Clustering of Socioeconomic, Behavioural, and Neonatal Risk Factors for Infant Health in Pregnant Smokers

Background: Tobacco smoking is a major cause of morbidity and mortality, including during pregnancy. Although effective ways of promoting smoking cessation during pregnancy exist, the impact of these interventions has not been studied at a national level. We estimated the prevalence of smoking throughout pregnancy in the Netherlands and quantified associations of maternal smoking throughout pregnancy with socioeconomic, behavioural, and neonatal risk factors for infant health and development. Methodology/Principal Findings: Data of five national surveys, containing records of 14,553 Dutch mothers and their offspring were analyzed. From 2001 to 2007, the overall rate of smoking throughout pregnancy fell by 42% (from 13. 2% to 7. 6%) mainly as a result of a decrease among highly educated women. In the lowest-educated group, the overall rate of smoking throughout pregnancy was six times as high as in the highest-educated group (18. 7% versus 3. 2%). Prenatal tobacco smoke exposure was associated with increased risk of extremely preterm (≤28 completed weeks) (OR 7. 25; 95% CI 3. 40 to 15. 38) and small-for-gestational age (SGA) infants (OR 3. 08; 95% CI 2. 66 to 3. 57). Smoking-attributable risk percents in the population (based on adjusted risk ratios) were estimated at 29% for extremely preterm births and at 17% for SGA outcomes. Infants of smokers were more likely to experience significant alcohol exposure in utero (OR 2. 08; 95%CI 1. 25 to 3. 45) and formula feeding in early life (OR 1. 91; 95% CI 1. 69 to 2. 16). Conclusions: The rates of maternal smoking throughout pregnancy decreased significantly in the Netherlands from 2001 to 2007. If pregnant women were to cease tobacco use completely, an estimated 29% of extremely preterm births and 17% of SGA infants may be avoided annually. © 2009 Lanting et al

Changes in quality of life into adulthood after very preterm birth and/or very low birth weight in the Netherlands

BACKGROUND: It is important to know the impact of Very Preterm (VP) birth or Very Low Birth Weight (VLBW). The purpose of this study is to evaluate changes in Health-Related Quality of Life (HRQoL) of adults born VP or with a VLBW, between age 19 and age 28. METHODS: The 1983 nationwide Dutch Project On Preterm and Small for gestational age infants (POPS) cohort of 1338 VP (gestational age <32 weeks) or VLBW (<1500 g) infants, was contacted to complete online questionnaires at age 28. In total, 33.8% of eligible participants completed the Health Utilities Index (HUI3), the London Handicap Scale (LHS) and the WHOQoL-BREF. Multiple imputation was applied to correct for missing data and non-response. RESULTS: The mean HUI3 and LHS scores did not change significantly from age 19 to age 28. However, after multiple imputation, a significant, though not clinically relevant, increase of 0.02 on the overall HUI3 score was found. The mean HRQoL score measured with the HUI3 increased from 0.83 at age 19 to 0.85 at age 28. The lowest score on the WHOQoL was the psychological domain (74.4). CONCLUSIONS: Overall, no important changes in HRQoL between age 19 and age 28 were found in the POPS cohort. Psychological and emotional problems stand out, from which recommendation for interventions could be derived

Maternal mortality after cesarean section in The Netherlands

Background. To assess cesarean section-related maternal mortality in The Netherlands during 1983-1992. Methods. A nationwide confidential enquiry into the causes of maternal death. Results. The risk of dying after vaginal birth was 0.04 per 1000 vaginal births (65/1.763.999) compared to 0.53 per 1000 cesarean births (57/108.587). The direct risk of dying from cesarean section was 0.13 per 1000 operations (14/108.587). In some women cesarean section did not initiate, but contributed to, the train of events leading to death. Adding this associated risk to the direct risk gives a fatality rate of 0.28 per 1000 cesarean births (30/108.587). Conclusions. Although cesarean section is a relatively safe procedure nowadays, birth by cesarean section in The Netherlands is seven limes more hazardous than vaginal birth. Keeping the cesarean birth rate as low as possible is therefore in the interest of women of reproductive age

Social lifestyle, risk-taking behavior, and psychopathology in young adults born very preterm or with a very low birthweight

\u3cp\u3eOBJECTIVE: To assess social lifestyle, risk-taking behavior, and psychopathology in young adults born very preterm or with a very low birthweight.\u3c/p\u3e\u3cp\u3eSTUDY DESIGN: This study was part of the 19-year follow-up in a large ongoing collaborative study in The Netherlands (the POPS study) on the long-term outcome of prematurity and dysmaturity. 656 adolescents from the POPS study without serious handicap were compared with peers in the general population in lifestyle, risk-taking behavior, psychopathology, and social participation.\u3c/p\u3e\u3cp\u3eRESULTS: Adolescents from the POPS study smoked significantly less than their peers. Compared with their peers, boys from the POPS study consumed alcohol less often, and girls from the POPS study consumed alcohol approximately as often. Lifetime drug-use was significantly lower than in the reference group. With the exception of fare-dodging, criminal behavior in POPS adolescents was significantly lower than in control subjects. Boys had more trouble in establishing a relationship. The clinical psychopathology reported by POPS subjects was not significantly higher than in control subjects.\u3c/p\u3e\u3cp\u3eCONCLUSION: Adolescents born very preterm or with a very low birthweight without serious disabilities engaged less in risk-taking behavior, did not show more psychopathology, but had more difficulties in establishing social contacts. The latter might be attributable to a more prominent internalizing behavior.\u3c/p\u3

Prevalence of smoking throughout pregnancy in the Netherlands 2001–2007.

<p>Prevalence of smoking throughout pregnancy in the Netherlands 2001–2007.</p

Prevalence of smoking throughout pregnancy by level of formal education (low, intermediate or high) in the Netherlands 2001–2007.

<p>Prevalence of smoking throughout pregnancy by level of formal education (low, intermediate or high) in the Netherlands 2001–2007.</p

(Multinomial) logistic regression analysis of maternal smoking status throughout pregnancy on preterm birth and intrauterine growth in the Netherlands 2001–2007.

<p>OR. Odds ratio.</p><p>CI. Confidence interval.</p>*<p>Odds ratios are adjusted for maternal social factors (age, single motherhood, level of formal education country of birth). Results on gestational age are also adjusted for parity and gender of the newborn.</p>$<p>Extremely preterm: ≤28 completed weeks; very preterm: 28–31; moderately preterm: 32–36 weeks; term ≥37.</p