Familial occurrence of preeclampsia

We conducted a cohort study on whether preeclampsia during the pregnancy of a mother is a risk factor for preeclampsia during the pregnancy of her daughter. Data from the Medical Birth Registry were combined with data from a local registry of births from 1955 to 1990. We could identify the births of 22,768 elder daughters and 2,959 younger daughters. These daughters had also experienced at least one delivery. If the mother had preeclampsia during her pregnancy with an elder daughter, then the elder daughter had an increased risk for preeclampsia in her first pregnancy (relative risk (RR) = 1.7; 95% confidence interval (CI) = 1.3-2.2). This increased risk persisted into the elder daughter's second pregnancy (RR = 1.7; 95% CI = 1.1-2.6). The risks for the daughters were also increased to a similar level if the mother had experienced preeclampsia in any other pregnancy. Furthermore, the risks were similarly elevated if only mothers with firstborn children were included in the analyses. Hence, preeclampsia during the pregnancy of a mother was a risk factor for development of preeclampsia during the pregnancy of her daughters; however, owing to a relatively small population attributable proportion, genetic predisposition explained only a minor part of the occurrence of preeclampsia in this population.

Different tuberculosis in men and women: beliefs from focus groups in Vietnam

After decades in decline, tuberculosis (TB) has been increasing worldwide. In 1993, the World Health Organisation declared TB a global emergency. Passive case-finding is an important part of TB control programmes, and this is strongly affected by people's perceptions and beliefs of TB and society's behaviour towards TB sufferers. The aim of this study was to describe the perceptions and beliefs of Vietnamese people regarding TB and its risk factors with special reference to differences between men and women. Sixteen focus group discussions (FGDs) were organised in four districts representing different regions in Vietnam and consisting of men and women, TB patients and non-TB participants. In general, participants had good knowledge of TB being a dangerous, contagious and infectious disease, caused by germs. However, traditional beliefs in different types of TB still exist, mainly among older people in rural areas, but also resorted to by other people once ill. Four main types of TB were reported: (1) 'Lao truyen' (hereditary TB), handed down from older generations to latter ones through 'family blood', regardless of sexes; (2) 'Lao luc' (physical TB), caused by hard work, more men affected; (3) 'Lao tam' (mental TB), caused by too much worrying-more women affected; and (4) 'Lao phoi' (lung TB), dangerous and caused by TB germs, transmitted through the respiratory system-more men affected. Other general risk factors were also mentioned. Men were perceived to get TB more often than women, as they were more exposed to risk factors during both work and leisure time. These traditional beliefs may contribute to long delays to TB diagnosis and increased social stigma and isolation of TB patients and their families due to erroneous beliefs in transmission routes. Our findings demonstrate areas where TB control programmes may be improved.

Impact of lactation on maternal body weight and body composition

Women worldwide generally lose weight and body fat during lactation. This loss, although increased by longer, more intensive breastfeeding, is modest and may be reduced by increased food intake and decreased activity. Higher parity and older age are associated with greater weight loss postpartum among poorly nourished women. Well-nourished women or those who breastfeed only for a limited time may not return to their prepregnant weight or body composition by the end of the lactation period. Those who are overweight or obese may have difficulty initiating or maintaining lactation. For the majority of women in the world, lactation is unlikely to represent a threat to their health. To advise women on how to optimize their health and lactational performance, one must consider all of the changes in maternal nutritional status that occur during a reproductive cycle, which may or may not compensate for the modest decreases in body weight associated with lactation.

Longer delays in tuberculosis diagnosis among women in Vietnam

SETTING

Study conducted in 23 randomly selected districts in four provinces of Vietnam.

OBJECTIVE

To describe and compare health seeking behaviour between men and women and to measure delays in tuberculosis (TB) diagnosis.

DESIGN

All patients (n = 1027) aged 15-49 years with new smear-positive pulmonary TB detected in the selected districts during 1996 were interviewed using a structured questionnaire.

RESULTS

Mean total delay to TB diagnosis was 13.3 weeks (95% confidence interval [CI] 11.5, 15.1) for women and 11.4 weeks (95% CI 10.6, 12.2) for men, including a patient's delay of 7.9 weeks (95% CI 6.5, 9.3) and 7.6 weeks (95% CI 6.9, 8.3) respectively. Doctor's delay was significantly longer among women (5.4 weeks, 95% CI 4.2, 6.6) than among men (3.8 weeks, 95% CI 3.3, 4.3). Women did not start seeking care later than men, nor did they have a different health seeking pattern. Women visited more health care providers than men (1.7 and 1.5 providers, respectively, P = 0.02).

CONCLUSION

Patient's delay is unacceptably long for both men and women. Women do not receive a diagnosis of TB by doctors or other health care providers as quickly as men once they seek health care. The reasons for this gender difference warrant further investigations.

Wife abuse among women of childbearing age in Nicaragua

OBJECTIVES

This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in León, Nicaragua.

METHODS

A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age.

RESULTS

The lifetime prevalence of spousal violence was 52% among ever-married women (n = 360). Spousal violence was significantly positively associated with poverty, parity, urban residence, and history of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation.

CONCLUSIONS

Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims.

Concurrent Prevalence of Chronic Energy Deficiency and Obesity among Women in Purworejo, Central Java, Indonesia

There are few studies on the nutritional status of nonpregnant women. A population-based, cross-sectional study of nutritional status in 5,817 non-pregnant women 15 to 49 years of age was conducted in Purworejo District, Indonesia, in 1996. Weight, height, mid-upper-arm circumference (MUAC), and triceps skinfold thickness were measured, and information on socio-economic, demographic, and reproductive factors was collected. Seventeen percent of the women had chronic energy deficiency and 11% were obese. Mean weight, MUAC, and triceps skinfold thickness corresponded to the 25th percentile of standards and mean height to the 5th percentile. Obesity was more common among older women and chronic energy deficiency among both the oldest and the youngest women. Women working in agriculture, not using contraceptives, and not owning a television, radio, or refrigerator were more likely to have chronic energy deficiency. In summary, both chronic energy deficiency and obesity existed in Purworejo, and risk factors were identified. Interventions are needed to improve the nutritional status of girls and women before and after pregnancy.

Linking maternal and infant benefits of a nutritional supplement during pregnancy and lactation

To evaluate the effect of a nutritional supplement on change in women's weight during a reproductive cycle and on the difference in birth weight between one infant and the previous one, we analyzed data on 176 complete reproductive cycles from an experiment that was conducted in rural Guatemala. Women with an initial weight <50 kg were classified as marginally nourished or malnourished. Women whose intake of the supplement was in the top 2 tertiles were distinguished from those whose intake was in the lowest tertile. Linear regression modeling was used to estimate the effect of supplementation on these outcomes and to control for confounding factors. Malnourished women gained weight during the reproductive cycle, but their second (study) infant tended to weigh less at birth than their prior-born infant. Higher intakes of supplement were associated with a less negative difference in birth weight. Marginally nourished women lost weight during the reproductive cycle and their second (study) infant tended to weigh more at birth than their prior-born infant. Higher intakes of supplement were associated with a less negative weight [corrected] trend for the women themselves. Well-nourished women and their infants did not show any of these benefits from supplementation. These findings help explain past contradictory findings on maternal depletion as well as on the benefits of nutritional supplementation for mothers and their infants.

Familial occurrence of dystocia

OBJECTIVE

A cohort study was conducted to determine the risk of dystocia for women whose mothers, sisters, or twin sisters had dystocia during childbirth.

STUDY DESIGN

A linked database was constructed between 2 separate Swedish birth registries. Obstetric data on mothers giving birth to daughters during the period 1955 to 1972 were studied. Among these daughters, sister-couples and twins were identified. The daughters subsequently became mothers during 1973 and 1990 and obstetric data on the first deliveries were also studied.

RESULTS

If a mother had dystocia when delivering her eldest daughter, this daughter had an increased risk of dystocia during her own first childbirth (odds ratio 1.7, 95% confidence interval 1.2 to 2.4). If the mother had an assisted instrumental delivery (vacuum extraction, forceps, or cesarean section) because of dystocia, there was a higher risk for her daughter to have an instrumental delivery because of dystocia (odds ratio 1.8, 95% confidence interval 1.0 to 3.1). Among primiparous sisters the risk of an instrumental delivery because of dystocia in a younger sister was more than tripled (odds ratio 3.5, 95% confidence interval 2.1 to 5.8) if her elder sister had a dystocic labor requiring instrumental intervention. The risk among twins increased more than 20-fold (odds ratio 24.0, 95% confidence interval 1.5 to 794.5) if 1 twin sister had dystocia during her first childbirth.

CONCLUSION

Dystocia has a familial occurrence, suggesting a possible genetic factor explaining inefficient uterine action.

Familial patterns in birth characteristics: impact on individual and population risks

BACKGROUND

Familial patterns in reproductive outcome have been suggested previously, but few studies have comprehensively evaluated both length of gestation and types of growth retardation.

METHODS

Information on intrauterine period and birth characteristics for a cohort of Swedish women born 1955-1972 was linked with information on these women's own reproductive experiences during 1973-1990. Familial trends in preterm deliveries, small-for-gestational age (SGA) births and two types of growth retardation were evaluated for mothers relative to their own birth characteristics (n = 4746), relative to their older sisters' deliveries (n = 2931) and among consecutive deliveries of the mothers (n = 14,209). Adjusted relative risks (RR) were calculated from logistic regression analyses.

RESULTS

Mothers who had themselves been preterm at birth were not at increased risk of any of the outcomes studied. Mothers who had themselves been SGA at birth had an almost 50% higher risk (NS) of giving birth to either a preterm or an SGA infant than had mothers who had not been SGA at birth. Mothers tended to repeat the same patterns in subsequent deliveries: RR was 3.7 for a second preterm delivery given a previous one and 7.8 for a second SGA delivery given a previous one. Among SGA siblings, chronic growth retardation was more often repeated than was acute growth retardation. Mothers with an older sister who had given birth to a preterm infant had an 80% higher risk of giving birth to a preterm infant.

CONCLUSIONS

Familial trends in gestational age and body proportions at birth were demonstrated; however, the relatively small population attributable risk per cents in Sweden are discussed.

Images of health and health care options among low income women in Punjab, Pakistan

We studied women's beliefs and experiences of health and health care among 42 women in an urban slum area in Lahore and a village 40 km outside of Lahore. Data were collected through repeated, in-depth interviews in Urdu or Punjabi totalling 200 hours. For triangulation purposes, four focus group discussions with additional women were performed, as well as in-depth interviews with eight mothers-in-law, three traditional practitioners and three medical practitioners. The women's images of health reflected expectations on the women in society. Women from the village and women from the lowest socioeconomic stratum (SES) spoke of health in terms of physical strength; women from the city and women from low SES spoke of health in terms of mental strength; and women from medium SES discussed it in terms of cultural competence. Overall, health had a very low priority in these women's lives. Two health problems were reported by all women: mental tension leading to headache and white vaginal discharge leading to body pains and fatigue. These health problems were seen as part of womanhood; if treatment was sought, it was often from traditional healers. Village women had a flexible, pragmatic attitude toward health care resources and used all types until treated. Their relation to the doctor was specific; they were mostly concerned with the medical treatment. In contrast, city women chose health care providers depending on type of illness, and being met with respect was for them of equal concern. Childbearing experiences influenced the perceptions of health and health care. Mothers of daughters were seen to both need and deserve less food, health care and attention. These mothers were less vocal about health complaints. Women without children spoke of health in terms of physical strength. These women may have less access to health care because children cannot be used as an "excuse", and because they are not worth spending resources on.

A new definition of maternal depletion syndrome

BACKGROUND

Although the term "maternal depletion syndrome" has been commonly used to explain poor maternal and infant health, whether such a syndrome actually exists remains unclear. This uncertainty may be due to the lack of a clear definition of the syndrome and the absence of theoretical frameworks that account for the many factors related to reproductive nutrition.

METHODS

We propose a new definition of maternal depletion syndrome within a framework that accounts for potential confounding factors.

RESULTS

Our conceptual framework distinguishes between childbearing pattern and inadequate diet as causes of poor maternal health; hence, our definition of maternal depletion syndrome has both biological and practical meaning. The new definition is based on overall change in maternal nutritional status over one reproductive cycle in relation to possible depletion and repletion phases and in relation to initial nutritional status.

CONCLUSIONS

The empirical application of this approach should permit the testing of the existence of maternal depletion syndrome in the developing world, and the distinction between populations where family planning will alleviate maternal depletion and those in which an improved diet is also necessary.