeclampsia among pregnancies conceived by IVF, but no significant association was found in intrauterine insemination and ovulation induction. [ABSTRACT FROM AUTHOR]

Objective: To assess the utilization of health care services by pregnant women affected by preeclampsia (PE). Design: Population-based study. Setting: Perinatal partnership hospitals in Ontario. Population: Obstetric deliveries in 2005 Canadian province of Ontario (about 95% of births). Methods: For each PE case, four subjects without PE matched by age, parity, plurality, and hospital at childbirth were chosen as the controls. We compared the utilization of intra-partum care services and infant outcomes between the two groups. We also estimated the extra costs to the health care system in Ontario for caesarean delivery and caring of extremely low birth weight infants attributable to PE during the neonatal period and in the first 2 years of life. Main Outcome Measures: Cesarean delivery, hospital stay, extremely low birth weight infants, cost. Results: Of the 120,611 obstetric deliveries included in this analysis, 1240 (1.3%) were diagnosed with PE. Patients with PE and matched controls were similar in maternal age, parity, and other demographic characteristics. Compared with study subjects without PE, those with PE had increased uses of spinal anesthesia, maternal transfer, Cesarean delivery, labour induction, neonatal transfer, newborn resuscitation, longer hospital stay for childbirth, and higher rates of preterm births and low birth weight. The extra costs to the health care system for cesarean delivery and caring of extremely low-birth-weight infants attributable to PE during the neonatal period and in the first 2 years of life in Ontario were $0.5 millions, 3.1 millions, and $5.1 million per year, respectively, if we use the reported PE rate in this database. Conclusion: PE is associated with substantially increased costs to the health care system. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of new-onset hypertension (NOH) in late pregnancy on fetal growth in singletons and twins. Methods: A retrospective cohort study was conducted to evaluate the effect of NOH on fetal growth in 17, 720, 900 singletons and 463, 104 twins born in the United States between 1995 and 2000. Results: NOH was associated with lower mean birth weight in both preterm and term singletons. Increased risk of low birth weight and decreased risk of high birth weight was associated with NOH in preterm and term singletons. NOH was associated with increased risk for small-for-gestational-age (SGA) births and decreased risk for large-for-gestational-age (LGA) births in preterm singletons, whereas it was associated with increased risk of both SGA and LGA births in term singletons. NOH was associated with higher mean birth weight in early preterm twins, and lower mean birth weight in term twins. Decreased risk for low birth weight was found in the NOH group among early preterm twins, and increased risk for low birth weight in term twins. NOH was associated with increased risk of SGA births and decreased risk for large-for-gestational-age (LGA) births in early preterm twins, while increased risk of SGA births in term twins. Conclusion: NOH is associated with slower fetal growth in singletons delivered at different gestational ages, but the effect varies in twins depending on gestational age at delivery with faster growth in early preterm twins. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between new-onset hypertension in late pregnancy (NOH) and fetal and infant mortality in early preterm, late preterm, and full-term twins. Methods: We conducted a retrospective cohort study in 275, 316 twins in 1995–1997 based on multiple birth registration dataset of USA. Generalized estimating equations (GEEs) was used to evaluate the odds ratios (OR) of fetal and infant death (at individual level) associated with NOH, with adjustment of potential confounders at both twin set level and individual level. Results: The risks for early neonatal death (OR = 0.52, 95% CI: 0.36, 0.76) and late neonatal death (OR = 0.57, 95% CI: 0.37, 0.87) were decreased in early preterm twins born to mothers with NOH compared with early preterm twins born to mothers with normal blood pressure. The decreased risks for fetal death (OR = 0.40, 95% CI: 0.30, 0.53; OR = 0.46, 95% CI: 0.53, 0.65) and infant death (OR = 0.35, 95% CI: 0.28, 0.44; OR = 0.68, 95% CI: 0.51, 0.91) were associated with NOH in both early and late preterm twins, whereas no association between NOH and fetal/infant mortality were observed in full-term twins. Conclusion: NOH is associated with lower risk of fetal death and infant death in preterm twins. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between maternal age, paternal age, and new-onset hypertension in late pregnancy. Methods: We carried out a retrospective cohort study of 9,302,675 pregnant women with live births in the United States between 1995 and 1998. Maternal and paternal ages were analyzed together using “couple age” in multivariate logistic regression models to reduce colinearity between maternal age and paternal age. The effect of paternal age was also analyzed with stratification of maternal age. Results: Compared with couples with both a maternal and paternal age of 20 to 34 years, an older maternal age (above 35 years) was associated with an increased risk for new-onset hypertension, except for couples with a very young father (below 20 years). Younger maternal age (below 20 years) was associated with a decreased risk for new-onset hypertension, except for couples with a very old father (above 45 years). There was no significant association between paternal age and new-onset hypertension with stratification of maternal age. Conclusion: Increased risk for new-onset hypertension in late pregnancy is significantly associated with advancing maternal age, whereas there is no association between paternal age and new-onset hypertension in late pregnancy. [ABSTRACT FROM AUTHOR]