High environmental temperature and preterm birth: a review of the evidence.

OBJECTIVE: to examine the evidence in relation to preterm birth and high environmental temperature. BACKGROUND: this review was conducted against a background of global warming and an escalation in the frequency and severity of hot weather together with a rising preterm birth rate. METHODS: electronic health databases such as: SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for research articles, that examined preterm birth and high environmental temperature. Further searches were based on the reference lists of located articles. Keywords included a search term for preterm birth (preterm birth, preterm, premature, <37 weeks, gestation) and a search term for hot weather (heatwaves, heat-waves, global warming, climate change, extreme heat, hot weather, high temperature, ambient temperature). A total of 159 papers were retrieved in this way. Of these publications, eight met inclusion criteria. DATA EXTRACTION: data were extracted and organised under the following headings: study design; dataset and sample; gestational age and effect of environmental heat on preterm birth. Critical Appraisal Skills Programme (CASP) guidelines were used to appraise study quality. FINDINGS: in this review, the weight of evidence supported an association between high environmental temperature and preterm birth. However, the degree of association varied considerably, and it is not clear what factors influence this relationship. Differing definitions of preterm birth may also add to lack of clarity. KEY CONCLUSIONS: preterm birth is an increasingly common and debilitating condition that affects a substantial portion of infants. Rates appear to be linked to high environmental temperature, and more especially heat stress, which may be experienced during extreme heat or following a sudden rise in temperature. When this happens, the body may be unable to adapt quickly to the change. As global warming continues, the incidence of high environmental temperature and dramatic temperature changes are also increasing. This situation makes it important that research effort is directed to understanding the degree of association and the mechanism by which high temperature and temperature increases impact on preterm birth. Research is also warranted into the development of more effective cooling practices to ameliorate the effects of heat stress. In the meantime, it is important that pregnant women are advised to take special precautions to avoid heat stress and to keep cool when there are sudden increases in temperature.

Women's experience of becoming caregivers to their ill partners: Gadamerian hermeneutics.

The recent morbidity trends in Australia indicate a steep rise in the number of individuals living with chronic illness who rely on the assistance of mostly women carers. Consequently, supporting and promoting carers' health should be a priority to sustain their health, and ensure their ability to provide care to a significant other. This interpretive hermeneutic study explored the lived experience of women during the transition of becoming carers to their male partners with various health conditions. Gadamerian hermeneutics were used to research participants' experiences allowing for interpretations that incorporated understandings of both worlds, those of the researcher and the participants. This negotiation of understandings made it possible to create mutual and new knowledge. The phenomenon 'entering transition' revealed itself as a precarious balance between a sense of loss and coping with the life changing situation. Yearning to preserve that equilibrium, the women did not wish to be considered as carers to their partners but expressed a need for maintaining the cohesiveness of their identity as part of a couple. One of the recommendations arising out of this study is that a different approach is needed to assist nurses and other health professionals to support this specific population of women carers in the community and in hospital settings.

Advanced maternal age and adverse perinatal outcome: a review of the evidence.

OBJECTIVE: To examine the evidence in relation to advanced maternal age (35-39 years), physiological risk and adverse perinatal outcome (stillbirth, low birth weight, preterm birth) in high-income countries. BACKGROUND: This review was conducted against a background of increasing maternal age (>35 years) and concerns for fetal and maternal welfare among this group. Consequent to these concerns, increasing trends of birth intervention such as caesarean section and instrumental birth are seen. Although evidence justifies a high rate of intervention among women aged more than 40 years, the evidence for such intervention in women aged 35-39 years is sketchy and often contradictory. METHODS: A systematic review was conducted of studies in English, that were published between 2000 and 2010. Studies were included if they had extractable data on maternal age (35-39 years) and perinatal outcomes. Of 102 retrieved publications, nine met these criteria. FINDINGS: Evidence from this review suggests that rates of adverse perinatal outcome, such as stillbirth, are linked to maternal age 35-39 years. However, rates of increase are modest until 40 years of age or more. The impact of changing maternal socio demographics appears to be of importance but is not yet well understood. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although risk and rates of adverse perinatal outcome are increased among women aged 35-39 years, midwives and women should also be aware that perinatal outcomes are generally favourable for this group. There is also some suggestion in the literature that social advantage may ameliorate some of the effect of advanced maternal age on perinatal outcome. Further research is required to evaluate the soundness and strength of this association.