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Background and Aim of the Study: Scientific Societies do not recommend the use of cell-free DNA (cfDNA) testing as a first-tier screening for microdeletion and microduplication syndromes (MMs). The aim of this study was to review the current available literature on the performance of cell-free DNA as a screening for MMs., Methods: Medline, Embase and the Cochrane Library were searched electronically from 2000 to January 2020 and articles reporting the diagnostic performance of cfDNA screening for MMs in large (>5000 cases) series were included. Between-study heterogeneity and random effect model for screen positive rate (SPR), false positive rate (FPR) and positive predictive value (PPV) were calculated., Results: We identified 42 papers, seven included, for a total of 474,189 pregnancies and 210 cases of MMs. Diagnostic verification of positive cases was available overall in 486 (71.68 %) of 678 cases. The weighted pooled SPR, FPR and PPV were 0.19% (95% CI = 0.09-0.33), 0.07 (95% CI = 0.02-0.15) and 44.1 (95% CI = 31.49-63.07). In conclusion, the pooled PPV of cfDNA testing in screening for MMs was about 40%, ranging from 29% to 91%, for an overall FPR <0.1%., Conclusions: No confirmatory analysis was available in cases that did not undergo invasive testing, which were the vast majority of cases with a negative test, and therefore, the DR and the negative predictive value cannot be determined., (© 2021 John Wiley & Sons Ltd.)

Objectives: Genetic predisposition and maternal body mass index (BMI) are risk factors for childhood adiposity, defined by either BMI or overweight. We aimed to investigate whether childhood-specific genetic risk scores (GRSs) for adiposity-related traits are associated with childhood adiposity independent of maternal BMI, or whether the associations are modified by maternal BMI., Methods: We constructed a weighted 26-SNP child BMI-GRS and a weighted 17-SNP child obesity-GRS in overall 1674 genotyped children within the Danish National Birth Cohort. We applied a case-cohort (N = 1261) and exposure-based cohort (N = 912) sampling design. Using logistic regression models we estimated associations of the GRSs and child overweight at age 7 years and examined if the GRSs influence child adiposity independent of maternal BMI (per standard deviation units)., Results: In the case-cohort design analysis, maternal BMI and the child GRSs were associated with increased odds for childhood overweight [OR for maternal BMI: 2.01 (95% CI: 1.86; 2.17), OR for child BMI-GRS: 1.56 (95% CI: 1.47; 1.66), and OR for child obesity-GRS 1.46 (95% CI: 1.37; 1.54)]. Adjustment for maternal BMI did not change the results, and there were no significant interactions between the GRSs and maternal BMI. However, in the exposure-based cohort design analysis, significant interactions between the child GRSs and maternal BMI on child overweight were observed, suggesting 0.85-0.87-fold attenuation on ORs of child overweight at higher values of maternal BMI and child GRS., Conclusion: GRSs for childhood adiposity are strongly associated with childhood adiposity even when adjusted for maternal BMI, suggesting that the child-specific GRSs and maternal BMI contribute to childhood overweight independent of each other. However, high maternal BMI may attenuate the effects of child GRSs in children., (© 2021. The Author(s).)

Objective: To analyse maternal factors associated with prematurity in public maternity hospitals., Design: Retrospective unmatched case-control study on two public maternity hospitals in the State of Acre, Brazil., Setting and Participants: A sample of 341 newborn infants of premature birth (< 37 weeks; case group) and 388 newborn infants of term delivery (≥ 37 weeks; control group)., Methods: A validated instrument was used for interviews, and information was collected from hospital records. The variables were divided into five blocks: (1) maternal sociodemographic and economic characteristics, (2) maternal biological and reproductive characteristics, (3) maternal habits, (4) pregnancy complications, and (5) neonatal characteristics. The hierarchical analysis was performed using multiple logistic regression., Results: The risk factors associated with premature birth were as follows: newborn infants of mothers who were born premature (p = 0.005), with low BMI (p = 0.006), history of a previous preterm child (p<0.003), who had stress (p = 0.020) and physical injury during pregnancy (p = 0.025), with quality of prenatal care classified as inadequate II (p = 0.001), which presented abnormal amniotic fluid volume (p<0.001), pre-eclampsia/eclampsia (p<0.001), bleeding (p = 0.013) and hospitalization during pregnancy (p = 0.001)., Conclusion: The variables that were associated with premature birth were mother born preterm, low BMI, previous premature child, stress and physical injury during pregnancy, prenatal care inadequate II, bleeding, abnormal amniotic fluid volume, pre-eclampsia/eclampsia and hospitalization during pregnancy. It is important to properly perform prenatal care, having a multidisciplinary approach as support, with the objective of keep up with changes in nutritional classification and monitoring of adverse clinical conditions., Competing Interests: Declaration of Competing Interest We have no conflicts of interest to disclose., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Previous measures of parental substance use have often paid limited attention to the co-occurrence of alcohol and drugs, or to the between-parent dynamics in the use of substances. These shortcomings may have important implications for our understandings of the relationship between parental substance use and child wellbeing. Using data from the Avon Longitudinal Study of Parents and Children, a UK community-based cohort study from 1990 onwards (n = 9,451), we identified groups of parental substance use using latent class analysis. The 4-class solution offered the best fit, balancing statistical criteria and theoretical judgement. The results show distinct classes across the range of parental substance use, including very low users, low users, moderate users and heavy users. These classes suggest that substance use patterns among mothers are somewhat mirrored by those of their partners, while heavy use of alcohol by mothers and their partners is related to increased mothers drug use. We suggest that studies that investigate the effects of parental substance use on child wellbeing should pay greater attention to the dynamics of substance use by parental figures., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A reciprocal crossbred embryo production approach was used to assess effects of maternal breed on embryo development in tropical conditions (average temperature 22.0 °C and 77.9% relative humidity). Oocytes were recovered by ovum pick-up (OPU) from Gyr and Holstein donors (n = 90 Holstein and 83 Gyr OPUs). Female F1 embryos were produced by fertilization with sperm bearing X-chromosomes from Holstein semen (n = 615 Gyr oocytes) or Gyr semen (n = 255 Holstein oocytes). Blastocysts were transferred to recipients 168 h post-insemination (h.p.i.) (n = 70-144) and there were assessments of pregnancies until birth. Oocyte number per OPU (Gyr 10.0 ± 0.7 compared with Holstein 6.3 ± 0.4) and percentage viable oocytes (Gyr 78.8 ± 1.9% compared with Holstein 71.2 ± 2.2%) were less for Holstein donor animals. There was a 2.8 fold fewer total number of F1 blastocysts when Holstein donors were used (Gyr: 260, Holstein: 91). Pregnancy assessment during the different stages of gestation indicated the percentage pregnancy was less when embryos were produced from Holstein oocytes (Gyr and Holstein respectively: early pregnancy, 47.9% compared with 38.6%; mid-pregnancy, 44.4% compared with 31.4%; late pregnancy, 41.0% compared with 22.9%). Pregnancy length was also affected by maternal breed (Gyr: 280.8 ± 0.6, Holstein: 286.3 ± 0.7). It is concluded that in a tropical environment the maternal breed affects crossbred embryo development with pregnancy rates during the latter stages of gestation being greater when Gyr oocytes are used for production of embryos., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Adverse birth outcomes continue to be a global public health challenge, particularly in low resource settings. Therefore, the present study aimed at assessing maternal determinants of low birth weight and neonatal asphyxia in the Upper West region of Ghana., Methods: An analytical cross sectional survey was conducted among mothers who attended child welfare clinics (CWC) in six sub-districts. Pregnancy outcome data and maternal nutritional, health service and socio-demographics were obtained using a pre-tested questionnaire. Determinants of low birth weight (LBW) and neonatal asphyxia were analyzed using chi-square and multivariable logistic regression modelling., Results: The results showed that the prevalence of low birth weight and neonatal asphyxia were 8.2% and 9.3% respectively. Multiple logistic regression showed that the risk of giving birth to a LBW baby was high among mothers who consumed alcoholic beverages [AOR = 5.93; 95% CI (1.22-28.84); p = 0.03], those who had food taboos during pregnancy [AOR = 3.31; 95% CI (1.02-10.77); p = 0.047] and not having additional meals [AOR = 3.16; 95% CI (1.0-10.0); p = 0.05] during pregnancy. Neonatal asphyxia was higher among new born babies whose mothers did not receive nutritional counselling in pregnancy [AOR = 5.64; 95% CI (1.48-21.60); p = 0.01] and those who had anaemia at 36 weeks gestation [AOR = 2.69; 95% CI (0.95-7.65); p = 0.06]., Conclusion: Maternal dietary practices during pregnancy could positively affect birth outcome in the Upper West Region of Ghana., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The persistence of elevated subtypes of aggression beginning in childhood have been associated with long-term maladaptive outcomes. Yet it remains unclear to what extent there are clusters of individuals following similar developmental trajectories across forms (i.e., physical and indirect) and functions (i.e., proactive and reactive) of aggression. We aimed to identify groups of children with distinct profiles of the joint development of forms and functions of aggression and to identify risk factors for group membership. A sample of 787 children was followed from birth to adolescence. Parent and teacher reports, and standardised assessments were used to measure two forms and two functions of aggressive behaviour, between six and 13 years of age along with preceding child, maternal, and family-level risk-factors. Analyses were conducted using a group-based multi-trajectory modelling approach. Five trajectory groups emerged: non-aggressors, low-stable, moderate-engagers, high-desisting, and high-chronic. Coercive parenting increased membership risk in the moderate-engagers and high-chronic groups. Lower maternal IQ increased membership risk in both high-desisting and high-chronic groups, whereas maternal depression increased membership risk in the high-desisting group only. Never being breastfed increased membership risk in the moderate-engagers group. Boys were at greater risk for belonging to groups displaying elevated aggression. Individuals with chronic aggression problems use all subtypes of aggression. Risk factors suggest that prevention programs should start early in life and target mothers with lower IQ. Strategies to deal with maternal depression and enhance positive parenting while replacing coercive parenting tactics should be highlighted in programming efforts.

Importance: Having a child with a major birth defect can be a life-changing and stressful event that may be associated with higher cardiovascular disease (CVD) risk, yet the long-term burden of CVD for the child's mother is unknown., Objective: To assess whether mothers of an infant born with a major congenital anomaly are at higher risk of CVD compared with a comparison cohort., Design, Setting, and Participants: A population-based cohort study using individual-level linked registry data in Denmark included 42 943 women who gave birth to an infant with a major congenital anomaly between January 1, 1979, and December 31, 2013; and follow-up was conducted until 2015. A comparison group, comprising 428 401 randomly selected women, was 10:1 matched to each affected mother by maternal age, parity, and her infant's year of birth. Data analyses were performed between November 1, 2017, and February 28, 2018., Exposures: Live birth of an infant with a major congenital anomaly., Main Outcomes and Measures: The primary outcome was a CVD composite outcome of acute myocardial infarction, coronary revascularization, or stroke. Secondary outcomes included individual components of the CVD composite and other cardiovascular outcomes, including unstable angina, congestive heart failure, atrial fibrillation, peripheral artery disease, ischemic heart disease, and aortic aneurysm. Cox proportional hazards regression analyses generated hazard ratios (HRs), adjusted for maternal demographic, socioeconomic, and chronic health indicators., Results: Median maternal age at baseline was 28.8 years (interquartile range, 25.3-32.5 years). After a median follow-up of 19.5 years (interquartile range, 9.9-27.6 years), 914 women whose infant had a major congenital anomaly experienced a CVD event (1.21 per 1000 person-years; 95% CI, 1.13-1.28 per 1000 person-years) vs 7516 women in the comparison group (0.99 per 1000 person-years; 95% CI, 0.97-1.01 per 1000 person-years), corresponding to an unadjusted HR of 1.23 (95% CI, 1.15-1.32), and an adjusted HR (aHR) of 1.15 (95% CI, 1.07-1.23). Women who gave birth to an infant with multiorgan anomalies had an even higher aHR (1.37; 95% CI, 1.08-1.72). Mothers of infants with a major anomaly also had an increased aHR of the individual components of the composite outcome and the other cardiovascular outcomes., Conclusions and Relevance: Women whose child had a major congenital anomaly experienced a 15% to 37% higher risk of premature cardiovascular disease. These women may benefit from targeted interventions aimed at improving their cardiovascular health.

Rationale: Food insecurity is a persistent social problem affecting one out of eight households in the United States. While evidence shows that public assistance programs (formal assistance) are effective in reducing food insecurity, there is more limited evidence documenting how informal support, through social capital, affects food insecurity., Objective: To examine the role of informal support (through instrumental social support, social cohesion, social control, and social participation) on food insecurity transitions using longitudinal data of a sample of disadvantaged urban mothers from the Fragile Families and Child Wellbeing Study. In addition, the study examines whether these associations vary by participation in the Supplemental Nutrition Assistance Program (SNAP) using interaction terms., Method: The sample includes 2481 mothers of children between ages three and five. The analysis uses unadjusted and adjusted logistic regressions. Interaction terms are included to examine formal and informal support. In addition, the analysis uses structural equation modeling to examine direct and indirect associations of the informal support variables on food insecurity., Results: Social support and social cohesion reduce the risk of food insecurity, reduce the risk of remaining food insecure, and reduce the risk of becoming food insecure. Social control has an indirect effect on food insecurity, which is mainly through social cohesion. Social participation also has an indirect effect through social support and social cohesion. SNAP participation for mothers with little to no informal support did not reduce the risk of food insecurity., Conclusion: Instead of focusing on improving the food access of households, interventions should be expanded to the neighborhood level. Building social capital for low-income residents would increase the cohesiveness of their neighborhoods and their access to social support, which would increase the availability of resources to prevent or overcome food insecurity and other hardships., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective Limited data are available that estimate the effect of gestational weight gain on maternal and neonatal outcomes in underweight women according to revised 2009 Institute of Medicine (IOM) guidelines. Methods A population-based historical cohort study of 21,674 underweight women in Missouri delivering liveborn, singleton, term infants in 2002-2008 was conducted. Adjusted odds ratios were calculated for gestational weight gain categories with multiple logistic regression, using the 2009 IOM recommended 28-40 pounds as the reference group. Results Women gaining >40 pounds compared to women gaining 28-40 pounds had significantly higher odds for preeclampsia (aOR 1.94, 95% CI 1.56-2.42, p < 0.001), cesarean delivery (aOR 1.40, 95% CI 1.28-1.53, p < 0.001), large-for-gestational-age (LGA) infant (aOR 2.32, 95% CI 2.00-2.70, p < 0.001), and 1 min APGAR score <4 (aOR 1.36, 95% CI 1.01-1.83, p < 0.05) and significantly lower odds for small-for-gestational-age (SGA) infant (aOR 0.53, 95% CI 0.48-0.59, p < 0.001). Women gaining <28 pounds compared to women gaining 28-40 pounds had significantly higher odds for SGA infant (aOR 1.85, 95% CI 1.69-2.03, p < 0.001) and significantly lower odds for preeclampsia (aOR 0.72, 95% CI 0.53-0.96, p < 0.05) and LGA infant (aOR 0.50, 95% CI 0.39-0.63, p < 0.001). Conclusion Women gaining more than the IOM recommendation were at higher risk for many adverse outcomes, but at lower risk for SGA infants. Women gaining less than the IOM recommendation were at higher risk for SGA infants but were protective for preeclampsia and LGA infants. Prospective studies of other short- and long-term maternal/infant outcomes are needed to evaluate the efficacy of the IOM guideline.

Objectives To investigate clustering of parental sociobehavioral factors and their relationship with the incidence of overweight and obesity in Iranian children. Methods Demographics, body weight, and certain medical characteristics of the parents of 2999 children were used to categorize parents by cluster; children's weights were assessed for each cluster. Specifically, survival analysis and Cox regression models were used to test the effect of parental clustering on the incidence of childhood overweight and obesity. Results Maternal metabolic syndrome, education level, age, body weight status, and paternal age had important roles in distinguishing clusters with low, moderate, and high risk. Crude incidence rates (per 10,000 person-years) of overweight and obesity were 416.8 (95% confidence interval (CI) 388.2-447.5) and 114.7 (95% CI 101.2-129.9), respectively. Children of parents with certain constellations of demographic and medical characteristics were 37.0 and 41.0% more likely to become overweight and obese, respectively. Conclusions for Practice The current study demonstrated the vital role of maternal characteristics in distinguishing familial clusters, which could be used to predict the incidence of overweight and obesity in children.

Objectives The authors investigated the association between maternal birth weight and adverse birth outcome as measured by rates of low birth weight (<2500 g, LBW), preterm birth (<37 weeks, PTB), and small for gestational age (weight <10th percentile for gestational age, SGA) among African American and White twin pregnancies. Methods Stratified and multivariable regression analyses were performed on the Illinois transgenerational dataset of non-Latina African American and non-Latina White twin pairs (born 1989-1991) and their mothers (born 1956-1976). Results Former LBW (n = 104) and non-LBW (n = 742) African American mothers had LBW rates in both twins of 76 and 56 %, respectively; RR (95 % CI) = 1.4 (1.2-1.6). Former LBW (n = 105) and non-LBW (n = 2136) White mothers had LBW rates in both twins of 41 and 34 %, respectively; RR = 1.2 (0.9-1.5). In multivariable regression models, the adjusted (controlling for maternal age, education, marital status, parity, prenatal care usage, and cigarette smoking) RR of LBW in both twins among former LBW (compared to non-LBW) African American and White mothers equaled 1.4 (1.2-1.6) and 1.2 (0.9-1.5), respectively. Maternal LBW was associated with a modestly increased risk of PTB but not SGA among African American twin pregnancies: adjusted RR = 1.3 (1.1-1.4) and 1.1 (0.8-1.5), respectively. Conclusions In African American twin pregnancies, maternal LBW is a risk factor for LBW in both twins. Further research is needed to determine whether a similar generational association occurs among non-Latina White twin pregnancies.

This study analyzes the intergenerational effects of late childbearing on offspring's adult longevity in a population in Utah (United States) that does not display evidence of parity-specific birth control-a so-called natural fertility population. Studies have found that for women who experience late menopause and prolonged reproduction, aging is postponed and longevity is increased. This is believed to indicate female "robustness" and the impact of biological or genetic factors. If indeed there is a genetic component involved, one would expect to also find evidence for the intergenerational transmission of longevity benefits. Our study investigates the relationship between prolonged natural fertility of mothers and their offspring's survival rates in adulthood. Gompertz regression models (N = 7,716) revealed that the offspring of mothers who were naturally fertile until a relatively advanced age lived significantly longer. This observed positive effect of late reproduction was not independent of but conditional upon survival of the mother to the end of her fecundity (defined as age 50). Offspring's relative risks at death beyond age 50 were 6-12 percent lower than those of their counterparts born to mothers who had an average age at last birth. Our results, which account for various early, adult, and later-life conditions, as well as shared frailty, suggest that there is a positive relationship between mother's age at last birth and offspring longevity, and strengthen the notion that age at menopause is a good predictor of this relationship.

This study investigated the relationships between various maternal characteristics and child outcomes in preschool age children. Participants included 128 mother-child pairs. Mothers and children participated in two observational tasks, clean-up and Tickle-Me-Elmo, which were coded for expressions of emotion, and mothers completed self-report surveys. A person-centered latent profile analysis was applied, identifying distinct maternal profiles defined by observed positive emotion expression and reported positive and negative emotionality, depressive symptoms, and parenting stress. Four profiles were identified, labeled Happy, Melancholic, Stressed, and Struggling. These profiles were found to be associated with child outcomes, including observed positive and negative emotion expression and problem behaviors. Specifically, the Melancholic and Struggling profiles tended to be negatively related to child emotion expression, while the Stressed and Struggling profiles tended to be related to greater child problem behaviors. The results highlight meaningful distinctions between concurrent, interacting maternal characteristics that contribute to child emotion socialization, and they suggest significant differentiations in the factors that contribute to child risk.

Importance: Several studies report an association between maternal smoking during pregnancy and offspring conduct disorder. However, past research evidences difficulty in disaggregating prenatal environmental influences from genetic and postnatal environmental influences., Objective: To examine the relationship between maternal smoking during pregnancy and offspring conduct problems among children reared by genetically related mothers and genetically unrelated mothers., Design, Setting, and Participants: The following 3 studies using distinct but complementary research designs were used: The Christchurch Health and Development Study (a longitudinal cohort study that includes biological and adopted children), the Early Growth and Development Study (a longitudinal adoption-at-birth study), and the Cardiff IVF (In Vitro Fertilization) Study (an adoption-at-conception study among genetically related families and genetically unrelated families). Maternal smoking during pregnancy was measured as the mean number of cigarettes per day (0, 1-9, or 10) smoked during pregnancy. Possible covariates were controlled for in the analyses, including child sex, birth weight, race/ethnicity, placement age, and breastfeeding, as well as maternal education and maternal age at birth and family breakdown, parenting practices, and family socioeconomic status., Main Outcomes and Measure: Offspring conduct problems (age range, 4-10 years) reported by parents or teachers using the behavior rating scales by Rutter and Conners, the Child Behavior Checklist and the Children's Behavior Questionnaire Short Form, and the Strengths and Difficulties Questionnaire., Results: A significant association between maternal smoking during pregnancy and offspring conduct problems was observed among children reared by genetically related mothers and genetically unrelated mothers. Results from a meta-analysis affirmed this pattern of findings across pooled study samples., Conclusions and Relevance: Findings across 3 studies using a complement of genetically sensitive research designs suggest that smoking during pregnancy is a prenatal risk factor for offspring conduct problems when controlling for specific perinatal and postnatal confounding factors.

The aim of this study is to characterize profiles of maternal care in a sample of Brazilian mothers, using a cultural-biological perspective. Participants were 315 women who had at least one child younger than six years-old. They were selected from six Brazilian states. In each state, two groups of mothers were studied, one from the capital and one from a small city. They were interviewed and answered scales on allocentrism, social support, adult attachment, and practices of childcare. Mothers' characteristics, the type of context (capital vs. small city), and reported childcare practices were used in a Tree analysis. A Correspondence analysis was performed using the four clusters obtained and mothers' answers regarding their youngest child. Univariate GLM analyses were performed to compare mothers in the four clusters in terms of their scores on the different scales. Four maternal profiles presenting distinctive patterns of association between mothers' characteristics and care practices displayed to the youngest child were identified. We conclude that maternal care is a multi-determined phenomenon and that the method employed in this study can give insights into how the combination of diverse social-biological factors can result in a set of childcare practices.

We undertook a community-level aggregate analysis in South Carolina, USA, to examine associations between mother-child conditions from a Medicaid cohort of pregnant women and their children using spatially interpolated arsenic (As) and lead (Pb) concentrations in three geographic case areas and a control area. Weeks of gestation at birth was significantly negatively correlated with higher estimated As (r(s) = -0.28, p = 0.01) and Pb (r(s) = -0.26, p = 0.02) concentrations in one case area. Higher estimated Pb concentrations were consistently positively associated with frequency of black mothers (all p < 0.02) and negatively associated with frequency of white mothers (all p < 0.01), suggesting a racial disparity with respect to Pb., (Copyright © 2012. Published by Elsevier Ltd.)

Background: The study examines the relationship between maternal nativity, maternal risks and birth outcomes in six Asian sub-populations., Methods: U.S.- versus foreign-born immigrants of Chinese (67,222), Japanese (18,275) and Filipino (87,1208), Vietnamese (45,229), Cambodian/Laotian (21,237), and Korean (23,430) singleton live births were assessed for maternal risks and birth outcomes., Results: U.S.-born Chinese and Japanese mothers had lower risk and increased preterm births but similar infant mortality, while U.S.-born Filipino mothers had higher risk and higher infant mortality. U.S.-born mothers of more recent Cambodian/Laotian and Vietnamese immigrants had higher risk and delivered more small and preterm births, while U.S.-born Korean mothers had higher risk but no differences in preterm and low birthweight delivery., Discussion: Asians in America are a distinctly heterogenous population in terms of the relationship between maternal risk factors and birth outcomes and the influence of maternal nativity on this relationship.

Estimations of IQ and emotional intelligence for self and parents were investigated. Previous studies in both Western and African cultures have found significant sex differences in self-estimates of IQ and emotional intelligence, while IQ was rated higher for fathers than mothers. These prior results suggest the findings should be invariant across culture, and were expected to be replicated here in a predominantly Islamic society with great sociopolitical changes with respect to the Islamic Revolution. 187 Iranian university students estimated their own and their parents' scores on IQ and 15 facets of emotional intelligence on a normal distribution graph. The present results showed no significant sex differences in self-estimates of these variables, while fathers were rated higher on IQ. The implications of these findings are offered in light of sociopolitical changes during the last three decades in Iran.

Background: Analyzing health conditions and medical utilization of mothers of children with attention-deficit/hyperactivity disorder (ADHD) can shed light on biologic, environmental, and psychosocial factors relating to ADHD., Objective: To examine health conditions, health care utilization, and costs of mothers of children with ADHD in periods before the child was diagnosed., Methods: Using automated data from Northern California Kaiser Permanente we identified mothers of children with ADHD, mothers of children without ADHD, and mothers of children with asthma. Mothers' diagnostic clusters, health care utilization, and costs were compared. Mothers of children with ADHD were compared with mothers of children without ADHD and, separately, to mothers of children with asthma., Results: Compared with mothers of children without ADHD, mothers of children with ADHD were more likely to be diagnosed with numerous medical and mental health problems in the 2 years after birth of their child, including depression [odds ratio (OR): 1.88], anxiety neuroses (OR: 1.64), obesity (OR: 1.70), and musculoskeletal symptoms (OR: 1.51). Results were similar for the year before delivery. Mothers of children with ADHD also had higher total health care costs per person in the year before ($1,003) and the 2 years after ($953) the birth of their child. Mothers of children with ADHD also were diagnosed with more health conditions and had higher health care costs than mothers of children with asthma., Conclusions: Our findings suggest that the likelihood of being diagnosed with ADHD is related to maternal conditions and use of health services that precede the child's diagnosis. Future studies are needed to clarify whether this is due to biologic, psychosocial, or environmental factors, or a combination.

Objective: To identify factors predictive of either lateral or prone infant sleep positioning., Study Design: We used data for 11340 mother-infant pairs from the Pregnancy Risk Assessment Monitoring System for infants born in Washington State, 1996 to 2002. We used predictive modeling to identify statistically significant (P < .05) predictors of lateral and prone sleep positioning., Results: Factors associated with both high-risk sleep positions included infant's year of birth, maternal race and ethnicity, maternal county of residence, and maternal parity. Mother's being US-born (versus foreign-born) and male infant sex were predictive only of prone sleep positioning. Having Medicaid as primary insurance, receipt of government benefits, low infant gestational age, and low birth weight were predictive only of lateral sleep positioning., Conclusions: Factors predictive of either high-risk sleep position should be considered when devising public health intervention strategies for the prevention of SIDS.

This study explored how mothers grouped into clusters according to multiple psychographic food decision influencers and how the clusters differed in nutrient intake and nutrient content of their household food supply. Mothers (n = 201) completed a survey assessing basic demographic characteristics, food shopping and meal preparation activities, self and spouse employment, exposure to formal food or nutrition education, education level and occupation, weight status, nutrition and food preparation knowledge and skill, family member health and nutrition status, food decision influencer constructs, and dietary intake. In addition, an in-home inventory of 100 participants' household food supplies was conducted. Four distinct clusters presented when 26 psychographic food choice influencers were evaluated. These clusters appear to be valid and robust classifications of mothers in that they discriminated well on the psychographic variables used to construct the clusters as well as numerous other variables not used in the cluster analysis. In addition, the clusters appear to transcend demographic variables that often segment audiences (eg, race, mother's age, socioeconomic status), thereby adding a new dimension to the way in which this audience can be characterized. Furthermore, psychographically defined clusters predicted dietary quality. This study demonstrates that mothers are not a homogenous group and need to have their unique characteristics taken into consideration when designing strategies to promote health. These results can help health practitioners better understand factors affecting food decisions and tailor interventions to better meet the needs of mothers.

In this article, we evaluate the relative power of differential exposure and differential vulnerability to stressors to account for variations in psychological distress between single and married mothers. The data for this assessment are derived from a longitudinal survey of 518 single mothers and 502 married mothers living in London, Ontario, Canada. Both cross-sectional and longitudinal analyses clearly reveal that the higher levels of psychological distress experienced by single mothers compared to married mothers are almost entirely related to their greater exposure to stress and strain rather than to any group differences in vulnerability to stressful experiences. Across a number of different dimensions of social stressors, single mothers are consistently more exposed to these stressors than married mothers are. Moreover, this differential exposure persists over time. In contrast, there is no evidence that single mothers are more vulnerable or reactive to stressors than are married mothers. We discuss these findings in terms of their implications for the sociology of mental health and for primary prevention.

No standards exist for reporting the accuracy and completeness of pregnancy histories created by linking the birth and fetal death certificates for all the deliveries occurring to one woman. To link certificates, analysts use deterministic and/or probabilistic approaches. Errors in linkage occur randomly and non-randomly. Any type of error can cause incorrect estimation of the magnitude of relationships. Methods for assessing linkage correctness are proposed. Analysts can detect errors in linkage by comparing the linkage results with the pregnancy history reported by the mother. The analyst interviews a random sample of women, ascertaining the dates and outcomes (stillbirth or live birth) for their births and, if the linkage used certificates from one state, the state where they occurred. For each woman, he/she then assesses the accuracy and completeness of this linkage by comparing it with her reported pregnancy history. An alternative approach is to chronologically sequence each woman's births. The parity for the most recent birth shows the number of babies born to the same woman and should equal the number of births that the analyst linked. In the absence of maternally reported pregnancy histories, an analyst can use data on the certificates to assess linkage correctness. Although this will show whether the correct number of births have been linked, it provides no information concerning the accuracy of linkages. It may be, however, the most universally applicable way of reporting the completeness of the linkage of deliveries.

Objectives: Numerous studies have used maternally linked birth records to investigate perinatal outcomes, maternal behaviors, and the quality of vital records birth data. Little attention has been given to assessing errors in the linkages and to understanding how such errors affect estimates derived from the linked data. The author developed a framework for conceptualizing maternal linkage error and measures for quantifying it, and examined the behavior of the new measures in a maternally linked file., Methods: Linkage errors were conceptualized as misclassification, with the classes being the maternal sets (records classified as representing different births to the same woman). The true linkage proportion, analogous to sensitivity, was used to capture the degree to which all of a woman's births were assigned to a single maternal set; the false linkage proportion, analogous to specificity, was used to capture the degree to which the assigned maternal sets combined births from different women. The behavior of the two proportions was examined by introducing increasing degrees of linkage error into a maternally linked file., Results: Both measures indicated greater misclassification with increasing simulated linkage errors., Conclusions: The new measures may be a useful tool for assessing the quality of maternally linked data, as well as other types of linked records where the linkages are within a single file. This is a necessary step towards developing methods for addressing misclassification bias in studies of maternally linked records through sensitivity analysis, adjustment, and other means.

Background: Detrimental effects of environmental tobacco smoke (ETS) exposure on child health are well documented. Because young children's primary exposure to ETS occurs in homes and automobiles, voluntary smoking restrictions can substantially reduce exposure. We assessed the prevalence of home and automobile smoking bans among U.S.- and Mexico-born Hispanics in the southwestern United States, and examined the influence of mother's country of birth and smoking practices on voluntary smoking bans and on child ETS exposure., Methods: U.S.- and Mexico-born Hispanic mothers of children aged 2 through 12 years were systematically sampled from health clinics in Albuquerque, New Mexico. In-person interviews were conducted with 269 mothers (75.4% response rate) to obtain information on main study outcomes (complete versus no/partial home and automobile smoking bans; child room and automobile ETS exposure) and risk factors (mother's country of birth, maternal and household smoking behaviors). Data were analyzed with chi square tests and logistic regression models., Results: Three-fourths (74-77%) of U.S.-born and 90-95% of Mexico-born mothers reported complete automobile and home smoking bans. In multivariate analyses, mother's U.S nativity, mother's current smoking, and presence of other adult smokers in the home were associated with significantly increased odds of not having a complete home or automobile smoking ban. Mother's smoking was associated with child ETS exposure both indoors (odds ratio [OR] = 3.31) and in automobiles (OR = 2.97). Children of U.S.-born mothers had increased odds of exposure to ETS indoors (OR = 3.24; 95% confidence interval [CI]: 1.37-7.69), but not in automobiles. Having complete smoking bans was associated with substantially reduced odds of child ETS exposure both indoors (OR = 0.10; 95% CI: 0.04-0.27) and in automobiles (OR = 0.14; 95% CI: 0.05-0.36)., Conclusion: This study of Hispanic mothers in the southwestern U.S. indicates that there are substantial differences between U.S.- and Mexico-born mothers in the prevalence of home and automobile smoking bans, and resulting child ETS exposure. Tobacco interventions to increase smoke-free environments for U.S. Hispanic children should focus on both home and automobile smoking practices, especially among U.S.-born mothers, and utilize strategies that impact smoking practices of all household members.

Background: Breastfeeding is an important factor in infant health and there have been no previous studies of breastfeeding practices in the different ethnic groups of this region of China. We aimed to compare breastfeeding rates and duration between Han, Uygur and other ethnic groups living in Xinjiang, PR China., Methods: A longitudinal study of infant feeding practices was undertaken using a sample that included different ethnic groups. Mothers were randomly recruited and interviewed in hospitals and after discharge were contacted in person or by telephone at approximately monthly intervals to obtain details of infant feeding practices., Setting: Xinjiang Uygur Autonomous Region, PR China., Subjects: A total of 1219 mothers (578 Han, 360 Uygur and 281 'other minority' mothers) who delivered babies during 2003 and 2004 were interviewed in five hospitals or institutes located in both urban and rural areas., Results: 'Any breastfeeding' rates in Han, Uygur and 'other minority' groups at discharge were 88.5 %, 94.3 % and 97.1 % respectively, and at six months 76.7 %, 54.7 % and 87.6 % respectively. While 'exclusive breastfeeding' rates in the Han, Uygur and 'other minority' groups at discharge were 78.0 %, 34.5 % and 83.1 % respectively, at six months they had fallen to 4.8 %, 0.4 % and 16.8 % respectively. The median duration of 'Exclusive breastfeeding' of Han, Uygur and 'other minority' babies were 1.5, 0.1 and 2.5 months respectively. The Uygur babies were least likely to be 'exclusive breastfed'., Conclusion: Uygur babies were least likely to be 'exclusive breastfed' and continued to 'any breastfeed' at six month. The 'any breastfeeding' rates in the Han group were lower in the first four months. An education program focused on breastfeeding continuation and exclusive breastfeeding is necessary in Xinjiang, especially for Uygur and Han ethnic groups.

This study is to compare infant mortality rates (IMRs) between US- and foreign-born mothers in New York City. The linked live birth-infant death records from 1995 to 1998 were analyzed. Overall US-born mothers had a higher IMR than foreign-born mothers, though there were great variations in IMRs by country of maternal birth among foreign-born mothers. US-born mothers had higher IMRs compared to foreign-born mothers for several maternal/infant characteristics. Logistic regression analyses indicated that infants of foreign-born mothers were less likely to die from prematurity, Sudden Infant Death Syndrome and external causes, but were more likely to die of congenital anomalies than those of US-born mothers. Further analyses on the interactions of maternal race/ethnicity and country of birth showed variations in the IMRs of leading causes of death. Infant mortality reduction strategies should be differentially targeted to minority mothers of different countries of birth, particularly for potentially preventable causes of deaths.

Objectives: To link data from the US assisted reproductive technology (ART) registry with the Massachusetts birth-infant death file to create a comprehensive dataset on the circumstances surrounding conception and maternal and infant outcomes for a population of ART-conceived infants., Methods: The authors sought to link data for 3704 ART-conceived live-born infants from 2703 deliveries in 1997-1998 involving Massachusetts resident mothers who gave birth in Massachusetts, Rhode Island, New Hampshire, or Connecticut to their corresponding Massachusetts birth record using a two-stage algorithm. Maternal and infant dates of birth served as the primary linkage variables. Maternal names for a subset of the ART-conceived infants were obtained and used in the second stage of the algorithm to confirm a sample of records that matched in Stage I, to resolve duplicate matches, and to link unmatched records., Results: In Stage I, 78% of ART deliveries matched with only one Massachusetts record, 2% matched with two records, and 20% remained unmatched. Overall, the complete algorithm using maternal name data for a portion of records yielded an 89% linkage rate. Nearly all of the records that matched during Stage I that were evaluated with maternal name data in Stage II were confirmed as correctly linked., Conclusions: This project confirms that high-yield data linkage can be achieved in the absence of specific identifiers (e.g., name and social security number). Nonetheless, additional matches were achieved when name data were obtained. This linkage creates the first population-based file in the US capturing detailed information on ART births.

Purpose: Solitary maternity is a significant problem of modern times requiring socio-economic and psychological, as well as perinatological studies. The twentieth anniversary of the Maternity Home managed by the Benedictine Samaritan Sisters motivated the present study., Material and Methods: Hospital discharge summaries of 429 women (group DSM) who lived at the Maternity Home between 26 July 1983 and 26 February 2002 were analyzed. This documentation was supplemented with hospital data on 177 women who gave birth at two Szczecin hospitals and on 13 who left the Home before delivery., Results: Residents of the Home came from all regions of Poland and from urban and rural societies. They were between 14 and 43 years of age (mean 22.6 +/- 5.7). 87.4% of them were single and 63.7% were primipara. 50.4% of them failed to complete primary education while 3.4% had university-level education. 6% were mentally and/or psychologically handicapped and 42.7% had no profession. The major causes of admission into the Home were: desire to hide the pregnancy, family conflicts, homelessness, difficult material situation, mental or physical disability, violence or alcoholism in the family. The control group comprised 400 women (group K) who gave birth at the Department of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin. 51.5% of them were primipara. The mean age in this group was 27.4 +/- 5.4 (17-44). 71.3% were married. The Majority had secondary (41.9%) or university (32.5%) education. Most of them worked as artisans, teachers or economists. Neurological or psychiatric diseases dominated in group DSM but otherwise no severe disease at all could be disclosed. Satisfactory prenatal care was provided to 33.1% of DSM patients and to 78% of group K. No prenatal care was provided to 9.5% of DSM patients and to 1.7% of group K. EPH gestosis was more often observed in DSM patients and imminent abortion, premature birth, PROM, urinary tract infection, and anaemia were more frequent in controls. More DSM patients had no treatment during pregnancy than controls. The use of tocolytics was significantly more frequent in DSM patients. Antibiotics and drugs accelerating maturation of the respiratory system were applied with similar frequency in both groups. Frequency of immature and mature births was similar in both groups. 84.2% of DSM patients and 68.8% of controls had natural delivery. Cesarian section was twice more frequent in group K. Immediate indications dominated in both groups (74.1% in DSM; 57.4% in K). No medication was used during delivery in 30% of patients. DSM patients more often required strong analgesics. Antibiotics and agents increasing uterine tension more often were used in K patients. Deliveries in both groups were usually without complications. Female genital tract injury was more frequent in DSM patients (20.9% in DSM; 14.8% in K). Delivery duration was similar in both groups, but the second part of delivery was longer in K primipara. Mean neonatal weight in the 1000-2500 g range was similar in both groups but was significantly higher in controls for 2501-4000 g neonates. The difference for newborns weighing more than 4000 g was not significant. There were no neonates weighing less than 1000 g. The clinical condition of newborns measured with the Apgar scale was worse in the DSM group after the 1st min, as well as after the 3rd and 5th min and the difference in each case was significant. Puerperium was usually uncomplicated. However, urinary tract infection was more frequent in DSM patients and anaemia was more frequent in controls. The duration of hospitalisation was similar in both groups (mean = 6 days). 120 of 177 DSM mothers left hospital together with their children, as compared to 99.3% in the control group. 87 children of mothers from the Maternity Home were offered for adoption., Conclusion: By studying unwed maternity it was observed that a holistic approach is the only way to disclose all the problems which are often unusually complex and concealed but which determine the normal development of an individual in the society. Analysis of the factors involved may help in attaining goals that serve the good of the society.

Objective: We analyzed the association between fetal death from congenital anomalies and paternal agricultural occupation in mothers who were employed and in housewives., Materials and Methods: The data consist of individual records from the Spanish Birth Register (1995-1999)., Results: The adjusted relative risk of fetal death in agricultural workers compared with nonagricultural was 1.24 (95% confidence interval = 0.38- 4.02) in mothers who were employed and 1.68 (95% confidence interval = 1.03-2.73) in housewives., Conclusion: The risk of fetal death in the offspring of agricultural workers exposed to pesticides around the time of conception was higher than in the offspring of nonagricultural workers in mothers who were housewives but not in mothers who worked outside the home.

Filicide is the killing of a child by a parent. To protect potential homicide victims, it is necessary to examine and identify intrapsychic and interpersonal dynamics that result in filicide. The current filicide classification systems have intended to yield better etiological understanding of the crime and ultimately lead to prevention strategies and accurate death certification. A framework of motives and precipitating factors that lead to filicide by mothers offers a starting point to examine this emotionally evocative and complex phenomenon.

Objective: To determine the association between maternal nativity and neonatal survival of twins among Black mothers., Methods: We conducted a retrospective cohort study of twin live births to Black mothers in the United States from 1995 through 1998. We compared levels of overall, early, and late neonatal mortality between twins of US-born and those of foreign-born Black mothers by using hazard ratios generated from a Cox Proportional Hazards Regression model. We adjusted for dependence of observations within twin clusters by means of the Robust Sandwich Estimator., Results: A total of 70,884 individual twin live births to US-born (64,035) and foreign-born (6,849) mothers were analyzed. Twins of US-born mothers had a 23% higher likelihood of dying within the neonatal period compared to those of foreign-born mothers (hazard ratio [HR]=1.23; 95% confidence interval [CI]=1.04-1.46). The disparity in neonatal demise occurred exclusively in the early neonatal period (HR=1.29; 95% CI, 1.06-1.50), with mortality indices comparable in the late neonatal period (HR=0.96; 95% CI, 0.68-1.35). Low and very low birth weight (P<.0001), preterm and very preterm (P<.0001), and small-for-gestational-age neonates (P<.0001) were more prevalent among twins of US-born mothers., Conclusions: Compared to those of foreign-born, twins of US-born Black mothers experienced higher mortality in the neonatal period. The mortality disadvantage resulted mainly from lower gestational age at birth and the preponderance of small-for-gestational-age babies among US-born Black mothers.

Unlabelled: Dermatoglyphic traits are formed under genetic control early in development and do not change thereafter, thus maintaining stability not affected by age., Methodology: We determined the dermatoglyphic traits of mothers of children with spina bifida cystica and compared then with controls matched for number, age and parity, by counting and classifying palmar, plantar and digital ridge pattern configurations of arches, loops, whorls and ridges based on standard techniques., Results: Palmar pattern types, showed absence of arches, significantly higher frequency of whorls (P > 0.05), lower total finger ridge count (TFRC) and higher Pattern Intensity Index (PII) in these mothers than in the controls (P > 0.001). However, no significant differences were observed between both groups in atd angle and a-b ridge count (P = 130, 0.70 respectively). Plantar pattern types showed loops restricted to the first two digits and absence of arches in the first digit in these mothers compared to controls in whom there were loops in the first four digits and a 100% frequency of arches. Similarly, PII was higher and Dankmeijer's Index (DI) lower in these mothers than in controls., Conclusion: Our findings demonstrate dermatoglyphic differences between both groups that suggest that mothers presenting with these traits are more predisposed to giving birth to children with spina bifida cystica.

The objective of this study was to identify factors affecting the purchase and preparation of fruits and vegetables according to stage of change for low-income African American women with young children. The think-aloud method was used to collect verbalization data in grocery stores as women shopped (N=70) and in their homes during meal preparation (N=68). Audiotaped verbalizations were transcribed verbatim before encoding. Content analysis procedures were used to identify common themes by stage of change. Factors affecting decision making that varied by stage of change were preferences and specific needs (eg, for meals, for family members). Preferences regarding variety, quantity, color, and liking were more often expressed by women in later stages. Women in the later stages also often used meal-planning skills to include fruits and vegetables in meals. Interventions could be tailored according to selected factors regarding purchase and preparation of fruits and vegetables by stage of change to contribute to greater changes in intake.

Background: Little is known about the role of breastfeeding contraindications in breastfeeding practices. Our objectives were to 1) identify predictors of breastfeeding initiation and duration among a cohort of predominantly low-income, inner-city women, and 2) evaluate the contribution of breastfeeding contraindications to breastfeeding practices., Methods: Mother-infant dyads were systematically selected from 3 District of Columbia hospitals between 1995 and 1996. Breastfeeding contraindications and potential predictors of breastfeeding practices were identified through medical record reviews and interviews conducted after delivery (baseline). Interviews were conducted at 3-7 months postpartum and again at 7-12 months postpartum to determine breastfeeding initiation rates and duration. Multivariable logistic regression analysis was used to identify baseline factors associated with initiation of breastfeeding. Cox proportional hazards models were generated to identify baseline factors associated with duration of breastfeeding., Results: Of 393 study participants, 201 (51%) initiated breastfeeding. A total of 61 women (16%) had at lease one documented contraindication to breastfeeding; 94% of these had a history of HIV infection and/or cocaine use. Of the 332 women with no documented contraindications, 58% initiated breastfeeding, vs. 13% of women with a contraindication. In adjusted analysis, factors most strongly associated with breastfeeding initiation were presence of a contraindication (adjusted odds ratio [AOR], 0.19; 95% confidence interval [CI], 0.08-0.47), and mother foreign-born (AOR, 4.90; 95% CI, 2.38-10.10). Twenty-five percent of study participants who did not initiate breastfeeding cited concern about passing dangerous things to their infants through breast milk. Factors associated with discontinuation of breastfeeding (all protective) included mother foreign-born (hazard ratio [HR], 0.55; 95% CI 0.39-0.77) increasing maternal age (HR for 5-year increments, 0.80; 95% CI, 0.69-0.92), and infant birth weight > or = 2500 grams (HR, 0.45; 95% CI, 0.26-0.80)., Conclusions: Breastfeeding initiation rates and duration were suboptimal in this inner-city population. Many women who did not breastfeed had contraindications and/or were concerned about passing dangerous things to their infants through breast milk. It is important to consider the prevalence of contraindications to breastfeeding when evaluating breastfeeding practices in high-risk communities.

Objective: This was a prospective study of the effects of maternal smoking during pregnancy on newborn neurobehavior, including dose-response relationships using self-report and a bioassay of nicotine exposure., Methods: The sample included 27 nicotine exposed and 29 unexposed full-term newborn infants with no medical problems from comparable social class backgrounds. Mothers were excluded for using illegal drugs during pregnancy, using antidepressant medication, or if they consumed >3 alcoholic drinks per month. Nicotine exposure was determined by maternal self-report and cotinine in maternal saliva. The NICU Network Neurobehavioral Scale (NNNS) was administered by masked examiners in hospital to measure neurobehavioral function. NNNS scores were compared between nicotine-exposed and -unexposed groups including adjustment for covariates. Dose-response relationships with NNNS scores were computed for maternal salivary cotinine and maternal report of number of cigarettes per day during pregnancy., Results: After adjustment for covariates, the tobacco-exposed infants were more excitable and hypertonic, required more handling and showed more stress/abstinence signs, specifically in the central nervous system (CNS), gastrointestinal, and visual areas. Dose-response relationships showed higher maternal salivary cotinine values related to more stress/abstinence signs (r =.530) including CNS (r =.532) and visual stress (r =.688) and higher excitability scores (r =.617). Cigarettes per day during pregnancy was related to more stress/abstinence signs (r =.582) including CNS (r =.561) and visual stress (r =.640)., Conclusions: These findings suggest neurotoxic effects of prenatal tobacco exposure on newborn neurobehavior. Dose-response relationships could indicate neonatal withdrawal from nicotine. Research directed at understanding the effects of cigarette smoking during pregnancy on infants can lead to improved public health outcome.

Workers need an efficient prenatal screener that can identify mothers at greatest risk of child abuse. Existing risk assessment methods are often invasive and difficult to administer. This study assessed child abuse risk in a sample of 49 expectant mothers using the Brigid Collins Risk Screener (BCRS). At three months postpartum, high-risk mothers scored significantly lower on the quality of infants' physical, social, and emotional environments than moderate or low-risk mothers. BCRS appears to offer a noninvasive, efficient approach to assessing risk of child abuse.

The objective of this research was to assess the association of child mortality with polygyny and maternal HIV status through a prospective community-based study in Rakai district, Uganda. We sought to test whether there was an indirect evidence that polygynous households in an HIV prevalent area may divert resources away from the children of HIV-infected mothers in favor of children with better survival prospects. We test this theory using data from a follow-up study which collected detailed behavioral and medical information at 10-month intervals on a cohort of over 4000 pregnant women and their infants (5300 person years of observation). Cox proportional hazards models estimated the mortality hazard (RR) associated with polygyny for children of HIV-negative and HIV-positive mothers. HIV prevalence in the full cohort of mothers was 11.9%, and 23% of mothers lived in polygynous households. Multivariate analysis showed an increased hazard of child mortality if the mother was HIV-positive (RR = 1.75, p<0.001). Maternal education reduced mortality, whereas low birth weight increased mortality risk. Polygyny was associated with an increase in the hazard of child mortality in the full sample (RR = 1.36, p<0.001) and in mothers who were HIV-positive (RR = 2.17, p<0.001), but not in HIV-negative mothers. Being born to an HIV-positive mother increased mortality risk and polygyny accentuated a child's risk of death. Polygyny had no significant effect on the survival of children with HIV-negative mothers. Polygynous households, where not all wives may have HIV, could be diverting resources away from the children of the infected wives.

Context: The National Survey of Family Growth (NSFG) classifies pregnancies as intended, mistimed or unwanted. However, these categories could be too broad, as a woman's feelings about a pregnancy, her health behaviors during pregnancy and thus her pregnancy outcomes may vary according to whether her pregnancy is moderately or seriously mistimed. These relationships have not yet been explored., Methods: Data from the 1995 NSFG were examined to assess associations between pregnancy mistiming and maternal characteristics. Descriptive and multivariate analyses were conducted of the extent of mistiming for each maternal characteristic. Chi-square and F-tests were used to examine the associations between a pregnancy's intendedness--according to a four-category classification--and maternal characteristics, maternal happiness ratings, maternal behaviors and pregnancy outcomes., Results: Fifty-five percent of mistimed pregnancies were mistimed by 24 months or less, 32% were mistimed by 25-60 months and 13% were mistimed by more than 60 months. According to multivariate analyses, pregnancies among younger women, never-married women and black women were mistimed by significantly more months than those among other women. The distribution of moderately mistimed pregnancies differed significantly from those of both seriously mistimed and unwanted pregnancies according to most maternal characteristics; there were few differences between intended and moderately mistimed pregnancies, and between seriously mistimed and unwanted pregnancies., Conclusions: Mistiming is not a unitary construct. Its extent is associated with maternal characteristics and behaviors. Future research on pregnancy intention should examine the extent of mistiming and consider alternatives to traditional definitions of intendedness.

In this paper we document the ways in which parental behavior and socioeconomic status affect children's health. We examine parental behavior in both the prenatal period and childhood. We present evidence on the correlation of this behavior with income and parents' socioeconomic status, and on the ways in which parents' actions affect children's health. We conclude that while health insurance coverage and advances in medical treatment may be important determinants of children's health, they cannot be the only pillars: Protecting children's health also calls for a broader set of policies that target parents' health-related behavior.

Objectives: This report presents 1999 period infant mortality statistics from the linked birth/infant death data set (linked file) by a variety of maternal and infant characteristics., Methods: Descriptive tabulations of data are presented., Results: In general, mortality rates were lowest for infants born to Chinese and Japanese mothers (2.9 and 3.4 per 1,000, respectively). Infants of Cuban, Central and South American, Mexican, and non-Hispanic white mothers had low rates, while rates were higher for infants of Puerto Rican and highest for non-Hispanic black mothers (13.9). Filipino mothers also had low rates. Rates were high for infants of Hawaiian and American Indian mothers. Infant mortality rates were higher for those infants whose mothers had no prenatal care, were teenagers, had 9-11 years of education, were unmarried, or smoked during pregnancy. Infant mortality was also higher for male infants, multiple births, and infants born preterm or at low birthweight. The three leading causes of infant death--Congenital malformations, low birthweight, and Sudden infant death syndrome (SIDS)--taken together accounted for 45 percent all infant deaths in the United States in 1999. Cause-specific mortality rates varied considerably by race and Hispanic origin. For infants of black mothers, the infant mortality rate for low birthweight was four times that for white mothers. For infants of American Indian mothers, the SIDS rate was 2.4 times that for non-Hispanic white mothers. SIDS rates for infants of Hispanic and Asian or Pacific Islander mothers, were 40-50 percent lower than those for non-Hispanic white mothers.

Some 5.9 million American mothers caring for young or school-aged children lack health insurance. Although nearly nine in ten uninsured mothers are members of working families, most lack access to affordable coverage through their job or a spouse's job. Most are ineligible for publicly subsidized coverage unless their incomes are far below the poverty line. The millions of uninsured mothers are at high risk of going without needed preventive and primary care. If they become seriously ill, their families can face the prospect of a financial crisis. The nation has made significant progress in extending health care coverage to children in low-income families through Medicaid and the State Children's Health Insurance Program (SCHIP), but no comparable effort has been made to insure the mothers of these children. A few states have started to address the problem by transforming their SCHIPs into family-based programs that also cover low-income parents. Bipartisan legislation under consideration, known as FamilyCare, would encourage this trend by providing more federal funding to states that could be used to extend health insurance to the parents of children already covered by publicly funded programs.

Objectives: The objective of this study was to understand how the dynamics of the health care provider-patient relationship differ between Medicaid patients and private pay patients in the context of obstetric care. Various aspects of the patient-physician relationship were examined including trust, commitment, dependence, social content, service quality, and behavioral outcomes such as satisfaction, referral behavior, ease of voice, and retention., Methods: Questionnaires were mailed to a sample of mothers who had recently given birth. MANOVA was used to compare the means of Medicaid patients with private pay patients for the variables of interest in the study., Results: Medicaid patients had lower commitment to their primary physician. They trusted the practice, the primary physician, and the other physicians in the practice less. They perceived themselves as less similar to both the overall practice and their primary physician and also rated their health care service experience lower. They were less satisfied and less likely to use the same practice for future pregnancies or make referrals. They also felt less comfortable voicing complaints., Conclusions: The evidence clearly indicates that Medicaid obstetric patients perceived their service experience more negatively than private pay patients. Health care providers know they must provide clinical quality for their patients, however, in treating Medicaid patients they need to focus on patient driven-quality as well. The results indicate that health care providers, particularly OB/GYNs, need to do a better job of determining and delivering the key performance criteria that Medicaid patients use to make trust judgements.

Objective: The present study investigated several components of a social information-processing model of child physical abuse. The main objective was to examine the extent to which high-risk, relative to low-risk, mothers differed in their evaluations, attributions, negative affect, and disciplinary choices for children's behavior, and to explore whether these differences may be expressed in interactions between risk status and mitigating information., Method: Nineteen high- and 19 matched low-risk mothers' evaluations of children transgressions, attributions, affect, and choices of disciplinary techniques were examined using six vignettes depicting a child engaging in moral, conventional, and personal transgressions. One-half of the vignettes contained mitigating information and one-half did not. High- and low-risk mothers were chosen based on their potential for physical child abuse. A three-factor (2 x 3 x 2) design was used to assess the dependent variables., Results: As expected, high-risk, relative to low-risk, mothers reported more hostile intent, stable and global attributions, aversiveness, annoyance, and use of power-assertion discipline. A risk group by type of transgression interaction was found for evaluation and indifference and a risk group by mitigating information interaction was found for evaluation of wrongness, internal attributions, and aversiveness. A risk by type of transgression by mitigating information interaction was found for global/specific attributions, aversiveness, and indifference toward child transgressions., Conclusions: Results support a social information processing model of child physical abuse, which suggests that high-risk, compared to low-risk, mothers process child-related information differently and use more power-assertive disciplinary techniques.

Background: In a prior study, we identified 4 groups following distinct developmental courses, or trajectories, of physical aggression in 1037 boys from 6 to 15 years of age in a high-risk population sample from Montréal, Québec. Two were trajectories of high aggression, a persistently high group and a high but declining group. The other 2 trajectories were a low group and a moderate declining group. This study identified early predictors of physical aggression trajectories from ages 6 to 15 years., Methods: In this study, logistic regression analysis was used to identify parental and child characteristics that distinguished trajectory group membership., Results: For boys displaying high hyperactivity and high opposition in kindergarten, the odds of membership in the 2 high aggression groups were increased by factors of 3.0 (95% confidence interval [CI], 2.0-4.3) and 2.7 (95% CI, 1.9-3.8), respectively, compared with boys without these risks. Counterpart odds ratios for the risk factors of mothers' teen-onset of parenthood and low educational attainment were 1.6 (95% CI, 1.1-2.2) and 1.8 (95% CI, 1.3-2.4), respectively. Only the maternal characteristics distinguished between the trajectory of persistently physical high aggression and the trajectory starting high but subsequently declining. For the 2 maternal risk factors combined, the odds ratio of persisting in high level physical aggression was 9.4 (95% CI, 2.9-30.4)., Conclusions: Kindergarten boys displaying high levels of opposition and hyperactivity are at high risk of persistent physical aggression. However, among kindergarten boys who display high levels of physical aggression, only mothers' low educational level and teenage onset of childbearing distinguish those who persist in high levels of physical aggression.

In an earlier paper, the author identified the role of maternal social characteristics on child mortality in Sub-Saharan Africa through statistical analysis (Iyun, 1992; GeoJournal, 26(1), 43-52). This follow-up analysis attempts to further analyze and determine the relative significance of environmental and maternal factors on childhood mortality in two contrasting towns in southwestern Nigeria. The research design takes advantage of the integration of the medical and social sciences. The results of the current analysis reveal interesting insights into child mortality and maternal factors on one hand and domestic environmental conditions on the other. They give credence to an ecological perspective as a way to understand the complexities behind child survival. Domestic environmental conditions were stronger predictors of child mortality in the more developed study town, Ota, than the more traditional town, Iseyin. However, in both sites maternal factors, in particular age of mother at marriage, age of mother at first childbirth and parity were statistically significant predictors of child mortality. Mother's education was only significant in the more urbanized center, and generally remains inconsistent in its relationship with child mortality. Furthermore, child mortality rates continued to be a function of an environmental factor, namely source of drinking water, and a child care behavior factor, where the child was kept when mother was at work, especially the market environment.

Globally, child mortality rates have been halved over the last few decades, a developmental success story. Nevertheless, progress has been uneven and in recent years mortality rates have increased in some countries. The present study documents the slowing decline in infant mortality rates in india; a departure from the longer-term trends. The major causes of childhood mortality are also reviewed and strategic options for the different states of India are proposed that take into account current mortality rates and the level of progress in individual states. The slowing decline in childhood mortality rates in India calls for new approaches that go beyond disease-, programme- and sector-specific approaches.