RESUMO
OBJECTIVE: To quantify the decreased incidence of sudden infant death syndrome (SIDS) and investigate risk profile changes associated with changes in infant sleep position. DESIGN: A population-based case-control study that used birth and death certificates from Washington State. Cases (n = 1515) were all singletons born in Washington between 1985 and 1995 (excluding 1991) who died of SIDS. Control cases (n = 6060) were randomly selected singletons born in the same period who did not die of SIDS. Multivariate logistic regression compared changes in the magnitude of associations between risk factors and SIDS before and after 1991. RESULTS: The incidence of SIDS in Washington declined from 2.6 (1985) to 1.0 (1998) per 1000 births. Over time, the risk of SIDS increased for low birth weight infants (odds ratio [OR] 2.1 rose to 3.6), and infants born to mothers who were smokers (OR 2.7 rose to 3.7), unmarried (OR 1.4 rose to 2.0), black (OR 1.4 rose to 2.5), or received limited prenatal care (OR 1.5 rose to 2.5). CONCLUSION: Five exposures were associated with increased risks of SIDS. These may not require a prone sleep position for their deleterious impact being associated with distinct causal pathways, or possibly indicating subpopulations yet to recognize the importance of the supine sleep position.
Assuntos
Diretrizes para o Planejamento em Saúde , Sono , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/etiologia , Decúbito Dorsal , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Incidência , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Recém-Nascido , Modelos Logísticos , Masculino , Estado Civil/estatística & dados numéricos , Idade Materna , Bem-Estar Materno/estatística & dados numéricos , Análise Multivariada , Razão de Chances , Paridade , Gravidez , Distribuição Aleatória , Fatores de Risco , Morte Súbita do Lactente/prevenção & controle , Washington/epidemiologiaRESUMO
The prevalence and determinants of primary caesarean section in Jamaica were estimated from a survey of women aged 14-49 years. Among 2328 women reporting 2395 live hospital births during the period January 1984 to May 1989, the prevalence of caesarean section was 4.1%. Repeat caesarean sections accounted for 1.3% of the hospital births during that period. Of the medical complications studied, prolonged labour and/or cephalopelvic disproportion carried the highest risks of primary caesarean section, followed by breech presentation, maternal diabetes, a high birth-weight baby, maternal hypertension, and a low birth-weight baby. The risk of primary caesarean section increased with maternal age, decreased with parity, was higher for urban than for rural residents, and was higher for births in private versus government hospitals.
PIP: Researchers analyzed data on 2395 hospital births which occurred to 2328 14-49 year old women between January 1984 and May 1989 living in 7 parishes of Jamaica to determine the prevalence and factors of cesarean section. The primary cesarean section rate for the 5.5-year period was 4.1% which is lower than the rates of some developing countries and of some developed countries such as the US. The repeat cesarean section rate was 1.3%. Cephalopelvic disproportion and/or prolonged labor (abnormal labor) accounted for 17.4% of all primary cesarean sections. Abnormal labor carried the greatest risk of primary cesarean section (logistic regression model beta=1.9). Other delivery complications which posed considerable risk of cesarean section included breech presentation (beta=1.68), maternal diabetes (beta=0.84), maternal hypertension (beta=0.47), large birth weight infant (beta=0.4), and low birth weight infant (beta=-0.15). These complications made up 22.3%, 7.1%, 7.4%, and 5.3% of all primary cesarean sections, respectively. Nonmedical determinants of primary cesarean section included 30-year old women (beta=1.04), 1-2 births (beta=-1.27), urban residence (beta=0.75), and delivering in a private hospital (beta=0.59). 5.3% of 30-year old mothers underwent a cesarean section compared with 3.8% of 30-year old mothers. 5.2% of women of parity 1-2 had a cesarean section whereas only 2.3% of those of parity =or 3 did. Urban mothers were more likely to have a cesarean section than were rural mothers (5.4% vs. 3.3%). 7.6% of mothers delivering at a private hospital underwent a cesarean section compared with 3.9% of those delivering at a government hospital. Well-designed studies of infant mortality in Jamaica can determine whether the country can attain low levels of early infant mortality while keeping its current low rate of cesarean section.
Assuntos
Cesárea/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Jamaica , Pessoa de Meia-Idade , Gravidez , Prevalência , Fatores de RiscoRESUMO
The prevalence and determinants of primary ceasarean section in Jamaica were estimated from a survey of women aged 14-19 years. Among 2328 women reporting 2395 live hospital births during the period January 1984 to May 1989, the prevalence of caesarean section was 4.1 percent. Repeat caesarean sections accounted for 1.3 percent of the hospital births during that period. Of the medical complications studied prolonged labour and/or cephalopelvic disproportion carried the highest risks of primary caesarean section, followed by breach presentation, maternal diabetes, a high birth-weight baby, maternal hypertension, and a low birth weight baby. The risk of primary caesarean section increased with maternal age, decreased with parity, was higher for urban than for rural residents, and was higher for births in private versus government hospitals. (AU)
Assuntos
Humanos , Gravidez , Adolescente , Adulto , Feminino , Cesárea/tendências , Estudo Comparativo , Prevalência , Fatores de Risco , Gravidez , JamaicaRESUMO
A specially designed method for measuring infant mortality among families with subsequent siblings of sudden infant death syndrome (SIDS) victims in the state of Washington, 1969 to 1984, yielded results similar to those from an earlier study in Norway. In both studies the SIDS rates among siblings were substantially lower than prior estimates. The rate of SIDS in siblings of infants who died of SIDS did not differ significantly from the SIDS rate among control infants matched for maternal age and birth order. Total infant mortality rates in the two groups were virtually identical. From the data at hand, it appears that earlier estimates of the risk of SIDS in siblings were inflated and that parents of SIDS victims can be counseled accordingly.