Birthweight below the tenth percentile: the relative and attributable risks of maternal tobacco consumption and other factors.

Analysis of 7776 singleton births defined a cohort of babies with birthweight below the 10th percentile after adjusting for gestational age and sex. The relative risk of a baby being small for gestational age in respect to a number of factors, such as parental anthropometry, demographic factors, behavior patterns (tobacco, cannabis, alcohol, and caffeine consumption), maternal pathology, and fetal abnormality, was calculated. The highest relative risks are associated with severe antepartum hemorrhage, severe pre-eclampsia, and severe fetal abnormality. As these are relatively rare events, a more accurate calculation of overall risk to the population as opposed to the individual can be obtained by studying the percent attributable risk of each of the factors. This demonstrates that maternal tobacco consumption is the major environmental risk factor in our population.

The mental health of women 6 months after they give birth to an unwanted baby: a longitudinal study.

This study reports a longitudinal prospective study of the impact of an unwanted pregnancy on the mental health of the mother. Data are derived from a Brisbane, Australian sample of 8556 mothers who were enrolled at their first clinic visit (mean gestation 18 weeks) and then interviewed again some 3-5 days after the birth and when the baby was 6 months of age. Standard scales of mental health were administered on each of these occasions and mothers whose babies were unwanted were compared with the rest of the sample. The results indicate that mothers of unwanted children have somewhat higher rates of anxiety and depression than the comparison group, but that the magnitude of the mental health differences between the two groups: (a) diminishes over the period of the follow-up, (b) may be partly attributable to the prior poor mental health of women giving birth to an unplanned and unwanted baby, (c) is such that relatively few women who give birth to an unwanted baby experience mental health problems. The paper considers the implications of these results for health planners, notes the absence of contrary data and the need to acknowledge that these results may reflect situational factors which are characteristic of but not necessarily limited to Brisbane.

Social factors associated with the decision to relinquish a baby for adoption.

Little is known about the characteristics, social circumstances and mental health of women who give a child up for adoption. This paper reports data from a longitudinal study of 8556 women interviewed initially at their first obstetrical visit. In total, 7668 proceeded to give birth to a live singleton baby, of which 64 then relinquished the baby for adoption. Relinquishing mothers were predominantly 18 years of age or younger, in the lowest family income group, single, having an unplanned and/or unwanted baby and reported that they were not living with a partner. These women were somewhat more likely to manifest symptoms of anxiety and depression both prior, and subsequent to, the adoption, but the majority of relinquishing mothers were of 'normal' mental health. The decision to relinquish a baby appears to be a consequence of an unwanted pregnancy experienced by an economically deprived single mother rather than the result of emotional or psychological/psychiatric considerations. These findings document a particular dimension of the impact of poverty on health.

Patient age and success in a human IVF programme.

Previous studies suggest that at around 40 years of age, pregnancy rates achieved by IVF programmes fall and pregnancy loss rates increase. The actual age at which this occurs has not been clearly delineated. This study of 2,692 patients including 94 aged 41 or over shows that satisfactory pregnancy rates can be achieved up to and including age 40. As age 40 is approached the pregnancy loss rate increases to around 40%. In the 41 years and over group the pregnancy rate was poor at 6% (6/94) and the pregnancy loss rate very discouraging at 83% (5/6).

The employment of mothers and the outcomes of their pregnancies: an Australian study.

One of the more dramatic structural changes in a number of western industrial societies has involved the increased participation of women in the paid labour force. Little is known about the health consequences of this change. This paper reports the findings of a prospective longitudinal study of 8,556 pregnant women who were interviewed on three occasions; early in their pregnancy, shortly after the birth of the baby and some six months later. Additional data were derived from the medical record of the delivery. The findings suggest that employed women and housewives differ in their health behaviour (e.g. number of missed appointments, attendance at antenatal classes, smoking) and emotional health in pregnancy, but that there are no significant differences between employed women and housewives in their physical health or pregnancy outcomes. Although none of the differences was statistically significant, virtually all of the indices of outcome were slightly more favourable for the housewives than for the employed women.

Socio-economic status and pregnancy outcome. An Australian study.

A prospective cohort of 8556 pregnant women attending the Mater Misericordiae Mothers' Hospital in Brisbane was examined to consider the impact of socio-economic status on pregnancy outcome. The indicators of socio-economic status selected were family income, maternal education and paternal occupational status. Pregnancy outcomes considered were preterm delivery, low birthweight, low birthweight for gestational age, and perinatal death. Subsidiary analyses were also undertaken for Apgar scores, time to establish respiration, need for mechanical respiration and admission to intensive care. Before adjustment, the main consistent association was between the occupational status of the father and three measures of perinatal morbidity. Initial adjustment for the mother's socio-demographic background and weight/height ratio reduced the strength and statistical significance of the above associations, while further adjustment for lifestyle variations between the three status groups further reduced the above associations to marginal statistical significance. The findings suggest that observed class differences in pregnancy outcome are attributable to the mother's personal characteristics (height/weight, parity) and her lifestyle.

A prospective longitudinal study of social, psychological and obstetric factors in pregnancy: response rates and demographic characteristics of the 8556 respondents.

This paper introduces the Mater Misericordiae Mothers' Hospital-University of Queensland Study of Pregnancy, a prospective study of 8556 pregnant women interviewed at their first clinic visit, and subsequently interviewed some days after the birth of the baby and again 6 months later. Additional data were derived from the medical record of the pregnancy and delivery. The study was designed to assess the impact of social, psychological and obstetric factors on pregnancy outcome. We present here details of the study design, sampling, response rates and demographic characteristics of the sample.

Unemployment and reproductive outcome. An Australian study.

The Mater-University of Queensland Study involves the follow-up of 8556 pregnant women who were enrolled at their first clinic visit. This analysis compares four groups of women categorized according to their own and their partners' employment status. Group 1 comprised women unemployed, partners not unemployed. Group 2 comprised women not unemployed with unemployed partners. Group 3 comprised women and partners who were both unemployed. In group 4 neither partner was unemployed. Initial analysis showed that there was a significant association between birthweight and birthweight for gestational age, and unemployment as reported by mothers. After adjustment for lifestyle variables (principally smoking) there were no remaining statistically significant associations.

Religious values, practices and pregnancy outcomes: a comparison of the impact of sect and mainstream Christian affiliation.

In this report 6566 women enrolled in the Mater-University of Queensland Study of Pregnancy (MUSP) were separated into three groups; members of religious sects, Christians who attend church frequently and Christians who are infrequent attenders. These three groups, respectively labelled Christian sects, Christian attenders and lukewarm Christians were compared on a number of social background, lifestyle and pregnancy outcome variables. The sect members appeared to have the most favourable health, lifestyles and healthy babies at delivery, though this latter finding appears attributable to specific characteristics of the mother and her lifestyle. On most measures the children of lukewarm Christians appear to manifest the worst health while Christian attenders form a group whose children's health is between that of sect members and lukewarm Christians.

Social class, religion and contraceptive failure in a sample of pregnant women in Brisbane.

PIP: 4000 pregnant women were specifically asked about the method of contraception they last used and whether their pregnancy was a consequence of a failure of contraception. Social, economic, and religious variables were examined to assess the extent to which these were associated with differing rates of contraceptive failure. As part of a longtitudinal study of the outcomes of pregnancy, all women seeking antenatal care at a large public hospital in Brisbane (Australia) were enrolled at their 1st visit. The direct method of standardization was used to examine the contraceptive failure rate for the demographic variables of interest. This allowed adjustment for any effect of associated variables by calculating a weighted average of the specific rates within each category. Variation in the standardized rates of contraceptive failure was examined by a chi-squared test and, where appropriate, supplementary stepwise chi-squared tests were used to detect an upward or downward trend in rates for an ordinal demographic variable. While the rate of unwanted/unplanned pregnancies differed according to the criterion chosen, the variation was between 22% who believed their pregnancy was attributable to a contraceptive failure and 58% who stated that they did not plan their pregnancy or were unsure about whether it was planned or not. Altogether 29% of women acknowledged the possibility or probability of contraceptive failure. Single women were about twice as likely as married women to report contraceptive failure. These differences were independent of age differences between the marital status group. Single women and those "living together" reported the highest failure rates regardless of the most recent method of contraception used. The standardized rate at which a particular method was reported to fail did not relate significantly to the mother's educational or occupational status. More educated women had higher contraceptive failure rates because they were more frequent users of the "rhythm" method and this method fails about half the time. Lower income women reported higher rates of contraceptive failure because they tended to be less successful users of oral contraceptives (OCs. Reported contraceptive failure rates appeared relatively consistent for the method of contraception reported. Women who were more frequent church attenders reported somewhat higher rates of contraceptive failure.^ieng

Understanding preterm labour: the use of Path Analysis.

A retrospective study was performed on 465 spontaneous preterm and 13,949 term births, in order to analyze the sequence of events that culminate in preterm labour. Twenty-one variables were investigated by the mathematical technique of Path Analysis. Nine direct and independent precursors of preterm labour were identified. These were antepartum haemorrhage, poor antenatal attendance, previous delivery of a small baby, multiple pregnancy, proteinuria, grand multiparity, cervical suture, low maternal weight, and a history of bleeding before 20 weeks.

Pregnancy after renal transplantation.

The results of a series of 6 pregnancies (including 1 set of twins) in renal transplant patients are presented with a review of the relevant literature. There were no fetal anomalies or deaths, or episodes of renal compromise or graft rejection. The important complications were hypertension (4), prematurity (4) and fetal growth retardation (2).

Information control and the exercise of power in the obstetrical encounter.

Interactions between doctor and patient involve participants with unequal power and possibly different interests. While a number of studies have focused upon the doctor/patient relationship, few have examined the utility of the concept of power and its capacity to help us understand the outcome of these interactions. The information sought by pregnant women from their obstetricians is used to provide a case study of one conceptualization and test of the utility of the concept of power. Pregnant women and their obstetricians are found to have different perceptions of the information that should be exchanged during their interactions. Women generally fail to obtain the information they want. Lower social class patients desire more and obtain less information than their higher status counterparts.

The use of antenatal tests of fetal welfare.

The value of antenatal tests of fetal welfare is a constant source of controversy and confusion to obstetricians and general practitioners. The proliferation of such tests indicates that none is ideal and all are relatively imprecise.

Poor antenatal attendance and obstetric performance.

A survey of attendance for antenatal care at a public hospital in Brisbane was carried out. "Poor attenders" were more likely to be young, unmarried, grande multiparous, or aboriginal, and to live in a poorer area of the City. This group comprised 6.5% of the total population, but accounted for 14.6% of all low Apgar scores, 23% of all low birth weight babies, 23.1% of all stillbirths, and 18.2% of all neonatal deaths.

Classical caesarean section in preterm deliveries.

A series of 14 classical Caesarean sections is reported, and the place of operation in certain preterm deliveries is discussed.

Perinatal death: audit and classification.

Two hundred and thirteen perinatal deaths occurred in a population of 10,539 deliveries over a 4-year period. The associated obstetric complications and circumstances were analysed. The majority of perinatal deaths occurred in fetuses in whom there was a serious malformation, or whose birth weight was less than 800 g. Of the 110 deaths which occurred in normal babies weighing 800 g or more, 54 were antepartum, 5 were intrapartum, and 51 were neonatal. The clinical features surrounding these deaths were classified, and their implications discussed.