摘要:

Summary.Identifying when ‐ during pregnancy, delivery or the postnatal period ‐ transmission of human immunodeficiency virus (HIV) from mother to infant usually takes place is critical to the development of methods to prevent maternal‐infant transmission. Evidence is reviewed in this paper as to whether transmission occurs prepartum (early or late in gestation), intrapartum, or postpartum with breast feeding. Evidence in support of the notion of prepartum transmission has come from isolation of HIV from aborted fetal organs, comparison of maternal‐child viral genotypes and study of neonatal cell‐mediated immune responses. Evidence against prepartum transmission is that fewer than half of the children later known to be HIV‐infected can be identified by virological tests carried out close to birth. A reduced rate of transmission in infants delivered by Caesarean section, and a reduced risk of transmission to second‐born twins delivered vaginally, offers support to the view that intrapartum factors influence the risk of HIV transmission. Transmission through breast feeding can occur if a mother is infected postpartum and seems to pose some additional risk if she is already infected at parturition. The risk of infection increases with the stage of maternal HIV disease, but specific immunological, clinical and viral characteristics need to be investigated further. A clinical trial of zidovudine, used during late pregnancy and delivery and given to the infant at birth, has reported a significant reduction in transmission. Primary prevention of HIV infection in women remains a princ

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00113.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00114.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00115.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00116.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.Few studies have followed pregnant women prospectively to examine the impact of violence on birth outcome. We included such an assessment in a prospective study of pregnancy among low‐income women. Nurses and social workers interviewed pregnant women (n = 364) and asked if they had been the object of violence since they became pregnant. These prenatal interviews were linked with information from perinatal records and with birth and death information. In total, 15.9% of women in the study indicated they had been abused since they became pregnant. Abused women were more likely to be teenagers and to have partners who were teenagers. Abused women were more likely to be primiparous, to smoke during pregnancy and to have physical problems related to stress. Women battered during pregnancy were more likely to suffer fetal distress or fetal death [Odds Ratio (OR) 3.68; 95% Confidence Interval (CI) 1.36,9.94], even after adjusting for maternal age and smoking status. Finally the infants of abused women were more likely to remain in hospital after their mother's discharge (OR: 3.75; 95% CI: 1.38, 10.23). Our findings suggest that fetuses may be compromisedin utero, as shown by higher rates of fetal distress and fetal death found among women physically abused during pregnanc

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00117.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.It was recently suggested that a previous abortion increases the risk of intrapartum infection in a following pregnancy. The authors hypothesised that abortion also could be associated with a higher risk of neonatal sepsis. A case‐control study of neonatal sepsis was conducted using the Washington State Birth Registry. Cases of sepsis were selected among singleton livebirths during the period 1984‐90, and compared with a control group for the occurrence of spontaneous or induced abortion in previous pregnancies. The risk estimates were calculated using a stratified analysis. After exclusion of primigravidae, the age‐adjusted odds ratio (OR) was 1.68, with a 95% confidence interval (CI) 1.33,2.11 for previous spontaneous abortion, and 2.20 (95% CI 1.73, 2.79) for induced abortion, compared with previous livebirth. After exclusion of nullipa‐rous women, the OR decreased to 1.19 (95% CI 0.90,1.58) for spontaneous abortion and 1.45 (95% CI 1.03, 2.04) for induced abortion. After controlling for the effect of parity, induced abortion is associated with an increased risk of neonatal sepsis in a subsequent pregnancy, but the association between spontaneous abortion and sepsis is small and nonsignificant. The authors suggest that the procedures involved in a therapeutic abortion might produce a latent, sub‐clinical infection that persists until the next pregnancy, and is then transmitted to th

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00118.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.This study compares the maternal sociodemographic and prenatal care characteristics and birth outcomes of US resident white and Japanese‐American mothers, using data from the state of Hawaii. The specific focus is to determine to what extent these factors can explain variations in newborn maturity and mortality indicators. Single livebirths to resident, non‐military dependent white and Japanese‐American mothers were selected for analysis from the 1979–1990 linked livebirth‐infant death files from Hawaii. Compared with white mothers, Japanese‐American mothers were significantly more likely to be married, age 18 years and older, have higher educational attainment, and have adequate prenatal care utilisation. The majority of Japanese‐American mothers were born in Hawaii, while the majority of white mothers were born on the US mainland. The mean birthweight of Japanese‐American infants was 200 g lighter than that of white infants. Infant mortality rates (IMRs) for both groups were below the US Year 2000 Health Objective. After controlling for maternal sociodemographic and prenatal care factors with logistic regression, Japanese‐American infants had significantly higher risks of low birthweight, preterm and very preterm birth and of being small‐for‐gestational age. These findings indicate that populations with preferential maternal sociodemographic and prenatal care risk indicators may still exhibit higher low birthweight percentages, but achieve c

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00119.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.A prospective survey was carried out in two Kathmandu hospitals and two rural districts to establish urban and rural perinatal mortality rates (PNMRs) for these four centres in Nepal and to ascertain the causes of perinatal mortality. All perinatal deaths occurring over a 1‐year period in the four centres were included (during which time there was a total of 14 967 births). Cause of death was established by contemporary review of hospital case records or by structured questionnaire (‘verbal autopsy’) in the rural areas. The PNMRs in the hospitals were 48.0 and 23.7 per thousand total births respectively, whilst those of the rural settings were 96.2 and 42.5 per thousand births. Perinatal asphyxia, low birthweight and infection were the most common causes but many of the deaths were unexplained. The high mortality rates were felt to reflect the difficult circumstances of childbirth in Nepal. It was concluded that a number of interventions would appear appropriate, but that these should be introduced in a scientific m

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00120.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.To determine the incidence of congenital hip dislocation (CDH) a retrospective study was carried out of cases occurring in a defined population using multiple information sources. Of 138600 children born in the period 1983–1987, a total of 243 were diagnosed with CDH, defined as those requiring splintage or surgery whose treatment extended beyond 6 months of age. Incidence and estimates of relative risks for pre‐disposing factors were determined. The rate was 1.75 cases per 1000 livebirths. Major risk factors were female gender and breech presentation. The proportions of cases identified before 1,3 and 6 months of age were 8,14 and 35%, respectively. Despite using a restrictive definition, we have obtained an incidence rate among the highest reported in any United Kingdom population. Early detection is widely accepted as desirable, but neonatal screening has proved ineffect

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00121.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Summary.Diet variability influences the accuracy of the assessment of the relationship between nutrient intake and disease. The present study investigates intra‐ and inter‐individual variability in an infant population at 12 months. The mothers of 79 infants completed a 7‐day weighted food record. No significant difference in nutrient intake was observed between males and females. For some nutrients an intra‐/inter‐individual variability ratio<1 was found. Adjustment for total calorie intake slightly altered the intra‐/inter‐individual variability ratio of many nutrients. An error margin of 10% or less for calories can be expected within an 18‐day study. Most nutrients however would need to be studied for over 30 days to give an error margin ≤10%. For dietary cholesterol, vitamins A, B6, C, and E, bracketing the error within the 10% margin would require an unrealistic time frame. Adjustments for calorie intake reduced the number of days in the dietary record for some nutrients. A lower intra/inter‐individual variability ratio was seen when data for adults and older in

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1995.tb00122.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY