Perinatal mortality in Scotland: 1970-9

Cumulative impact of early maternal marital age during the childbearing period

Early marriage of girls, close to age of menarche, is a widespread practice in Arab countries. Knowledge on the cumulative effect of early maternal marriage on maternal and infant health during the childbearing period is insufficient. The objectives of this study were to estimate the prevalence of early maternal marriage in Jeddah, identify its relation with other maternal risk factors, and investigate the cumulative impact of early maternal marriage on subsequent maternal health and pregnancy outcomes throughout the reproductive period. Data were collected from six randomly selected primary health care units in Jeddah City. Married women with an infant < or = 12 completed months of age were interviewed and information on sociodemographic characteristics, maternal health and previous pregnancy outcomes were collected. Early marriage of girls before the age of 16 years accounted for 26.5% of the study population and was reported by a third of mothers currently below the age of 20 years. Illiterate mothers, housewives, multiparae, smokers and those married to a relative reported the highest proportion of marriages before their sixteenth birthday. Those who married before the age of 16 were at about double the risk of developing chronic diseases and experiencing miscarriage, stillbirths and infant deaths. These results suggest that early maternal marriage still exists in our community and is intimately related to other maternal risk factors. Maternal marriage < 16 years appears to be fraught with insecurities for the mother and infant throughout the whole length of the childbearing period and not merely the first pregnancy. Thus, even if culture norms claim early marriage of girls, it should be discouraged before the age of 16 years. Moreover, it is recommended that future research on maternal and infant health considers the cumulative effect of the various risk factors during the whole reproductive period and not only a single pregnancy outcome.

[Inequalities in mortality in the barrios of Barcelona, 1983-89]

This study is aimed to describe the differences in mortality among the 38 wards of the city of Barcelona for the period 1983-89. Mortality data for years 1983 to 1989 came from the death certificates. The indicators used for the 38 city wards and the 10 city districts were: Comparative Mortality Figure, Ratio, Ratio of Potential Years of Life Lost, and Life Expectancy at birth. A descriptive analysis of these indicators by wards and district is offered; a cluster analysis based on these indicators was also performed. Wards from the same district are considered homogeneous for a given indicator, when all ward's values are higher, equal or lower to district average. The ward with the most unfavourable indicators and worst situation was Montjuïc, an exponent of shanty town problems until few years ago and located near the centre. Next in ranking, from worst to best situation, did appear the four wards of the city centre district, the old historical quarter. Other wards with high mortality rates were some peripheral areas, nearly all built recently such as Ciutat Meridiana, Bon Pastor and Zona Franca, and also other old wards, such as Poble Sec. Cluster analysis classified the wards with higher mortality in several different clusters, clearly split from the other more homogeneous wards. Five of 10 districts have been considered as homogeneous. This study has allowed a deeper knowledge of the geographical distribution of mortality in the city of Barcelona, until now analysed by city districts.

Secular trends in the effect of socio-economic factors on birth weight and infant survival in Sweden

Time trends in the effect of socio-economic factors on low birth weight, stillbirth, perinatal deaths and deaths up to the age of one were studied using a medical birth registry linked to census information from 1975, 1980, and 1985. For each census year, delivery outcome the following year was studied. Two socio-economically different groups of women were studied, defined by occupation/education, cohabitation, and citizenship--one privileged and one under-privileged group. A difference in birth weight distribution was found between the two groups which is only partly explainable by different smoking habits in early pregnancy and did not substantially change during the ten year observation period. In 1976, there was virtually no difference in infant mortality between the two groups. In 1981 and 1986, infant mortality had decreased in both groups but more strongly so in the privileged group, and a difference between the groups therefore appeared.

Time trends in neonatal mortality among twins and singletons in New York City, 1968-1986

The objective of this study was to compute yearly neonatal mortality rates (NMRs) in twins and compare these to rates in singletons during the same time period. The focus was on time trends in birthweight-specific twin mortality in the birth population of New York City during the years 1968 to 1986. The study population was all twin livebirths greater than or equal to 500 g birthweight (N = 45,605), with a comparison group of all singleton livebirths in the same birthweight range (N = 2,191,144). Data came from the New York City Department of Health's computerized vital records on livebirths and infant deaths. Between 1968 and 1986 the crude NMR declined 39% in twins and 47% in singletons. In twins there were birthweight-specific declines of 69% to 84% between 1000 g and 2499 g. However, there was only a 19% decline in the twin NMR over 2499 g. This contrasts with a 50% decline in the singleton NMR over 2499 g. In New York City, modern medical care has been remarkably successful in lowering the NMR in low birthweight twins. However, more effort must be made to understand the etiology of perinatal problems in twins with birthweights greater than 2500 g.

Infant, neonatal, postneonatal and perinatal mortality in Spain, 1975-1984. Interregional and interannual differences

The national infant, neonatal, postneonatal and perinatal mortality in Spain does not reflect the differences which exist among regions. The aim of the present study is to demonstrate and to quantify these differences, as well as their annual trends. We have also attempted to define groups of regions presenting similar rates. The results of the study confirmed a decrease in all mortality rates during the analyzed period. Regions were grouped according to their rates. Differences between the top and the bottom groups (with the lowest and the highest rates, respectively) resulted in statistical significance. However, the differences between these and the middle groups were not sharply defined. In addition, a clear geographic aggregation was evidenced in both top and bottom groups. These differences are mainly due to economic and sanitary factors.

Perinatal mortality and mother's marital status at birth in subsequent siblings

The effect of marital status on perinatal mortality is studied for births in Norway, 1967-1981, in terms of relative risk (RR) of unmarried vs. married mothers. The births were linked in units of sibships. At first birth, RR decreased from 1.86 in 1967-1971 to 1.32 in 1977-1981. At second birth the perinatal mortality varied greatly according to marital history with a RR of 2.03 when comparing sibships where mothers were unmarried at both pregnancies with mothers married at both pregnancies. Almost no excess risk was demonstrated for mothers that were married at second birth, but unmarried at first. These mothers appeared to have no excess risk even at the first birth in spite of being unmarried. The results suggest that marital status is still a risk factor to be considered, even in the Scandinavian countries where the marginal effect of marital status in recent years has been reported to be low. To an increasing extent, the high risk women, previously identified by marital status, are now hidden in a larger low risk group which apparently has more stable family relations, e.g. tending to be married at second birth.

Factors affecting the outcome of maternity care. 1. Relationship between staffing and perinatal deaths at the hospital of birth

This is the first of two papers describing a retrospective study of maternity hospitals in an English health region using data for the years 1977-83. The research was designed to investigate the relationship between resources (such as staff and equipment) and the outcomes of births at maternity units. Considerable variation in medical and nursing staffing levels in the units in the study was observed. Regression analysis suggests that, after taking account of differences in very low weight births at each unit, the level of paediatric staffing at a maternity unit is a significant factor in explaining differences in "in house" mortality. There was no identifiable relationship between staff categories other than paediatricians and the rate of perinatal death at the hospital of delivery. As selective referral and transfers between hospitals may affect the interpretation of these findings, a second paper follows presenting the results of a further analysis that adjusts both resources and outcomes to take account of neonatal transfers.

Unmarried at delivery. II. Perinatal morbidity and mortality

The British Birth Survey included 98% of all deliveries in Great Britain in one week of April 1970. For this report, singleton births to 934 Single (never-married), 301 Once-married (widowed, separated or divorced) and 15 225 Married mothers were compared. After allowing for maternal age, parity and smoking history, there was still a reduction in birth weight in the two unmarried groups, which was mainly associated with pre-term gestation rather than growth retardation. Perinatal mortality was considerably elevated, especially for the Once-married. The excess mortality was mainly among the 'Macerated normally formed stillbirths' and 'Asphyxia' categories of the Wigglesworth classification.

Changing patterns of perinatal and infant mortality in Western Australia: implications for prevention

Perinatal and infant mortality rates have fallen dramatically in the developed world this century. A review of perinatal and infant mortality in Western Australia from 1970 to 1981 was undertaken, to examine trends in birthweight-specific and cause-specific rates. The predominant causes of death are now congenital malformation, stillbirth of unknown cause, preterm birth and cot death. Perinatal and infant mortality rates are unlikely to be reduced substantially until the reasons for these four causes of death are elucidated.

Influence of maternal age, parity and social class on perinatal mortality in Scotland: 1960-82

This paper examines secular changes in the influence of maternal age, parity and social class on perinatal mortality in Scotland. Despite changes in reproductive behaviour, improved access to maternity services and more effective perinatal care, the influence of maternal age and social class on perinatal mortality remained unchanged between 1960 and 1982. Although there were no significant changes in the traditional J-shaped association between parity and stillbirths, cross-sectional analysis shows that in the early 1980s the risk of both neonatal and perinatal deaths decreased as parity increased: this finding is consistent with the pattern of risks observed in longitudinal studies and retrospective surveys of reproductive histories. The stability of age, parity and social class effects thus suggests that little if any of the overall decrease in Scottish perinatal mortality can be attributed to a significant narrowing of relative risks in the obstetric population.

A comparative analysis of birthweight for gestational age standards

The possible consequences of the use of various birthweight-for-gestational age standards in a local population were investigated. Birthweight-for-gestational age standards based on the analysis of 55 387 births occurring to women resident in the area of the Greater Glasgow Health Board (GGHB) between 1975 and 1979 were estimated. The Glasgow based standard was then compared with a number of growth standards reported for other populations, including the widely adopted standards of Thomson et al. (1968). The relative performance of each standard when applied to the Glasgow population was assessed by calculating the sensitivity, specificity and predictive value of the various standards vis-à-vis the distribution of light-for-dates infants defined according to the Glasgow standard. The results suggest that both the accurate assessment of fetal growth at birth and the evaluation of screening procedures for antenatal detection of growth retardation require growth standards reflecting the pattern of fetal growth and development in the population at risk.

An audit of caesarean section in a maternity district

A prospective study of the clinical indications for caesarean sections performed in a large specialist maternity hospital was carried out during the first 3 months of 1981; similar information was collected retrospectively for 1976 and 1971. Demographic changes in the obstetric population were considered. The district section rate increased from 4.4-13% in the last decade. The three most important clinical indications contributing to the rise of caesarean section in primiparae were cephalopelvic disproportion, slow progress and breech presentation. The rate of sections began to fall during the audit and has continued to decrease in the months since. Although it is rather early to draw conclusions, this trend may reflect the critical attention focused on section policy during the period of the study.