Risk factors for small for gestational age births in Ahmedabad, India.

Intra-uterine growth retardation is an important public health problem in many developing countries. The authors conducted a case-control study of low birth weight (LBW) in three teaching hospitals and a population survey in Ahmedabad city, India during 1987-1988. To identify and quantify risk factors for small for gestational age births, we divided the low birth weight and control infants into small for gestational age (SGA, n = 617) and appropriate for gestational age (AGA, n = 1851) using an Indian birth weight by gestational age standard. Logistic regression was used to estimate adjusted odds ratios for important risk factors. Prevalence of risk factors was estimated from a community sample survey of mothers (n = 1102) who had delivered in the past year. Attributable risks were calculated from odds ratios and prevalence data. The most important risk factors for SGA was poor maternal nutritional status (weight < 51 kg) with an attributable risk of 42 per cent. Other significant risk factors were anaemia, primiparity, poor obstetric history, lack of antenatal care and hypertension during pregnancy, and birth defects, each of which contributed only moderately to the attributable risk. The analysis indicates that improvement of maternal nutrition and antenatal care might prevent a substantial portion of SGA births in this and similar populations.

Plasma prolactin in patients with colorectal cancer. Value in follow-up and as a prognosticator.

BACKGROUND: Preoperative plasma prolactin and carcinoembryonic antigen (CEA) levels were assessed to monitor disease recurrence and to identify low-risk and high-risk patients with Dukes B or C colorectal cancer. METHODS: Prolactin and CEA were estimated by radioimmunoassay method. Blood samples were collected preoperatively and sequentially thereafter from patients with colorectal cancer (N = 114); the samples were compared with samples from age-matched healthy control subjects (smokers and nonsmokers, N = 45). For rest of the analysis, patients with Dukes A disease (N = 7) were not included because of the small number. In monitoring recurrences, the criteria for positive test for the two markers was a continual increase in the marker level after an initial decrease or persistent high level of the marker. These were the indicators of relapse or no response to treatment. To determine the efficacy of the preoperative markers, the patients were grouped according to disease status at the end of 3 years, i.e., patients who had response to the treatment modalities (N = 52) and patients who later had progressive disease (N = 55). To determine the prognostic significance of preoperative marker levels, the patients were divided according to the cutoff levels (upper normal limits); for prolactin the cutoff level was 20.0 ng/ml plasma, and for CEA it was 5.0 ng/ml plasma. RESULTS: Both of the markers were significantly high in patients with colorectal cancer compared with the markers of their respective control subjects (P < 0.0001). In monitoring disease course, the predictive power of prolactin was 100%, whereas that of CEA was 66%. Prolactin showed a lead time of 2-3 months. Preoperative prolactin levels were significantly higher in patients who later had progressive disease (P < 0.001) than in patients who had response to the treatments. However, such an intergroup variation was not observed for CEA. Patients with preoperative levels of prolactin greater than 20.0 ng/ml had shorter overall survival times than did those with prolactin levels less than 20.0 ng/ml plasma; such a trend was not observed for patients with CEA levels less than 5.0 ng/ml and those with CEA levels greater than 5.0 ng/ml plasma. CONCLUSION: Prolactin is a better overall marker than is CEA in patients with Dukes B or C colorectal cancer. The authors recommend the use of plasma prolactin levels to help identify low-risk and high-risk patient subgroups so that high-risk patients may be followed up more intensely and treated accordingly. Hyperprolactinemic patients with Dukes B or C disease have shortened survival time.

Risk factors for preterm and term low birthweight in Ahmedabad, India.

To identify and quantify risk factors for preterm and term low birthweight (LBW) we conducted a hospital-based case-control study, linked with a population survey in Ahmedabad, India. The case-control study of 673 term LBW, 644 preterm LBW cases and 1465 controls showed that low maternal weight, poor obstetric history, lack of antenatal care, clinical anaemia and hypertension were significant independent risk factors for both term and preterm LBW. Short interpregnancy interval was associated with an increased risk of preterm LBW birth while primiparous women had increased risk of term LBW. Muslim women were at a reduced risk of term LBW, but other socioeconomic factors did not remain significant after adjusting for these more proximate factors. Estimates of the prevalence of risk factors from the population survey was used to calculate attributable risk. This analysis suggested that a substantial proportion of term and preterm LBW births may be averted by improving maternal nutritional status, anaemia and antenatal care.

PIP: In 1987-1988, researchers compared data on 1317 low birth weight (LBW) infants and 1465 control infants born in 3 teaching hospitals in Ahmedabad, India to calculate attributable risk (AR) for factors contributing to low birth weight. 673 of the infants were full term yet LBW due to intrauterine growth retardation. 644 of LBW infants were preterm births. They also conducted a population survey in Ahmedabad to estimate the prevalence of risk factors. LBW prevalence stood at 30%. Low maternal weight, poor pregnancy history, lack of prenatal care, clinical anemia, and hypertension were all significant independent risk factors for term and preterm LBW infants (p.05). Primiparous women were more likely to have a term LBW infant than other women (p.05). Interpregnancy intervals =or 6 months was more likely to result in delivery of a preterm LBW infant than longer interpregnancy intervals (p.05). Muslim women were at a much lower risk of delivering a term LBW infant than were Hindu women (p.05). Other than primiparity for term LBW infants (AR=21.9%), maternal weight between 41-45 kg was the single greatest risk factor for LBW (AR=21.5% for term and 19.8% for preterm). Yet low maternal weight had greater adjusted odds ratios (OR) than did maternal weight between 41-45 kg (OR=6.9 and 6.2 vs. OR=3.1 and 2.9). Maternal weight was used to measure nutritional status. Clinical anemia also carried a high Ar, especially for term LBW infants (3.7-8.2% vs. 2.8-7.3% for preterm infants). Another risk factor with considerable AR was no prenatal care (5.8% for term and 14.4% for preterm). These results emphasized the need for health and nutrition interventions to reduce the incidence of both preterm and term LBW infants in urban India.

Levels and risk factors for perinatal mortality in Ahmedabad, India.

To estimate levels and determinants of perinatal mortality, we conducted a hospital-based surveillance and case-control study, linked with a population survey, in Ahmedabad, India. The perinatal mortality rate was 79.0 per 1000, and was highest for preterm low-birth-weight babies. The case-control study of 451 stillbirths, 160 early neonatal deaths and 1465 controls showed that poor maternal nutritional status, absence of antenatal care, and complications during labour were independently associated with substantially increased risks of perinatal death. Multivariate analyses indicate that socioeconomic factors largely operate through these proximate factors and do not have an independent effect. Estimates of attributable risk derived from the prevalence of exposures in the population survey suggest that improvements in maternal nutrition and antenatal and intrapartum care could result in marked reductions of perinatal mortality.

PIP: Levels and risk factors for perinatal mortality in Ahmedabad, India, were investigated through an approach that combined institutional surveillance, a case-control survey, and a linked population-based survey. In the three government teaching hospitals in Ahmedabad, there were 15,893 births in July 1987-June 1988, of which 739 were stillbirths and 517 were early (within the first week of life) neonatal deaths. The case-control study collected detailed data on 451 of these stillbirths and 160 of the early neonatal deaths while the population-based survey covered 1102 women who delivered in the study period. The perinatal mortality rate in the study hospitals was 79/1000 births (46.4/1000 for stillbirths and 34.1/1000 for early neonatal deaths). The relative risk of perinatal mortality was 21.1 (95% confidence interval, 17.8-25.2) for preterm low-birthweight infants compared to full-term normal-birthweight babies, but only 2.6 (2.1-3.2) for full-term low-birthweight infants. Multivariate analysis indicated that the risks of both stillbirth and early neonatal mortality were significantly increased by a history of previous stillbirth, prematurity in the last pregnancy, low maternal weight, clinical anemia, no prenatal care, vaginal bleeding during pregnancy, elevated diastolic blood pressure, convulsions, antepartum hemorrhage, breech delivery, Cesarean section delivery, and congenital malformations. Socioeconomic factors such as low maternal education, agricultural occupation, and lack of a toilet lost all significance after adjustment for confounding factors. Overall, these findings suggest that improved maternal nutrition and antenatal/intrapartum care could have a substantial impact on reducing perinatal mortality in India.