Association of young maternal age with adverse reproductive outcomes.

BACKGROUND: Pregnancy in adolescence is associated with an excess risk of poor outcomes, including low birth weight and prematurity. Whether this association simply reflects the deleterious sociodemographic environment of most pregnant teenagers or whether biologic immaturity is also causally implicated is not known. METHODS: To determine whether a young age confers an intrinsic risk of adverse outcomes of pregnancy, we performed stratified analyses of 134,088 white girls and women, 13 to 24 years old, in Utah who delivered singleton, first-born children between 1970 and 1990. Relative risk for subgroups of this study population was examined to eliminate the confounding influence of marital status, educational level, and the adequacy of prenatal care. The adjusted relative risk for the entire study group was calculated as the weighted average of the stratum-specific risks. RESULTS: Among white married mothers with educational levels appropriate for their ages who received adequate prenatal care, younger teenage mothers (13 to 17 years of age) had a significantly higher risk (P < 0.001) than mothers who were 20 to 24 years of age of delivering an infant who had low birth weight (relative risk, 1.7; 95 percent confidence interval, 1.5 to 2.0), who was delivered prematurely (relative risk, 1.9; 95 percent confidence interval, 1.7 to 2.1), or who was small for gestational age (relative risk, 1.3; 95 percent confidence interval, 1.2 to 1.4). Older teenage mothers (18 or 19 years of age) also had a significant increase in these risks. Even though sociodemographic variables associated with teenage pregnancy increase the risk of adverse outcomes, the relative risk remained significantly elevated for both younger and older teenage mothers after adjustment for marital status, level of education, and adequacy of prenatal care. CONCLUSIONS: In a study of mothers 13 to 24 years old who had the characteristics of most white, middle-class Americans, a younger age conferred an increased risk of adverse pregnancy outcomes that was independent of important confounding sociodemographic factors.

Ischemic heart disease and acute myocardial infarction mortality among police officers.

The relationship between the occupation of police officer and ischemic heart disease (IHD) mortality was examined through case-control studies using 1968/78 death certificate records from Rhode Island and Utah. IHD was divided into two subcategories--acute myocardial infarction (AMI) and other IHD. In both states, the odds ratio (OR) for AMI was significantly elevated (Rhode Island, OR = 1.3; Utah, OR = 1.8), and was higher than the OR for other IHD (Rhode Island, OR = 1.1; Utah, OR = 1.4). The odds ratio for AMI was higher in the less than 65 yr age group (Rhode Island, OR = 2.1; Utah, OR = 2.1) than in the greater than or equal to 65 yr age group (Rhode Island, OR = 0.9; Utah, OR = 1.6). These results suggest that the elevated risk for IHD among police officers observed in this and other studies is primarily due to an elevated risk for AMI. The pattern of diminishing risk with age suggests a risk factor, possibly stress, the effect of which diminishes when exposure ceases at retirement.

The 1989 revisions of the US Standard Certificates of Live Birth and Death and the US Standard Report of Fetal Death.

The US Standard Certificates and Reports are models used by state vital statistics offices to develop documents for the collection of data about vital events. The 1989 revisions incorporate some major modifications to previous versions. Both the Standard Certificate of Live Birth and the Standard Report of Fetal Death utilize a checkbox format to elicit information on medical and other risk factors affecting the pregnancy, complications of labor and/or delivery, obstetric procedures, method of delivery, congenital anomalies, and abnormal conditions of the newborn. Revisions to the Standard Certificate of Death include modifications to the medical certification section and the addition of decedent's educational attainment. Items requesting information about Hispanic origin are added to all of these documents. The rationale behind these changes and their intended use are discussed.