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Objective To examine the relationship between antenatal care, iron and folic acid supplementation and tetanus toxoid vaccination during pregnancy in Indonesia and the risk of early neonatal death (death in days 0-6 of life). Methods We analysed pooled data on neonatal survival in singleton infants born in the 5 years before each of the Indonesian demographic and health surveys of 1994, 1997 and 2002-2003. Only the most recently born infant of each mother was included. Multivariate Cox proportional hazards models were used to identify factors linked to early neonatal death. Findings Of the 40 576 infants included, 442 experienced early neonatal death. After adjustment, the risk of early neonatal death was significantly reduced for infants of mothers who received either any form of antenatal care (hazard ratio, HR: 0.48; 95% confidence interval, CI: 0.31-0.73), any quantity of iron and folic acid (HR: 0.53; 95% CI: 0.36-0.77) or [greater than or equal to] 2 tetanus toxoid injections (HR: 0.66; 95% CI: 0.48-0.92). When we analysed different combinations of these measures, iron and folic acid supplementation provided the main protective effect: early neonatal deaths were still significantly reduced among infants whose mothers received iron and folic acid supplements but no other form of antenatal care (HR: 0.10; 95% CI: 0.01-0.67), or the supplements but < 2 tetanus toxoid injections (HR: 0.46; 95% CI: 0.29-0.73). Subsequent analysis showed that 20% of early neonatal deaths in Indonesia could be attributed to a lack of iron and folic acid supplementation during pregnancy. Conclusion Iron and folic acid supplementation during pregnancy in Indonesia significantly reduced the risk of early neonatal death and could also do so in other low- and middle-income countries. Objectif Examiner la relation entre soins antenatals, supplementation en fer et en acide folique et vaccination par l&apos;anatoxine tetanique pendant la grossesse d&apos;une part et risque de deces neonatal precoce (intervenant entre 0 et 6 jours de vie) d&apos;autre part, en Indonesie. Methodes Nous avons analyse des donnees combinees sur la survie des nouveau-nes, issus d&apos;une grossesse monofoetale dans les 5 ans precedant chacune des enquetes demographiques et sanitaires menees en Indonesie en 1994, 1997 et 2002-2003. Seul le dernier ne des enfants de chaque mare avait ete inclus dans l&apos;etude. Nous avons utilise des modeles multivaries a risque proportionnel de Cox pour identifier les facteurs lies a la mortalite neonatale precoce. Resultats Parmi les 40576 enfants pris en compte, 442 sont decedes avant l&apos;age de 7 jours. Apres ajustement, le risque de deces neonatal precoce apparaissait significativement reduit pour les enfants dont les meres avaient recu une forme quelconque de soins antenatals (rapport de risques, RR: 0,48; intervalle de confiance a 95%: 0,31-0,73), du fer et de l&apos;acide folique en une quantite quelconque (RR: 0,53; IC a 95%: 0,36-0,77) ou 2 injections et plus d&apos;anatoxine tetanique (RR: 0,66; IC 95%: 0,48-0,92). L&apos;analyse de differentes combinaisons de ces mesures montre que c&apos;est la supplementation en fer et en acide folique qui fournit I&apos;effet protecteur le plus important La mortalite neonatale precoce etait encore significativement reduite chez les nourrissons dont les meres avaient recu une telle supplementation en l&apos;absence d&apos;autre forme de soins antenatals (RR: 0,10;IC a 95%: 0,01-0,67) ou cette supplementation et moins de 2 injections d&apos;anatoxine tetanique (RR: 0,46; IC a 95%: 0,29-0,73). L&apos;analyse realisee a la suite a mis en evidence que 20% des deces neonatals precoces survenant en Indonesie pourraient etre attribues a l&apos;absence de supplementation en fer et en acide folique pendant la grossesse. Conclusion En Indonesie, l&apos;apport d&apos;une supplementation en fer et en acide folique pendant la grossesse a reduit significativement le risque de deces neonatal precoce et pourrait en faire autant dans d&apos;autres pays revenu faible ou intermediaire, Objetivo Estudiar en Indonesia la relacion existente entre, por un lado, la atencion prenatal, los suplementos de hierro y acido folico y la vacunacion con anatoxina tetanica durante el embarazo y, por el otro, el riesgo de muerte neonatal precoz (defuncion dentro de los primeros 6 dias de vida). Metodos Analizamos datos combinados sobre la supervivencia neonatal de lactantes nacidos de embarazos monofetales en los 5 anos anteriores a cada una de las encuestas de demografla y salud de Indonesia de 1994, 1997 y 2002-2003. Solo se incluyo en el estudio al lactante de menor edad de cada madre. Para determinar los factores relacionados con la muerte neonatal precoz se aplicaron modelos multifactoriales de riesgos proporcionales de Cox. Resultados De los 40 576 lactantes estudiados, 442 fallecieron tempranamente en el periodo neonatal. Tras ajustar las cifras, el riesgo de muerte neonatal precoz se reduje de manera significativa cuando las madres habian recibido cualquier tipo de atencion prenatal (razon de riesgos instantaneos (hazard ratio, HR): 0,48; intervalo de confianza del 95%: 0,31-0,73), cualquier cantidad de hierro y acido folico (HR: 0,53, IC95%: 0,36-0,77) o [greater than or equal to] 2 inyecciones de anatoxina tetanica (HR: 0,66; IC95%: 0,48-0,92). Cuando analizamos las diferentes combinaciones de esas medidas, observamos que los suplementos de hierro y acido folico tenian el mayor efecto protector: la mortalidad neonatal precoz seguia siendo considerablemente inferior entre los lactantes cuyas madres habian recibido suplementos de hierro y acido folico, pero ninguna otra forma de atencion prenatal (HR: 0,10; IC95%: 0,01-0,67), o bien los suplementos pero menos de 2 inyecciones de anatoxina tetanica (HR: 0,46, IC95%: 0,29-0,73). Analisis posteriores mostraron que el 20% de la mortalidad neonatal precoz registrada en Indonesia podia atribuirse a la falta de suplementos de hierro y acido folico durante el embarazo. Conclusion La administracion de suplementos de hierro y acido folico durante el embarazo redujo significativamente el riesgo de muerte neonatal precoz en Indonesia, y la medida podria tener el mismo efecto en otros paises de ingresos bajos y medios., Introduction Globally, approximately 4 million infants die each year in the neonatal period, with 75% dying in the early neonatal period (i.e. in the first 7 days of life). (1,2) [...]

Objective: To quantify the residential mobility rate in a population of pregnant women expecting their first baby. Method: We verified residential mobility in a cohort of 585 primiparous Australian women who were enrolled in late pregnancy and had participated in a randomised controlled trial and followed-up to at least 16 weeks post-partum. Results: We found a residential mobility rate of 19%. Movers and non-movers differed by socio-demographic factors, with movers more likely be younger, relative risk (RR)=2.14 (95% confidence interval (CI) 1.41-3.13), and not living with a partner RR=2.46 (95% CI 1.60-3.77). Conclusion: Most prospective epidemiological studies can expect some attrition in the study population. The family formation period is acknowledged as a highly mobile time and this mobility may contribute to loss to follow-up. Implications: Researchers planning prospective studies in pregnant populations should consider the impact of residential mobility, especially differential mobility, and implement strategies to reduce attrition and optimise response rates. Key words: Residential mobility; follow-up studies; pregnant women; epidemiologic research design. doi: 10.1111/j.1753-6405.2008.00188.x

Objective: To assess trends and outcomes of postpartum haemorrhage (PPH) in New South Wales (NSW). Methods: A population-based descriptive study of all 52,151 women who had a PPH either during the hospital stay for the birth of their baby or requiring a re-admission to hospital between 1994 and 2002. Data were obtained from the de-identified computerised census of NSW hospital in-patients and analysed to examine trends over time. The outcome measures included maternal death, hysterectomy, admission to intensive care unit (ICU), transfusion and major maternal morbidity, including procedures to reduce blood supply to the uterus, acute renal failure and postpartum coagulation defects. Results: From 1994 to 2002 both the number and adjusted (for under-reporting) rate of PPH during the birth admission increased from 8.3% of deliveries to 10.7%. The rate of PPH adjusted for maternal age and mode of delivery was similar to the unadjusted rate. There was a sixfold increase in the rate of transfusions from 1.9% of women who haemorrhaged to 11.7%. Hospital readmissions for PPH declined from 1.2% of deliveries to 0.9%. These were statistically significant changes. There were no significant changes in the rate of hysterectomies, procedures to reduce blood supply to the uterus, admissions to ICU, acute renal failure or coagulation defects. Conclusion: The increased rate of PPH during the birth admission is concerning. The increase in PPH could not be explained by increasing maternal age or caesarean sections. Linked birth and hospital discharge data could determine whether the increase in PPH is caused by other changes in obstetric practices or population.

Background: Low birthweight (<2500 g) is often used as a population-level indicator of maternal-child health, as it is easy to measure and correlates with poorer infant health outcomes. However, it conflates preterm birth and intrauterine growth restriction, which have different causal pathways and require different approaches to prevention. Small for gestational age (SGA) (a proxy for growth restriction) and preterm birth may be more informative measures. We evaluated low birthweight as a population-level indicator. Methods: We conducted a population-based cohort study of singleton live births in New South Wales (NSW), Australia, using linked data from 1994–2006 birth, hospital, death and educational records, with follow-up until 2014. Outcomes of babies born of low birthweight, preterm and SGA were compared with well-grown term infants (i.e. not low birthweight or SGA). Overlap between groups and temporal trends were also examined. Results: Of 1 093 765 singleton live births, 47 946 (4.4%) infants were low birthweight and had poorer outcomes than well-grown term infants (2.7% vs. 0.1% infant mortality; 13% vs. 6% below national minimum numeracy standard). SGA and preterm infants also had poorer outcomes (0.5%, 2.3% infant mortality respectively; 10%, 11% below numeracy standard) but 80% of SGA and 47% of preterm infants were not low birthweight. For all outcomes, low birthweight identified a smaller proportion of infants with poor outcomes than preterm birth and than either SGA or low birthweight at term. The proportion of low-birthweight births remained constant over time, while the proportion of births that were preterm increased and proportion of SGA decreased. Conclusions: Low birthweight, SGA and preterm infants are all at higher risk of poorer outcomes but low birthweight inadequately captures, and masks trends in, both preterm births and births that are SGA. Reporting preterm births and an indicator of growth restriction at term will identify vulnerable groups better than using the measure of low birthweight. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine trends in the pregnancy profile and outcomes of urban and rural women. METHODS: Data were obtained from the NSW Midwives Data Collection on births in NSW, 1990-1997. Associations between place of residence (urban/rural) and maternal factors and pregnancy outcomes were examined, including changes over time. RESULTS: From 1990 to 1997 there were 685,631 confinements in NSW and these mothers resided as follows: 76% metropolitan, 5% large rural centres, 8% small rural centres, 11% other rural areas and 1% remote areas. Rural mothers were more likely to be teenagers, multiparous, without a married or de facto partner, public patients and smokers. Births in rural areas declined, particularly among women aged 20-34 years. Infants born to mothers in remote communities were at increased odds of stillbirth and low Apgar scores (all women) and small-for-gestational-age (SGA) (Indigenous women only). CONCLUSIONS: The profile of pregnant women in rural NSW is different from their urban counterparts and is consistent with relative socioeconomic disadvantage and possibly suboptimal maternity services in some areas. While increased risk of SGA is associated with environmental factors such as smoking and nutrition, the reasons for increased risk of stillbirth are unclear. Although there does not appear to be an increased risk of preterm birth for rural women this may be masked by transfer of high-risk pregnancies interstate. IMPLICATIONS: Maternity services need to be available and accessible to all rural women with targeting of interventions known to reduce low birthweight and perinatal death.

Objective: To assess awareness, knowledge and behaviour relating to Listeria among recent mothers (12 weeks post-partum) in Western Australia and determine the usefulness of a Listeria information pamphlet. Method: A postal survey of a random 10% sample of Western Australian mothers whose babies were born between 1 January and 13 April 1997. Results: Of the 680 women surveyed, 509 (75%) responded and 451 (89%) respondents had heard of Listeria. The 11% who had not heard of Listeria had higher odds of living in a rural area, speaking a foreign language at home, having less formal education, being younger, having had an unplanned pregnancy, and having not taken folic acid supplements. Respondents who had seen the Listeria pamphlet had greater odds of correctly identifying foods at risk of Listeria. Of the women who had heard of Listeria, 90% had avoided certain foods during their pregnancy. Risk factors for not changing eating behaviour were similar to those for not having heard of Listeria. Conclusions: Factors associated with not having heard of Listeria, not having seen the pamphlet and not having changed behavior were similar, suggesting that there may be a group of women who are less likely to be aware of Listeria or other health issues and/or may be resistant to health-related behaviour changes. Implications: The Listeria pamphlet is an effective medium for educating pregnant women about Listeria. Rural, young, single and non-English speaking background women may require a different or supplementary approach.