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Risk factors and obstetric complications of large for gestational age births with adjustments for community effects: results from a new cohort study.

Ng SK, Olog A, Spinks AB, Cameron CM, Searle J, McClure RJ - BMC Public Health (2010)

Bottom Line: Pre-pregnancy obesity (adjusted OR = 2.73, 95% CI = 1.49-5.01), previous pregnancy (adjusted OR = 2.03, 95% CI = 1.08-3.81), and married mothers (adjusted OR = 1.85, 95% CI = 1.00-3.42) were significantly associated with large for gestational age babies.Communities associated with a higher proportion of large for gestational age births were identified.The findings improve the evidence-base on which to base preventive interventions to reduce the impact of high birth weight on maternal and child health.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Medicine, Griffith University Logan Campus, Meadowbrook, QLD 4131, Australia..

ABSTRACT

Background: High birth weight has serious adverse impacts on chronic health conditions and development in children. This study identifies the social determinants and obstetric complications of high birth weight adjusted for gestational age and baby gender.

Methods: Pregnant women were recruited from three maternity hospitals in South-East Queensland in Australia during antenatal clinic visits. A questionnaire was completed by each participant to elicit information on eco-epidemiological exposures. Perinatal information was extracted from hospital birth records. A hierarchical mixture regression model was used in the analysis to account for the heterogeneity of birth weights and identify risk factors and obstetric complications of births that were large for gestational age. A generalized linear mixed model was used to adjust for (random) "community" effects.

Results: Pre-pregnancy obesity (adjusted OR = 2.73, 95% CI = 1.49-5.01), previous pregnancy (adjusted OR = 2.03, 95% CI = 1.08-3.81), and married mothers (adjusted OR = 1.85, 95% CI = 1.00-3.42) were significantly associated with large for gestational age babies. Subsequent complications included the increased need for delivery by caesarean sections or instrumental procedures (adjusted OR = 1.98, 95% CI = 1.10-3.55), resuscitation (adjusted OR = 2.52, 95% CI = 1.33-4.79), and transfer to intensive/special care nursery (adjusted OR = 3.76, 95% CI = 1.89-7.49). Communities associated with a higher proportion of large for gestational age births were identified.

Conclusions: Pre pregnancy obesity is the principal modifiable risk factor for large for gestational age births. Large for gestational age is an important risk factor for the subsequent obstetric complications. The findings improve the evidence-base on which to base preventive interventions to reduce the impact of high birth weight on maternal and child health.

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Related in: MedlinePlus

Nine communities, designated by postal area (POA) codes, with a higher proportion of large for gestational age births.
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Figure 1: Nine communities, designated by postal area (POA) codes, with a higher proportion of large for gestational age births.

Mentions: The unadjusted estimated proportion of large for gestational age births was 10.3%. We identified nine communities (postal code areas of participating mothers) that are associated with a higher proportion of large for gestational age births. These nine communities (Figure 1) have a higher proportion of mothers who possess some of those identified risk factors for large for gestational age babies. Of substantial importance is the finding that three of the communities (postal areas 2486, 4127, and 4280) have a large positive community effect (adjusted ORs are ranged from 1.7 to 2.2), that accounts for unknown adverse effects from the community other than those identified risk factors. The twelve pre-determined characteristics of the nine communities are presented in Table 4. Comparing to other communities, postal areas 4128 and 4129 have higher family incomes, higher labour force participations, but lower percentages of migrants moved in the community within a year. On the other hand, postal areas 4207, 4209, and 4213 have a lower population density but a higher proportion of females doing unpaid domestic work. The postal areas 4223 and 4280 have lower population densities and lower proportions of persons speaking other languages at home. They also have lower proportions of migrants moved in the community within a year. The postal area 2486 is unique; it has a higher percentage of indigenous persons but lower labour force participation.


Risk factors and obstetric complications of large for gestational age births with adjustments for community effects: results from a new cohort study.

Ng SK, Olog A, Spinks AB, Cameron CM, Searle J, McClure RJ - BMC Public Health (2010)

Nine communities, designated by postal area (POA) codes, with a higher proportion of large for gestational age births.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2921393&req=5

Figure 1: Nine communities, designated by postal area (POA) codes, with a higher proportion of large for gestational age births.
Mentions: The unadjusted estimated proportion of large for gestational age births was 10.3%. We identified nine communities (postal code areas of participating mothers) that are associated with a higher proportion of large for gestational age births. These nine communities (Figure 1) have a higher proportion of mothers who possess some of those identified risk factors for large for gestational age babies. Of substantial importance is the finding that three of the communities (postal areas 2486, 4127, and 4280) have a large positive community effect (adjusted ORs are ranged from 1.7 to 2.2), that accounts for unknown adverse effects from the community other than those identified risk factors. The twelve pre-determined characteristics of the nine communities are presented in Table 4. Comparing to other communities, postal areas 4128 and 4129 have higher family incomes, higher labour force participations, but lower percentages of migrants moved in the community within a year. On the other hand, postal areas 4207, 4209, and 4213 have a lower population density but a higher proportion of females doing unpaid domestic work. The postal areas 4223 and 4280 have lower population densities and lower proportions of persons speaking other languages at home. They also have lower proportions of migrants moved in the community within a year. The postal area 2486 is unique; it has a higher percentage of indigenous persons but lower labour force participation.

Bottom Line: Pre-pregnancy obesity (adjusted OR = 2.73, 95% CI = 1.49-5.01), previous pregnancy (adjusted OR = 2.03, 95% CI = 1.08-3.81), and married mothers (adjusted OR = 1.85, 95% CI = 1.00-3.42) were significantly associated with large for gestational age babies.Communities associated with a higher proportion of large for gestational age births were identified.The findings improve the evidence-base on which to base preventive interventions to reduce the impact of high birth weight on maternal and child health.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Medicine, Griffith University Logan Campus, Meadowbrook, QLD 4131, Australia..

ABSTRACT

Background: High birth weight has serious adverse impacts on chronic health conditions and development in children. This study identifies the social determinants and obstetric complications of high birth weight adjusted for gestational age and baby gender.

Methods: Pregnant women were recruited from three maternity hospitals in South-East Queensland in Australia during antenatal clinic visits. A questionnaire was completed by each participant to elicit information on eco-epidemiological exposures. Perinatal information was extracted from hospital birth records. A hierarchical mixture regression model was used in the analysis to account for the heterogeneity of birth weights and identify risk factors and obstetric complications of births that were large for gestational age. A generalized linear mixed model was used to adjust for (random) "community" effects.

Results: Pre-pregnancy obesity (adjusted OR = 2.73, 95% CI = 1.49-5.01), previous pregnancy (adjusted OR = 2.03, 95% CI = 1.08-3.81), and married mothers (adjusted OR = 1.85, 95% CI = 1.00-3.42) were significantly associated with large for gestational age babies. Subsequent complications included the increased need for delivery by caesarean sections or instrumental procedures (adjusted OR = 1.98, 95% CI = 1.10-3.55), resuscitation (adjusted OR = 2.52, 95% CI = 1.33-4.79), and transfer to intensive/special care nursery (adjusted OR = 3.76, 95% CI = 1.89-7.49). Communities associated with a higher proportion of large for gestational age births were identified.

Conclusions: Pre pregnancy obesity is the principal modifiable risk factor for large for gestational age births. Large for gestational age is an important risk factor for the subsequent obstetric complications. The findings improve the evidence-base on which to base preventive interventions to reduce the impact of high birth weight on maternal and child health.

Show MeSH
Related in: MedlinePlus