The intricate diversity of human-nature relations: Evidence from Finland.

Supporting sustainability requires understanding human-nature relations, which we approached as social constructions that can be studied through nature-related discourses. We examined human-nature relations in Finland by combining approaches from environmental social sciences and arts-based research into a mixed-methods design. A public online survey (n = 726) and post-performance audience interviews (n = 71) portrayed nature positively. Respondents' ideas of nature ranged from natural scientific to philosophical; from dualistic to holistic; and from ecocentric to anthropocentric. A factor analysis revealed discourses focusing on wellbeing, conservation, ecoanxiety, pro-environmentalism, outdoor activity, and enjoying nature. Interviews added spiritual and over-generational aspects and revealed the importance of embodied experiences in nature relations. We identified dimensions that structure the relations, including human-nature positionality, engagement and contact with nature, and conception and thought. The emotional and experiential aspects, and nature-related practices, deserve further research. We demonstrate how a diversity of human-nature relations co-exists and co-evolves.

Enhancing multifunctionality in European boreal forests: The potential role of Triad landscape functional zoning.

Land-use policies aim at enhancing the sustainable use of natural resources. The Triad approach has been suggested to balance the social, ecological, and economic demands of forested landscapes. The core idea is to enhance multifunctionality at the landscape level by allocating landscape zones with specific management priorities, i.e., production (intensive management), multiple use (extensive management), and conservation (forest reserves). We tested the efficiency of the Triad approach and identified the respective proportion of above-mentioned zones needed to enhance multifunctionality in Finnish forest landscapes. Through a simulation and optimization framework, we explored a range of scenarios of the three zones and evaluated how changing their relative proportion (each ranging from 0 to 100%) impacted landscape multifunctionality, measured by various biodiversity and ecosystem service indicators. The results show that maximizing multifunctionality required around 20% forest area managed intensively, 50% extensively, and 30% allocated to forest reserves. In our case studies, such landscape zoning represented a good compromise between the studied multifunctionality components and maintained 61% of the maximum achievable net present value (i.e., total timber economic value). Allocating specific proportion of the landscape to a management zone had distinctive effects on the optimized economic or multifunctionality values. Net present value was only moderately impacted by shifting from intensive to extensive management, while multifunctionality benefited from less intensive and more diverse management regimes. This is the first study to apply Triad in a European boreal forest landscape, highlighting the usefulness of this approach. Our results show the potential of the Triad approach in promoting forest multifunctionality, as well as a strong trade-off between net present value and multifunctionality. We conclude that simply applying the Triad approach does not implicitly contribute to an overall increase in forest multifunctionality, as careful forest management planning still requires clear landscape objectives.

Semi-natural habitats in the European boreal region: Caught in the socio-ecological extinction vortex?

We propose to consider semi-natural habitats-hotspots for biodiversity-being caught in a socio-ecological extinction vortex, similar to the phenomenon described for species threatened with extinction. These habitats are essentially socioecological systems, in which socioeconomic drivers are interlinked with ecological processes. We identify four highly interlinked and mutually reinforcing socio-economic processes, pertaining to the importance of semi-natural habitats for (i) agricultural production, (ii) policy, research and development; (iii) vocational education in the fields of agricultural sciences and (iv) public's experiences with semi-natural habitats. Evidence from six countries in the boreal region demonstrates that recent slowing down or even reversal of two processes are insufficient to stop the extinction vortex phenomenon. We suggest research directions to ascertain the phenomenon, monitor its development and develop proactive actions to weaken the vortex. It is highly plausible that interventions directed at most, if not all, of the key vortex processes are needed to reverse the overall deteriorating trends of a socio-ecological system.

Innovative treatment modalities for urinary incontinence: a European survey identifying experience and attitude of healthcare providers.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25% to 51%. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI). A European research consortium is investigating an innovative system based on information and communication technology for the conservative treatment of women with SUI. When introducing a new intervention, implementation barriers arise and need to be identified. Therefore, we investigated healthcare providers' experience with and attitude towards innovative care options. METHODS: We performed an online survey to assess (1) the characteristics and practice of healthcare providers, (2) current protocols for SUI, (3) current use of biofeedback, and (4) knowledge about serious gaming. The survey was sent to members of professional societies in Europe (EUGA), UK (BSUG) and The Netherlands (DPFS). RESULTS: Of 341 questionnaires analyzed (response rate between 18% and 30%), 64% of the respondents had access to a protocol for the treatment of SUI, and 31% used biofeedback when treating patients with SUI. However, 92% considered that biofeedback has a clear or probable added value, and 97% of those who did not use biofeedback would change their practice if research evidence supported its use. Finally, 89% of respondents indicated that they had no experience of serious gaming, but 92% considered that it could be useful. CONCLUSIONS: Although inexperienced, European urogynecologists and physical therapists welcome innovative treatment options for the conservative treatment of SUI such as portable wireless biofeedback and serious gaming. Scientific evidence is considered a prerequisite to incorporate such innovations into clinical practice.

Maternal socioeconomic status and the risk of asthma among offspring.

BACKGROUND: To evaluate the association between maternal socioeconomic status (SES) during pregnancy and asthma among offspring. METHODS: A retrospective observational hospital-based birth cohort study in a university-based Obstetrics and Gynecology department in Finland. A total of 40 118 women with singleton live births between 1989 and 2007 were linked with data from the register for asthma medication for their offspring (n = 2518). Pregnancy and maternal SES factors were recorded during pregnancy and labor. SES was categorized thus: upper white-collar workers (highest SES), lower white-collar workers, blue-collar workers, others (lowest SES) and cases with missing information. Logistic regression analysis was used to determine the association between maternal SES and childhood asthma. RESULTS: We found no convincing evidence of a direct association between maternal SES and childhood asthma. Parental smoking was the clearest factor affecting asthma among children of lower white-collar workers. Differences in pregnancy and delivery characteristics were observed between the SES groups. CONCLUSIONS: Maternal socioeconomic status had no significant direct impact on the prevalence of asthma in this Finnish birth cohort. Finnish public health services appeared to offer equal quality services independently of SES. TRIAL REGISTRATION: The study is registered in Kuopio University Hospital register (TUTKI): ID 5302448 .

Outcome of assisted reproductive technology (ART) and subsequent self-reported life satisfaction.

OBJECTIVE: To compare life satisfaction between women with successful or unsuccessful outcome after assisted reproductive treatment (ART) by taking into account the time since the last ART. DESIGN: Cohort study. SETTING: Tertiary hospital. PATIENTS: A total of 987 consecutive women who had undergone ART during 1996-2007 were invited and altogether 505 women participated in the study. INTERVENTIONS: A postal enquiry with a life satisfaction scale. MAIN OUTCOME MEASURE: Self-reported life satisfaction in respect to the time since the last ART. RESULTS: In general, women who achieved a live birth after ART had a significantly higher life satisfaction than those who had unsuccessful ART, especially when compared in the first three years. The difference disappeared in the time period of 6-9 years after ART. The unsuccessfully treated women who had a child by some other means before or after the unsuccessful ART had comparable life satisfaction with successfully treated women even earlier. CONCLUSIONS: Even if unsuccessful ART outcome is associated with subsequent lower level of life satisfaction, it does not seem to threaten the long-term wellbeing.

Maternal fecundity and asthma among offspring-is the risk programmed preconceptionally? Retrospective observational study.

OBJECTIVE: To evaluate the association between maternal fecundity factors and time to pregnancy and risk of asthma in offspring. DESIGN: Retrospective observational hospital-based birth cohort study. SETTING: A university-based obstetrics and gynecology department. PATIENT(S): A total of 40,914 women, who delivered between 1989 and 2007, were linked with the register for asthma reimbursement (n = 2,577) for their offspring. Fecundity factors were recorded during pregnancy. Logistic regression analyses were used. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Asthma among offspring. RESULT(S): The risk of asthma was significantly increased if the mother had any infertility problems (adjusted odds ratio [adjusted OR] 1.39, 95% confidence interval [CI] 1.19-1.63), medical infertility treatment (aOR 1.43, 95% CI 1.13-1.80), or any infertility treatment (aOR 1.50, 95% CI 1.26-1.79). The risk of asthma among offspring was also higher among mothers who had more than two miscarriages (aOR 1.25, 95% CI 1.04-1.51) and time to pregnancy over 3 months (aOR 1.25, 95% CI 1.07-1.45). CONCLUSION(S): These findings suggest that maternal subfertility exposes offspring to an increased risk of asthma. CLINICAL TRIAL REGISTRATION NUMBER: The study is registered in Kuopio University Hospital register (TUTKI): ID 5302448.

Do allopatric male Calopteryx virgo damselflies learn species recognition?

There is a growing amount of empirical evidence that premating reproductive isolation of two closely related species can be reinforced by natural selection arising from avoidance of maladaptive hybridization. However, as an alternative for this popular reinforcement theory, it has been suggested that learning to prefer conspecifics or to discriminate heterospecifics could cause a similar pattern of reinforced premating isolation, but this possibility is much less studied. Here, we report results of a field experiment in which we examined (i) whether allopatric Calopteryx virgo damselfly males that have not encountered heterospecific females of the congener C. splendens initially show discrimination, and (ii) whether C. virgo males learn to discriminate heterospecifics or learn to associate with conspecifics during repeated experimental presentation of females. Our experiment revealed that there was a statistically nonsignificant tendency for C. virgo males to show initial discrimination against heterospecific females but because we did not use sexually naïve individuals in our experiment, we were not able to separate the effect of innate or associative learning. More importantly, however, our study revealed that species discrimination might be further strengthened by learning, especially so that C. virgo males increase their association with conspecific females during repeated presentation trials. The role of learning to discriminate C. splendens females was less clear. We conclude that learning might play a role in species recognition also when individuals are not naïve but have already encountered potential conspecific mates.

Adverse Outcomes of IVF/ICSI Pregnancies Vary Depending on Aetiology of Infertility.

In vitro fertilization (IVF) is a risk factor for pregnancy, but there have been few studies on the effect of infertility's aetiology. Thus, we have assessed the role of aetiology on IVF pregnancy outcomes in a retrospective cohort study comparing the outcomes of IVF singleton pregnancies with those of spontaneous pregnancies in the general Finnish population. The study group consisted of 255 women with births resulting from singleton IVF pregnancies. Six subgroups were formed according to the following causes of infertility: anovulation (27%), endometriosis (19%), male factor (17%), tubal factor (15%), polycystic ovary syndrome (11%), and unexplained infertility (12%). The reference group consisted of 26,870 naturally conceived women. Adjusted odds ratios (AORs), for confounding factors such as age and parity, were estimated using logistic regression analysis. Women with endometriosis and anovulation had increased risks of preterm birth (AOR 3.25, 95% CI 1.5-7.1 and AOR 2.1, and 95% CI 1.0-4.2, resp.), while women in couples with male factor infertility had a twofold risk of admission to neonatal intensive care (AOR 2.5, 95% CI 1.2-5.3). The findings show that the aetiology of infertility influenced the obstetrics outcome, and that pooling results may obscure some increased risks among subgroups.

Intravenous oxycodone for pain relief in the first stage of labour--maternal pharmacokinetics and neonatal exposure.

Physiological changes during pregnancy may change pharmacokinetics of compounds. Oxycodone is an increasingly used opioid agonist in acute pain management but its pharmacokinetics in labouring women has not been established. We studied the maternal pharmacokinetics and neonatal exposure of intravenous oxycodone for pain relief in the first stage of labour. The study was prospective, open-labelled and with a control group. After informed consent, 15 nulliparous parturients and newborns, and newborns in a control group were studied. In the study group, oxycodone boluses of 1 mg i.v., up to a cumulative dose of 5 mg, was administered when labour pain score was 5/10 or higher. As the control group, 30 other newborns after uncomplicated deliveries with no systemic opioids were assessed for the neonatal outcome. In the study group, maternal pharmacokinetics of oxycodone was measured from plasma concentrations during labour, and neonatal exposure was assessed from umbilical plasma samples using population pharmacokinetic methods. Maternal plasma oxycodone concentration decreased with a median half-life of 2.6 hr (range, 1.8-2.8). Oxycodone concentrations in the umbilical plasma 2.7 µg/l (0.3-14.5) were similar as in maternal plasma 2.4 (0.1-14.8) µg/l at the time of birth. No severe or unexpected adverse effects were noted. To conclude, firstly, maternal elimination half-life of i.v. oxycodone was significantly shorter than that reported in non-pregnant women, and secondly, maternal plasma oxycodone at the birth correlated well with neonatal umbilical concentrations and may, thus, be used as an estimate of neonatal exposure.

Comparison of the pregnancy outcomes of subfertile women after infertility treatment and in naturally conceived pregnancies.

BACKGROUND: Adverse obstetric outcomes in pregnancies achieved through assisted reproductive technology (ART) could either be due to the technology or to the underlying subfertility or to both. To address this issue, we compared the pregnancy outcomes of singletons conceived naturally after a long time to pregnancy (TTP) with those of ART pregnancies. METHODS: We analysed an existing birth database. Altogether 428 ART pregnancies were compared with 928 spontaneously conceived pregnancies with TTP of 2 years or more, during the period 1989-2007 at Kuopio University Hospital, Finland. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for pregnancy outcomes. RESULTS: Between treated and untreated subfertile women no significant differences were found in the rates of Caesarean sections (OR 1.21, 95% CI 0.89-1.64), preterm births (OR 1.28, 95% CI 0.81-2.03), small for gestational age (SGA) birthweight (OR 0.95, 95% CI 0.65-1.39), need of neonatal intensive care (OR 1.28, 95% CI 0.88-1.88) or low Apgar scores (OR 1.19, 95% CI 0.47-3.04). However, compared with pregnancies of women with TTP 0-6 months, ART pregnancies had significantly increased risks of preterm or very preterm birth, low birthweight and need of neonatal intensive care. CONCLUSIONS: The risks of preterm birth, SGA, need for neonatal intensive care and low Apgar scores were not significantly different between subfertile women who conceived spontaneously and those who conceived through ART indicating that maternal factors relating to subfertility and not only infertility treatment are associated with adverse pregnancy outcomes.

Decreased PAPP-A is associated with preeclampsia, premature delivery and small for gestational age infants but not with placental abruption.

OBJECTIVE: To investigate links between first trimester Down's syndrome screening markers and adverse pregnancy outcomes; preeclampsia (PE), small for gestational age (SGA), preterm delivery (PD) and placental abruption (PA) in spontaneous, chromosomally normal pregnancies. STUDY DESIGN: Cohort study in a university hospital. Data during pregnancy were routinely collected from a total study population of 2844 pregnant women between 2005 and 2007. Four study groups were pregnancies with PE (N=175), PA (N=17), PD (N=213) and SGA (N=275) plus a reference group with normal outcome (N=2164). The median MOMs of maternal serum concentrations of pregnancy associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (fß-hCG) were compared using two-tailed pooled t-tests, continuous variables were compared using Student's two-way t-tests, and Chi-square tests were used to analyse dichotomous variables. Fisher's exact test was used when there were fewer than five units in any of the classes. RESULTS: The median MOM of maternal serum PAPP-A was significantly lower in women with PE, PD and SGA (0.79, 0.80 and 0.79 MOM, respectively) than in the reference group (0.99 MOM) (p<0.01). The median MOM of maternal serum fß-hCG was also significantly lower in the SGA group (0.90 MOM) and in the PE and PD groups (0.86 and 0.92 MOM) than in the reference group (0.99 MOM, p=0.02). There was no detectable difference between the biochemical markers in the PA group and the reference group. No statistical difference was found between NT MOMs in the reference and study groups. CONCLUSION: The concentrations of first trimester screening (FTS) serum markers were lower in pregnancies where PE, PD and SGA occurred. In the latter two cases, there was an inverse association between incidence and PAPP-A and fß-hCG values. However, the development of PA during pregnancy could not be predicted from biochemical marker concentrations. The mechanism behind PA is probably less dependent on the placenta than on the decidua.

Prolonged time to pregnancy is associated with a greater risk of adverse outcomes.

Births with known time to pregnancy (TTP) during the period 1989-2007 (n=17,114) were analyzed to investigate associations between TTP and pregnancy outcome among couples that conceived spontaneously. The adjusted odds ratio (95% confidence interval) for poor neonatal health, including low Apgar score, low umbilical vein pH, and need for neonatal intensive care, was 1.51 (1.09-2.09) in women who had a TTP of 25-36 months and 1.60 (1.18-2.19) in women who had a TTP of >or=37 months compared with women with a TTP of 0-6 months.

Increased time-to-pregnancy and first trimester Down's syndrome screening.

BACKGROUND: Time-to-pregnancy (TTP) is a clinical tool used to measure uterine receptivity and a couples' fertility in spontaneously conceived pregnancies. The objective of this study was to examine the effects of TTP on first trimester Down's syndrome (DS) markers in spontaneous, chromosomally normal pregnancies and to compare the results to those in IVF pregnancies. METHODS: A case-control study was conducted amongst patients attending a university hospital in Finland. During 2005-2007 data on pregnant women in Kuopio, with singleton pregnancies, routinely collected by the Department of Obstetrics and Gynaecology of Kuopio University Hospital and Eastern Finland Laboratory Centre were compiled. The data comprised information gathered in first trimester DS screening [age of the mother, serum hCG free beta subunit (fbeta-hCG) and pregnancy-associated plasma protein A (S-PAPP-A) levels and the nuchal translucency (NT) of the fetus], body mass index, method of conception [spontaneous or in vitro fertilization (IVF)], TTP (in spontaneous pregnancies), maternal chronic diseases, smoking habits of the mother, outcome of the pregnancy and prior pregnancy complications. Spontaneous pregnancies were classified into three groups by TTP: 0-12 months (the reference group, N = 1164), 13-24 months (N = 112) and > or = 25 months (N = 70). Screening data from IVF pregnancies (N = 39) were collected for comparison. The size of the total study population was 1385. RESULTS: The median/geometric mean multiple of median (MOM) of S-PAPP-A was significantly lower (P < 0.01) in women with a TTP over 25 months (0.89/0.83 MOM) and in the IVF group (0.95/0.84 MOM) compared with the reference group (1.01/1.03 MOM). However, first trimester S-fbeta-hCG and NT MOMs were not statistically different between the study groups. Consequently, the proportion of DS screening positives was significantly higher in women with TTP > or = 25 months (12.9 versus 2.1%), but not in the IVF group (2.6%). CONCLUSIONS: A TTP of over 2 years altered the levels of DS screening serum markers to levels similar to those observed in IVF pregnancies, with a decrease in PAPP-A levels compared with the reference group. These results raise the possibility that such changes could be related to subfertility rather than to the use of assisted reproductive technology.

Under-attending free antenatal care is associated with adverse pregnancy outcomes.

BACKGROUND: Most pertinent studies of inadequate antenatal care concentrate on the risk profile of women booking late or not booking at all to antenatal care. The objective of this study was to assess the outcome of pregnancies when free and easily accessible antenatal care has been either totally lacking or low in number of visits. METHODS: This is a hospital register based cohort study of pregnancies treated in Kuopio University Hospital, Finland, in 1989 - 2001. Pregnancy outcomes of women having low numbers (1-5) of antenatal care visits (n = 207) and no antenatal care visits (n = 270) were compared with women having 6-18 antenatal visits (n = 23137). Main outcome measures were: Low birth weight, fetal death, neonatal death. Adverse pregnancy outcomes were controlled for confounding factors (adjusted odds ratios, OR: s) in multiple logistic regression models. RESULTS: Of the analyzed pregnant population, 1.0% had no antenatal care visits and 0.77% had 1-5 visits. Under- or non-attendance associated with social and health behavioral risk factors: unmarried status, lower educational level, young maternal age, smoking and alcohol use. Chorio-amnionitis or placental abruptions were more common complications of pregnancies of women avoiding antenatal care, and pregnancy outcome was impaired. After logistic regression analyses, controlling for confounding, there were significantly more low birth weight infants in under- and non-attenders (OR:s with 95% CI:s: 9.18 (6.65-12.68) and 5.46 (3.90-7.65), respectively) more fetal deaths (OR:s 12.05 (5.95-24.40) and 5.19 (2.04-13.22), respectively) and more neonatal deaths (OR:s 10.03 (3.85-26.13) and 8.66 (3.59-20.86), respectively). CONCLUSION: Even when birth takes place in hospital, non- or under-attendance at antenatal care carries a substantially elevated risk of severe adverse pregnancy outcome. Underlying adverse health behavior and possible abuse indicate close surveillance of the newborn.

Smoking in early gestation or through pregnancy: a decision crucial to pregnancy outcome.

OBJECTIVE: To assess maternal risk profile and pregnancy outcome of women who continued to smoke, reduced smoking to less than five cigarettes per day or did not smoke during pregnancy. METHODS: We analyzed a population-based database of 26,414 singleton pregnancies from 1989 to 2001. Odds ratios (ORs) for adverse pregnancy outcomes were obtained from multiple logistic regression models. RESULTS: The prevalence of smoking in early pregnancy was 25.7% and went down to 12.7% at 20 weeks of pregnancy. Women who smoked were more often young, primiparous or unmarried, used alcohol and more often had prior pregnancy terminations than women who did not smoke. Women who reduced smoking were mostly primiparous, and they also quit using alcohol. Continuing to smoke was associated with elevated risks of small-for-gestational-age infants (SGA) (OR 2.11), preterm birth (OR 1.15) and perinatal death (OR 1.15). SGA was avoided by reducing smoking, but not prematurity (OR 1.18) or elevated risk of perinatal death (OR 1.18). CONCLUSION: Smoking in early gestation and through pregnancy is associated with adverse pregnancy outcomes, and some of the harmful effects can be avoided by reducing smoking, although the behavioral risk profile of those who reduced smoking is closer to that of smokers than of non-smokers.

Obstetric outcome in post-term pregnancies: time for reappraisal in clinical management.

BACKGROUND: The objective of this study was to determine the outcome of pregnancy in post-term cases compared with term cases in a well defined population receiving modern obstetric care. METHODS: We utilized the population-based birth registry data of the Kuopio University Hospital (1990-2000) to investigate pregnancy outcome in 1,678 post-term singleton pregnancies. The general obstetric population (n=22,712) was used as a reference group in logistic regression analysis. RESULTS: The overall frequency of post-term pregnancies was 6.9% and the incidence of post-term pregnancies was found to be increased in obese, primiparous, and smoking women, whereas in women with chronic diseases and obstetric risks deliveries were induced earlier. The risks of macrosomia, maternal complications, and operative deliveries were increased in post-term pregnancies. Post-term infants experienced meconium passage (21.2% versus 12.8%) (p<0.01) and intrapartum asphyxia (3.4% versus 2.1%) (p<0.01) significantly more often than the controls. However, the stillbirth rate was low, probably due to careful monitoring of these pregnancies. CONCLUSIONS: Although high-risk pregnancies were not allowed to come post-term, postmaturity per se is a moderate risk state compromising fetal well-being with regard to meconium passage and acid-base status at birth. We conclude that simple antenatal monitoring beyond 42 weeks reduces perinatal mortality but is inefficient in reducing meconium-stained liquor seen with increasing gestation.

Induced abortion: not an independent risk factor for pregnancy outcome, but a challenge for health counseling.

PURPOSE: Low birth weight (LBW), preterm births, abnormal placentation, and miscarriages have been associated with prior induced abortions. An incidence-related effect has been suggested. The objective of this study is to assess the effects of prior induced abortions on obstetric risk factors and pregnancy outcome in conditions of free high-standard maternity care used by almost the entire pregnant population in Finland. METHODS: We analyzed a population-based database including 26,976 singleton pregnancies from 1989 to 2001, of which 2364 were among women with one prior induced abortion and 355 women had had at least two prior induced abortions. Data included maternal risk factors, pregnancy characteristics, and obstetric outcome measures and were based on results of a self-administered questionnaire at 20 weeks of pregnancy and clinical records. Odds ratios (ORs) concerning pregnancy outcomes were calculated in multiple logistic regression analysis. RESULTS: Induced abortions were associated with several known pregnancy risk factors; specifically, maternal age older than 35 years, unemployment, unmarried status, low educational level, smoking, alcohol consumption, overweight condition, and chronic illnesses. Preterm birth (OR, 1.19; 95% confidence interval, 1.01-1.41) in women with one prior abortion (7.3% versus 6.2%) and LBW (OR, 1.54; 95% confidence interval, 1.02-2.32) in women with two or more prior abortions (7.0% versus 4.7%) appeared to be more common, but after logistic regression analysis, we found no evidence of adverse pregnancy outcomes. CONCLUSIONS: Induced abortion is not an independent risk factor for adverse obstetric outcome. Marked health behavioral pregnancy risks are associated with prior induced abortions. Health counseling of these women is a challenge, but this objective has not yet been achieved.

Fetal macrosomia--a continuing obstetric challenge.

BACKGROUND: Macrosomic fetuses represent a continuing challenge in obstetrics. OBJECTIVES: We studied maternal risk factors of fetal macrosomia and maternal and infant outcome in such cases. METHODS: A retrospective cohort study was carried out with a total of 26,961 singleton pregnancies between 1989 and 2001. Records of 886 mothers who gave birth to live born infants weighing > or =4,500 g were compared to those of 26,075 mothers with normal weight (<4,500 g) infants. Multiple regression analysis was used to identify independent reproductive risk factors. Perinatal complications were also assessed. RESULTS: The incidence of fetal macrosomia was 3.4%. Diabetes, previous macrosomic birth, postdatism (>42 weeks of gestation), obesity (BMI > 25 before pregnancy), male infant, gestational diabetes mellitus, and non-smoking were independent risk factors of fetal macrosomia, with adjusted risks of 4.6, 3.1, 3.1, 2.0, 1.9, 1.6, 1.4, respectively. In the macrosomic group, birth and maternal traumas occurred significantly more often than in the control group. However, records of subsequent pregnancies (n = 250) after the study period showed that a previous uncomplicated birth appeared to decrease complication risks. CONCLUSIONS: Most cases of fetal macrosomia occur in low-risk pregnancies and evaluation of maternal risks cannot accurately predict which women will eventually give birth to an overweight newborn. After an uncomplicated birth of a macrosomic infant, vaginal delivery may be a safe option for the infant and mother.

Does unemployment in family affect pregnancy outcome in conditions of high quality maternity care?

BACKGROUND: The influence of unemployment in the family on pregnancy outcome is controversial. Only a few studies have involved investigation of the effect of unemployment of the father on pregnancy. The objective of this study was to assess the effects of unemployment of one or both parents on obstetric outcome in conditions of free antenatal care attended by the entire pregnant population. METHODS: The data of 24,939 pregnancies included maternal risk factors, pregnancy characteristics and outcome, and was based on a self administered questionnaire at 20 weeks of pregnancy and on clinical records. RESULTS: Unemployment was associated with adolescent maternal age, unmarried status and overweight, anemia, smoking, alcohol consumption and prior pregnancy terminations. Multivariate logistic regression analysis indicated that after controlling for these maternal risk factors small differences only were found in pregnancy outcomes between unemployed and employed families. Unemployed women had significantly more often small-for-gestational-age (SGA) infants, at an OR of 1.26 (95% CI: 1.12-1.42) whereas, in families where both parents were unemployed, the risk of SGA was even higher at an OR of 1.43 (95% CI: 1.18-1.73). Otherwise, pregnancy outcome was comparable in the groups studied. CONCLUSION: Free antenatal care was unable to fully overcome the adverse pregnancy outcomes associated with unemployment, SGA risk being highest when both parents are unemployed.