Risk and protective factors in early child development: Results from the All Our Babies (AOB) pregnancy cohort.

BACKGROUND: Understanding factors that protect against early developmental delay among children who are experiencing adversity can inform prevention and early intervention strategies. AIMS: To identify risk factors for development delay at one year and protective factors for developmental delay in 'at risk' environments (poor maternal mental health and socio-demographic risk). METHODS AND PROCEDURES: Data was analyzed from 3360 mother-child dyads who participated in the All Our Babies (AOB) pregnancy cohort. Participants completed four questionnaires spanning pregnancy to one year postpartum and provided access to medical records. Risk factors for developmental delay at age one were identified using bivariate methods and multivariable modeling. Protective factors for child development in 'at risk' family environments were identified using bivariate analyses. OUTCOMES AND RESULTS: At one year, 17% of children were developmentally delayed, defined as scoring in the monitoring zone on at least 2 of the 5 developmental domains of the Ages and Stages Questionnaire. Prenatal depression, preterm birth, low community engagement, and non-daily parent-child interaction increased the risk of delay. Protective factors for children in 'at risk' environments included relationship happiness, parenting self-efficacy, community engagement, higher social support, and daily parent-child interaction. CONCLUSIONS AND IMPLICATIONS: The study results suggest that maternal and infant outcomes would be improved, even for vulnerable women, through identification and intervention to address poor mental health and through normalizing engagement with low cost, accessible community resources that can also support parent-child interaction.

Health care costs of persons with newly diagnosed hepatitis C virus: a population-based, observational study.

The objective of this paper was to conduct an analysis of the health services costs for persons who have been diagnosed with hepatitis C, from the time of diagnosis. Data were based on 1230 persons diagnosed with hepatitis C in 1998 in the Capital Health region of Alberta. Identifiers and dates of diagnosis were sent to Alberta Health and Wellness where records were linked to those of physician visits and billings, as well as hospital (inpatient and outpatient) visit records. Costs were assigned to all visits, and data were analysed for one pre- and two post-diagnosis years. Total cost per person increased from $2630 (Canadian) to $3514 between the pre- and first post-diagnosis year. They then returned to $2694 in the second post-diagnosis year. Liver-related costs were a low portion of the total in all periods, though they increased following diagnosis. Mental-health related costs were the largest component. Observational data present a more balanced picture of the costs of persons with hepatitis C, though most current estimates are not based on such data. Our results indicate that, when analysed within the picture of the entire person, liver-related costs (which have been the focus of most studies to date) are the tip of the iceberg.

Factors influencing childbearing decisions and knowledge of perinatal risks among Canadian men and women.

BACKGROUND: Women age 35 and older account for an increasing proportion of births and are at increased risk of having difficulties conceiving and of delivering a multiple birth, low birth weight infant, and/or preterm infant. Little is known about men's and women's understanding of the maternal age related risks to pregnancy. OBJECTIVES: 1) To determine the factors influencing the timing of childbearing for non-parenting men and women, 2) to determine knowledge among non-parenting men and women about maternal age-related reproductive risks, the consequences of low birth weight and multiple birth, and issues related to infertility, and 3) to determine characteristics associated with limited knowledge of these reproductive risks. METHODS: An age-stratified random sample of individuals, aged 20-45 years and without children, completed a computer-assisted telephone interview from two urban regions of Alberta, Canada (1006 women and 500 men). RESULTS: Factors that influenced timing of childbearing for both men and women included: financial security (85.8%) and partner suitability to parent (80.2%). Over 70% of men and women recognized the direct relationship between older maternal age and conception difficulties. Less than half knew that advanced maternal age increased the risk of stillbirth, caesarean delivery, multiple birth and preterm delivery. CONCLUSIONS: Poor understanding of the links between childbearing after age 35, pregnancy complications and increased risk of adverse infant outcomes limits adults' ability to make informed decisions about timing of childbearing.

The content of prenatal care and its relationship to preterm birth in Alberta, Canada.

Prenatal care is universally acknowledged as the hallmark of preventive care for pregnant women, and it is commonly assumed to have a positive influence on birth outcomes. The results of studies that have examined the impact of prenatal care on adverse birth outcomes, however, have been equivocal. These investigations have focused primarily on initiation of prenatal care and its timing, and not on the content of care received. Using data obtained from maternal self-reports and an electronic perinatal database, we examined the relationship between selected components of prenatal care (i.e., medical management, health education, and health advice) and the birth of a preterm infant. We found that health care providers are meeting the clinical guidelines for the medical management of pregnancy, but they are not adequately meeting pregnant women's needs for health education and advice. We found no association between the content of prenatal care and the birth of a preterm infant. Prenatal care must focus more on providing health education and advice to pregnant women.

What do women know about the risks of delayed childbearing?

BACKGROUND: Women aged 35 and older account for an increasing proportion of births and are at increased risk of pregnancy complications and poor infant outcomes. The objectives of the study were: 1) to determine what women know about delayed childbearing, including pregnancy complications and outcomes associated with low birthweight (LBW, < 2500 grams), preterm delivery (< 37 weeks) and multiple birth, and 2) to assess the characteristics of women with limited knowledge of risks. METHODS: A computer-assisted telephone interview survey was conducted with 1,044 randomly selected women who delivered their first live-born infant, between July 2002 and September 2003, in two urban centres, Calgary and Edmonton, in Alberta, Canada. RESULTS: The proportion of women aware of specific childbearing risks associated with advanced maternal age were as follows: conception difficulties (85.3%), multiple birth (24.0%), caesarean section (18.8%), preterm delivery (21.8%), and LBW (11.2%). Knowledge of specific developmental and health-related risks of suboptimal infant outcomes ranged between 18.0% and 46.5%. Logistic regression revealed that limited knowledge of maternal age-related pregnancy risks were associated with unplanned pregnancy (OR, 1.48; 95% CI, 1.03-2.14), smoking (OR, 1.83; 95% CI, 1.29-2.60) and non-use of fertility treatment (OR, 2.15; 95% CI, 1.44-3.19). Characteristics associated with limited knowledge of the risks associated with suboptimal birth outcomes were: age 35-39 years (OR, 2.98; 95% CI, 1.35-6.58), less than post-graduate education (< or = high school OR, 2.14; 95% CI, 1.20-3.82), and not currently enrolled as a student (OR, 1.75; 95% CI, 1.02-3.00). CONCLUSIONS: Many women are generally unaware of the potential consequences of delayed childbearing. There are missed opportunities in preconception counselling and education, which should be addressed to allow for more informed decision-making about family planning.

The relationship between self-reported emotional health, demographics, and perceived satisfaction with prenatal care.

Aims to describe pregnant women with poor emotional health and the relationship between self-reported emotional health and prenatal care satisfaction. To this end, 1,265 women who delivered a live-born singleton infant were interviewed and information abstracted from prenatal records. Concludes that patient assessment of satisfaction with prenatal care may be related to both self-reported emotional health and delivery of medical care. Identifying and addressing emotional health of prenatal patients may improve compliance with medical recommendations, ultimately improving health outcomes.

Do maternal characteristics and past pregnancy experiences predict preterm delivery among women aged 20 to 34?

OBJECTIVE: To identify key demographic, lifestyle, and medical indicators for preterm births in women aged 20 to 34. METHODS: A population-based, case-control study consisting of 987 women aged 20 to 34, who delivered a liveborn singleton infant at <37 weeks' gestation in Alberta between May 1999 and August 2000. Controls delivered liveborn infant(s) at > or =37 weeks' gestation. Information was obtained from computer-assisted telephone interviews, and the provincial Physician Notice of Stillbirth/Birth database. Analysis included bivariate and logistic regression techniques. RESULTS: Logistic regression modelling indicated that significant risk factors for preterm delivery included poor past pregnancy outcome (odds ratio [OR] 6.4), poor emotional health (OR 1.8), more than 3 years or less than 1 year between pregnancies (OR 1.4 and 1.9, respectively), polyhydramnios and oligohydramnios (OR 4.1), bleeding at greater than 20 weeks' gestation (OR 10.4), malpresentation (OR 2.9), gestational hyper- tension (OR 2.2), and gestational hypertension with proteinuria (OR 4.4). Women who had fewer than 10 prenatal visits, regardless of attending prenatal classes, were at highest risk of preterm delivery (OR 6.7). CONCLUSIONS: In this population of women aged 20 to 34 years, few prenatal visits, poor emotional health prior to pregnancy, and conditions of the current pregnancy were strongly associated with preterm singleton birth.