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Background: Maternal pregestational diabetes and obesity are risk factors for birth defects. Diabetes and obesity often occur together; it is unclear whether their co‐occurrence compounds birth defect risk. Methods: We analyzed 1997–2011 data on 29,671 cases and 10,963 controls from the National Birth Defects Prevention Study, a multisite case‐control study. Mothers self‐reported height, pregestational weight, and diabetes (pregestational and gestational; analyzed separately). We created four exposure groups: no obesity or diabetes (referent), obesity only, diabetes only, and both obesity and diabetes. We estimated odds ratios (ORs) using logistic regression and the relative excess risk due to interaction (RERI). Results: Among mothers with pregestational obesity without diabetes, modest associations (OR range: 1.1–1.5) were observed for neural tube defects, small intestinal atresia, anorectal atresia, renal agenesis/hypoplasia, omphalocele, and several congenital heart defects. Pregestational diabetes, regardless of obesity, was strongly associated with most birth defects (OR range: 2.0–75.9). Gestational diabetes and obesity had a stronger association than for obesity alone and the RERI (in parentheses) suggested additive interaction for hydrocephaly (1.2; 95% confidence interval [CI]: −0.1, 2.5), tetralogy of Fallot (0.9; 95% CI: −0.01, 1.8), atrioventricular septal defect (1.1; 95% CI: −0.1, 2.3), hypoplastic left heart syndrome (1.1; 95% CI: −0.2, 2.4), and atrial septal defect secundum or not otherwise specified (1.0; 95% CI: 0.3, 1.6; only statistically significant RERI). Conclusions: Our results do not support a synergistic relationship between obesity and diabetes for most birth defects examined. However, there are opportunities for prevention by reducing obesity and improving glycemic control among women with pregestational diabetes before conception. [ABSTRACT FROM AUTHOR]

Objective To examine the potential effects of prenatal smokeless tobacco use on selected birth outcomes. Design A population-based, case-control study using a retrospective medical record review. Population Singleton deliveries 1997-2005 to Alaska Native women residing in western Alaska. Methods Hospital discharge codes were used to identify potential case deliveries and a random control sample. Data on tobacco use and confirmation of pregnancy outcomes were abstracted from medical records for 1123 deliveries. Logistic regression was used to examine associations between tobacco use and pregnancy outcomes. Adjusted odds ratios ( OR), 95% confidence intervals (95% CI), and p-values were calculated. Main outcomes measures Preterm delivery, pregnancy-associated hypertension, and placental abruption. Results In unadjusted analysis, smokeless tobacco use was not significantly associated with preterm delivery ( OR 1.44, 95% CI 0.97-2.15). After adjustment for parity, pre-pregnancy body mass index, and maternal age, the point estimate was attenuated and remained non-significant. No significant associations were observed between smokeless tobacco use and pregnancy-associated hypertension (adjusted OR 0.92, 95% CI 0.56-1.51) or placental abruption (adjusted OR 1.11, 95% CI 0.53-2.33). Conclusions Prenatal smokeless tobacco use does not appear to reduce risk of pregnancy-associated hypertension or to substantially increase risk of abruption. An association between smokeless tobacco and preterm delivery could not be ruled out. Components in tobacco other than nicotine likely play a major role in decreased pre-eclampsia risk in smokers. Nicotine adversely affects fetal neurodevelopment and our results should not be construed to mean that smokeless tobacco use is safe during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: We examined the risk of gestational diabetes mellitus (GDM) among foreign-born and U.S.-born mothers by race/ethnicity and BMI category. Design and Method: We used 2004-2007 linked birth certificate and maternal hospital discharge data of live, singleton deliveries in Florida to compare GDM risk among foreign-born and U.S.-born mothers by race/ethnicity and BMI category. We examined maternal BMI and controlled for maternal age, parity, and height. Results: Overall, 22.4% of the women in our study were foreign born. The relative risk (RR) of GDM among women who were overweight or obese (BMI ≥ 25.0 kg m−2) was higher than among women with normal BMI (18.5-24.9 kg m−2) regardless of nativity, ranging from 1.3 (95% confidence interval (CI) = 1.0, 1.9) to 3.8 (95% CI = 2.1, 7.2).Foreign-born women also had a higher GDM risk than U.S.-born women, with RR ranging from 1.1 (95% CI = 1.1, 1.2) to 2.1 (95% CI = 1.4, 3.1). This finding was independent of BMI, age, parity, and height for all racial/ethnicity groups. Conclusions: Although we found differences in age, parity, and height by nativity, these differences did not substantially reduce the increased risk of GDM among foreign-born mothers. Health practitioners should be aware of and have a better understanding of how race/ethnicity and nativity can affect women with a high risk of GDM. Although BMI is a major risk factor for GDM, it does not appear to be associated with race/ethnicity or nativity. [ABSTRACT FROM AUTHOR]

We compared written text on infant death certificates for deaths coded as sudden infant death syndrome (R95), unknown cause (R99), and accidental suffocation (W75). Using US mortality files supplemented with the death certifiers' written text for all infant deaths with International Classification of Diseases (ICD)-10 assigned codes R95, R99, and W75, we formed cause-of-death subcategories from common themes identified from the written text. Among all infant deaths in 2003-2004, the underlying cause of death was listed as R99 for 2128 deaths, R95 for 4408 deaths, and W75 for 931 deaths. Among the postneonatal deaths, the differences in subcategories varied between assigned ICD-10 codes: for R99-coded deaths, 45.8% were categorized as 'Unknown' and 48.6% as 'Pending'; for R95-coded deaths, 67.7% were categorized as 'sudden infant death syndrome (SIDS)'; and for W75-coded deaths, 76.4% were categorized as 'Suffocation.' Examination of the written text on the death certificates demonstrates variability in the assigned ICD-10 codes which could have an important effect on the estimates of SIDS cases in the United States. [ABSTRACT FROM AUTHOR]

Objective. To examine the effects of maternal prenatal smokeless tobacco use on infant birth size. Design. A retrospective medical record review of 502 randomly selected deliveries. Population and Setting. Singleton deliveries to Alaska Native women residing in a defined geographical region in western Alaska, 1997-2005. Methods. A regional medical center's electronic records were used to identify singleton deliveries. Data on maternal tobacco exposure and pregnancy outcomes were abstracted from medical records. Logistic models were used to estimate adjusted mean birthweight, length and head circumference for deliveries to women who used no tobacco ( n=121), used smokeless tobacco ( n=237) or smoked cigarettes ( n=59). Differences in mean birthweight, length and head circumference, 95% confidence intervals and p-values were calculated using non-users as the reference group. Main Outcome Measures. Infant birthweight, crown-heel length and head circumference. Results. After adjustment for gestational age and other potential confounders, the mean birthweight of infants of smokeless tobacco users was reduced by 78g compared with that of infants of non-users ( p=0.18) and by 331g in infants of smokers ( p<0.01). No association was found between maternal smokeless tobacco use and infant length or infant head circumference. Conclusions. We found a modest but non-significant reduction in the birthweight of infants of smokeless tobacco users compared with infants of tobacco non-users. Because smokeless tobacco contains many toxic compounds that could affect other pregnancy outcomes, results of this study should not be construed to mean that smokeless tobacco use is safe during pregnancy. [ABSTRACT FROM AUTHOR]

Although cigarette smoking remains the most prevalent form of tobacco use in girls and in women of reproductive age globally, use of non-cigarette forms of tobacco is prevalent or gaining in popularity in many parts of the world, especially in low- and middle-income countries. Sparse but growing evidence suggests that the use of some non-cigarette tobacco products during pregnancy increases the risk of adverse pregnancy outcomes. In this paper we review the literature on the prevalence of non-cigarette tobacco product use in pregnant women and in women of reproductive age in high-, middle-, and low-income countries and the evidence that maternal use of these products during pregnancy has adverse health effects. In addition, we communicate findings from an international group of perinatal and tobacco experts that was convened to establish research priorities concerning the use of non-cigarette tobacco products during pregnancy. The working group concluded that attempts to develop a public health response to non-cigarette tobacco use in women are hindered by a lack of data on the epidemiology of use in many parts of the world and by our limited understanding of the type and magnitude of the health effects of these products. We highlight research gaps and provide recommendations for a global research agenda. [ABSTRACT FROM AUTHOR]

A commentary is presented that discusses tobacco use and exposure to secondhand smoke (SHS) among pregnant women residing in low- and middle-income countries. The authors enumerate some conditions caused by tobacco use in several high-income nations. They offer a chart of research priorities related to tobacco exposure during pregnancy in low- and middle-income nations. They emphasize the need to place tobacco exposure among pregnant women in the context of international challenges to women's health.

The article focuses on a study on the trends in pre-pregnancy obesity among women who delivered live infants in nine states in the U.S. from 1993 to 2003. Complications associated with maternal obesity during pregnancy, including preeclampsia, are cited. According to the results, the prevalence rate of pre-pregnancy obesity rose 69.3% during the study period. It suggest a consistent contact with health care providers during pregnancy to alleviate the effects of obesity for future pregnancies.

A letter to the editor is presented in response to the article about two meta-analyses focusing on maternal obesity and the risk of two major adverse reproductive outcomes, caesarean delivery and gestational diabetes mellitus.