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Now we are Four gives us a comprehensive look at how kiwi kids from the Growing Up in New Zealand study are faring. In particular, we can see how the situation of mothers changes when children pass from infancy to early childhood. The biggest shift for most children is that they now attend early childhood education, and most are reported to be generally happy and healthy and spending time getting to know their peers. This means that we also see greater employment of mothers, leading to improved economic circumstances for these households. Nearly half of this generation of mothers live in private rental accommodation and experience multiple changes of address. The effect of this on access to services needs further exploration. Pacific households appear to bear the most significant effects of overcrowding, as seen in the reporting by Pacific mothers that half of their four-year-olds sleep in a room with adults. We also see: •Families moving homes frequently, with half of the children experiencing one or more residential moves since the age of two. One question this raises relates to what impact this has on continuous health care and early childhood education services, and ensuring places are available in local schools? •The increasing number of children living with a single parent as the cohort gets older. This has implications for agencies developing services and systems to support sole parents and their children. •A greater proportion of Māori children living in single-parent households compared to other ethnic groups. Previous research by Superu identified that these families tend to face greater financial stress which impacts their ability to function well. There is a clear need to address this. •One in five mothers experience depressive symptoms during or since pregnancy. This suggests a need to understand how our mental health services can better serve the mothers who aren’t currently getting the support they need. •By the age of four, 97 percent of children spe

Infants are increasingly cared for by adults other than their parents. Here we describe non-parental infant care within a diverse cohort; and investigate the relationship between parents’ antenatal intentions and actual infant care. 6822 New Zealand women were recruited during pregnancy and asked about their intentions for childcare. Non-parental care was assessed when infants were nine months old: 1717 (25%) of the 6853 cohort children were receiving more than 8 h per week of regular non-parental care. In comparison with infants of European mothers, infants of Asian or Pacific mothers were more likely to be cared for by extended family; and infants of Māori mothers were more likely to receive centre-based care. Infants from families with lower household incomes, living in more deprived areas were more likely to be cared for by family. When their infants were nine months old, mothers from low- to medium-income households were less likely to be using the type of non-parental care they had intended antenatally, and the same was true when their children were aged 2 years.

Objective To examine prospectively multiple indicators of pregnancy health and associations with adverse birth outcomes within a large, diverse sample of contemporary women. Design A cohort of pregnant women who gave birth during 2009–10. Population We enrolled a sample of 6822 pregnant New Zealand (NZ) women: 11% of all births in NZ during the recruitment period. Methods We analysed a number of maternal health indicators and behaviours during pregnancy in relation to birth outcomes using multivariable logistic regression. Associations were described using adjusted odds ratios and 95% confidence intervals. Main outcome measures Three birth outcomes, low birth weight (LBW), pre-term birth (PTB) and delivery type, were measured via linkage with maternity hospital perinatal databases. Small for gestational age (SGA) was then defined as below the 10th percentile by week of gestation. Results Modelling of birth outcomes after adjusting for confounders indicated patterns of increased risk of LBW and PTB for women who smoke, have elevated pre-pregnancy body mass index (BMI), or with insufficient pregnancy weight gain. SGA was associated with maternal smoking, alcohol use, insufficient weight gain and nausea and vomiting during pregnancy. Risk of caesarean section was associated with having a diagnosed illness before pregnancy, elevated BMI, greater pregnancy weight gain and less pregnancy exercise. Number of risk factor variables were then used to model birth outcomes. Women with multiple risk factors were at increased risk compared with those who had no risk factors. Conclusions Women with multiple health risks are at particular risk of adverse birth outcomes.