Search

Among those with a severe maternal morbidity (SMM) event and a subsequent birth, we examined how the risk of a second SMM event varied by patient characteristics and intrapartum hospital utilization. We used a Massachusetts population-based dataset that longitudinally linked in-state births, hospital discharge records, prior and subsequent births, and non–birth-related hospital utilizations for birthing individuals and their children from January 1, 1999, to December 31, 2018, representing 1,460,514 births by 907,530 birthing people. We restricted our study sample to 2,814 people who had their first SMM event associated with a singleton birth and gave birth a second time within the study period. Our outcome measure was recurrence of SMM in the second birth. We calculated the prevalence of SMM at second birth, compared SMM conditions between births, and estimated the adjusted risk ratios and 95% confidence intervals for having an SMM event at second birth among those who had an SMM at the first birth. We also examined overall hospital utilization including inpatient admissions, emergency room visits, and observational stays, and hospital utilization by interpregnancy intervals (IPIs) between the first and second birth. There were 2,814 birthing people with at least one birth after the first SMM singleton birth. Among those, 198 (7.0%) had a subsequent SMM. The percentage of people with a second SMM event varied by age, race/ethnicity, insurance, IPI, and history of hypertension at first case of SMM (all p <.05). Between births, people with a second SMM event had significantly higher proportions of inpatient admissions (60.1% vs. 33.2.0%; p <.001), emergency room visits (71.7% vs. 57.7%; p <.001), and observational stays (35.4% vs. 19.5%; p <.001) compared with those who did not experience a second SMM event. Hospital utilization after a birth with SMM might indicate an elevated risk of a second SMM event. Providers should counsel their patients about prevention and warning signs. [ABSTRACT FROM AUTHOR]

Background: A healthy child can make way for a healthy adult. Some of the factors that can be used to determine the health of a young child are nutritional status of the child, the developmental milestones achieved, and frequency of illness. Objectives: The health status of children and associated factors are determined. Methods: This is a community-based cross-sectional study with 271 participants. The height and weight of the child were measured; questions were asked regarding developmental milestones achieved and frequent illnesses. An interview schedule was used to enquire about the determinants of health status. Descriptive statistics were done; Chi-square test and regression were used to determine association between the health status of children and determinants. Results: A total of 127 (46.86%) were found to have a good health status. Family type (Chi square value 9.568; P value = 0.002), birth spacing (Chi square 20.540; P value < 0.001), term or pre-term birth (Chi square 4.598; P value = 0.032), chronic medical problem in the child (Chi square 11.074; P value = 0.001), and immunization status of the child (Chi square 5.666; P value = 0.017) were found to have significant association with the health status of the child. By logistic regression, pre-term child birth and family type were found to have higher odds. Conclusion: For better health of the child, specific focus on birth spacing, term birth of baby, better care of the ill, and complete immunization play vital roles. [ABSTRACT FROM AUTHOR]

Research from the medical and social science literature has found that spacing births closely together leads to adverse health and socioeconomic outcomes for the younger child. More recent evidence using inter-family comparisons is challenging the validity of those results. However, while inter-family comparisons allow for time-invariant unobservable heterogeneity across families, they cannot fully control for changes in families that occur over time and may affect both decisions about birth intervals as well as child outcomes. To our knowledge, this paper provides the first examination of the effects of birth spacing on later childhood cognitive outcomes that accounts for both time-invariant and time-varying heterogeneity in the same models. Instrumental variables estimations on data from Indonesia indicate that younger siblings perform significantly better on maths assessment exams when they are spaced farther apart from their immediately older sibling. This effect appears to be concentrated among the poorest and least educated households. The data thus suggest that close spacing may be detrimental to the socioeconomic outcomes of the younger sibling. [ABSTRACT FROM AUTHOR]

In many South Asian contexts, specific dates are auspicious and inauspicious for health-related behaviours and outcomes. This study analysed the effect of lunar date-related auspicious beliefs in Nepal on childbirths and neonatal health outcomes. Using the daily birth records from a tertiary maternity hospital, we empirically examined whether births occurred disproportionally around full moon days. We found an average of 10.7 extra births on and before full moon days, with an average of 7.5 extra Caesarean deliveries on full moon days. We demonstrated that births occurring on or before the full moon day have poor neonatal health outcomes. However, a subsample analysis suggested better health outcomes for low-risk mothers and worse health outcomes for high-risk mothers. These findings suggest that low-risk mothers may move their deliveries to auspicious dates with fewer complications than high-risk mothers. The results emphasise the need for additional research to distinguish health service demand from supply influences on birth timing in Nepal. [ABSTRACT FROM AUTHOR]

Background: Event histories such as marriage and birth have been used to study fertility behavior of women. Understanding the timing of these events provide insight to reproductive patterns of the population. Thus, the aim of this study was to assess the timing of marriage and durations of birth intervals and their associated factors, and and to examine their effects on the current fertility among women in Dabat health and demographic surveillance system site, Northwest Ethiopia. Methods: A community based cross-sectional survey was carried out in the beginning of 2020 among 1649 women of reproductive age group. Data were collected using structured and interviewer administered questionnaire. The parametric survival analysis was employed to estimate the relationships among socioeconomic and demographic variables with outcome variables, the timing of age at first marriage and duration of birth intervals. Results: This study confirmed that median age at first marriage was the lowest estimated at 15 years which was below the national and regional average. The result of the study also revealed that married women waited almost a median duration of three years for their first, second, third and fourth child which was increased to nearly four years for three years preceding the survey. The parametric survival analysis showed woman's education, occupation, and current age were the predictors of age at first marriage. divorce experience, women empowerment and marriage cohort were the determinant factors of first birth interval; women education, child death, and ideal number of children were the predictors of second and third birth intervals; and media exposure and child death experience of women were predictors of fourth birth interval. Conclusion: The study indicated that median age at first marriage was the lowest though the successive birth intervals were longer. The survival analysis identified women's education, occupation, child death and ideal number of children affected the timing of age at first marriage and duration of birth intervals. Hence, encouraging women for higher education and giving opportunity to women in employments may contribute for delaying age at first marriage and increasing the duration of birth intervals which in turn slowing down the fertility of women. [ABSTRACT FROM AUTHOR]

There remains a considerable concern among both patients and oncologists that having a live birth (LB) after breast cancer might adversely impact survival. analysis of survival in a national cohort of women with breast cancer diagnosed at age 20–39 years between 1981 and 2017 (n = 5181), and subsequent LB using Scottish Cancer Registry and national maternity records. Cases had at least one subsequent LB, each was matched with up to six unexposed cases without subsequent LB, accounting for guaranteed time bias. In 290 women with a LB after diagnosis, overall survival was increased compared to those who did not have a subsequent LB, HR 0.65 (95%CI 0.50–0.85). Women with subsequent LB who had not had a pregnancy before breast cancer showed increased survival (HR 0.56, 0.38–0.82). There was a progressively greater interaction of subsequent LB with survival with younger age, thus for women aged 20–25 years, HR 0.30 (0.12–0.74) vs. those aged 36–39, HR 0.89 (0.42–1.87). In women with LB within five years of diagnosis, survival was also increased (HR 0.66; 0.49–0.89). Survival following LB was similar to unexposed women by ER status (both positive and negative) and in those known to have been exposed to chemotherapy. This analysis provides further evidence that for the growing number of women who wish to have children after breast cancer, LB does not have a negative impact on overall survival. This finding was confirmed within subgroups, including the youngest women and those not previously pregnant. • The impact of childbirth on survival after breast cancer remains controversial. • National cancer and birth data were used to analyse an unbiased large cohort. • Live birth was associated with improved or similar survival after breast cancer. • This was confirmed by age at diagnosis, previous pregnancy, and ER status. • These findings are reassuring for young women wishing children after breast cancer. [ABSTRACT FROM AUTHOR]

Background: Neonatal near-miss (NNM) cases refer to situations in which babies are on the verge of dying between the ages of 0 and 28 days due to severe morbidity that occurs during pregnancy, delivery, or extra-uterine life, but survive either by luck or due to high-quality health care. Identifying NNM cases and addressing their determinants is crucial for devising comprehensive and relevant interventions to tackle neonatal morbidity and mortality. Hence, this study aimed at finding out the determinants of NNM in neonates admitted to public hospitals in Hadiya zone, southern Ethiopia. Methods: A hospital-based unmatched case-control study was conducted in three selected hospitals in southern Ethiopia from May 1 to June 30, 2021. A total of 484 participants took part in the study (121 cases and 363 controls). Controls were chosen using systematic sampling approaches, whereas cases were recruited consecutively at the time of discharge. Cases were selected based on the Latin American Centre for Perinatology (CLAP) criteria of an NNM. A structured interviewer-administered questionnaire and a data extraction checklist were used for data collection. The Data were entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. A multivariable logistic regression analysis with a p-value of <0.05 was used to determine the determinants of NNM. Results: Ninety-seven (80.1%) and 56 (46.2%) near-miss cases encountered at least one pragmatic and management criteria, respectively. The most common pragmatic and management criteria were gestational age less than 33 weeks (44.6%) and intravenous antibiotic usage up to 7 days and before 28 days of life (27.3%), respectively. A short birth interval [AOR = 2.15, 95% CI: 1.29, 3.57], lack of ANC [AOR = 3.37; 95%CI: 1.35, 6.39], Caesarean mode of delivery [AOR = 2.24; 95%CI: 1.20, 4.16], the occurrence of a third maternal delay [AOR = 3.47; 95% CI: 2.11, 5.75], and poor birth preparedness and complication readiness (BPCR) plan[AOR = 2.50; 95% CI: 1.49,4.13] were identified as a significant determinants of NNM. Conclusion and recommendation: The provision of adequate ANC should be a priority for health care providers at service delivery points. To avoid serious neonatal problems, mothers who deliver by Cesarean section should receive more attention from their families and health care providers. Health care providers in the ANC unit should encourage pregnant women to implement the WHO-recommended elements of the BPCR plan. To achieve optimal birth spacing, healthcare providers should focus on the contraceptive provision. Unnecessary delays in health facilities during childbirth should be avoided at all costs. [ABSTRACT FROM AUTHOR]

Background Anemia is one of the most important disorders in the world mostly affecting children and pregnant women. Objective This study aims to assess the prevalence of maternal anemia and its related factors among pregnant women in Golestan Province of Iran. Methods This cross-sectional analytical study was conducted on 1000 pregnant women referred to a comprehensive health center affiliated to Golestan University of Medical Sciences, Golestan, Iran in 2020. Chi-square (x²) and multiple logistic regression analysis were used to find demographic/obstetric factors related to maternal anemia. Results The prevalence of anemia was 18.4%; 19.27% had severe anemia, 63.03% had moderate anemia and 17.7% were with mild anemia. The interpregnancy interval, parity, age of first pregnancy, age of marriage, pregnancy month, history of urinary tract infection, number of medical care, and education had a significant relationship with maternal anemia (P<0.05), but the place of residence and the place to get medical care had no significant relationship with the maternal anemia. Conclusion With increase in the pregnancy month, history of urinary tract infection, low age of marriage, low number of received medical care, and low educational level, the risk of maternal anemia increases. It is important to identify women at risk of anemia and ensure adequate and timely care for them. [ABSTRACT FROM AUTHOR]

Summary: We study the effect of childbirth and birth timing on female labor market outcomes in Italy. The impact is traced up to 21 years since school completion by estimating a factor analytic model with dynamic selection into treatments. We find that childbirth, especially the first delivery, negatively affects female earnings and participation. Women having their first child soon after school exit catch up with childless women after 12–15 years. The negative consequences are smaller if the first child is delayed up to 7–9 years after school completion or if a second childbirth occurs within 6 years since school exit. [ABSTRACT FROM AUTHOR]

We examine whether a mother's early return to work after her first birth improves her employment status in the short term and the long term (3 and 10/12 years after the child's birth). Specifically, this research investigates whether a mother is more likely to be in full‐time employment if she returns to work within 1 year of childbirth (i.e. without using her allowable parental leave to the full). We estimate recursive bivariate probit models for a mother's early return to work and her subsequent employment status using July births as an instrument. Our approach is unique in that we shed light on the relationship between the timing of a birth (birth month) and the timing of a mother's return to work after childbirth. The birth month affects the cut‐off dates for admission into a licensed childcare facility in Japan, which, in turn, affects the timing of a mother's return to work. Our empirical evidence reveals that a mother's early return to work after her first birth has a positive causal effect on the likelihood of her being in full‐time employment in the long term (10 and 12 years after childbirth). We do not find any causal effect of an early return to work on working full time in the short term (3 years after childbirth). [ABSTRACT FROM AUTHOR]

Background: Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries.Methods: This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women's age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child's birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors.Results: Mother's age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child's birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04-1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36-1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88-2.28).Conclusion: Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing. [ABSTRACT FROM AUTHOR]

Aim: Enterovirus is a common pathogen. Although mostly asymptomatic, this infection has the potential to be life-threatening in neonates. This article aims to describe the early neonatal outcomes in peripartum infection.Methods: We performed a retrospective cohort study in a tertiary hospital between 1/2014 and 5/2019. The enterovirus infection was established by real-time polymerase chain reaction analysis.Results: Out of 161 neonates tested for the enterovirus infection 13 (8%) were positive. Maternal fever was the most common sign (n = 8, 66.7%). The mean gestational age at delivery was 36 + 5 (range 30 + 5 to 40 + 6 weeks). The mean time interval from birth to neonatal manifestations of infection was 5.2 (0-9) days. The most common presenting sign in the neonates was fever (n = 8, 61.5%). All neonates required the neonatal intensive care unit. The neonatal mortality rate was 3/13 (23%).Conclusion: The neonatal morbidity and mortality from the enterovirus infection may have been associated with the severity of maternal presentation at the time of admission. Enterovirus real-time polymerase chain reaction analysis should be considered as part of the maternal evaluation in cases of maternal fever of unknown origin. Deferral of the induction of delivery for term pregnancies with confirmed enterovirus infections should be considered. [ABSTRACT FROM AUTHOR]

Background: Difficulties related to eating are often reported in children born preterm. The objective of this study was to quantitatively synthesize available data on the prevalence of problematic feeding in children under 4 years of age who were born preterm.Methods: Literature was identified from PubMed, CINAHL, and PsycInfo. The search was limited to English language and publication years 2000-2020. To be included in the meta-analysis, the article had to report the prevalence of problematic oral feeding within a population of children born prematurely (< 37 weeks' gestation), and the child age at the time of study had to be between full-term corrected age and 48 months. For studies meeting inclusion criteria, the following data were extracted: sample size and subsamples by gestational age and/or child age at time of study; definition of problematic feeding; measures used for assessment of feeding; gestational age at time of birth of sample; child age at time of study; exclusion criteria for the study; and prevalence of problematic feeding. Random-effects meta-analyses were performed to estimate the prevalence of problematic feeding across all studies, by gestational age at birth, and by child age at time of study.Results: There were 22 studies that met inclusion criteria. Overall prevalence of problematic feeding (N = 4381) was 42% (95% CI 33-51%). Prevalence was neither significantly different across categories of gestational age nor by child age at the time of study. Few studies used psychometrically-sound assessments of feeding.Conclusion: Problematic feeding is highly prevalent in prematurely-born children in the first 4 years of life regardless of degree of prematurity. Healthcare providers of children born preterm should consider screening for problematic feeding throughout early childhood as a potential complication of preterm birth.Systematic Review Registration Number: Not applicable. [ABSTRACT FROM AUTHOR]

Do firstborn children have a height advantage? Empirical findings have found mostly that, yes, second or higher-order children often lag behind firstborns in height outcomes, especially in developing countries. However, empirical investigations of birth-order effects on child height overlook the potential impact that birth spacing can have. We provide an explanation for the negative birth-order effect on stunting outcomes for young Indian children and show it is driven by short preceding-birth spacing. We find that firstborn children are taller than children of higher birth order: The height-for-age gap for third (or higher)-order children is twice the gap for children second in birth order. However, this pattern is observed when spacing between later-born children and their immediate elder siblings is fewer than 3 y. Interestingly, the firstborn height advantage disappears when later-born children are born at least 3 y after their elder siblings. Thus, our findings indicate that spacing length between children explains differences in height, over birth order. Although India's family planning policy has resulted in a substantial reduction in total fertility, its achievement in spacing subsequent births has been less impressive. In showing that spacing can alleviate or aggravate birth-order effects on attained height, our study fills an evidence gap: Reducing fertility alone may not be sufficient in overcoming negative birth-order effects. To reduce the detrimental effects of birth order on child stunting, policy responses--and therefore research priorities--require a stronger focus on increasing the time period between births. [ABSTRACT FROM AUTHOR]

It is claimed by some that the number of births occurring at the time of the full moon is greater than other phases of the lunar cycle; however, many publications fail to substantiate the claim leading to the conclusion it is myth. We tested using a novel approach the null hypotheses: (i) human birth is not lunar cycle-dependent and (ii) the number of births occurring at or around the time of the full moon is not different from the number occurring at the time of the other phases of the lunar cycle. We reviewed the birth records from 1 January 1996 to 16 March 2007 of the obstetric department of our hospital, which was then located in a relatively undeveloped area of Fukutsu city in Fukuoka Prefecture of southern Japan. A total of 1507 births satisfied all inclusion criteria, among others, being full-term and following spontaneously initiated labor. When the birth data were analyzed as done by other investigators, i.e. total number of births per lunar day, lunar phase was not found to be influential. However, more detailed analyses on the subset of babies born specifically during the nighttime hours (N = 362) revealed the number of births varied in relation specifically to the changing amount of moonlight during the nighttime at different stages of the lunar cycle, with highest number of births at or around the time of the full moon. In contrast, analyses on the subset of babies born specifically during the daytime hours (N = 377) revealed the number of births varied in relation specifically to the changing amount moonlight during the daytime at different stages of the lunar cycle, with the highest number of births at or around the time of the new moon. The initiation and culmination of human birth are typically a nocturnal process. The findings of this investigation are consistent with the hypothesis natural nighttime parturition is influenced by lunar phase, particularly the full moon, and, thus, they are consistent with the belief the moon exerts an affect upon the timing of human birth. We speculate the long-hold belief of the association between birth and lunar phase may be based on historical observations that in the absence of artificial light at night nocturnal births occurred in elevated number when the full moon brightly illuminated the nighttime sky. [ABSTRACT FROM AUTHOR]

Objective: To know how the phenomenon of active paternal upbringing is shown from the father-child contact experience during birth. Method: Analysis of secondary information from a qualitative study of a phenomenological nature. Transcripts of interviews and focus groups of all the fathers who participated in a father-child contact protocol for a doctoral thesis. Results: The study revealed the global structure of the phenomenon, whose central axis corresponds to "father who advances towards the integral connection with his child and is committed with parenting", and its three comprehensive categories: expectations of being a father and actor in parenting; the experience of being a father at birth time; and the everyday of the upbringing. Conclusion: Prenatal preparation and skin-to-skin contact during birth mobilize the father towards commitment and involvement with the upbringing of his child from the beginning. [ABSTRACT FROM AUTHOR]

Copyright of Revista Cuarzo (REC) is the property of Fundacion Universitaria Juan N. Corpas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Studies have focused on the effect of short birth spacing on childhood mortality, yet very little attention has been paid to the possibility of an inverse relationship such that child mortality might also positively or negatively affect birth spacing. In Nigeria, where both fertility and child mortality are high, this inverse relationship is a possible reason for the country's high fertility. The objective of this study was to examine the effect of child death on time to birth of the next child. Data were drawn from the 2013 Nigerian Demographic Health Survey. The study sample comprised 188,986 live births born to women aged 15-49 years within the five years preceding the survey. A multivariate Cox proportional hazard regression model was fitted to the data, and hazard ratios with 95% confidence intervals calculated. More than half of the mothers (68%) already had a next birth by 36 months after the death of the index child. Controlling for other covariates, the Cox regression model showed that the likelihood of next birth was higher when the index child had died compared with when the index child survived (HR: 2.21; CI: 2.03-2.41). Sub-group analysis by geo-political regions in Nigeria showed that in all regions there was a higher likelihood of having a next birth following the death of a preceding child. Death of the index child was found to be a major factor that shortens the length of birth intervals in Nigeria. It is therefore important that the Government of Nigeria intensifies efforts aimed at reducing infant mortality and encouraging adequate birth spacing. [ABSTRACT FROM AUTHOR]

Stunting is a well-known child health indicator for chronic malnutrition. The nutritional status of children is a good gauge for the nutritional well-being of the population, and it is, nowadays, one of the key issues in interrupting generational poverty transmissions as they bear the brunt of poverty. There has been scarcity of disaggregated survey to explore covariates of child stunting. This study attempted to identify socio-economic, demographic and other proximate factors associated with stunting of children under the age of five in Fitche town. The survey was cross-sectional, conducted using multistage sampling procedures to collect information from 160 children and caregivers. The anthropometric, descriptive and logistic analyses to determine the prevalence and identify covariates of child stunting were applied using Epi info and STATA software. Logistic analysis of the effects of selected child and maternal characteristics, child caring practices, and environmental health conditions on child stunting was done. Therefore, birth order, family size, maternal education, remittances, farm income, income from women employment and size of cultivated land were found to be the strongest predictors. However, the estimated coefficients of vaccine status of the child, Low Birth Weight, latrine facility in the house, morbidity status of the child, child birth interval, distance to the nearest health center, antenatal care visit of the mother and household's source of water indicated theoretically inconsistent and statistically insignificant effect on the likelihood of child stunting. The prevalence of child stunting was 45%, which is significantly higher than the regional and national averages. Among children who were stunted, 11.9 % were moderately stunted compared to 33.1% who were severely stunted. The proportion of stunted children for male was greater than female. There is a need to increase maternity care and education as this would make them amenable to health interventions that help improve not only their nutritional status and that of their child but also improve their income earning potential and food purchasing power. Addressing poverty may lead to improvements in the nutrition status of children as household economic status significantly determines nutritional status in the town. [ABSTRACT FROM AUTHOR]

Background: Poor mental health status among both pregnant and postpartum women is commonly reported worldwide. The associations between mental health outcomes and giving birth to the second child since the implementation of China's universal two-child policy have not been identified.Methods: A large-scale based mental health survey was conducted between March 2017 and December 2018 in Suzhou, China. The survey evaluated the symptoms of anxiety, hypomania, depression and poor sleep quality among both pregnant and postpartum women.Results: A total of 3113 questionnaires were collected, the prevalence of anxiety, hypomanic and depressive symptoms and poor sleep quality in our sample were 3.2% (95%CI: 2.6%-3.9%), 51.7% (95%CI: 49.9%-53.4%), 12.4% (95%CI: 11.3%-13.6%) and 37.8% (95%CI: 36.0%-39.5%), respectively. Logistic regression showed that giving birth to the second child was positively associated with women's age, and was negatively correlated with higher educational level and living in rented housing. Women with the second pregnancy or child were positively associated with anxiety symptoms in the whole sample (OR = 1.75, 95%CI: 1.11-2.75) and among prenatal women (OR = 2.11, 95%CI: 1.16-3.83), while it was inversely correlated with depressive symptoms among postpartum women (OR = 0.63, 95%CI: 0.41-0.99).Conclusions: Women giving birth a second time were more prone to have anxiety symptoms among the prenatal women and the whole sample, and less likely to have depressive symptoms among the postpartum women. Efficacious measures and interventions are essential to improve maternal mental health. [ABSTRACT FROM AUTHOR]

Background: The issue of child marriage is a form of human rights violation among young women mainly in resource-constrained countries. Over the past decades, child marriage has gained attention as a threat to women's health and autonomy. This study explores the prevalence of child marriage among women aged 20–24 years in sub-Saharan Africa countries and examines the association between child marriage and fertility outcomes. Methods: Latest DHS data from 34 sub-Saharan African countries were used in this study. Sixty thousand two hundred and fifteen women aged 20–24 years were included from the surveys conducted 2008–2017. The outcome variables were childbirth within the first year of marriage (early fertility), first preceding birth interval less than 24 months (rapid repeat of childbirth), unintended pregnancy, lifetime pregnancy termination, the use of modern contraceptive methods, lifetime fertility and any childbirth. The main explanatory variable was child marriage (< 18 years) and the associations between child marriage and fertility outcomes were examined from the ever-married subsample to estimate odds ratios (ORs) and 95% CIs using binary logistic regression models. Results: In the study population, the overall prevalence of women who experience child marriage was 54.0% while results showed large disparities across sub-Saharan African countries ranging from 16.5 to 81.7%. The prominent countries in child marriage were; Niger (81.7%), Chad (77.9%), Guinea (72.8%), Mali (69.0%) and Nigeria (64.0%). Furthermore, women who experience child marriage were 8.00 times as likely to have ≥3 number of children ever born (lifetime fertility), compared to women married at ≥18 years (OR = 8.00; 95%CI: 7.52, 8.46). Women who experience child marriage were 1.13 times as likely to use modern contraceptive methods, compared to adult marriage women (OR = 1.13; 95%CI: 1.09, 1.19). Those who married before the legal age were 1.27 times as likely to have lifetime terminated pregnancy, compared to women married at ≥18 years (OR = 1.27; 95%CI: 1.20, 1.34). Also women married at < 18 years were more likely to experience childbirth, compared to women married later (OR = 5.83; 95%CI: 5.45, 6.24). However, women married at < 18 years had a reduction in early childbirth and a rapid repeat of childbirth respectively. Conclusion: Implementing policies and programmmes against child marriage would help to prevent adverse outcomes among women in sub-Saharan Africa. Also, social change programmes on child-marriage would help to reduce child marriage, encourage the use of modern contraceptive, which would minimize lifetime terminated pregnancy and also children ever born. [ABSTRACT FROM AUTHOR]

Today, drug misuse and abuse is becoming a major problem worldwide. Birth weight of a newborn remains an important predictor of infant and child morbidity and mortality. In 2006, approximately one in four newborns in Jimma Zone, Ethiopia, had low birth weight. About 19% of pregnant women attending antenatal care in heath institutions of Jimma Zone were using khat during pregnancy. However, there is a lack of research on predictors of low birth weight especially the potential effect of khat use during pregnancy. To examine the effect of khat use during pregnancy on birth weight of newborn in Jimma town, Ethiopia. Institution-based case-control study design was conducted on a total of 336 mother-newborn pairs recruited at birth from public health facilities in Jimma town during April–June, 2013. One hundred twelve mothers who gave a live birth at term with a birth weight of < 2.5 kg were considered as cases, and 224 mothers who gave a live birth at term with a birth weight of ≥ 2.5 kg were considered as controls. Study subjects were selected consecutively. Maternal khat use during pregnancy was assessed using the Composite International Diagnostic Interview (CIDI) scale. Data were analyzed using Statistical Package for Social Sciences software (SPSS) for Windows version 16. Logistic regression analysis was employed to examine the independent effect of maternal khat use during pregnancy on the birth weight of the newborn. The internal reliability (Cronbatch's α) for the CIDI scale was 0.74. The odds of low birth weight among babies born from mothers who used khat during pregnancy were 12 times higher compared to those born from non-users. The odds of low birth weight among babies born from mothers who gained weight less than 10 kg during pregnancy were 11 times higher than those born from mothers who gained weight greater than 10 kg during pregnancy. The odds of low birth weight among babies born from mothers who had a birth interval of less than 3 years from the previous delivery were 3.5 times higher compared to those babies born from mothers who had a birth interval of greater than 3 years. Maternal khat use during pregnancy is strongly associated with low birth weight of the newborn. The observed association between maternal khat use during pregnancy and low birth weight of the newborn calls for public health interventions to reduce maternal khat use during pregnancy and its consequence on the health of the newborn. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the effect of timing of first childbirth on the child wage-penalty experienced by working mothers in Japan. There is an increasing age of first childbirth and increasing labor force participation rate of Japanese women: does it indicate that the presence of children causes women to pay a high price for motherhood? Design/methodology/approach: This study estimates regression equations explaining the labor wages of working women, using a longitudinal data set from the Japan Household Panel Survey (the JHPS/KHPS 2004–2015). The fixed-effect method is utilized to control the bias that results from unobserved individual-specific characteristics. Findings: The results indicate that having children negatively affects the wages of Japanese women. However, there is no variation in the child wage-penalty between early child bearers (age 27 years or younger) and late child bearers (older than 27 years). In addition, an additional year of post-birth work experience contributes equally to an additional year of pre-birth work experience on wage gains. These findings remain robust with an alternate cut-off age of 30-years old. Originality/value: There is no previous study that relates the timing of the first birth to the motherhood wage-penalty in Japan. This study indicates that the timing of childbirth does not seem to be an important factor in the improvement of women's labor wages. Thus, delaying childbirth may not be an optimal birth timing to maximize the lifetime earnings of Japanese women, especially for those who are career-minded. [ABSTRACT FROM AUTHOR]

Dolmabahce Palace known as the last palace of the empire bears traces of western lifestyle both in terms of architecture and objects used in it. Within that period, the mentality of reform became spread into the enviroment not only spatially but from the state order to the daily life. Sultan Abdulaziz (1830-1876) one of the sons of Mahmud II (1785- 1839), continued to live in Dolmabahce Palace after Sultan Abulmejid (1823-1861). In this article, our aim is to take the children of Sultan Abdulaziz to the center and to talk about their lives in Dolmabahce Palace and to understand what kind of space was opened for a child in the palace. For that aim, the preparations and ceremonies such as velâdet-i hümâyûn and sûr-ı hıtan whose subjects were children were examined. Then, the space opened for the child in the palace in terms of material culture was focused on. The article extends to the lives of children of palace, from materials prepared for the children at the birth, to the objects and toys used in their daily life. [ABSTRACT FROM AUTHOR]

Study Question: What is the cumulative incidence of live birth and mean time to pregnancy (by conception after IVF/ICSI or natural conception) in women experiencing unexplained recurrent implantation failure (RIF) following IVF/ICSI treatment?Summary Answer: In 118 women who had experienced RIF, the reported cumulative incidence of live birth during a maximum of 5.5 years follow-up period was 49%, with a calculated median time to pregnancy leading to live birth of 9 months after diagnosis of RIF.What Is Known Already: Current definitions of RIF include failure to achieve a pregnancy following IVF/ICSI and undergoing three or more fresh embryo transfer procedures of one or two high quality embryos or more than 10 embryos transferred in fresh or frozen cycles. The causes and optimal management of this distressing condition remain uncertain and a range of empirical and often expensive adjuvant therapies is often advocated. Little information is available regarding the long-term prognosis for achieving a pregnancy.Study Design, Size, Duration: Two hundred and twenty-three women under 39 years of age who had experienced RIF without a known cause after IVF/ICSI treatment in two tertiary referral university hospitals between January 2008 and December 2012 were invited to participate in this retrospective cohort follow up study.Participants/materials, Setting, Methods: All eligible women were sent a letter requesting their consent to the anonymous use of their medical file data and were asked to complete a questionnaire enquiring about treatments and pregnancies subsequent to experiencing RIF. Medical files and questionnaires were examined and results were analysed to determine the subsequent cumulative incidence of live birth and time to pregnancy within a maximum 5.5 year follow-up period using Kaplan Meier analysis. Clinical predictors for achieving a live birth were investigated using a Cox hazard model.Main Results and the Role Of Chance: One hundred and twenty-seven women responded (57%) and data from 118 women (53%) were available for analysis. During the maximum 5.5 year follow up period the overall cumulative incidence of live birth was 49% (95% CI 39-59%). Among women who gave birth, the calculated median time to pregnancy was 9 months after experiencing RIF, where 18% arose from natural conceptions.Limitations, Reasons For Caution: Since only 57% of the eligible study cohort completed the questionnaire, the risk of response bias limits the applicability of the study findings.Wider Implications Of the Findings: This study reports a favorable overall prognosis for achieving live birth in women who have previously experienced RIF, especially in those who continue with further IVF/ICSI treatments. However since 51% did not achieve a live birth during the follow-up period, there is a need to distinguish those most likely to benefit from further treatment. In this study, no clinical factors were found to be predictive of those achieving a subsequent live birth.Study Funding/competing Interest(s): This study was funded by the University Medical Center Utrecht, in Utrecht and the Academic Medical Centre, in Amsterdam. NSM has received consultancy and speaking fees and research funding from Ferring, MSD, Merck Serono, Abbott, IBSA, Gedion Richter, and Clearblue. During the most recent 5-year period BCJMF has received fees or grant support from the following organizations (in alphabetic order); Actavis/Watson/Uteron, Controversies in Obstetrics & Gynecology (COGI), Dutch Heart Foundation, Dutch Medical Research Counsel (ZonMW), Euroscreen/Ogeda, Ferring, London Womens Clinic (LWC), Merck Serono, Myovant, Netherland Genomic Initiative (NGI), OvaScience, Pantharei Bioscience, PregLem/Gedeon Richter/Finox, Reproductive Biomedicine Online (RBMO), Roche, Teva, World Health Organisation (WHO).None of the authors have disclosures to make in relation to this manuscript. [ABSTRACT FROM AUTHOR]

Objective  We determined whether time between deliveries is associated with developing diabetes at the time of a subsequent delivery. Study Design  This is a case–control study of women who had two consecutive singleton births at the same institution with no pregestational diabetes in the baseline pregnancy. Cases were defined as women who were diagnosed with any type of diabetes at the time of the subsequent delivery. Controls were defined as women who had no diagnosis of diabetes at the time of the subsequent delivery. Interdelivery interval (IDI) was categorized as < 18, 18 to 60, or > 60 months. Results Of 12,263 women, 4.1% (N  = 501) were diagnosed with diabetes at the subsequent delivery. Women with diabetes were more likely to have an IDI of >60 months than women without diabetes (9.0 vs. 4.2%, p  < 0.001). After controlling for confounding factors, an IDI > 60 months remained associated with development of pregestational or gestational diabetes by the conclusion of the subsequent pregnancy (adjusted odds ratio = 2.13 compared with an IDI of 18–60 months, 95% confidence interval 1.44–3.15). Conclusion  A longer IDI is an independent risk factor for the development of diabetes at the time of a subsequent delivery. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

One of the most engaging claims of Patel and Moore's book is that abstract ideas have played a powerful role legitimating the exploitation of swathes of humanity, through distinguishing ontologically and epistemologically between nature and society. As most women, and indigenous people, were defined as part of nature, their labours and lives, including their care labour, were deemed to be part of nature and thereby legitimately exploitable. The authors claim that the cheapening of care arose from the separation of spheres between care work and paid work, between home and the economy, arising from the development of enclosures and the demise of the commons. What the book does not address, however, is how the exploitation of women's domestic and care labour was not only beneficial to capitalism: men of all classes were and are beneficiaries of women's unpaid care labour. The authors also suggest that the primary purpose of caring is to reproduce people for capitalism. But caring is not undertaken simply at the behest of capitalism. Nurturing and caring for others are defining features of humanity given the lengthy dependency of humans at birth and at times of vulnerability. The logic of care is very different to market logic. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between inter‐twin delivery interval and short‐term perinatal outcomes of the second twin after vaginal delivery of the first twin. Methods: Retrospective cohort study including twin pregnancies with a vaginal delivery of the first twin between January 2011 and September 2017 in a tertiary hospital in Melbourne, Australia. The main outcome measure was a composite of adverse neonatal outcome (at least one of perinatal death, admission to neonatal intensive care unit (NICU), endotracheal intubation, Apgar <7 at five minutes and cord lactate >4.0 mmol/L). Proportions of adverse outcomes for the second twin were compared between groups of intervals ≤ or >10 and ≤ or >30 min. Results: The composite adverse neonatal outcome occurred in 201 (58.2%) and a caesarean section occurred in seven cases (2%) of the 345 pregnancies included. Delivery interval was associated with higher cord lactate. Low Apgar scores were more frequent with intervals >30 min (17.9% vs 6.6%, P = 0.03), as well as caesarean section for the second twin (10.7% vs 1.3%, P = 0.01). Composite adverse outcome and admission to NICU were not significantly influenced by the delivery interval. Predictors of adverse outcome were gestational age, abnormal cardiotocography and breech delivery of the second twin. Conclusion: The inter‐twin delivery interval is associated with higher rates of low Apgar scores and higher cord lactate for the second twin. These associations do not translate into higher rates of admission to NICU and their long‐term clinical implications are uncertain. [ABSTRACT FROM AUTHOR]

Background: Brazil experienced important progress in maternal and child health in recent decades. We aimed at describing secular trends as well as socioeconomic and ethnic inequalities in reproductive history indicators (birth spacing, previous adverse perinatal outcome, parity and multiple births) over a 33-year span.Methods: Four population-based birth cohort studies included all hospital births in 1982, 1993, 2004 and 2015 in Pelotas, Southern Brazil. Information on reproductive history was collected through interviews. Indicators were stratified by family income quintiles and skin colour. Absolute and relative measures of inequality were calculated.Results: From 1982 to 2015, the proportion of primiparae increased from 39.2% to 49.6%, and median birth interval increased by 23.2 months. Poor women were more likely to report short intervals and higher parity, although reductions were observed in all income and ethnic groups. History of previous low birthweight was inversely related to income and increased by 7.7% points (pp) over time-more rapidly in the richest (12.1 pp) than in the poorest quintile (0.4 pp). Multiple births increased from 1.7% to 2.7%, with the highest increase observed among the richest quintile and for white women (220% and 70% increase, respectively). Absolute and relative income and ethnic-related inequalities for short birth intervals increased, whereas inequalities for previous low birthweight decreased over time.Conclusions: In this 33-year period there were increases in birth intervals, multiple births and reports of previous low-birthweight infants. These trends may be explained by increased family planning coverage, assisted reproduction and a rise in preterm births, respectively. Our results show that socioeconomic and ethnic inequalities in health are dynamic and vary over time, within the same location. [ABSTRACT FROM AUTHOR]

Background: The length of interval between successive childbirths (birth interval) might influence the incidence of breast cancer, either by stimulating or by inhibiting the factors that are responsible for the initiation of breast cancer or its early development.Methods: This is a case-control study nested in a cohort of 47,479 Finnish grand-multiparous (GM) women born after 1934, and registered as having had at least five births before 2013. The 1354 women with breast cancer diagnosis were compared with controls (1:5) matched by parity and date of birth of the mother. Conditional logistic regression was used to estimate odds ratios of the risk of ductal and lobular breast cancer subtypes associated with each of the intervals between the 1st and 5th birth, stratified by age at diagnosis. Age at first and last birth before index date were used as covariates.Results: Increased intervals between the 1st and 5th births were associated with an increased risk of lobular breast cancer. In contrast, regarding ductal cancer, premenopausal women with shorter length of interval (< 2 years) between the 1st and 2nd birth had greater risk and longer intervals (3+ years) were associated with reduced risk. Spacing between the 2nd and 5th birth did not influence the risk of ductal breast cancer.Conclusion: The findings of our study suggest that the effect of the length of birth interval on breast cancer depends on the age and histology. The protective effect of shorter birth intervals on lobular breast among postmenopausal women and the opposite effect on ductal cancer in premenopausal women may reflect distinct differentiation and functional roles of lobular and ductal cells, and possibly also different response to hormonal exposure. [ABSTRACT FROM AUTHOR]

Birth spacing has emerged since the early 1980s as a key concept to improve maternal and child health, triggering interest in birth spacing practices in low-income countries, and drawing attention to prevailing norms in favour of long birth intervals in West Africa. In Senegal, the Wolof concept of Nef, which means having children too closely spaced in time, is morally condemned and connotes a resulting series of negative implications for family well-being. While Nef and "birth spacing" intersect in key ways, including acknowledging the health benefits of longer birth intervals, they are not translations of each other, for each is embedded in distinct broader cultural and political assumptions about social relations. Most notably, proponents of the demographic concept of birth spacing assume that the practice of using contraception after childbearing to postpone births could contribute to "empowering" women socially. In Senegal, by contrast, preventing Nef (or short birth intervals) is also viewed as strengthening family well-being by allowing women to care more fully for their family. This paper draws on policy documents and interviews to explore women's and men's understanding of Nef, and in turn critically reflect on the demographic concept of birth spacing. Our findings reinforce the relevance of the concept of birth spacing to engage with women and men around family planning services in Senegal. Accounts of the Nef taboo in Senegal also show that social norms stigmatising short birth intervals can legitimise constraints faced by women on control of their body. [ABSTRACT FROM AUTHOR]

Ever since Coronavirus disease 2019 (COVID-19) has been declared a pandemic by World Health Organization (WHO) it has gradually become top cause of morbidity. Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) possesses the tendency to cause severe symptoms in patients with a weakened immune system. In the setting where a mother develops mild COVID-19 infection yet remains stable, responds to medical treatment and there is no fetal compromise; the pregnancy may be continued to term with close surveillance. What is important in the current scenario is that the patients of COVID-19 along with any other comorbidities or medical conditions are at more risk of having fatal disease then the ones with COVID-19 alone. The pregnancy is one physiological condition in which a patient can face drastic pathological complications with COVID-19 if not given the due care. [ABSTRACT FROM AUTHOR]

We only need to stop and observe young children to see how movement is at the very core of early childhood development: as the baby turns in utero, as her body is manipulated for childbirth, as the infant seeks to explore the world – all of these experiences are about movement. The environment, interactions with people and objects and genetic factors all influence the development of fine motor, gross motor and locomotor skills. Providing young children with time and space to refine their physical skills allows them to be masters of their journey of exploration. Children’s muscles develop like snowflakes - from the top to the bottom and from the inside out, with the extremities being the last to develop. Securing core strength for primary muscle growth and development is fundamental for future health, strength and posture. Infants need opportunities to kick their legs, roll, crawl, swing, jump, balance and climb to strengthen the core as well as develop balance, co-ordination and control. [ABSTRACT FROM AUTHOR]

Provision of immediate postpartum intrauterine device (PPIUD) insertion within maternity settings can overcome many of the barriers faced by women in accessing this method after childbirth. Uptake of PPIUD can help reduce the risk of a subsequent unintended pregnancy and improve spacing between births. PPIUD insertion is not yet routinely available in the UK and evidence to support the practical implementation of the service in this setting is lacking. Shared learning and experience of providers may assist in the wider availability of PPIUD. A routine PPIUD service has been successfully established within a public maternity setting in Edinburgh (UK) and this article utilizes an implementation framework to discuss the approach. It is feasible to deliver PPIUD within a UK public health setting and an implementation framework may assist in wider dissemination of this service. [ABSTRACT FROM AUTHOR]

Study Question: Does the interval from delivery to initiation of a subsequent ART treatment cycle impact clinical pregnancy or live birth rates?Summary Answer: An interval from delivery to treatment start of <6 months or ≥24 months is associated with decreased likelihood of clinical pregnancy and live birth.What Is Known Already: Short interpregnancy intervals are associated with poor obstetric outcomes in the naturally conceiving population prompting birth spacing recommendations of 18-24 months from international organizations. Deferring a subsequent pregnancy attempt means a woman will age in the interval with an attendant decline in her fertility.Study Design, Size, Duration: Retrospective analysis of the Society for Assisted Reproductive Technology Clinical Outcome Reporting System (SARTCORS) cohort containing 61 686 ART cycles from 2004 to 2013.Participants/materials, Setting, Methods: The delivery-to-cycle interval (DCI) was calculated for patients from SARTCORS with a history of live birth from ART who returned to the same clinic for a first subsequent treatment cycle. Generalized linear models were fit to determine the risk of clinical pregnancy and live birth by DCI with subsequent adjustment for factors associated with outcomes of interest. Predicted probabilities of clinical pregnancy and live birth were generated from each model.Main Results and the Role Of Chance: A DCI of <6 months was associated with a 5.6% reduction in probability of clinical pregnancy (40.1 ± 1.9 versus 45.7 ± 0.6%, P = 0.009) and 6.8% reduction in live birth (31.6 ± 1.7 versus 38.4 ± 0.6%, P = 0.001) per cycle start compared to a DCI of 12 to <18 months. A DCI of ≥24 months was associated with a 5.1% reduction in probability of clinical pregnancy (40.6 ± 0.5 versus 45.7 ± 0.6%, P < 0.001) and 5.7% reduction in live birth (32.7 ± 0.5 versus 38.4 ± 0.6%, P < 0.001) compared to 12 to <18 months.Limitations, Reasons For Caution: The SART database is reliant upon self-report of many variables of interest including live birth. It remains unclear whether poorer outcomes are a result of residual confounding from factors inherent to the population with a very short or long DCI or the interval itself.Wider Implications Of the Findings: Birth spacing recommendations for naturally conceiving populations may not be generally applicable to patients with a history of infertility. Patients planning ART treatment should wait a minimum of 6 months, but not more than 24 months, from a live birth for optimization of clinical pregnancy and live birth rates.Study Funding/competing Interest(s): National Center for Advancing Translational Sciences, National Institutes of Health, UCSF-CTSI Grant number UL1TR001872. The authors have no competing interests. [ABSTRACT FROM AUTHOR]

Abstract: Background: To examine the effect of inter‐twin delivery interval on umbilical artery pH and Apgar score of the second twin after vaginal delivery of the first twin. Methods: Retrospective study conducted at a single teaching hospital. All pregnant women with twin gestation who delivered the first twin vaginally at more than 24 weeks between 1995 and 2015 were included. Major malformations and intrauterine deaths of one or both twins were excluded. Women were divided into those who had an inter‐twin delivery interval of less than 30 minutes (group 1) or 30 minutes or more (group 2). Primary outcome was umbilical artery pH less than 7.1 and/or Apgar score less than 7 at 5 minutes of the second twin. Generalized linear regression with log was performed to evaluate the association with delivery interval. Results: Of 88 145 deliveries during this period, 1955 (2.2%) were twins. Overall, 713 twin pregnancies, 596 (83.6%) in group 1 and 117 (16.4%) in group 2, were eligible and included. Mean inter‐delivery interval was 11.0 ± 6.5 and 52.5 ± 31.5 minutes in groups 1 and 2, respectively. After adjusting for variables found significantly different between the groups in univariate analysis, inter‐delivery interval of less than 30 minutes or 30 minutes or more was not a significant risk factor for pH less than 7.1 and/or Apgar less than 7 (P = .91). The cesarean rate for delivery of the second twin after vaginal delivery of the first twin was 4.3% overall, with a higher rate among group 2 compared with group 1 (18.2% and 3.2%, respectively; P = .001). Conclusions: The second twin's Apgar score and cord artery pH are probably not affected when the inter‐twin delivery interval exceeds 30 minutes. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of adverse effects caused by implantation of single-rod Etonogestrel implant (Implanon) in females seeking birth spacing after delivery of previous pregnancy. Study Design: Descriptive case series. Setting: Unit V, Department of Obstetrics & Gynecology, and Lady Aitcheson Hospital Lahore. Period: One year from 01/04/2015 to 31/03/2016. Materials & methods: A total of 130 women fulfilling our selection criteria were selected. The ENG implant is a single (coaxial) rod made up of an ethylene vinyl acetate (EVA) copolymer core (40% EVA) containing 68mg ENG, surrounded by a 60mm skin of EVA copolymer (100% EVA). The implant was inserted during days 1 to 5 of spontaneous menses and left in place and adverse effects (abnormal vaginal bleeding or pregnancy) was measured (as per operational definition) for a period of 3 months. All this information was recorded in proforma (attached). Data was entered and analyzed in SPSS version 17.0. Results: The mean age of females was 29.08 ± 4.027 years with minimum and maximum age of 20 and 40 years. Adverse events were seen in 36(27.7%) of the females while other 94(72.3%) did not have any adverse effect of implantation of single-rod Etonogestrel implant (Implanon) in females seeking birth spacing after delivery of previous pregnancy. Abnormal vaginal bleeding was reported by 19(14.6%) and pregnancy was occurred in 17(13.1%) of the females. Conclusion: According to the findings of this study we found less adverse effects like abnormal vaginal bleeding in 19(14.6%) females and pregnancy was occurred in 17(13.1%) of the females. Hence we conclude Implanon is an effective mode of contraception in females seeking birth spacing and can be adopted in females seeking family planning. [ABSTRACT FROM AUTHOR]

Background Significant reduction in the global burden of neonatal mortality was achieved through the millennium development goals. In Nigeria, however, only a marginal reduction was realized. This study assesses the rural-urban differences in neonatal mortality rate ( NMR) and the associated risk factors in Nigeria. Methods The dataset from the 2013 Nigeria demographic and health survey ( NDHS), disaggregated by rural-urban residence (n = 20 449 and 9935, respectively), was explored using univariate, bivariate, and multivariable analysis. Complex samples analysis was applied to adjust for the unequal selection probabilities due to the multi-stage cluster sampling method used in the 2013 NDHS. The adjusted relationship between the outcome and predictor variables was assessed on multi-level logistic regression analysis. Results NMR for rural and urban populations was 36 and 28 deaths per 1000 live births, respectively. Risk factors in urban residence were lack of electricity access (adjusted OR [ AOR], 1.555; 95% CI: 1.089-2.220), small birth size (as a proxy for low birthweight; AOR, 3.048; 95% CI: 2.047-4.537), and male gender ( AOR, 1.666; 95% CI: 1.215-2.284). Risk factors in rural residence were small birth size (a proxy for low birthweight; AOR, 2.118; 95% CI: 1.600-2.804), and birth interval <2 years ( AOR, 2.149; 95% CI: 1.760-2.624). Cesarean delivery was a risk factor both in rural ( AOR, 5.038; 95% CI: 2.617-9.700) and urban Nigeria ( AOR, 2.632; 95% CI: 1.543-4.489). Conclusions Determinants of neonatal mortality were different in rural and urban Nigeria, and rural neonates had greater risk of mortality than their urban counterparts. [ABSTRACT FROM AUTHOR]

Objectives: We assessed whether interpregnancy interval (IPI) length after live birth and after pregnancy termination was associated with preterm birth (PTB).Design: Multiyear birth cohort.Settings: Fetal death, birth and infant death certificates in California merged with Office of Statewide Health Planning and Development.Population: One million California live births (2007-10) after live birth and after pregnancy termination.Methods: Logistic regression was used to estimate odds ratios (ORs) of PTB of 20-36 weeks of gestation and its subcategories for IPIs after a live birth and after a pregnancy termination. We used conditional logistic regression (two IPIs/mother) to investigate associations within mothers.Main Outcome Measure: PTB relative to gestations of ≥ 37 weeks.Results: Analyses included 971 211 women with IPI after live birth, and 138 405 women with IPI after pregnancy termination with 30.6% and 74.6% having intervals of <18 months, respectively. IPIs of <6 months or 6-11 months after live birth showed increased odds of PTB adjusted ORs for PTB of 1.71 (95% CI 1.65-1.78) and 1.20 (95% CI 1.16-1.24), respectively compared with intervals of 18-23 months. An IPI >36 months (versus 18-23 months) was associated with increased odds for PTB. Short IPI after pregnancy termination showed a decreased OR of 0.87 (95% CI 0.81-0.94). The within-mother analysis showed the association of increased odds of PTB for short IPI, but not for long IPI.Conclusions: Women with IPI <1 or >3 years after a live birth were at increased odds of PTB-an important group for intervention to reduce PTB. Short IPI after pregnancy termination was associated with reduced odds for PTB and needs to be further explored.Tweetable Abstract: Short and long IPI after live birth, but not after pregnancy termination, showed increased odds for PTB. [ABSTRACT FROM AUTHOR]

Background: First childbirth in a woman's life is one of the most important events in her life. It marks a turnaround when she might have to drop roles of career building and education, for motherhood and parenthood. The timing of the commencement of these roles affects the child bearing behavior of women as they progress in their reproductive ages. Prevalent early first childbirth in Nigeria has been reported as the main cause of high population growth and high  fertility, mortality and morbidity among women, but little has been documented on the progression into first birth as well as factors affecting it in Nigeria. This paper modelled timing of first birth among women in Nigeria and determined socio-demographic and other factors affecting its timing.Methods: We hypothesized that background characteristics of a woman will influence her progression into having first birth. We developed and fitted a survival analysis model to understand the timing of first birth among women in Nigeria using a national representative 2013 NDHS data. Women with no children were right censored as of the date of the survey. The Kaplan Meier survival function was used to estimate the probabilities of first birth not occurring until certain ages of women while Cox proportional hazard regression was used to model the timing of first births at 5 % significance level.Results: About 75.7 % of the respondents had given birth in the Northern region of Nigerian compared with 63.8 % in the South. Half (50.1 %) of the first childbirth occurred within the 15-19 years age bracket and 38.1 % within 20-29 years. The overall median survival time to first birth was 20 years (North 19, South 22), 27 years among women with higher education and 18 years for those with no formal education. The adjusted hazard of first birth was higher in the Northern region of Nigeria than in the South (aHR = 1.24, 95 % CI: 1.20-1.27), and higher in rural areas than in urban areas (aHR = 1.15, 95 % CI: 1.12-1.19). Also, hazard of earlier first birth tripled among women with no education (aHR = 3.36, 95 % CI: 3.17-3.55) compared to women with higher education. The significant factors affecting age at first birth are education, place and zone of residence, age at first marriage, religion, ethnicity and use of contraceptives.Conclusions: This study showed that progression into early first birth is most affected by the education standing of women as well as age at first marriage. Delay of first childbirths as a strategy for fertility reduction and maternal health improvement can be achieved if women are empowered early in life with quality education. Stakeholders should therefore, give adequate attention to educating the girl child. Adverse socio-cultural norms of betrothing and marrying young girls should be abrogated, while health education and promotion of need to delay child bearing must be intensified especially among rural dwellers and also in Northern Nigeria. [ABSTRACT FROM AUTHOR]

Most studies on birth intervals and infant mortality ignore pregnancies that do not result in live births. Yet, fetal deaths are important in infant mortality analyses for three reasons: ignoring fetal deaths between two live births lengthens the measured interval between births, implying that short intervals are underestimated; the recommended inter-pregnancy interval (IPI) after a fetal loss is shorter (6 months) than after a live birth (24 months), as the effect of IPI on outcomes might differ according to the previous type of pregnancy outcome; fetal death will selectively reduce the population at risk of neonatal mortality, leading to biased results. This study uses the Heckman selection model to simultaneously estimate the combined effect of IPI duration and the type of pregnancy outcome at the start of the interval on pregnancy survival and neonatal mortality. The analysis is based on retrospective data from the Rwanda Demographic Health Surveys of 2000, 2005 and 2010. The results show a significant selection effect. After controlling for the selection bias, short (<6 months) and long (>60 months) intervals after a fetal death reduce the chances of pregnancy survival, but no longer have an effect on neonatal mortality. For intervals starting with a live birth, the reverse is true. Short intervals (<24 months) do not affect pregnancy survival but increase the odds of neonatal mortality. If the previous child died in infancy, the highest odds are found for neonatal death regardless of the IPI duration. [ABSTRACT FROM PUBLISHER]

Objective To assess the influence of inadequate birth spacing on birth timing distribution across gestation. Design Population-based retrospective cohort study using vital statistics birth records. Setting Ohio, USA. Study Population Singleton, non-anomalous live births ≥20 weeks to multiparous mothers, 2006-2011. Methods Birth frequency at each gestational week was compared following short IPIs of <6, 6-12 and 12-18 months versus referent group, normal IPI ≥18 months. Main outcome measures Frequency of birth at each gestational week; preterm <37 weeks; <39 and ≥40 weeks. Results Of 454 716 births, 87% followed a normal IPI ≥18 months, 10.7% had IPI 12-18 months and 2.2% with IPI <12 months. The risk of delivery <39 weeks was higher following short IPI <12 months, adj OR (odds ratio) 2.78 (95% CI 2.64, 2.93). 53.3% of women delivered before the 39th week after IPI <12 months compared with 37.5% of women with normal IPI, P < 0.001. Likewise, birth at ≥40 weeks was decreased (16.9%) following short IPI <12 months compared to normal IPI, 23.2%, adj OR 0.67 (95% CI 0.64, 0.71). This resulted in a shift of the frequency distribution curve of birth by week of gestation to the left for pregnancies following a short IPI <12 months and 12-18 months compared to, birth spacing ≥18 months. Conclusions While short IPI is a known risk factor for preterm birth, our data show that inadequate birth spacing is associated with decreased gestational age for all births. Pregnancies following short IPIs have a higher frequency of birth at all weeks of gestation prior to 39 and fewer births ≥40 weeks, resulting in overall shortened pregnancy duration. [ABSTRACT FROM AUTHOR]

Background: Parturition lines have been described in the teeth of a number of animals, including primates, but never in modern humans. These accentuated lines in dentine are comprised of characteristic dark and light component zones. Aim: The aim of this study was to review the physiology underlying these lines and to ask if parturition lines exist in the third molar tooth roots of mothers known to have had one or more children during their teenage years. Methods: Brief retrospective oral medical obstetric histories were taken from four mothers and compared with histological estimates for the timing of accentuated markings visible in longitudinal ground sections of their wisdom teeth. Results: Evidence of accentuated markings in M3 root dentine matched the age of the mother at the time their first child was born reasonably well. However, the dates calculated for inter-birth intervals did not match well. Conclusions: Parturition lines corresponding to childbirth during the teenage years can exist in human M3 roots, but may not always do so. Without a written medical history it would not be possible to say with confidence that an accentuated line in M3 root dentine was caused by stress, illness or was a parturition line. [ABSTRACT FROM AUTHOR]