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The study purpose was to assess the relationship between various grades of preterm birth (moderate preterm: 33-36 weeks; severe preterm: 27-32 weeks; extreme preterm: ≤ 26 weeks) in the first pregnancy and neonatal mortality (death within 28 days of birth; early: 0-7 days; late: 8-28 days) in the second pregnancy. Using the Missouri maternally-linked dataset (1989-2005), a population-based, retrospective cohort analysis with propensity score-weighted matching was conducted on mothers with two consecutive singleton live births (n = 310,653 women). Women with a prior preterm birth were more likely to subsequently experience neonatal death. The odds increased in a dose-dependent pattern with ascending severity of the preterm event in the first pregnancy (moderate preterm: AOR = 1.32; 95% CI: 1.10-1.60; severe preterm: AOR = 2.62; 95% CI: 2.01-3.41; extreme preterm: AOR = 5.84; 95% CI: 4.28-7.97; p value for trend < 0.001). However, the pathway for the relationship between prior preterm birth and subsequent neonatal mortality may be the recurrence of preterm birth. [ABSTRACT FROM AUTHOR]

The article presents a study which assessed the link between all-cause infant mortality in the first pregnancy and the risk of preterm birth in the second pregnancy. Topics discussed include risk factors for preterm birth, maternal socio-demographic characteristics in the second pregnancy which are considered covariates, and the differences in the prevalence of pregnancy complications in the second pregnancy among mothers based on exposure status.

To examine the association between prior infant mortality and subsequent risk for small for gestational age (SGA). This population-based, retrospective cohort study used the Missouri maternally linked, longitudinal dataset (1989-2005). Analyses were restricted to women who had two singleton pregnancies during the study period. Logistic regression was conducted to obtain adjusted odds ratios (AOR) and 95 % confidence intervals (CI) for the association between infant mortality in the first pregnancy and SGA in the second pregnancy. Women with a prior occurrence of infant death were more likely to be black and obese and had lower educational levels and had higher rates of pregnancy-related complications (p < 0.01). White women with previous infant mortality were at 1.46 times greater risk for SGA in the subsequent pregnancy (AOR = 1.46, 95 % CI = 1.24-1.71). For black women with prior infant death, the risk for SGA increased to 2.77 times (AOR = 2.77, 95 % CI = 2.19-3.51). White mothers who experienced infant mortality coupled with SGA in the first pregnancy had a nearly threefold heightened risk for SGA in the second pregnancy (AOR = 2.89, 95 % CI = 2.21-3.78), whereas black women with this history were more than four times as likely to have an infant with SGA (AOR = 4.60 95 % CI = 3.05-6.96). Prior occurrence of infant mortality is associated with increased risk for subsequent SGA. This finding has important implications for health professionals, as targeted inter-conception strategies for women who have experienced infant death, as well as SGA, may be warranted.

Objective: To determine whether female genital mutilation (FGM) is a risk factor for intimate partner violence (IPV) and its subtypes (physical, sexual and emotional)., Design: Population-based cross-sectional study., Setting: The study used the 2006 Demographic and Health Survey (DHS) conducted in Mali., Population: A total of 7875 women aged 15-49 years who responded to the domestic violence and female circumcision modules in the 2006 administration of the DHS in Mali., Methods: Multivariable logistic regression was used to compute adjusted odds ratios (aOR) and 95% confidence intervals (CI) to measure risk for IPV., Main Outcome Measures: The outcomes of interest were IPV and its subtypes., Results: Women with FGM were at heightened odds of IPV (aOR 2.71, 95% CI 2.17-3.38) and IPV subtypes: physical (aOR 2.85, 95% CI 2.22-3.66), sexual (aOR 3.24, 95% CI 1.80-5.82), and emotional (aOR 2.28, 95% CI 1.68-3.11). The odds of IPV increased with ascending FGM severity (P for trend <0.0001). The most elevated odds were observed among women with severe FGM, who were nearly nine times as likely to experience more than one IPV subtype (aOR 8.81, 95% CI 5.87-13.24)., Conclusions: Study findings underscore the need for multi-tiered strategies, incorporating policy and education, to reduce FGM and IPV, potentially improving the holistic health and wellbeing of Malian women., (© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.)

Purpose: To examine the association between small for gestational age (SGA) in the first pregnancy and risk for infant mortality in the second pregnancy., Methods: This is a population-based, retrospective cohort study in which we used the Missouri maternally linked cohort dataset for 1978-2005. Analyses were restricted to women who had two singleton pregnancies during the study period. The exposure was SGA in the first pregnancy, whereas the primary outcome was infant mortality in the second pregnancy. Kaplan-Meier Estimate and Cox proportional hazard regression were conducted., Results: Infant mortality was significantly greater among mothers with previous SGA (P < .01). A persistent association of previous SGA with subsequent infant mortality was observed (adjusted hazard ratio [AHR] 1.35, 95% confidence interval [95% CI] 1.24-1.48). Race-specific data illustrated that black women with a previous SGA birth were 40% more likely to experience infant mortality (AHR 1.40, 95% CI 1.21-1.63) than their counterparts without a history of SGA, but white women with a previous SGA had an increased risk of 31% (AHR 1.31, 95% CI 1.17-1.46)., Conclusions: Women with previous SGA bear increased risks for subsequent infant mortality, which was greater among black mothers. Hence, SGA plays an important role in the black-white disparity in infant mortality. Women's previous childbearing experiences could serve as important criterion in determining appropriate interconception strategies to improve infant health and survival., (Copyright © 2012 Elsevier Inc. All rights reserved.)

In this population-based retrospective study, we sought to investigate the association between HIV/AIDS during pregnancy and adverse birth outcomes, including low birth weight (LBW), very low birth weight (VLBW), preterm birth (PTB), very preterm birth (VPTB), and small for gestational age (SGA), among women in Florida by sociodemographic variables. Using data from Florida's maternally linked birth cohort files, we examined singleton live births in the state during 1998 to 2007 (N = 1,698,107). The study population was categorized based on the maternal HIV/AIDS status. Poisson regression models were used to generate adjusted rate ratios (ARR) to estimate the association between HIV/AIDS status and fetal growth parameters. The main outcome measures were fetal growth parameters, including LBW, VLBW, PTB, VPTB, and SGA. As compared to HIV/AIDS-negative women, mothers with HIV/AIDS had elevated risks for LBW (ARR = 1.40; 95% CI = 1.30-1.50), VLBW (ARR = 1.25; 95% CI = 1.04-1.51), SGA (ARR = 1.26; 95% CI = 1.17-1.35), PTB (ARR = 1.23; 95% CI = 1.03-1.47), and VPTB (ARR = 1.27; 95% CI = 1.20-1.36). Risk estimates for LBW and SGA were highest among Hispanics mothers with HIV/AIDS, while white mothers with HIV/AIDS had the highest risk levels for VLBW and PTB, compared to their HIV/AIDS negative counterparts. Our findings show that women with HIV/AIDS have elevated risks for inhibited fetal growth and shortened gestation with important racial/ethnic variation. This is the first known population-based study that reveals racial/ethnic differences in HIV/AIDS-related fetal growth morbidity outcomes.

Research investigating the role of paternal age in adverse birth outcomes is limited. This population-based retrospective cohort study used the Missouri maternally linked data set from 1989 to 2005 to assess whether paternal age affects fetal birth outcomes: low birth weight (LBW), preterm birth (PTB), stillbirth, and small size for gestational age (SGA). We examined these outcomes among infants across seven paternal age-groups (<20, 20-24, 25-29, 30-34, 35-39, 40-45, and >45 years) using the generalized estimating equation framework. Compared with infants born to younger fathers (25-29 years), infants born to fathers aged 40 to 45 years had a 24% increased risk of stillbirth but a reduced risk of SGA. A 48% increased risk of late stillbirth was observed in infants born to advanced paternal age (>45 years). Moreover, advanced paternal age (>45 years) was observed to result in a 19%, 13%, and 29% greater risk for LBW, PTB, and VPTB (very preterm birth) infants, respectively. Infants born to fathers aged 30 to 39 years had a lower risk of LBW, PTB, and SGA, whereas those born to fathers aged 24 years or younger had an elevated likelihood of experiencing these same adverse outcomes. These findings demonstrate that paternal age influences birth outcomes and warrants further investigation.

Purpose: To assess the association between bariatric surgery and pregnancy-related outcomes among obese and non-obese women in the state of Florida., Methods: We conducted a population-based, retrospective cohort analysis using vital records and hospital discharge data in Florida during 2004-2007. Women were categorized based on prior bariatric surgery and pre-pregnancy obesity status. Maternal complications (i.e., anemia, pre-eclampsia, gestational diabetes, chronic hypertension, endocrine disorders, cesarean section, prolonged hospital stay) and fetal morbidities [macrosomia, preterm birth, small for gestational age (SGA)] were the outcomes of interest. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were computed., Results: Mothers with a prior history of bariatric surgery, regardless of obesity status, were more likely to have anemia, chronic hypertension, endocrine disorders, and SGA infants. Classification based on prior history of bariatric surgery and obesity status showed that non-obese mothers with prior bariatric surgery were more likely to have anemia, chronic hypertension, endocrine disorders, and SGA infants, whereas obese mothers without prior bariatric surgery were at greater risk of having gestational diabetes, chronic hypertension, macrosomic infants (AOR = 1.69, 95% CI = 1.65-1.73), and prolonged hospital stay as compared to non-obese mother without prior bariatric surgery., Conclusions: Although prior bariatric surgery is associated with multiple negative maternal and fetal outcomes, it is protective against infant macrosomia in obese mothers. Our findings support the need for preconception/interconception services tailored for former bariatric surgery patients to improve maternal and feto-infant health outcomes.

This study sought to examine the association between maternal HIV/AIDS infection and neonatal neurologic conditions in the state of Florida. We analyzed all births in the state of Florida from 1998 to 2007 using hospital discharge data linked to birth certificate records. The main outcomes of interest included selected neonatal neurologic complications, namely: fetal distress, cephalohematoma, intracranial hemorrhage, seizure, feeding difficulties, and other central nervous system complications. The sample size for this study was 1,645,515 records. All forms of substance abuse as well as cesarean section deliveries were more frequent in mothers with HIV/AIDS. Infants born to HIV-infected mothers showed higher proportions of feeding difficulties and seizures whereas HIV-negative mothers had a greater proportion of cases of fetal distress and cephalohematoma. Seizures and feeding difficulties are common among infants born to HIV/AIDS infected mothers. This population-based retrospective cohort study provides further understanding of the association between maternal HIV/AIDS status and neonatal neurological outcomes.

Objective: To examine the association between infant mortality in a first pregnancy and risk for stillbirth in a second pregnancy., Design: Population-based, retrospective cohort study., Setting: Maternally linked cohort data files for the state of Missouri., Population: Women who had two singleton pregnancies in Missouri during the period 1989-2005 (n = 320 350)., Methods: Women whose first pregnancy resulted in infant death were compared with those whose infant from the first pregnancy survived the first year of life. The Kaplan-Meier product limit estimator was employed to compare probabilities for stillbirth in the second pregnancy between both groups of women. Adjusted hazard ratios (AHRs) and 95% confidence intervals (95% CIs) were generated to assess the association between infant mortality in the first pregnancy and stillbirth in the second pregnancy., Main Outcome Measures: Exposure was defined as infant mortality in the first pregnancy, and the outcome was defined as stillbirth in the second pregnancy., Results: Women with prior infant deaths were about three times as likely to experience stillbirth in their subsequent pregnancy (AHR 2.91; 95% CI 2.02-4.18). White women with a previous infant death were nearly twice as likely to experience a subsequent stillbirth, compared with white women with a surviving infant (AHR 1.96; 95% CI 1.13-3.39). Black women with a previous infant death were more than four times as likely to experience subsequent stillbirth, compared with black women with a surviving infant (AHR 4.28; 95% CI 2.61-6.99)., Conclusions: Previous infant mortality results in an elevated risk for subsequent stillbirth, with the most profound increase observed among black women. Interconception care should consider prior childbearing experiences to avert subsequent fetal loss., (© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.)

Background and Aims: To examine the association between maternal hepatitis B and C mono- and co-infections with singleton pregnancy outcomes in the state of Florida., Methods: We analysed all Florida births from 1998 to 2007 using birth certificate records linked to hospital discharge data. The main outcomes of interest were selected pregnancy outcomes including preterm birth, low birth weight (LBW), small for gestational age (SGA), fetal distress, neonatal jaundice and congenital anomaly., Results: The study sample consisted of 1,670,369 records. Human immunodeficiency virus co-infection and all forms of substance abuse were more frequent in mothers with hepatitis B and C infection. After using multivariable modelling to adjust for important socio-demographical variables and obstetric complications, women with hepatitis C infection were more likely to have infants born preterm [odds ratio (OR), 1.40; 95% confidence intervals (CI), 1.15-1.72], with LBW (OR, 1.39; 95% CI, 1.11-1.74) and congenital anomaly (OR, 1.55; 95% CI, 1.14-2.11). In addition, women with hepatitis B infection were less likely to have infants born SGA (OR, 0.79; 95% CI, 0.66-0.95)., Conclusions: Our findings provide further understanding of the association between maternal hepatitis B or C carrier status and perinatal outcomes. Infants born to women with hepatitis C infection appear to be at risk for poor birth outcomes, including preterm birth, LBW and congenital anomaly., (© 2011 John Wiley & Sons A/S.)