Preterm birth in the first pregnancy and risk of neonatal death in the second pregnancy: a propensity score-weighted matching approach.

The study purpose was to assess the relationship between various grades of preterm birth (moderate preterm: 33-36 weeks; severe preterm: 27-32 weeks; extreme preterm: ≤ 26 weeks) in the first pregnancy and neonatal mortality (death within 28 days of birth; early: 0-7 days; late: 8-28 days) in the second pregnancy. Using the Missouri maternally-linked dataset (1989-2005), a population-based, retrospective cohort analysis with propensity score-weighted matching was conducted on mothers with two consecutive singleton live births (n = 310,653 women). Women with a prior preterm birth were more likely to subsequently experience neonatal death. The odds increased in a dose-dependent pattern with ascending severity of the preterm event in the first pregnancy (moderate preterm: AOR = 1.32; 95% CI: 1.10-1.60; severe preterm: AOR = 2.62; 95% CI: 2.01-3.41; extreme preterm: AOR = 5.84; 95% CI: 4.28-7.97; p value for trend < 0.001). However, the pathway for the relationship between prior preterm birth and subsequent neonatal mortality may be the recurrence of preterm birth.

All-cause infant mortality and the risk for subsequent preterm birth.

AIM: The aim of this paper was to assess the association between all-cause infant mortality (death<365 days) in the first pregnancy and the risk of preterm birth (<37 weeks of gestation) in the second pregnancy. METHODS: Using the Missouri maternally linked dataset from 1989 to 2005 (N.=639134 singleton live births), we conducted a population-based retrospective cohort analysis with women who had two singleton births between 1989 and 2005. We employed Cox Proportional Hazards Regression to generate adjusted hazard ratios (AHR) and 95% confidence intervals (CI) to approximate relative risks. RESULTS: Prior infant mortality was associated with an increased risk for preterm birth in the second pregnancy (AHR=1.96, 95% CI=1.80-2.13). For black women, the risk of preterm birth following infant mortality was more than three-fold (AHR=3.37, 95% CI=2.92-3.89), while the risk for white women was twice as high (AHR=2.04, 95% CI=1.86-2.26) (referent=white women without infant death in the first pregnancy). CONCLUSION: Women with a history of infant mortality are at risk for preterm birth in subsequent pregnancies. This risk was significantly elevated for black women. These findings provide further evidence that previous childbearing experiences play a critical role in the occurrence of adverse feto-infant outcomes.

The association between female genital mutilation and intimate partner violence.

OBJECTIVE: To determine whether female genital mutilation (FGM) is a risk factor for intimate partner violence (IPV) and its subtypes (physical, sexual and emotional). DESIGN: Population-based cross-sectional study. SETTING: The study used the 2006 Demographic and Health Survey (DHS) conducted in Mali. POPULATION: A total of 7875 women aged 15-49 years who responded to the domestic violence and female circumcision modules in the 2006 administration of the DHS in Mali. METHODS: Multivariable logistic regression was used to compute adjusted odds ratios (aOR) and 95% confidence intervals (CI) to measure risk for IPV. MAIN OUTCOME MEASURES: The outcomes of interest were IPV and its subtypes. RESULTS: Women with FGM were at heightened odds of IPV (aOR 2.71, 95% CI 2.17-3.38) and IPV subtypes: physical (aOR 2.85, 95% CI 2.22-3.66), sexual (aOR 3.24, 95% CI 1.80-5.82), and emotional (aOR 2.28, 95% CI 1.68-3.11). The odds of IPV increased with ascending FGM severity (P for trend <0.0001). The most elevated odds were observed among women with severe FGM, who were nearly nine times as likely to experience more than one IPV subtype (aOR 8.81, 95% CI 5.87-13.24). CONCLUSIONS: Study findings underscore the need for multi-tiered strategies, incorporating policy and education, to reduce FGM and IPV, potentially improving the holistic health and wellbeing of Malian women.

Infant mortality and subsequent risk of stillbirth: a retrospective cohort study.

OBJECTIVE: To examine the association between infant mortality in a first pregnancy and risk for stillbirth in a second pregnancy. DESIGN: Population-based, retrospective cohort study. SETTING: Maternally linked cohort data files for the state of Missouri. POPULATION: Women who had two singleton pregnancies in Missouri during the period 1989-2005 (n = 320 350). METHODS: Women whose first pregnancy resulted in infant death were compared with those whose infant from the first pregnancy survived the first year of life. The Kaplan-Meier product limit estimator was employed to compare probabilities for stillbirth in the second pregnancy between both groups of women. Adjusted hazard ratios (AHRs) and 95% confidence intervals (95% CIs) were generated to assess the association between infant mortality in the first pregnancy and stillbirth in the second pregnancy. MAIN OUTCOME MEASURES: Exposure was defined as infant mortality in the first pregnancy, and the outcome was defined as stillbirth in the second pregnancy. RESULTS: Women with prior infant deaths were about three times as likely to experience stillbirth in their subsequent pregnancy (AHR 2.91; 95% CI 2.02-4.18). White women with a previous infant death were nearly twice as likely to experience a subsequent stillbirth, compared with white women with a surviving infant (AHR 1.96; 95% CI 1.13-3.39). Black women with a previous infant death were more than four times as likely to experience subsequent stillbirth, compared with black women with a surviving infant (AHR 4.28; 95% CI 2.61-6.99). CONCLUSIONS: Previous infant mortality results in an elevated risk for subsequent stillbirth, with the most profound increase observed among black women. Interconception care should consider prior childbearing experiences to avert subsequent fetal loss.