Gradients in low birthweight by maternal education: A comparative perspective

Background

Longstanding research has shown strong inequalities in low birthweight by household income. However, most such research has focused on Anglophone countries, while evidence emerging from other developed countries suggest a stronger role of education rather than incomes in creating inequalities at birth. This paper compares gradients in low birthweight by maternal education, as well as explores underlying mechanisms contributing to these gradients, in France, the United States, and the United Kingdom.

Methods

Analyses are based on harmonized data from large, nationally-representative samples from France, UK and US. We use regression models and decomposition methods to explore the relative role of several possible mechanisms in producing birthweight inequalities.

Results

Inequalities in low birth weight across maternal education groups were relatively similar in the United States, the United Kingdom and France. However, the individual-level mechanisms producing such inequalities varied substantially across the three countries, with income being most important in the US, pregnancy smoking being most evident in France, and the UK occupying an intermediate position. Differences in the mechanisms producing birth health inequalities mirror differences in the policy environment in the three countries.

Conclusion

While inequalities in health appear from the earliest moments in many countries, our results suggest research on birth health inequalities, and therefore policies, is not easily generalizable across national contexts, and call for more scholarship in uncovering the "whys" of health inequalities in a variety of contexts.

Educational gradients in the prevalence of medically assisted reproduction births in a comparative perspective

OBJECTIVE

To study educational gradients in births after medical assisted reproduction across five countries with different institutional arrangements.

DESIGN

We use logistic regression and compute predicted probabilities to estimate the association between education and giving birth after assisted reproduction, before and after adjustment for maternal age at delivery and marital/partnership status, using an overall sample of about 3.9 million live births in five countries.

SUBJECTS

This study includes survey or register data containing information on births in five countries: N=61, 564 for Denmark, N= 37,533 for France, N=12,889 for Spain, N= 17,097 for the United Kingdom, and N=3,700,442 for the United States.

INTERVENTION (FOR RCT) OR EXPOSURE (FOR OBSERVATIONAL STUDIES)

None.

MAIN OUTCOME MEASURES

Probability of a child being born after medically assisted reproduction for mothers with a university degree relative to those having less than a university degree.

RESULTS

University educated mothers are more likely to give birth after assisted reproduction compared to mothers with lower levels of education. After adjustment for socio-demographic characteristics, educational differences disappear in the United Kingdom and to some extent Spain, whilst they attenuate but persist in the other countries. The United States seems to show a larger educational gradient.

CONCLUSION

The results suggest that the institutional setting around assisted reproduction may moderate the gradient. A possible explanation may be access to treatments, as the United States - the context with the lowest subsidization - seems to show larger educational gradients than other contexts. In a context of global postponement of childbearing to older ages, mothers with lower levels of socioeconomic resources might find it more difficult to fully realise their fertility intentions in countries with a less generous subsidization of treatments.

Medically assisted reproduction and mental health in adolescence: evidence from the UK Millennium Cohort Study

BACKGROUND

The number and proportion of children conceived through medically assisted reproduction (MAR) is steadily increasing yet the evidence on their mental health in adolescence is inconclusive. Two main mechanisms with opposite effects can explain differences in mental health outcomes by conception mode: while more advantaged parental characteristics could positively influence it, higher parental stress could have a negative influence.

METHODS

Linear and logistic estimations on a longitudinal population-based birth cohort study of 9,897 individuals to investigate whether adolescents conceived through MAR are more likely than naturally conceived (NC) children to experience mental health problems at age 17, as reported by adolescents themselves and their parents. We test whether this association is confounded and/or mediated by parental background characteristics collected when the cohort member was around 9 months old (maternal age, maternal education level, ethnicity, income quintile), family structure variables measured in adolescence (number of siblings in the household at age 15, parental household structure at age 14) or maternal distress at age 14.

RESULTS

Children conceived naturally and through MAR self-reported similar mental health outcomes. The only differences between MAR and NC adolescents are in the parental reports, with parents who conceived through MAR reporting their children had 3.82 (95% CI: 1.140 to 11.54) and 2.35 (95% CI: 1.145 to 4.838) higher odds of falling within the high category of SDQ total difficulties and emotional symptoms scales, respectively. The results did not change on adjustment for mediators, such as maternal distress, number of siblings in the household and parental household structure.

CONCLUSIONS

The results reveal a lack of or small differences in MAR adolescents' mental health outcomes compared to children who were conceived naturally. While the results based on the parental reports could suggest that MAR adolescents are at higher risk of suffering from mental health problems, the differences are small and not supported by adolescents' own reports. The difference between MAR and NC adolescent's parental report might reflect differences in parental concern, their relationship or closeness and can help to reconcile the mixed findings of previous studies.

Defining and Identifying Only Children: A Research Note on the Concept and Measurement Illustrated With UK Survey Data

Despite increasing interest in the circumstances and outcomes of only children in the demographic literature, the conceptualization of this group has received limited scholarly attention. This research note argues for greater engagement by demographers and social scientists in the conceptualization and identification of only children by addressing three aims. First, we outline potential definitions of only children, present a framework to guide researchers' decisions, and evaluate whether only children can be reliably identified using the British birth cohort studies. Second, we show that the prevalence estimates are contingent on the timing of measurement in childhood, indicating the need for caution when deriving only-child status from cross-sectional household grid data. Third, we demonstrate that both the size and the characteristics of the only-child group may differ across definitions, highlighting that the accurate operationalization of some definitions is particularly restricted by survey designs that prioritize mothers for data collection on children and families. We argue that researchers interested in sole children's outcomes must choose the most appropriate measure for a given research question and, given that many datasets limit how accurately any indicator of only children can capture the chosen definition, reflect on how the operationalization of their measure might affect the results.

Generational differences in physical health and disability in the United States and Europe

Objectives

Declines in mortality have typically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States (US), are less healthy than previous generations at the same age. We compared generational trends in physical health in the US, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts.

Methods

Using data from nationally representative studies of adults aged ≥50 years from the US (Health and Retirement Study, n=26,939), England (English Longitudinal Study of Ageing, n=14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, n=72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959).

Results

Age-adjusted prevalence of doctor-diagnosed chronic disease increased across cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the US and Europe, we observed a structural break in disability trends, with declines observed in pre-war cohorts slowing, stalling, or reversing for cohorts born since 1945.

Discussion

In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.

Partnership trajectories preceding medically assisted reproduction

The number of people who undergo medically assisted reproduction (MAR) to conceive has increased considerably in recent decades. However, existing research into the demographics and the partnership histories of this growing subgroup is limited. Using unique data from Finnish population registers on nulliparous women born in Finland in 1971-77 (n = 21,129; ∼10 per cent of all women) who had undergone MAR treatment, we created longitudinal partnership histories from age 16 until first MAR treatment. We identified six typical partnership trajectories and used relative frequency sequence plots to investigate heterogeneity in partnership transitions within and between these groups. The majority of women (60.7 per cent) underwent MAR with their first partner, followed by women who underwent MAR in a second (21.5 per cent) or higher-order partnership (7.1 per cent), while 10.7 per cent underwent MAR without a partner. On average, women undergoing MAR were relatively young (with around half starting treatment before age 30) and were highly educated with high incomes.

Loneliness during the Pregnancy-Seeking Process: Exploring the Role of Medically Assisted Reproduction

This study explores whether undergoing medically assisted reproduction (MAR) is associated with experiencing loneliness and whether this association varies by gender and having a live birth. Using two waves of the Generations and Gender Survey (n = 2,725) from countries in Central and Eastern Europe, we estimate the changes in levels of emotional and social loneliness among pregnancy seekers in heterosexual relationships and test if they vary by the mode of conception while controlling for individual sociodemographic characteristics. Individuals who underwent MAR experienced increased levels of social loneliness compared to individuals who were trying to conceive spontaneously. This association is entirely driven by respondents who did not have a live birth between the two observation periods, while the results did not differ by gender. No differences emerged in emotional loneliness. Our findings suggest that increased social loneliness during the MAR process might be attributable to infertility-related stress and stigma.

ART and the forgotten siblings: a call for research

A broader definition of infertility is the incapacity to have the intended number of children. However, most literature on ART exclusively focuses on live birth as an outcome, rather than on the capacity to fully realize the reproductive wishes of the couples. This issue has probably received scant attention because the total fertility rate is below replacement levels in affluent countries, and one may simplistically assume that only a minority of couples may be interested in more than one child. This assumption, however, is unproven and presumably erroneous. Unfortunately, evidence on the rate of return in couples who conceived their first child with ART is scant and information on the intended number of children in infertile couples is lacking. In general, we plea for more research on this subject. The documentation of an intended number of children above two and a high return rate in infertile couples may lead to changes in clinical practice, such as the storage of oocytes or embryos prior to initiating embryo transfers. This could improve the chance of conceiving the second child when the couple comes back some years later. In addition, the identification of the determinants for non-return as well as those explaining the gap between the intended and the realized number of children may reveal specific barriers and possibly how to tackle them. However, at present, available evidence is insufficient to advocate any intervention. Thorough research is warranted.

Birth Outcomes Following Assisted Reproductive Technology Conception Among Same-Sex Lesbian Couples vs Natural Conception and Assisted Reproductive Technology Conception Among Heterosexual Couples

This study uses registry data to compare birth outcomes, including birth weight, gestational age, low birth weight, and preterm delivery, in assisted reproductive technology (ART) pregnancies among same-sex lesbian couples vs natural conceptions and ART pregnancies among heterosexual couples.

Health outcomes of only children across the life course: An investigation using Swedish register data

Only children (with no full biological siblings) are a growing subgroup in many high-income settings. Previous studies have largely focused on the short-term developmental outcomes of only children, but there is limited evidence on their health outcomes. Using Swedish population register data for cohorts born 1940-75, we compare the health of only children with that of children from multi-child sibling groups, taking into account birth order, family size, and presence of half-siblings. Only children showed lower height and fitness scores, were more likely to be overweight/obese in late adolescence, and experienced higher later-life mortality than those with one or two siblings. However, only children without half-siblings were consistently healthier than those with half-siblings, suggesting that parental disruption confers additional disadvantages. The health disadvantage was attenuated but not fully explained by adjustment for parental characteristics and after using within-family maternal cousin comparison designs.

The Well-Being of Adolescents Conceived Through Medically Assisted Reproduction: A Population-Level and Within-Family Analysis

Medically assisted reproduction (MAR) plays an increasingly important role in the realization of fertility intentions in advanced societies, yet the evidence regarding MAR-conceived children's longer-term well-being remains inconclusive. Using register data on all Finnish children born in 1995-2000, we compared a range of social and mental health outcomes among MAR- and naturally conceived adolescents in population-averaged estimates, and within families who have conceived both through MAR and naturally. In baseline models, MAR-conceived adolescents had better school performance and the likelihood of school dropout, not being in education or employment, and early home-leaving were lower than among naturally conceived adolescents. No major differences were found in mental health and high-risk health behaviours. Adjustment for family sociodemographic characteristics attenuated MAR adolescents' advantage in social outcomes, while increasing the risk of mental disorders. The higher probability of mental disorders persisted when comparing MAR adolescents to their naturally conceived siblings. On average, MAR adolescents had similar or better outcomes than naturally conceived adolescents, largely due to their more advantaged family backgrounds, which underscores the importance of integrating a sociodemographic perspective in studies of MAR and its consequences.

Maternal age and the risk of low birthweight and pre-term delivery: a pan-Nordic comparison

BACKGROUND

Advanced maternal age at birth is considered a risk factor for adverse birth outcomes. A recent study applying a sibling design has shown, however, that the association might be confounded by unobserved maternal characteristics.

METHODS

Using total population register data on all live singleton births during the period 1999-2012 in Denmark (N = 580 133; 90% population coverage), Norway (N = 540 890) and Sweden (N = 941 403) and from 2001-2014 in Finland (N = 568 026), we test whether advanced maternal age at birth independently increases the risk of low birthweight (LBW) (<2500 g) and pre-term birth (<37 weeks gestation). We estimated within-family models to reduce confounding by unobserved maternal characteristics shared by siblings using three model specifications: Model 0 examines the bivariate association; Model 1 adjusts for parity and sex; Model 2 for parity, sex and birth year.

RESULTS

The main results (Model 1) show an increased risk in LBW and pre-term delivery with increasing maternal ages. For example, compared with maternal ages of 26-27 years, maternal ages of 38-39 years display a 2.2, 0.9, 2.1 and 2.4 percentage point increase in the risk of LBW in Denmark, Finland, Norway and Sweden, respectively. The same patterns hold for pre-term delivery.

CONCLUSIONS

Advanced maternal age is independently associated with higher risk of poor perinatal health outcomes even after adjusting for all observed and unobserved factors shared between siblings.

Parental fecundability and neurodevelopmental delays and difficulties in offspring

BACKGROUND

Impaired neurodevelopment is reported among children conceived by assisted reproductive technologies (ART). However, this might be explained by conditions underlying parental subfecundity, rather than the ART procedure.

METHODS

We examined associations of parental time-to-pregnancy (TTP) and conception by ART with neurodevelopmental traits up to 8 years of age, including motor and language skills, social delays and difficulties, and inattention-hyperactivity, among 92 142 singletons participating in the Norwegian Mother, Father and Child Cohort Study (MoBa). Mothers reported TTP and neurodevelopmental traits through questionnaires. Mean differences in standardized neurodevelopmental traits were estimated using linear regression, adjusting for maternal age, parity, educational level, body mass index and smoking, and paternal age.

RESULTS

A longer TTP was associated with decreased language skills and motor skills at 6, 18 and 36 months (P-values for trend ≤0.01), prosocial skills delay at 36 months (P-values for trend ≤0.001) and increased scores for inattention-hyperactivity traits at all ages up to 8 years (P-values for trend from 0.06 to 0.01). Effect sizes were small, ranging between 0.03 and 0.05 difference in the standardized neurodevelopmental scores. Estimates for ART were imprecise, but there were no differences between children conceived by ART and naturally conceived children of subfecund parents (TTP ≥12 months).

CONCLUSIONS

Longer parental TTP is modestly but robustly associated with offspring neurodevelopmental delays and difficulties, with no added impact of ART. Future studies should investigate the underlying causes of-or aspects related to-parental subfecundity which might explain the association with offspring neurodevelopmental delays and difficulties.

Sibling group size and BMI over the life course: Evidence from four British cohort studies

Only children, here defined as individuals growing up without siblings, are a small but growing demographic subgroup. Existing research has consistently shown that, on average, only children have higher body mass index (BMI) than individuals who grow up with siblings. How this difference develops with age is unclear and existing evidence is inconclusive regarding the underlying mechanisms. We investigate BMI trajectories for only children and those with siblings up to late adolescence for four British birth cohorts and across adulthood for three cohorts. We use data on BMI from ages 2-63 years (cohort born 1946); 7-55 years (born 1958); 10-46 (born 1970) and 3-17 years (born 2000-2002). Using mixed effects regression separately for each cohort, we estimate the change in BMI by age comparing only children and those with siblings. The results show higher average BMI among only children in each cohort, yet the difference is substantively small and limited to school age and adolescence. The association between sibling status and BMI at age 10/11 is not explained by differential health behaviours (physical activity, inactivity and diet) or individual or family background characteristics in any of the cohorts. Although persistent across cohorts, and despite the underlying mechanism remaining unexplained, the substantively small magnitude of the observed difference and the convergence of the trajectories by early adulthood in all cohorts raises doubts about whether the difference in BMI between only children and siblings in the UK context should be of research or clinical concern. Future research could usefully be directed more at whether only children experience elevated rates of disease, for which high BMI is a risk factor, at different stages of the life course and across contexts.

The cognitive development from childhood to adolescence of low birthweight children born after medically assisted reproduction-a UK longitudinal cohort study

Background

Previous research has documented that children conceived through medically assisted reproduction (MAR) are at increased risk of poor birth outcomes, such as low birthweight (LBW), which are risk factors for stunted longer-term cognitive development. However, parents who undergo MAR to conceive have, on average, advantaged socioeconomic backgrounds which could compensate for the negative effects of being born LBW. Previous studies have not analysed whether the negative effects of LBW are attenuated among MAR conceived children.

Methods

We draw on the UK Millennium Cohort Study (sweeps 1–6) which contains a sub-sample of (N = 396) MAR-conceived children. The dependent variable measures cognitive ability at around ages 3, 5, 7, 11 and 14. We examine the cognitive development of four groups of children: MAR-conceived low birthweight (MAR LBW); MAR-conceived non-low birthweight (MAR NLBW); naturally conceived low birthweight (NC LBW); naturally conceived non-low birthweight (NC NLBW). We estimate the two following linear regression models for each sweep: (i) a baseline model to examine the unadjusted association between cognitive development and low birthweight by mode of conception; and (ii) a model adjusted by socio-demographic family characteristics.

Results

In baseline models, MAR LBW children [age 3: β  =  0.021, 95% confidence interval (CI): -0.198, 0.241; age 5: β  =  0.21, 95% CI: 0.009, 0.418; age 7: β  =  0.163, 95% CI: -0.148, 0.474; age 11: β  =  0.003, 95% CI: -0.318, 0.325; age 14: β  =  0.156, 95% CI: -0.205, 0.517], on average perform similarly in cognitive ability relative to NC NLBW at all ages, and display higher cognitive scores than NC LBW children until age 7. When we account for family characteristics, differences are largely attenuated and become close to zero at age 14.

Conclusions

Despite the higher incidence of LBW among MAR compared with NC children, they do not seem to experience any disadvantage in their cognitive development compared with naturally conceived children. This finding is likely explained by the fact that, on average, MAR children are born to socioeconomically advantaged parents.

Medically assisted reproduction and parent-child relationships during adolescence: evidence from the UK Millennium Cohort Study

STUDY QUESTION

Do the parent–child relationships of adolescents born after medically assisted reproduction (MAR) using the parents’ own gametes differ from those of adolescents born after natural conception (NC)?

SUMMARY ANSWER

MAR and NC families have similar parent–child relationships in terms of closeness and conflict frequency, except that MAR mothers report being closer to their children than NC mothers.

WHAT IS KNOWN ALREADY

Prior work on parent–child relationships during childhood has reported mixed findings. While some studies have documented no differences between MAR and NC families, others have shown that MAR families have greater levels of warmth and positive feelings than NC families. Evidence on parent–child relationships during the adolescent period is generally positive but is limited because of the small number of existing studies and the reliance on small samples.

STUDY DESIGN, SIZE, DURATION

This work is based on the UK Millennium Cohort Study, whose study members were born in 2000–2002. The analyses focused on Sweep 6 which was collected when cohort members were around 14 years old. We also relied on variables collected in Sweep 1, when cohort members were aged around 9 months, to account for characteristics that could confound or mediate the relationship between MAR and our outcomes. The attrition rate between Sweeps 1 and 6 was 36.7%.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The final sample consisted of 10 233 cohort members, 320 of whom were conceived with the help of MAR (3.1%). A total of six dependent variables were used to measure, when the cohort members were around 14 years old, levels of parent–child closeness and conflict, reported separately by the mother, the father and the cohort member. Linear models were used to analyse the association between parent–child relationships before and after adjustment for socio-demographic characteristics and mental health.

MAIN RESULTS AND THE ROLE OF CHANCE

Sweep 6 achieved a response rate of 76.3% of the eligible sample. The results show that, on average, MAR and NC families had similar parent–child relationships in terms of closeness and conflict frequency. The only difference was that MAR mothers reported being closer to their children than NC mothers both before (β = 0.149, P < 0.05) and after (β = 0.102, P < 0.1) adjustment for family socio-demographic characteristics and mental health.

LIMITATIONS, REASONS FOR CAUTION

The outcome variables are self-reported by each of the respondents and could be subject to social desirability bias. Second, some parents may have not reported they conceived through donor insemination, which could result in the analytical sample including a small subset of children who were not genetically related to their parents. Third, the data did not include information about whether the children were aware of their conception mode, since the Millennium Cohort Study did not collect information on MAR disclosure. Moreover, they did not allow us to study other aspects of parent–child relationships. Finally, as we observed parent–child relationships at only one moment in time; we were unable to test whether they changed over time.

WIDER IMPLICATIONS OF THE FINDINGS

The results suggest that the difficulties and the stress parents underwent to conceive through MAR did not translate into more difficult parent–child relationships during adolescence. Given the increasing number of children conceived via MAR, the finding that MAR and NC families had similar parent–child relationships in terms of closeness and conflict frequency is reassuring.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by European Research Council agreement n. 803959 (MARTE to A.G.). The authors declare no competing interests.

TRIAL REGISTRATION NUMBER

n/a

Mental Health Around the Transition to First Birth: Does Medically Assisted Reproduction Matter?

Previous research has shown that childbearing is associated with short-term improvements in women's subjective well-being but that these effects depend on the timing and quantum of the birth as well as on the parents' education and socioeconomic status. These studies did not address whether and, if so, how this effect varies according to the mode of conception. This represents an important knowledge gap, given that conceptions through medically assisted reproduction (MAR) have been increasing rapidly in recent decades, exceeding 5% of live births in some European countries. Drawing on nine waves (2009/2010-2017/2018) of the UK Household Longitudinal Study, we use distributed fixed-effects linear regression models to examine changes in women's mental health before, during, and after natural and MAR conceptions. The results show that the mental health of women who conceived naturally improved around the time of conception and then gradually returned to baseline levels; comparatively, the mental health of women who conceived through MAR declined in the year before pregnancy and then gradually recovered. The findings also indicate that women's happiness decreased both two years and one year before an MAR conception and then increased above the baseline in the year of pregnancy. We further show that the deterioration in mental health and subjective well-being before an MAR conception affects both partners, which could be part of a longer process in which the partners potentially suffer from stress related not solely to the MAR treatments themselves but also to the experience of subfertility.

The cognitive development from childhood to adolescence of low birthweight children born after medically assisted reproduction-a UK longitudinal cohort study

Background

Previous research has documented that children conceived through medically assisted reproduction (MAR) are at increased risk of poor birth outcomes, such as low birthweight (LBW), which are risk factors for stunted longer-term cognitive development. However, parents who undergo MAR to conceive have, on average, advantaged socioeconomic backgrounds which could compensate for the negative effects of being born LBW. Previous studies have not analysed whether the negative effects of LBW are attenuated among MAR conceived children.

Methods

We draw on the UK Millennium Cohort Study (sweeps 1–6) which contains a sub-sample of (N = 396) MAR-conceived children. The dependent variable measures cognitive ability at around ages 3, 5, 7, 11 and 14. We examine the cognitive development of four groups of children: MAR-conceived low birthweight (MAR LBW); MAR-conceived non-low birthweight (MAR NLBW); naturally conceived low birthweight (NC LBW); naturally conceived non-low birthweight (NC NLBW). We estimate the two following linear regression models for each sweep: (i) a baseline model to examine the unadjusted association between cognitive development and low birthweight by mode of conception; and (ii) a model adjusted by socio-demographic family characteristics.

Results

In baseline models, MAR LBW children [age 3: β  =  0.021, 95% confidence interval (CI): -0.198, 0.241; age 5: β  =  0.21, 95% CI: 0.009, 0.418; age 7: β  =  0.163, 95% CI: -0.148, 0.474; age 11: β  =  0.003, 95% CI: -0.318, 0.325; age 14: β  =  0.156, 95% CI: -0.205, 0.517], on average perform similarly in cognitive ability relative to NC NLBW at all ages, and display higher cognitive scores than NC LBW children until age 7. When we account for family characteristics, differences are largely attenuated and become close to zero at age 14.

Conclusions

Despite the higher incidence of LBW among MAR compared with NC children, they do not seem to experience any disadvantage in their cognitive development compared with naturally conceived children. This finding is likely explained by the fact that, on average, MAR children are born to socioeconomically advantaged parents.

The demographics of assisted reproductive technology births in a Nordic country

STUDY QUESTION

What are the socio-demographic characteristics of families in Norway who have children after assisted reproductive technology (ART), and have these characteristics changed over time?

SUMMARY ANSWER

Parents who conceive through ART in Norway tend to be advantaged families, and their socio-demographic profile has not changed considerably over the period 1985-2014.

WHAT IS KNOWN ALREADY

A small number of studies show that couples who conceive through ART tend to be socio-economically advantaged.

STUDY DESIGN, SIZE, DURATION

Norwegian Population Register, the Medical Birth Register and the national data bases were linked to study all live births in Norway between 1985 and 2014.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The sample consisted of 1 757 768 live births. Simple bivariate analyses were performed to describe the socio-demographic characteristics of parents who conceived through ART and changes in these characteristics over the time period 1985-2014. We used linear probability models to estimate the association between parental income and giving birth after ART from 2000 to 2014, before and after adjustment for maternal age at delivery, education and area of residence.

MAIN RESULTS AND THE ROLE OF CHANCE

Parents conceiving through ART were more likely to be older, with the highest levels of income and education, and married. Their socio-demographic profiles did not change considerably during the period 1985-2014. In the unadjusted model, parents belonging to the top income quartile were 4.2 percentage points more likely (95% CI: 4.1 to 4.3) to have conceived through ART than parents who belonged to the bottom income quartile. Adjustment for maternal age only partially reduced the income disparities (for the top income quartile by 35% (β = 2.7 with 95% CI: 2.5 to 2.8)). Additional adjustment for maternal education, marital status and area of residence did not further attenuate the associations.

LIMITATIONS, REASONS FOR CAUTION

The data does not enable us to tell whether the lower numbers of children conceived through ART amongst more disadvantaged individuals is caused by lower success rates with ART treatment, lower demand of ART services or barriers faced in access to ART. The study focuses on Norway, a context characterised by high subsidisation of ART services.

WIDER IMPLICATIONS OF THE FINDINGS

Even though in Norway access to ART services is highly subsidised, the results highlight important and persisting social inequities in use of ART. The results also indicate that children born after ART grow up in resourceful environments, which will benefit their development and well-being.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by European Research Council agreement n. 803959 (to A.G.), by Economic and Social Research Council grant ES/M001660/1 and by the Research Council of Norway through its Centres of Excellence funding scheme, project number 262700. The authors have no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

Do Children Carry the Weight of Divorce?

Relatively few studies have examined the physical health of children who experience parental separation. The few studies on this topic have largely focused on the United States and have used cross-sectional designs. Our study investigates the relationship between parental separation and children’s body mass index (BMI) and overweight/obesity risk using the UK Millennium Cohort Study. Treating parental separation as a process, we analyze variations in children’s physical health before and after the date of their parents’ separation in order to capture potential anticipation, adaptation, delayed, or cumulative effects. We estimate fixed-effects models to account for the potential correlation between children’s physical health and unobserved factors associated with parental separation, such as socioeconomic background and other time-invariant parental characteristics. We find no evidence of statistically significant anticipation effects in the build-up to parental separation or of statistically significant changes in children’s physical health immediately after separation. However, our results show that in the longer term, the BMI of children whose parents separate significantly deviates from the BMI of children from intact families. Furthermore, this association is especially strong for separations that occur when children are under age 6.

Maternal age and risk of low birth weight and premature birth in children conceived through medically assisted reproduction. Evidence from Finnish population registers

STUDY QUESTION

Does the risk of low birth weight and premature birth increase with age among mothers who conceive through medically assisted reproduction (MAR)?

SUMMARY ANSWER

Among MAR mothers, the risk of poorer birth outcomes does not increase with maternal age at birth except at very advanced maternal ages (40+).

WHAT IS KNOWN ALREADY

The use of MAR treatments has been increasing over the last few decades and is especially diffused among women who conceive at older ages. Although advanced maternal age is a well-known risk factor for adverse birth outcomes in natural pregnancies, only a few studies have directly analysed the maternal age gradient in birth outcomes for MAR mothers.

STUDY DESIGN, SIZE, DURATION

The base dataset was a 20% random sample of households with at least one child aged 0-14 at the end of 2000, drawn from the Finnish population register and other administrative registers. This study included children who were born in 1995-2000, because the information on whether a child was conceived through MAR or naturally was available only from 1995 onwards.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The outcome measures were whether the child had low birth weight (LBW, <2500 g at birth) and whether the child was delivered preterm (<37 weeks of gestation). Conceptions through MAR were identified by examining data on purchases of prescription medication from the National Prescription Register. Linear probability models were used to analyse and compare the maternal age gradients in birth outcomes of mothers who conceived through MAR or naturally before and after adjustment for maternal characteristics (i.e. whether the mother suffered from acute/chronic conditions before the pregnancy, household income and whether the mother smoked during pregnancy).

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 56 026 children, 2624 of whom were conceived through MAR treatments, were included in the study. Among the mothers who used MAR to conceive, maternal age was not associated with an increased risk of LBW (the overall prevalence was 12.6%) at ages 25-39. For example, compared to the risk of LBW at ages 30-34, the risk was 0.22 percentage points lower (95% CI: -3.2, 2.8) at ages 25-29 and was 1.34 percentage points lower (95% CI: -4.5, 1.0) at ages 35-39. The risk of LBW was increased only at maternal ages ≥40 (six percentage points, 95% CI: 0.2, 12). Adjustment for maternal characteristics only marginally attenuated these associations. In contrast, among the mothers who conceived naturally, the results showed a clear age gradient. For example, compared to the risk of LBW (the overall prevalence was 3.3%) at maternal ages 30-34, the risk was 1.1 percentage points higher (95% CI: 0.6, 1.6) at ages 35-39 and was 1.5 percentage points higher (95% CI: 0.5, 2.6) at ages ≥40. The results were similar for preterm births.

LIMITATIONS, REASON FOR CAUTION

A limited number of confounders were included in the study because of the administrative nature of the data used. Our ability to reliably distinguish mothers based on MAR treatment type was also limited.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first study to analyse the maternal age gradient in the risk of adverse birth outcomes among children conceived through MAR using data from a nationally representative sample and controlling for important maternal health and socio-economic characteristics. This topic is of considerable importance in light of the widespread and increasing use of MAR treatments.

STUDY FUNDING/COMPETING INTEREST(S)

Funding for this project was provided by the European Research Council (grant no. 803959 MARTE to Alice Goisis and grant no. 336475 COSTPOST to Mikko Myrskylä). E.S. reports personal fees from Theramex, personal fees from Merck Serono, personal fees from Health Reimbursement Arrangement, non-financial support from Merck Serono and grants from Ferring, grants from Theramex, outside the submitted work. The remaining authors have no competing interests.

TRIAL REGISTRTION NUMBER

N/A.

Mind the gap: The health advantages that accompany parental marriage vary by maternal nativity

Using data from the UK Millennium Cohort Study (MCS), we examine whether and how the health benefits of having two biological parents in a continuous marital relationship vary by maternal nativity and ethnicity, comparing UK-born White mothers with: (1) White mothers born in wealthy countries; (2) ethnic minority mothers from South Asia; and (3) ethnic minority mothers born in Africa. Making novel use of classification and regression tree (CART) methods, we examine whether marital status is a uniform marker of economic advantage or better health-related behaviours across the four maternal nativity and ethnic groups. The findings, which indicate that the health-related advantages associated with parental marriage are not uniform across the four nativity and ethnic groups, have implications for future research on family gaps in well-being and the socio-economic determinants of health.

Is the relationship between men's age at first birth and midlife health changing? Evidence from two British cohorts

Becoming a father, particularly for the first time, is a central transition in men's lives, and whether this transition takes place early or later in life may have important ramifications on the whole later life course. Previous research has shown that men who father their first child early in life have poorer later-life health than men who postpone having children. However, it is not known how selection by cognitive ability and other childhood characteristics confound the association between the timing of fatherhood and later-life health, or how the association is changing over time as parenthood is postponed to an older age. We investigate the association between men's age at the birth of their first child and midlife self-rated health in two British cohorts born in 1958 and 1970. The study employs logit models. Relative to men who had their first child when they were between 25 and 29 years old, men who had their first child before the age of 20 have the poorest health, followed by men who had a child when they were 20–24 years old. This result was observed in both cohorts. Childhood cognitive ability, which previous research has not analyzed, strongly contributed to this association, and to a greater extent than other childhood characteristics. For the 1970 cohort, those who became fathers at age 35 or older had the best health. This advantage was not found for the 1958 cohort. These findings suggest that the relationship between young age at fatherhood and midlife health is strongly confounded by cognitive ability, and that in recent cohorts a new pattern of advantage among older fathers has emerged.

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Early fatherhood shows associations with poorer self-rated health in midlife.

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Childhood cognitive ability strongly confounds this association.

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First-time fathers aged 35 years or older have the best health in the 1970 cohort.

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A similar health advantage in older fathers is not found in the 1958 cohort.

When richer doesn't mean thinner: Ethnicity, socioeconomic position, and the risk of child obesity in the United Kingdom

BACKGROUND

A range of studies report a robust association between family socioeconomic position and the prevalence of child overweight/obesity. On average, children from poorer backgrounds are more likely to be overweight/obese than children from more advantaged families. However, a small number of US studies have shown that, for ethnic minority children, the association is either nonexistent or reversed.

OBJECTIVE

We test if the link between socioeconomic position and child overweight/obesity at age 7 is heterogeneous in the United Kingdom where rates of obesity are particularly high for some groups of ethnic minority children.

METHODS

We use nationally representative data from the UK Millennium Cohort Study as well as descriptive analyses and logistic regression models.

RESULTS

Poorer White children are at higher risk of overweight/obesity than higher income White children. However, socioeconomic disparities are reversed for Black African/Caribbean children and nonexistent for children of Indian and Pakistani/Bangladeshi origin. Moreover, the health behaviours that explain socioeconomic disparities in child overweight/obesity for the White group appear to be irrelevant in explaining differences by socioeconomic position for the Black Caribbean and African groups.

CONCLUSIONS

We should be careful in assuming that higher socioeconomic position is protective against child overweight/obesity for all groups of the population.

CONTRIBUTION

This study shows for the first time important variation by ethnicity in the link between socioeconomic position and child overweight/obesity - and in the underlying mechanisms linking them - in the United Kingdom.

Medically assisted reproduction and birth outcomes: a within-family analysis using Finnish population registers

BACKGROUND

Children born after medically assisted reproduction are at higher risk of adverse birth outcomes than are children conceived naturally. We aimed to establish the extent to which this excess risk should be attributed to harmful effects of treatment or to pre-existing parental characteristics that confound the association.

METHODS

We used data from Finnish administrative registers covering a 20% random sample of households with at least one child aged 0-14 years at the end of 2000 (n=65 723). We analysed birthweight, gestational age, risk of low birthweight, and risk of preterm birth among children conceived both by medically assisted reproduction and naturally. First, we estimated differences in birth outcomes by mode of conception in the general population, using standard multivariate methods that controlled for observed factors (eg, multiple birth, birth order, and parental sociodemographic characteristics). Second, we used a sibling-comparison approach that has not been used before in medically assisted reproduction research. We compared children conceived by medically assisted reproduction with siblings conceived naturally and, thus, controlled for all observed and unobserved factors shared by siblings.

FINDINGS

Between 1995 and 2000, 2776 (4%) children in our sample were conceived by medically assisted reproduction; 1245 children were included in the sibling comparison. Children conceived by medically assisted reproduction had worse outcomes than did those conceived naturally, for all outcomes, even after adjustments for observed child and parental characteristics-eg, difference in birthweight of -60 g (95% CI -86 to -34) and 2·15 percentage point (95% CI 1·07 to 3·24) increased risk of preterm delivery. In the sibling comparison, the gap in birth outcomes was attenuated, such that the relation between medically assisted reproduction and adverse birth outcomes was statistically and substantively weak for all outcomes-eg, difference in birthweight of -31 g (95% CI -85 to 22) and 1·56 percentage point (95% CI -1·26 to 4·38) increased risk of preterm delivery.

INTERPRETATION

Children conceived by medically assisted reproduction face an elevated risk of adverse birth outcomes. However, our results indicate that this increased risk is largely attributable to factors other than the medically assisted reproduction treatment itself.

FUNDING

European Research Council, the Academy of Finland, and the Signe and Ane Gyllenberg Foundation.

Secular changes in the association between advanced maternal age and the risk of low birth weight: A cross-cohort comparison in the UK

Existing studies provide contradictory evidence concerning the association between child health and advanced maternal age. A potential explanation for the lack of consensus on this issue is changes over time in the costs and benefits of giving birth at an advanced age. This is the first study to investigate secular changes in the characteristics of older mothers and in the association between advanced maternal age and child health. We use data from four UK cohort studies, covering births from 1958 to 2001, and use low birth weight (LBW) as a marker for child health. We find that across successive birth cohorts, the negative association between advanced maternal age and LBW becomes progressively weaker; and that this pattern is partially explained by secular changes in the characteristics of older mothers. Our results suggest that associations between maternal age and child outcomes are tied to a specific population and point in time.

Paternal age and the risk of low birth weight and preterm delivery: a Finnish register-based study

Background

Based on existing studies, there is no conclusive evidence as to whether and why paternal age matters for birth outcomes.

Methods

We used Finnish population registers on 106 652 children born 1987–2000. We first document the unadjusted association between paternal age and the risk of low birth weight (LBW; <2500 g) and preterm birth (<37 weeks’ gestation). Second, we investigate whether the unadjusted association is attenuated on adjustment for child’s, maternal and parental socioeconomic characteristics. Third, by adopting a within-family design which involves comparing children born to the same father at different ages, we additionally adjust for unobserved parental characteristics shared between siblings.

Results

The unadjusted results show that being born to a father aged 40+, as opposed to a father aged 30–34, is associated with an increased risk of LBW of 0.96% (95% CI 0.5% to 1.3%) and to a younger father (<25) with a 1% (95% CI 0.6% to 1.3%) increased risk. The increased risk at younger paternal ages is halved on adjustment for the child’s characteristics and fully attenuated on adjustment for child/parental characteristics. The increased risk at paternal ages 40+ is partially attenuated on adjustment for maternal characteristics (β=0.62%; 95% CI 0.13% to 1.1%). Adjustment for unobserved parental characteristics shared by siblings further attenuates the 40+ coefficient (β=0.4%; 95% CI −0.5% to −1.2%). Results for preterm delivery are similar.

Conclusions

The results underscore the importance of considering paternal age as a potential risk factor for adverse birth outcomes and of expanding research on its role and the mechanisms linking it to birth outcomes.

The reversing association between advanced maternal age and child cognitive ability: evidence from three UK birth cohorts

Background: Studies on advanced maternal age—defined here as age 35 or older—and children’s cognitive ability report mixed evidence. Previous studies have not analysed how the time period considered in existing studies influences the association.

Methods: We analysed trends in the association between maternal age and cognitive ability using data from the 1958 National Child Development Study (n = 10 969), the 1970 British Cohort Study (n = 9362) and the 2000–2002 Millennium Cohort Study (n = 11 600). The dependent variable measures cognitive ability at age 10/11 years. Cognitive scores were standardised to a mean of zero and a standard deviation of one.

Results: For the 1958–70 cohort studies, maternal ages 35 –39 were negatively associated with children's cognitive ability compared with maternal ages 25–29 (1958 cohort β = −0.06 standard deviations (SD) 95% confidence interval (CI): −0.13, −0.00; 1970 cohort β = −0.12 SD 95% CI: −0.20, −0.03). By contrast, for the 2000–2002 cohort study maternal ages 35–39 were positively associated with cognitive ability (β = 0.16 SD 95% CI: 0.09, 0.23). For maternal ages 40+, the pattern was qualitatively similar. These cross-cohort differences were explained by the fact that in the earlier cohorts advanced maternal age was associated with high parity, whereas in the 2000–2002 cohort it was associated with socioeconomically advantaged family background.

Conclusions: The association between advanced maternal age and children’s cognitive ability changed from negative in the 1958 and 1970 cohorts to positive in the 2000–2002 cohort because of changing parental characteristics. The time period considered can constitute an important factor in determining the association between maternal age and cognitive ability.

Application of a who Protocol on Medical Therapy for Oncologic Pain in an Internal Medicine Hospital

Pain symptomatology is present in 60 % – 80 % of patients affected by advanced cancer, but in most cases it is not adequately treated. Our series, composed of 45 patients affected by cancer in an advanced stage, demonstrates how the application of common concepts of pharmacotherapy, standardized according to a sequential scheme proposed by the WHO, makes it possible to reach total control (in 24.4 % of our cases) or only slight residual persistence (in 68.8 % of our cases) of pain from cancer, with scarce side effects that are easily controlled with symptomatic therapy. According to the type of pain, its behavior in relation to the therapy effected and any previous pharmacologic treatment, the proposed pharmacologic scheme foresees, as the first step, the use of nonnarcotic drugs, eventually associated or substituted with weak narcotics or finally with strong narcotics. Attention is given to modulation of the administration, to guarantee an analgesic effect throughout the day, thus preventing the pain. Irrespective of the analgesic scheme employed, it is more effective if patients affected by chronic oncologic pain (who present an important emotional component) are treated contemporaneously with ansiolytic and antidepressive drugs and those in which nerve structures are involved are treated with steroids. In conclusion, pain of an oncologic patient in an advanced stage can almost always be alleviated or often eliminated by the rigorous application of therapeutic concepts well known by physicians but for various reasons often neglected in clinical practice.

Advanced Maternal Age and the Risk of Low Birth Weight and Preterm Delivery: a Within-Family Analysis Using Finnish Population Registers

Advanced maternal age at birth is considered a major risk factor for birth outcomes. It is unclear to what extent this association is confounded by maternal characteristics. To test whether advanced maternal age at birth independently increases the risk of low birth weight (<2,500 g) and preterm birth (<37 weeks' gestation), we compared between-family models (children born to different mothers at different ages) with within-family models (children born to the same mother at different ages). The latter procedure reduces confounding by unobserved parental characteristics that are shared by siblings. We used Finnish population registers, including 124,098 children born during 1987-2000. When compared with maternal ages 25-29 years in between-family models, maternal ages of 35-39 years and ≥40 years were associated with percentage increases of 1.1 points (95% confidence intervals: 0.8, 1.4) and 2.2 points (95% confidence intervals: 1.4, 2.9), respectively, in the probability of low birth weight. The associations are similar for the risk of preterm delivery. In within-family models, the relationship between advanced maternal age and low birth weight or preterm birth is statistically and substantively negligible. In Finland, advanced maternal age is not independently associated with the risk of low birth weight or preterm delivery among mothers who have had at least 2 live births.

Advantages of later motherhood

BACKGROUND

In high-income countries childbearing has been increasingly postponed since the 1970s and it is crucial to understand the consequences of this demographic shift. The literature has tended to characterize later motherhood as a significant health threat for children and parents.

OBJECTIVES

We contribute to this debate by reviewing recent evidence suggesting that an older maternal age can also have positive effects.

MATERIALS

Literature linking the age at parenthood with the sociodemographic characteristics of the parents, with macrolevel interactions, and with subjective well-being.

METHODS

Comprehensive review of the existing literature.

RESULTS

Recent studies show that there can also be advantages associated with later motherhood. First, whilst in past older mothers had low levels of education and large families, currently older mothers tend to have higher education and smaller families than their younger peers. Consequently, children born to older mothers in the past tended to have worse outcomes than children born to younger mothers, whilst the opposite is true in recent cohorts. Second, postponement of childbearing means that the child is born at a later date and in a later birth cohort, and may benefit from secular changes in the macroenvironment. Evidence shows that when the positive trends in the macroenvironment are strong they overweigh the negative effects of reproductive ageing. Third, existing studies show that happiness increases around and after childbirth among older mothers, whereas for younger mothers the effect does not exist or is short-lived.

CONCLUSION

There are important sociodemographic pathways associated with postponement of childbearing which might compensate or even more than compensate for the biological disadvantages associated with reproductive ageing.

Family Trajectories and Well-being of Children Born to Lone Mothers in the UK

We investigate how lone mothers' heterogeneity in partnership trajectories is associated with children's well-being. We use data from the Millennium Cohort Study, which follows a large sample of children born in the UK in 2000-2002. We divide children who were born to lone mothers into four groups based on their mothers' partnership trajectories between birth and age seven, which cover more than 80% of these children's family experiences. We then analyse how these trajectories are associated with markers of health, cognitive and socio-emotional outcomes measured at around age seven. We find that compared to the children that live continuously with lone mothers, children whose biological father stably joined the household have better cognitive and socio-emotional outcomes. In contrast, children in trajectories characterised by living with a stepfather or who experienced biological father joining in the family followed by biological parents' dissolution had outcomes similar to children living continuously with lone mothers. The results underscore the importance of treating children born to lone mothers as a heterogeneous category.

What influences 11-year-olds to drink? Findings from the Millennium Cohort Study

BACKGROUND

Drinking in youth is linked to other risky behaviours, educational failure and premature death. Prior research has examined drinking in mid and late teenagers, but little is known about the factors that influence drinking at the beginning of adolescence. Objectives were: 1. to assess associations of parental and friends' drinking with reported drinking among 11 year olds; 2. to investigate the roles of perceptions of harm, expectancies towards alcohol, parental supervision and family relationships on reported drinking among 11 year olds.

METHODS

Analysis of data from the UK Millennium Cohort Study on 10498 11-year-olds. The outcome measure was having drank an alcoholic drink, self-reported by cohort members.

RESULTS

13.6 % of 11 year olds reported having drank. Estimates reported are odds ratios and 95 % confidence intervals. Cohort members whose mothers drank were more likely to drink (light/moderate = 1.6, 1.3 to 2.0, heavy/binge = 1.8, 1.4 to 2.3). Cohort members whose fathers drank were also more likely to drink but these estimates lost statistical significance when covariates were adjusted for (light/moderate = 1.3, 0.9 to 1.9, heavy/binge = 1.3, 0.9 to 1.9). Having friends who drank was strongly associated with cohort member drinking (4.8, 3.9 to 5.9). Associated with reduced odds of cohort member drinking were: heightened perception of harm from 1-2 drinks daily (some = 0.9, 0.7 to 1.1, great = 0.6, 0.5 to 0.7); and negative expectancies towards alcohol (0.5, 0.4 to 0.7). Associated with increased odds of cohort member drinking were: positive expectancies towards alcohol (1.9, 1.4 to 2.5); not being supervised on weekends and weekdays (often = 1.2, 1.0 to 1.4); frequent battles of will (1.3, 1.1 to 1.5); and not being happy with family (1.2, 1.0 to 1.5).

CONCLUSIONS

Examining drinking at this point in the lifecourse has potentially important public health implications as around one in seven 11 year olds have drank, although the vast majority are yet to explore alcohol. Findings support interventions working at multiple levels that incorporate family and peer factors to help shape choices around risky behaviours including drinking.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study

Background: There is limited evidence on which risk factors attenuate income inequalities in child overweight and obesity; whether and why these inequalities widen as children age. Method: Eleven thousand nine hundred and sixty five singletons had complete data at age 5 and 9384 at age 11 from the Millennium Cohort Study (UK). Overweight (age 5 : 15%; age 11 : 20%) and obesity (age 5 : 5%; age 11 : 6%) were defined using the International Obesity Taskforce body mass index cut-points. To measure socioeconomic inequalities, we used quintiles of family income and as risk factors, we considered markers of maternal health behaviours and of children’s physical activity, sedentary behaviours and diet. Binary and multinomial logistic regression models were used. Results: The unadjusted analyses revealed stark income inequalities in the risk of obesity at age 5 and 11. At age 5, children in the bottom income quintile had 2.0 (95% CI: 1.4–2.8) increased relative risk of being obese whilst at age 11 they had 3.0 (95% CI: 2.0–4.5) increased risk compared to children in the top income quintile. Similar income inequalities in the risk of overweight emerged by age 11. Physical activity and diet were particularly important in explaining inequalities. Income inequalities in obesity and overweight widened significantly between age 5 and 11 and a similar set of risk factors protected against upward and promoted downward movements across weight categories. Conclusions: To reduce income inequalities in overweight and obesity and their widening across childhood the results support the need of early interventions which take account of multiple risk factors.

How Are Children of Older Mothers Doing? Evidence from the United Kingdom

Childbearing has been increasingly delayed in Western countries. As older mothers are likely to be advantaged over their younger counterparts, the demographic literature has tended to view this demographic trend as potentially beneficial for child well-being. Conversely, less attention has been given to medical studies showing that giving birth at advanced ages is associated with health risks for children. This article uses data from the Millennium Cohort Study (UK) and ordinary least squares and logistic regression models to compare cognitive and behavioral outcomes, and obesity at age 5 for first-born children by maternal age at first birth. On one hand, the findings suggest that giving birth to the first child at ages 30-39 compared to ages 23-29 is positively associated with children's cognitive and behavioral outcomes and not associated with obesity. On the other hand, delaying the first birth to ages 40 and above is not associated with children's cognitive and behavioral outcomes and is associated with increased risk of obesity. Although the results are unable to support the argument that this occurs because of the health risks associated with giving birth at advanced maternal ages, they suggest that there is a need to more closely investigate the potential trade-offs involved when births are delayed toward older maternal ages.

Active treatment of patients with "incurable disease": what's the point?

What is active treatment of patients with “incurable disease”? I believe that it is not limited to the care of the patients’ symptoms, but goes further. We can and must control pain, breathlessness, nausea and vomiting, intestinal obstruction, insomnia… but something else remains for us to face, something paradoxically made more evident by the absence of symptoms: the patients’ emotional suffering, suffering deep in their heart, the most hidden, but which becomes apparent in the season of death. So, what can we do? We must be able to understand their needs and to stay with them, protecting the uniqueness of their person in the face of an imminent death.

Social age deadlines for the childbearing of women and men

BACKGROUND

This study examines whether social age deadlines exist for childbearing in women and men, how they vary across countries, whether they are lower than actual biological deadlines and whether they are associated with childbearing at later ages and the availability of assisted reproduction techniques (ARTs).

METHODS

This study is based on the European Social Survey, Round 3 (2006-2007), which covers 25 countries. Data were gathered on social age deadlines for childbearing in women (21 909 cases) and men (21 239 cases) from samples of representative community-dwelling populations aged 15 and older.

RESULTS

Social age deadlines for childbearing were perceived more frequently for women than men. These deadlines are often lower than actual biological limits, and for women and men alike: 57.2% of respondents perceived a maternal social age deadline ≤ 40 years of age; 46.2% of the respondents perceived a paternal social age deadline ≤ 45 years of age. There is also considerable variability in deadlines across countries, as well as within them. At the country level, the presence of social age deadlines for the childbearing of women was negatively associated with birth rates at advanced ages and the prevalence of ART, and later deadlines were positively associated with these factors.

CONCLUSIONS

It is important to understand the factors that increase and limit late fertility. While biological factors condition fertility, so do social expectations. These findings provide widespread evidence across Europe that social limits exist alongside biological ones, though both sets of factors are more binding for women.