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Background: Maternal body mass index (BMI) outside the normal range and smoking are both associated with adverse perinatal outcomes, but their interaction needs further investigation., Aim: The aim of this study was to analyse the combined effects of smoking and BMI on birth weight, preterm birth rate, the somatic development of neonates, and complications of pregnancy., Material and Methods: Data from 508 926 singleton pregnancies from the German Perinatal Survey of 1998-2000 were analysed according to maternal BMI and smoking., Results: Preterm birth rates were higher for non-smoking underweight (8.3%) and obese women (6.7%) than for normal weight (6.0%) or overweight women (5.6%); rates were higher in smokers than in non-smokers for every BMI category. The mean birth weight increased with increasing BMI and was decreased by smoking; it was 2,964 g in underweight smokers and 3,556 g in obese non-smokers. Small for gestational age (SGA) rates were least in obese women and highest in underweight women; large for gestational age (LGA) rates varied in the opposite direction. In smokers SGA rates were higher than in non-smokers for every BMI category and LGA rates were always lower. Hypertension, proteinuria, oedema, and pre-eclampsia/eclampsia were more common as BMI increased but were always lower in smokers. Pre-eclampsia/eclampsia occurred in 0.7% of underweight smokers but in 9.6% of obese non-smokers., Conclusions: Smoking and low maternal BMI in combination can cause high rates of preterm birth and SGA neonates as well as low mean birth weight. Although smoking offers some apparent benefit regarding LGA rates and pre-eclampsia this should not distract from its overall adverse influence., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: The aim of this study was to compare neonatal outcomes in primiparous women with and without previous extrauterine pregnancies., Material and Methods: We analysed data from 207 171 singleton pregnancies in primiparous women from the German Perinatal Survey of 1998-2000. To minimise confounding factors, we only included women without previous miscarriages or terminations of pregnancy and performed comparisons separately for 3 maternal age groups as well as for all cases together., Results: Women with and without previous extrauterine pregnancies were of comparable height and weight but women with previous extrauterine pregnancies were on average older (29.2 vs. 26.6 years). The preterm birth rate was higher in women with previous extrauterine pregnancies (9.4% vs. 6.8%, odds ratio 1.42 [95% confidence interval 1.18-1.69], p<0.001; analysing all cases together) as was the rate of neonates with a low birth weight ≤ 2 499 g (7.9% vs. 5.7%, odds ratio 1.43 [95% confidence interval 1.17-1.72], p>0.001; analysing all cases together). The proportions of neonates classified as small, appropriate, or large for gestational age were rather similar in women with and without previous extrauterine pregnancies; likewise Apgar scores differed only slightly, although for some comparisons statistical significance was reached in spite of the small magnitude of differences., Conclusions: Previous extrauterine pregnancies are associated with higher rates of preterm birth and infants of low birth weight in subsequent pregnancies., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: The influence of previous interruptions, miscarriages and IUFD on the IUGR and preterm rate as well as on the somatic staging (gestational age and birth weight) of the new born is a subject of controversial discussion in the literature. The present paper attempts to quantify these risks of the medical history. 2 282 412 singleton pregnancies of the period 1995 to 2000 were evaluated from the German Perinatal Database. For the analysis 1 065 202 pregnancies (46.7 %) of those mothers without any live birth in the medical history were assessed. To exclude any influence from previous abortions patients with previous miscarriages and IUFDs were excluded. The control collective were new borns whose mothers had suffered neither from miscarriages nor from abortions or IUFD., Results: Previous interruptions, miscarriages and IUFD influence the rate of new borns with low birth weight and increase the rate of prematurity. With increasing numbers of isolated or combined risks in the medical history, the rate of newborns with a low birth weight or with prematurity is increased. The lowest risk was found after one interruption, the highest rate with two or more IUFDs. Interruptions, miscarriages or IUFD are not risk factors for IUGR or SGA., Conclusion: Previous interruptions, miscarriages and IUFD are relevant risk factors for prematurity and are related with low birth weight of the new borns. Pregnant women with such risk factors have to been considered as risk pregnancies and need intensive surveillance.

Human reproduction is a biological phenomenon, however, sociocultural factors such as marital status influence pregnancy outcome and reproductive success. In the present study the impact of maternal marital status on pregnancy outcome was tested for all births, which had taken place in Austria between 1999 and 2004, which met the following criteria: single births, nulliparity, mothers older than 19 years (n = 179 830). The rate of preterm delivery (< 37 beginning weeks of gestation) and rate of low birth weight (< 2500 g) among term births were significantly higher among unmarried mothers in comparison to married mothers. Additionally the newborns of unmarried mothers were significantly lighter and shorter than those of married mothers. This was especially true of immigrant mothers. No significant differences between married and unmarried mothers were found regarding mode of delivery. Even at the beginning of the 21st century unmarried status represents an important stress factor for pregnant women.

Clinical and animal studies have shown a higher risk of an aggravated course of renal disease in childhood after birth for babies small for gestational age (SGA). In addition relative "supernutrition" and fast weight gain in early infancy seem to support the development of later disease. In a retrospective analysis of 62 cases of idiopathic nephrotic syndrome treated between 1994 and 2004 at a university centre for paediatric nephrology, we related the course of disease to birth weight and to the weight gain in the first 2 years of life. Six children were born SGA (birth weight <-1.5 standard deviation score), and 56 were born as appropriate for gestational age (AGA). In all SGA children renal biopsy was performed, while only 55% of the AGA children underwent renal biopsy (P = 0.07), showing no difference in renal histology. In the SGA group, four of six patients developed steroid resistance (vs 12/56 AGA, P < 0.05). Of the SGA children, 83% needed antihypertensive treatment in the course of the disease compared to 39% of the AGA children (P = 0.07). The extent of weight gain between birth and 24 months of age did not influence the course of disease. In conclusion, we were able to find evidence for an aggravated course of idiopathic nephrotic syndrome in former SGA children. Independently of birth weight, weight gain in the first 2 years of life did not influence the course of disease.

Background: As about 20 % of pregnant women smoke, 137,000 of the 685,795 neonates delivered in Germany in 2005 have been affected by smoking during pregnancy. Caring for neonates born prematurely because of smoking results in additional costs. We have attempted to estimate these costs., Material and Methods: Data of 1,815,318 pregnancies were collected from the German perinatal statistics of 1995-1997. In 876,645 cases there was information regarding smoking. Of these, 699,134 pregnant women were non-smokers and 177,511 were smokers. To determine the number of preterm births due to smoking, we compared the distribution of the duration of pregnancy of the non-smoking cohort to that of the smoking cohort. From the difference between this and the actual distribution of the duration of pregnancy among smokers we determined the number of additional preterm births caused by smoking. For the analysis of the associated costs we used the actual costs of care and daily rates used in neonatology., Results: For 2002 we estimate 43 million Euros of additional costs due to neonates born prematurely because of smoking., Conclusions: We present a rough estimate of the additional health care costs for neonates because of smoking. Costs were estimated only with regard to premature deliveries. Other effects of smoking during pregnancy on neonatal health were not considered. More detailed cost analyses will likely reveal even higher costs.

In the period from 1969 to 1976 there born 14.368 living single infants with known duration of pregnancy in the gynecological clinic of the district hospital of Schwerin.--By means of this material was proved, if there is a relation between professional activity and the birth of "infants of low birth weight".--For some professional groups such a relation could be demonstrated.

Attention was given to the relationship between induced abortion in primigravidae and the course as well as outcome of subsequent pregnancy. Reference is made to the women hospitalised for childbirth in the obstetric ward of the Regional Hospital of Schwerin, between 1969 and 1977. Chi-square testing revealed highly significant differences between women with preceding legal abortion, on the one hand, and those without, on the other, with regard to birth weight of the newborn, duration of pregnancy, cervical insufficiency, need for cerclage, imminent abortion, morbidity during pregnancy inside and outside hospital, and the need for using shute forceps on delivery. No difference was established regarding the occurrence of Rh incompatibility, pyelonephritis of the pregnant women, iron deficit anaemia, and gestosis during pregnancy.

Multidimensional retrospective studies were conducted into possible correlations between case histories of induced abortion and premature deliveries, on the one hand, and deliveries of "children with low birth weight", on the other, with reference being made to the ordinal number of birth. Included were 13,287 single newborns, after mothers with twins, stillbirths, and abortion records had been excluded. "Children with low birth weight" up to 2,500 g accounted for 5.4 per cent of these newborns. The investigation was complete, in that all newborns were examined in the obstetric department of the Regional Hospital of Schwerin, between 1969 and 1977. Records of premature delivery and induced abortion were found to play a great epidemiological role in the context of "children with low birth weight" up to 2,500 g, but the general trend for such children for the period under review had remained unaffected by the Free Medical Abortion Act of 1972. Nevertheless, mothers with previous abortions during the period studied contributed to a moderate rise of the total number of "newborns with low birth weight".

Retrospective polydimensional studies were conducted into correlations between age, parity, and occupation (social status) of gravidae, on the one hand, and deliveries of "infants of low birth weight", on the other. The reference group amounted to 16.729 newborns, twins and stillbirth excluded, with 5.85 per cent of those newborns with low birth weights up to 2,500 g. Included in the above figure are all newborns delivered in the Regional Hospital of Schwerin, between 1969 and 1977.--Any single factor quoted, age, parity, and occupation, was found to affect birth weight, effects being by the following order: parity, age, occupation.

Infants with a very low birthweight (less than 1500 g) have a fundamental influence on perinatal mortality and mortality of babies up to one year also nowadays. The epidemiological role of different signs of risk in the context of the birth of these children is presented. The total mortality of the infants with a very low birthweight (less than 1500 g) was 64,4%. Usually there were combinations of factors, which caused the death of the infants. Complications of secundinae, immaturity and malformations were the substantial factors of lethality of the stillbirths. At the mortality of babies there were intracranial bleedings and immaturity (less than 1000 g, less than 28 completed weeks of pregnancy) in the foreground of the causes of death.

Evidence has been produced to higher risk for unmarried pregnant women to deliver children with low birth weight, with reference being made to the files of the Gynaecological Hospital of the Region of Schwerin and, more particularly, to single live births, between 1969 and 1977. That higher risk was found to depend on other factors, as well, with particular emphasis on residence and occupation. The risk, however, was found to be lowered, when it came to second births and decline in the rate of low birth weight, in the context of unmarried mothers. Yet, the decline was less strong, as compared to married mothers, and the risk associated with unmarried women, consequently, remains to be regularly 60 per cent above average. These findings are considered by the authors as being relevant to supervision and guidance of women during pregnancy.

Polydimensional retrospective studies were conducted into correlations between interruption of pregnancy, abortion, and premature birth of infants weighing less than 2,501 g, on the one hand, and the general phenomenon of low birth weight, on the other. Reference was made to parity. The studies were undertaken over a period between 1969 and 1977. The birth total investigated was 17,076, stillbirths and twins excluded.-The impact of all factors involved as well as the statistical significance were tested and verified by calculation of information measure 2-I, followed by an approximative chi 2-test. The results suggested that the parameters studied were of somewhat staggered impact upon low birth weight. Premature birth, interruption of pregnancy, and abortion was the order of impact at all parity levels studied.