Birth Outcomes - Women's Health Highlights: Recent Findings (continued)

Birth Outcomes

•Mothers' anxiety and history of abuse contribute to risk for low birthweight babies.
According to this study of 554 pregnant women, abuse and anxiety are linked to low birthweight, possibly due to their effects on a woman's hormone levels. The women were seen at obstetric clinics in Memphis, TN, from 1990 to 1991, and most were black, poor, and unmarried. Those who experienced either verbal or physical abuse during pregnancy delivered babies that averaged 3.5 ounces lighter than women who did not suffer abuse, anxious mothers delivered babies that were 2.50 ounces lighter than average. The researchers also found a link between high-crime neighborhoods and low birthweight infants; mothers who experienced neighborhood stress delivered babies 2.28 ounces lighter than average. Witt, Keller, Gottlieb, et al., J Behav Health Serv Res, 2009 (AHRQ grants T32 HS00063, T32 HS00083). See also Fried, Cabral, Amaro, and Aschengrau, J Midwifery Womens Health 53(6):522-528, 2008 (AHRQ grant HS08008).

•No clear association found between inherited thrombophilia and small-for-gestational- age fetuses.
Pregnant women who suffer from blood disorders that cause excessive clotting (thrombophilia) are sometimes given blood thinning drugs to prevent intrauterine growth restriction (IUGR) or small-for-gestational-age fetuses (below the 10th percentile for a given gestational age). A meta-analysis of 19 studies found no clear association between inherited thrombophilia and IUGR. Facco, You, and Grobman, Obstet Gynecol 113(6):1206-1216, 2009 (AHRQ grant T32 HS00078).

•Primary care doctors blame lack of time for failing to counsel women about drugs that cause birth defects.
Eight focus groups were held with 48 primary care physicians in Pittsburgh, PA, to discuss counseling women about drugs that cause birth defects (teratogens). The doctors reported several barriers to providing such counseling, including short appointment times, lack of reimbursement for counseling, limited resources for finding up-do-date drug information, problems in determining a woman's reproductive plans, and concerns that such counseling may cause the woman to refuse a needed drug. The physicians proposed several solutions, including online plain language information on the risks of taking teratogenic drugs and reminders in electronic medical records to ask patients about their childbearing plans. Schwarz, Santucci, Borrero, et al., Birth Defects Res A Clin Mol Teratol 85(10):858-863, 2009 (AHRQ grant HS17093).

•Race and ethnicity appear not to have an effect on c-section delivery outcomes.
The researchers tested two risk-adjustment models for primary c-section rates to determine whether adding race and ethnicity to an otherwise identical model would improve the predictive impact of the model. They found that the two models did not differ substantially in predictive discrimination or in model calibration. They conclude that race and ethnicity can safely be left out of cesarean rate risk-adjustment models. Bailit and Love, Am J Obstet Gynecol 69:e1-e5, 2008 (AHRQ grant HS14352).

•Few data are available on the incidence and outcomes of cesarean delivery on maternal request.
The researchers reviewed published reports from 1990 through 2005 and found only 82 articles marginally related to cesarean delivery on maternal request (CDMR). They report that the incidence of CDMR appears to be increasing, but accurately assessing either its true incidence or trends over time is difficult because of the dearth of research focused on the topic. They cite the need to create a minimum data set, reach a consensus on terminology to be used, improve study design and statistical analyses, deal better with confounders, and consider the value and/or utility of different outcomes. Cesarean Delivery on Maternal Request, Evidence Report/Technology Assessment No. 133 (AHRQ Publication No. 06-E009)* (AHRQ contract 290-02-0016).

•Maternal weight gain is associated with some outcomes for mothers and babies.
According to this review of the scientific evidence, there is a strong association between a pregnant woman's weight gain and the following outcomes: preterm birth, total birthweight, low birthweight, large- and small-for-gestational- age infants, and very large infants. The researchers found a moderate association between maternal weight gain and two additional outcomes: cesarean delivery and postpartum weight retention for up to 3 years following childbirth. Outcomes of Maternal Weight Gain, Evidence Report/Technology Assessment No. 168 (AHRQ Publication No. 08-E009)* (AHRQ Contract 290-02-0016).

•Among disadvantaged minority women, Hispanics have better birth outcomes than blacks.
Researchers analyzed the pregnancy outcomes of 10,755 Medicaid-insured women who gave birth at one North Carolina medical center between 1994 and 2004. They found that black women were younger than the other women and were more likely to have another medical condition while pregnant, to remain in the hospital for more than 4 days, to have a preterm birth or small-for-gestational-age infant, to have preeclampsia, and to have a stillbirth. Birth outcomes for Hispanic women were similar to or better than those for white women. For example, Hispanic women were 34 percent less likely than other women to have a preterm birth. Brown, Chireau, Jallah, and Howard, Am J Obstet Gynecol 197:e1-e9, 2007 (AHRQ grant HS13353).

•Study details association between maternal asthma and smoking and bronchiolitis in infants.
Researchers studied hospitalizations for bronchiolitis among infants of 100,000 women enrolled in the Tennessee Medicaid program during 1995-2003. They found that infants of mothers who smoked and had asthma were twice as likely to end up in the emergency department (ED) with bronchiolitis as infants whose mothers had neither problem. Infants whose mothers had only one of the problems had a lower but still significantly elevated risk for ED visits and hospitalizations compared with infants whose mothers had neither problem. Although maternal asthma was the most important of these two risk factors, infants were 50 percent more likely to be hospitalized for bronchiolitis if their mothers had asthma and also smoked. Carroll, Gebretsadik, and Griffin, Pediatrics 119(6):1104-1112, 2007 (AHRQ grant HS10384).

•Pregnant minority women with asthma are at increased risk for poor outcomes.
Among pregnant women with asthma, this study found that minority women have significantly higher rates of preterm labor, gestational diabetes, and infection of the amniotic cavity than white women. Black women were the youngest (age 24) and had the highest incidence of preterm labor (5.5 percent) and pregnancy-induced hypertension (5 percent). Asian women had the highest occurrence of gestational diabetes (7.2 percent) and were more than three times as likely as white women to have infection of the amniotic cavity (5.7 vs. 1.8 percent, respectively). Black and Hispanic women also had more infections of the amniotic cavity (3.1 and 2.7 percent, respectively) than white women. Findings are based on examination of 11 adverse outcomes across four ethnic groups of 13,900 pregnant women with asthma who gave birth in 1998 and 1999. MacMullen, Tymkow, and Shen, Am J Matern Child Nurs 31(4):263-268, 2006 (AHRQ grant HS13506).

•Majority of low-income black women are unhappy with their body size 6 months after giving birth.
Body image dissatisfaction is associated with negative self-esteem and depression, and all three can be intensified during the postpartum period. Black mothers are twice as likely to suffer from postpartum depression as white mothers, according to this study. The researchers examined body perceptions among black women at four inner city clinics at 2 and 6 months postpartum. At 6 months postpartum, 79 percent of the women felt they did not meet what they considered to be a healthy size for women their age; 20 percent of the women thought they were too small and wanted to gain weight. Boyington, Johnson, and Carter-Edwards, J Obstet Gynecol Neonatal Nurs 36(2):144-151, 2007 (AHRQ grant HS13353).

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Women's Health Highlights: Recent Findings (continued)