Determinants of female fecundity and outcome of pregnancy : epidemiological cohort studies to the effects of age, biometry and life style habits

Becoming a mother is no more a matter of destiny only, but increasingly a matter of choice as wel!. Until recently, having children was as natura! as eating, drinking and dying. Children just "happened" during the course of (married) life. However in modem societies life does not just "happen" any more; life is organized around the assumption that men and women should fee! free to choose the goals in their Jives and the ways to achieve such a goal, in other words: to plan their Jives ahead. With the general availability of education, it was possible for women also to achieve a professional goal through a career path. With the availability of contraception, especially since the introduetion of the pill in the sixties, it was possible to design a reproductive "career" as to the question: Do I want children at all; if yes how many and when? In order to abserve changes in societal trends, the disciplines of epidemiology and demography are more suitable than the medica! sciences. A medica! doctor has been educated for the "exception", the individual patient approach and not for the "rule". Demograpbic data show that of those Dutch females who are now fifty years of age or older, about 10% have remairred childless. Of those, now 40 years old, 15% has nat had a child yet. The Netherlands Central Bureau of Stalistics prediets a further increase in childlessness at 40 to about 20-25% for females bom after 1965. Because there are no indications that infertility among females, who are currently 40 years of age, is higher than in previous generations, it seems that voluntary childlessness has risen considerably among women1 Thus an increasing number of women appear to plan a career of non-reproduction. However the women who do plan a reproductive "career" do not only opt for fewer children than in the past, but also that the child should be perfect, in impeccable state. A realm of prenatal screening services are developed to distinguish during early pregnancy between the affected and unaffected fetus; leaving the subsequent decision to carry the pregnancy to term to the individual parents. In other words a desired pregnancy does not necessarily lead to a desireful pregnancy outcom

Moderate drinking : No impact on female fecundity

Objective: To determine the effect of moderate alcohol intake on probability of conception. Design: Prospective cohort study. Setting: Normal healthy women enrolled in an artificial donor insemination program. Patients: Women starting artificial donor insemination for the very first time were selected. Interventions: Alcohol exposure was measured through a self- administered questionnaire at intake of study. Main Outcome Measure: A first positive pregnancy test as indicative for conception. Results: Women with moderate alcohol intake had a slightly higher, though not significant, probability of conception compared with nondrinkers (Hazard Ratio 1.20; 95% confidence interval 0.90 to 1.60). Conclusion: Moderate alcohol intake has no negative impact on female fecundity

Social class, ethnicity and other risk factors for small for gestational age and preterm delivery in the Netherlands

Social class and ethnicity are important risk factors for small-for-gestational-age and preterm delivery in many countries. This study was performed to assess whether this is also the case in the Netherlands, a country with a high level of social security, relatively small income differences and easy access to medical care for all its inhabitants. Other risk factors that were taken into account were smoking, drinking, occupation, age and height. Information was collected by interview in the first 3 weeks of life of the mothers of 2027 (response 97%) live-born singletons born in the period from April 1988 to October 1989 in the study area. After adjustment for possible confounding factors very low social class, compared with high social class, was significantly associated with reduced birthweight (-4.0%; 95% CI, -7.4% to -0.7%), but not with preterm delivery (OR, 2.09; 95% CI, 0.67-6.48). The adjusted birthweight of Turkish infants (2.7%; 95 CI, -1.1% to 6.5%) and the adjusted birthweight of infants from Suriname or the Antilles (-1.6%; 95% CI, -5.5% to 2.1%) were not significantly different compared with infants of Dutch mothers. After adjustment, the frequency of preterm birth was lower in Turkish infants, but not significantly (OR, 0.22; 95% CI, 0.04-1.10), whereas the frequency of preterm birth in infants from Suriname or the Antilles was significantly higher (OR, 2.51; 95% CI, 1.04-6.08) compared with Dutch infants. Of the other factors the main risk factors were smoking (negatively related with birthweight) and maternal age. Mothers aged 40 years and older had an increased risk (OR, 5.53; 95% CI, 1.72-17.77) of preterm delivery compared with mothers of 20-29 years. After adjustment, higher maternal height was significantly associated with higher birthweight, but also with a decreased risk of preterm delivery. We conclude that in the Netherlands infants of very low social class are at increased risk for low birthweight for gestational age and that a background from Suriname or the Antilles is associated with an increased risk for preterm delivery. Taller mothers not only have heavier infants, but these infants also appear to be less often premature. Older mothers are at increased risk for preterm delivery