Do infants with major congenital anomalies have an excess of macrosomia?

BACKGROUND: Infants that develop congenital anomalies may also have an excess prevalence of macrosomia (birth weight > or =4,000 g). This may indicate that abnormalities of glycemic control play a role in the etiology of birth defects. This study was undertaken to determine whether all infants with congenital anomalies have an excess of macrosomia and whether it is confined to specific types of anomalies. METHODS: A case-control study was conducted, comparing the birth weights of 8,226 infants with congenital anomalies ascertained by the Texas Birth Defects Monitoring Division with those of 965,965 infants without birth defects. Odds ratios were calculated to determine the association between birth weight and congenital anomalies, for 45 specific defects, and for all these defects combined. RESULTS: For all 45 defects combined, a significant association occurred only in the highest birth weight category. Infants with congenital anomalies were more likely than infants without birth defects to have a birth weight > or =4,500 g (OR = 1.65; 95% CI = 1.39-1.96). Infants born with ventricular septal defects, atrial septal defects, ventricular hypertrophy, or anomalies of the great vessels were 1.5-2.5 times more likely to weigh > or =4,000 g than were infants without birth defects. Based on small numbers, a stronger excess of macrosomia was observed for infants with encephalocele, holoprosencephaly, anomalies of the corpus callosum, preaxial polydactyly, and omphalocele. CONCLUSIONS: Our data suggest that infants with specific congenital anomalies are more likely to be macrosomic than are infants without an anomaly. If these findings are confirmed, associations between macrosomia and specific types of birth defects may help to identify birth defects that are caused by alterations in glycemic control.

Understanding the Hispanic paradox.

PURPOSE: This paper reviews the literature on the nature of the Hispanic paradox and the major explanations provided for it. We conclude by suggesting directions for future research. DATA IDENTIFICATION AND STUDY SELECTION: Articles were selected by a systematic review procedure using Medline (1966 through 1999) and Sociological Abstracts (1963 through 1999), as well as focused searches on specific diseases or factors believed to influence Hispanic health. FINDINGS: For the past twenty years there has been widespread evidence of an Hispanic paradox in the United States, in which most Hispanic groups are characterized by low socioeconomic status, but better than expected health and mortality outcomes. A closer look reveals variations by age, gender, Hispanic subgroup, acculturation, country of birth, and cause of death. Possible under-reporting of Hispanic deaths, "salmon bias" and healthy migrant effects, and risk profile may contribute to, but do not explain, the paradox. The reasons for this paradox are likely to be multifactorial and social in origin. CONCLUSIONS: Empirical studies should be conducted on the protective effects of immigrant status, identification with a subculture, interaction between acculturation and socioeconomic status, and supportive aspects of Hispanic culture.

Psychosocial factors associated with teenage pregnancy in Jamaica.

The self-esteem and perceived maternal care and control of 134 Jamaican schoolgirls and 108 pregnant adolescents and teenage mothers were compared. The girls were 14 through 17 years of age, from working-class backgrounds, and living in rural and urban areas. Adapted versions of the Coopersmith Self-Esteem Inventory and the Parental Bonding Instrument were administered. Results indicated that the two groups did not differ in perceived maternal care and control. However, the self-esteem of urban schoolgirls was significantly higher than that of their once-pregnant counterparts. This was also true of the total sample. Urban teenagers without father figures were nearly 2.7 times more likely to have been pregnant than were those living with adult male relatives. Thus, father-figure absence and low self-esteem may combine as risk factors for teenage pregnancy in urban Jamaica.

Psychosocial factors associated with teenage pregnancy in Jamaica

The self-esteem and perceived maternal care and control of 134 Jamaican schoolgirls and 108 pregnant adolescents and teenage mothers were compared. The girls were 14 through 17 years of age, from working-class backgrounds, and living in rural and urban areas. Adapted versions of the Coopersmith Self-Esteem Inventory and the Parental Bonding Instrument were administered. Results indicated that the two groups did not differ in perceived maternal care and control. However, the self-esteem of urban schoolgirls was significantly higher than that of their once-pregnant counterparts. This was also true of the total sample. Urban teenagers without father figures were nearly 2.7 times more likely to have been pregnant than were those living with adult male relatives. Thus, father-figure absence and low self-esteem may combine as risk factors for teenage pregnancy in urban Jamaica. (AU)