Serial translabial sonographic measurement of cervical dimensions between 24 and 34 weeks' gestation in pregnant Thai women.

OBJECTIVE: To assess serial changes of cervical dimensions in pregnant Thai women between 24 and 34 weeks' gestation by translabial sonography. METHODS: A longitudinal study of cervical dimensions obtained by translabial sonography at 24, 28, 30, 32, and 34 weeks' gestation in 144 women was conducted. The gestational age at labor was recorded and women were defined as having preterm labor or term labor according to whether there was onset of true labor pain before or after 37 completed weeks, respectively. Cervical changes over time were analyzed by repeated ANOVA. The associations between cervical dimensions and gestational age, parity and prepregnancy body mass index were calculated by multiple linear regression analysis. RESULTS: Cervical length decreased whereas cervical width increased as gestational age advanced. Cervical length and width in women with term labor, but only cervical length in women with preterm labor, changed significantly throughout the period of 24-34 weeks' gestation (P < 0.01). The cervix was significantly longer in parous women and in women with a body mass index of more than 26 kg/m2, but was shorter in women of advanced gestational age. The cervix was significantly wider in parous women and in those of advanced gestational age. Weekly crude rate, adjusted for parity and prepregnancy body mass index, of both cervical length shortening and cervical width widening was 0.4 mm in women with term labor. Women with preterm labor had cervical shortening of 0.5 mm per week. CONCLUSIONS: Gestational age, parity and prepregnancy body mass index are significantly associated with the dynamic changes of cervical length and width in Thai women. These factors should be considered when assessing normal values of cervical dimensions and for predicting the risk of preterm delivery.

Socioeconomic and work related determinants of pregnancy outcome in southern Thailand.

STUDY OBJECTIVE: To examine the effect of socioeconomic status on pregnancy outcome in an urbanised area in a rapidly developing country. METHODS: A cohort of 1797 pregnant women who attended antenatal care clinics at the two 700 bed hospitals in Hatyai city was recruited from September 1994 to November 1995. The pregnant women were followed up from the 17th week of gestation until delivery. The socioeconomic indicators selected were family socioeconomic status, maternal education, maternal occupation, family income and work exposure characteristics based upon Karasek's job content questionnaires. Pregnancy outcomes were birth weight, low birth weight, small for gestational age and preterm delivery. MAIN RESULTS: Mean birth weight correlated with socioeconomic status and income but after adjustment for parity, maternal age and height, weight at delivery day, baby sex, obstetrical complications and antenatal care utilisation, only family income remained correlated with birth weight. No association with any socioeconomic status indicators was found when using dichotomous outcome (low birth weight, small for gestational age or preterm delivery). Only high psychological job demand was associated with small for gestational age. Confounder adjustment indicated that the observed social status differences in pregnancy outcomes were mainly attributable to mother's characteristics and antenatal service use. CONCLUSIONS: Socioeconomic indicators alone were not associated with reduced fetal growth or preterm delivery in this study, which recruited mainly lower or middle class women. Karasek's psychological job demand was only weakly correlated with small for gestational age infant.

The effect of heavy maternal workload on fetal growth retardation and preterm delivery. A study among southern Thai women.

Heavy maternal workloads are considered to be hazardous to the fetus. The effects of physical activity during pregnancy on low birth weight (LBW), small for gestational age (SGA), and prematurity were assessed from a sample of 1797 women in a follow-up study at the antenatal clinic of two hospitals in southern Thailand. The women were interviewed twice, at 17 and 32 gestational weeks. Outcome data were obtained from medical records and the newborn gestational age determined using Dubowitz's score. The risk of SGA was elevated for women working > 50 hours/week, squatting in work, commuting > 1 hour/day, and having high psychological job demands; the risk of preterm delivery was increased with obstetrical complications. Women who worked long hours and had demanding work conditions had an elevated risk of giving birth to SGA infants but not of preterm delivery.

Are long working hours and shiftwork risk factors for subfecundity? A study among couples from southern Thailand.

OBJECTIVE: To estimate the effect of long working hours and shift work on time to pregnancy. METHODS: Cross sectional samples with retrospective data collection from two 700 bed hospitals at secondary to tertiary care level in Hatyai district, Songkhla Province, Thailand. The study was conducted from March 1995 to November 1995 among 1496 pregnant women attending the antenatal clinics. Subfecundity was defined as time to pregnancy longer than 7.8, 9.5, or 12 months (time to pregnancy was calculated from the date at which the couples started having sexual relations without any contraception until last menstrual date). RESULTS: The descriptive analyses were restricted to 1201 planned pregnancies and the analytical part to 907 working women. Separate analyses on primigravid women were also done. Logistic regressions adjusted for age, education, body mass index, menstrual regularity, obstetric and medical history, coital frequency, and potential exposure to reproductive toxic agents, showed an odds ratio (OR) associated with female exposure to long working hours of 2.3 (95% confidence interval (95% CI) 1.0 to 5.1) in primigravid and 1.6 (1.0 to 2.7) in all pregnant women. Male exposure to long working hours and shiftwork showed no association with subfecundity. The OR of subfecundity was highest when both partners worked > 70 hours a week irrespective of the cut off point used (OR 4.1 (95% CI 1.3 to 13.4) in primigravid women; OR 2.0 (95% CI 1.1 to 3.8) in all pregnant women). CONCLUSIONS: Long working hours is a risk factor for subfecundity especially for women. Shiftwork was not associated with subfecundity in this study.

Fecundity in Thai and European regions: results based on waiting time to pregnancy.

Very little is known about the frequency of subfecundity in different cultures, ethnic groups and regions. To fill this gap, the European Study Group on Infertility and Subfecundity established data on the prevalence of infertility and subfecundity in five European regions. In this study, a comparison of fecundity was made between 4035 Caucasian women from five European countries and 1496 Asian women from southern Thailand. Fecundity was measured using 'time to pregnancy', i.e. the time women took to conceive after stopping contraceptive methods. The Thai primigravid women had a shorter time to pregnancy than European women, whereas time to pregnancy was found to be longer among Thai multigravidae, although this was not statistically significant. This study has illustrated that cross-culture comparison of subfecundity is difficult despite using a common protocol and questionnaire because of differences in the use of contraceptive methods and a different concept of pregnancy planning. The distribution of time to pregnancy for the Thai women was not outside the variation found within the European samples.

PIP: Little is known about the frequency of subfecundity in different cultures, ethnic groups, and world regions. The European Study Group on Infertility and Subfecundity compared fecundity between 4035 Caucasian women from five European countries (Denmark, Germany, Sweden, Italy, and France) and 1496 Asian women from southern Thailand. Fecundity was measured as the time women took to conceive after stopping contraceptive usage. About 40% of women in both groups were pregnant for the first time. 52% of Thai women with no prior live birth, compared with only 20% of Europeans, had never used contraception. The most commonly used contraceptive methods among Thai women were Depo-Provera injection (51.3%), withdrawal (21.1%), and condoms (13.8%); European women were most likely to have used condoms (28.9%), safe period (25.6%), and withdrawal (22.6%). 16.1% of the European group and 17.5% of the Thai group had a time to pregnancy exceeding 12 months. Although the differences were not statistically different, Thai primigravid women had a shorter time to pregnancy than European women while Thai multigravidae had a longer time. The crude odds ratio of subfecundity (time to pregnancy more than 9.5 months) among primigravid women was 0.8 (95% CI, 0.6-1.0) in Thai couples compared with European women and 1.2 (95% CI, 1.0-1.5) among multigravid women. Although the distribution of time to pregnancy for the Thai women was not outside the variation found within European samples, subfecundity is presumed caused by a different mix of exposures in the two cultural settings.

A survey into process and worker's characteristics in the wood furniture industry in Songkhla Province, southern region of Thailand.

A cross-sectional survey of the wood furniture industry was conducted in southern Thailand in February 1993. The aim was to examine the manufacturing process, occupational hazards at the workplace, workers' demographic characteristics, period of employment, incidence rate of work related injury and some reproductive history of workers. Altogether 69 managers and 1,000 workers participated in the study. There are 2 main types of wood industry, rubberwood and hardwood. The rubberwood industry is semi-automated with advanced technology, has a female-dominated workforce of 200-300 workers per factory and overseas-market orientation. The hardwood industry is based in small-scale workplaces ranging from 20 to 60 workers, domestic-market orientation and has a male-dominated workforce. Most of the workers were young, single, of low education and were high turnover rate laborforce, with arduous work and long working hours per week. Solvent was the most frequent chemical exposure. The person-year incidence of chemical exposure in female workers was higher than in male workers for every group of chemicals. The incidence of accidents was twice as high as the official rate. The standardized fertility ratio of female wood workers was only 51.6% of that of the Thai female population. There was a high abortion rate among women who became pregnant inside the wood industry compared to that among pregnancies outside the wood factory. Wood industry workers were exposed to occupational hazards and accident-prone work conditions.

Is moderate alcohol intake in pregnancy associated with the craniofacial features related to the fetal alcohol syndrome?

Social drinking in pregnancy is common in many countries despite the fact that alcohol in high doses has teratogenic properties. The public health implications would be appreciable if even moderate alcohol consumption were associated with embryonal or fetal maldevelopment. A presumably sensitive marker of an alcohol effect was used in this study, namely the fetal craniofacial features included in the Fetal Alcohol Syndrome. The study was based upon self-reported alcohol intake and photographs taken at birth or at 18 months of children born to mothers with a low or moderate alcohol intake during pregnancy. These women were selected during pregnancy by a two-stage sampling from all in well defined regions. Data were available concerning 323 pregnant women and some 200 to 220 children. A short palpebral fissure, a short nose to upper-lip distance and a broad root of the nose were expected to be associated with alcohol intake in early pregnancy, but such an association was only seen between binge drinking and a short palpebral fissure. No associations proved statistically significant at the 18-month examination and any association could merely be secondary to the known association between alcohol and birth weight.