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

Increase in Prevalence of Overweight in Dutch Children and Adolescents: A Comparison of Nationwide Growth Studies in 1980, 1997 and 2009

To assess the prevalence of overweight and obesity among Dutch children and adolescents, to examine the 30-years trend, and to create new body mass index reference charts. Design: Nationwide cross-sectional data collection by trained health care professionals. Participants: 10,129 children of Dutch origin aged 0-21 years. Main Outcome Measures: Overweight (including obesity) and obesity prevalences for Dutch children, defined by the cut-off values on body mass index references according to the International Obesity Task Force. Results: In 2009, 12.8% of the Dutch boys and 14.8% of the Dutch girls aged 2-21 years were overweight and 1.8% of the boys and 2.2% of the girls were classified as obese. This is a two to three fold higher prevalence in overweight and four to six fold increase in obesity since 1980. Since 1997, a substantial rise took place, especially in obesity, which increased 1.4 times in girls and doubled in boys. There was no increase in mean BMI SDS in the major cities since 1997. Conclusions: Overweight and obesity prevalences in 2009 were substantially higher than in 1980 and 1997. However, the overweight prevalence stabilized in the major cities. This might be an indication that the rising trend in overweight in the Netherlands is starting to turn. © 2011 Schönbeck et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Development, Problem Behavior, and Quality of Life in a Population Based Sample of Eight-Year-Old Children with Down Syndrome

OBJECTIVE: Children with Down syndrome (DS) have delayed psychomotor development. We investigated levels of development, problem behavior, and Health-Related Quality of Life (HRQoL) in a population sample of Dutch eight-year-old children with DS. Developmental outcomes were compared with normative data of eight-year-old children from the general population. METHOD: Over a three-year-period all parents with an eight-year-old child with DS were approached by the national parent organization. Developmental skills were assessed by means of the McCarthy Scales of Children's Ability. To measure emotional and behavioral problems we used the Child Behavior Checklist. HRQoL was assessed with the TNO-AZL Children's Quality of Life questionnaire. Analyses of variance were applied to compare groups. RESULTS: A total of 337 children participated. Mean developmental age was substantially lower than mean calendar age (3.9 years, SD 0.87 and 8.1 years, SD 0.15 respectively). Mean developmental age was significantly lower among boys than girls (3.6 (SD 0.85) and 4.2 years (SD 0.82) respectively; p<0.001). Compared with the general population, children with DS had more emotional and behavioral problems (p<0.001). However on the anxious/depressed scale, they scored significantly more favorably (p<0.001). Significantly lower HRQoL scores for the scales gross motor skills, autonomy, social functioning and cognitive functioning were found (p-values<0.001). Hardly any differences were observed for the scales physical complaints, positive and negative emotions. CONCLUSION: Eight-year-old children with DS have an average developmental delay of four years, more often have emotional and behavioral problems, and have a less favorable HRQoL compared with children from the general population

70-річчя члена-кореспондента НАН України В.П. Моторного

28 липня виповнилося 70 років видатному математику членові-кореспондентові НАН України Віталію Павловичу Моторному

Male predominance in fetal distress during labor

OBJECTIVE: The purpose of this study was to assess the association between fetal sex and the occurrence of fetal distress during labor. STUDY DESIGN: This was a prospective cohort study that incorporated data about 423,033 singleton pregnancies from the national perinatal database for secondary obstetric care in The Netherlands. All singleton pregnancies on record that were delivered under the responsibility of obstetricians in The Netherlands between January 1, 1990, and December 31, 1994, were analyzed. Data about fetal sex, gestational age at delivery, birth weight, fetal distress during labor, mode of delivery, signs of asphyxia at birth, and perinatal death were collected. The associations between sex and the occurrence of operative delivery for fetal distress, low 5-minute Apgar score (score, 0-3), and perinatal death were evaluated by logistic regression analysis. RESULTS: Male fetuses are at increased risk for fetal distress during labor, for low Apgar scores, and for perinatal death. After adjustment for fetal birth weight and gestational age at delivery, the odds ratios were 1.48, 1.27, and 1.27, respectively. All three associations were highly statistically significant (P <.0001). CONCLUSION: Male fetuses are at increased risk during labor and deliver

Regional Variation in Prevalence of Oral Cleft Live Births in the Netherlands 1997-2007: Time-Trend Analysis of Data from Three Dutch Registries

The Eurocat registry Northern Netherlands (NNL) has been used in regional context, as well as in national/international context, to describe the epidemiology of oral clefts (OC). However, the region NNL seems to have prevalence data different fromDutch national registries and certain other European areas. Thismay be due to differences in registration methods or geographical variation. To investigate whether the prevalence of OC live births varies regionally in the Netherlands, we established time trends for NNL and the rest of the Netherlands over 1997-2007 using data from two national registries (the OC Registry and The Netherlands Perinatal Registry) and a regional registry (Eurocat NNL). We found that the overall live-birth prevalence-comprising cleft lip/alveolus +/- cleft palate and cleft palate only-was significantly higher in NNL (15.1-21.4 per 10,000) than in the rest of the Netherlands (13.2-16.1 per 10,000). None of the registries showed significant trends for NNL, whereas both national registries showed that the live-birth prevalence of cleft lip/alveolus +/- cleft palate decreased significantly in the rest of the Netherlands. Despite some differences in prevalence between the registries, they showed similar regional variation in prevalence and trends. In conclusion, the prevalence of OC live births varies significantly in the Netherlands, not only between but also within registries. This underlines that extrapolation of regional cleft data should be done with caution. To further investigate OC etiology and evaluate preventive strategies, future studies should consider geographical differencesbetween and within countries-regarding the various cleft sub-phenotypes among live births, stillbirths, and pregnancy terminations. (C) 2011 Wiley Periodicals, Inc