RESUMO
OBJECTIVE: To describe trends in delayed diagnosis of critical congenital heart defects (CCHDs) with prenatal and postnatal screening advances. STUDY DESIGN: We evaluated a retrospective cohort of live births with CCHD delivered between 2004 and 2018 from a statewide, population-based birth defects surveillance system in Massachusetts. Demographic information were obtained from vital records. We estimated timely (prenatal or birth/transfer hospital) and delayed diagnosis (after discharge) proportions by year and time periods coinciding with the transition to mandatory pulse oximetry in 2015. RESULTS: We identified 1524 eligible CCHD cases among 1â087â027 live births. By 2018, 92% of cases received a timely diagnosis, most prenatally. From 2004 to 2018, prenatal diagnosis increased from 46% to 76% of cases, while hospital diagnosis decreased from 38% to 17%, and delayed diagnosis declined from 16% to 7%. These trends were consistent across all characteristics evaluated. Among cases without a prenatal diagnosis, the proportion with delayed diagnosis did not change over time, even after implementation of mandatory pulse oximetry screening. Prenatal detection increased the most among severe cases (treated or died in first month of life). Well-appearing newborns without prenatal diagnosis made up 79% of delayed diagnosis cases by 2015-2018. Delayed diagnosis was most common for coarctation. CONCLUSIONS: While prenatal diagnosis of CCHD increased dramatically, there was no reduction in delayed diagnosis among postnatally diagnosed infants, even after pulse oximetry screening became mandatory. Pulse oximetry may not reduce delayed diagnosis in settings with high prenatal detection, and other strategies are needed to ensure timely diagnosis of well-appearing newborns.
Assuntos
Diagnóstico Tardio , Cardiopatias Congênitas , Lactente , Gravidez , Feminino , Recém-Nascido , Humanos , Estudos Retrospectivos , Triagem Neonatal , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Diagnóstico Pré-Natal , OximetriaRESUMO
OBJECTIVE: Prior studies indicate that inadequate and excessive gestational weight gain (GWG) are associated with poor maternal and infant outcomes, and that stress and anxiety may contribute to GWG. However, these studies often failed to use validated measures of stress and anxiety, measured only total GWG, and were limited to largely non-Hispanic White populations. We explored the association between stress and anxiety and GWG. METHODS: We used data from 1,308 participants in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women 18-40 years of age (2006-2012). We measured stress with the Perceived Stress Scale and anxiety with the State-Trait Anxiety Scale, and abstracted GWG from medical records. RESULTS: The average GWG was 31.0 ± 16.1 pounds. More than one-half of participants (51.8%) exceeded Institute of Medicine guidelines for GWG. After adjusting for age and pre-pregnancy body mass index, women in the highest quartiles of stress and anxiety in early pregnancy had approximately 4 lbs lower GWG (ß = -3.89; SE = 1.54; p = .012 and ß = -4.37; SE = 1.54; p = .005, respectively) as compared with those in the lowest quartiles. Similarly, women in the highest quartiles of mid/late pregnancy stress and anxiety had lower GWG (ß = -3.84 lbs; SE = 1.39; p = .006, and ß = -3.51 lbs; SE = 1.38; p = .011, respectively) and a lower rate of GWG in the second and third trimesters (ß = -0.117 lbs/week; SE = 0.044; p = .008 and ß = -0.116 lbs/week; SE = 0.043; p = .007, respectively), compared with those in the lowest quartiles. CONCLUSIONS: High stress and anxiety were associated with lower GWG. Interventions to decrease stress and anxiety during pregnancy should include counseling on maintaining healthy GWG.
Assuntos
Ganho de Peso na Gestação , Complicações na Gravidez , Ansiedade , Índice de Massa Corporal , Feminino , Hispânico ou Latino , Humanos , Gravidez , Estudos Prospectivos , Porto Rico/epidemiologiaRESUMO
Background: Short interpregnancy interval (IPI) is associated with risk of adverse pregnancy outcomes; however, few studies have evaluated the role of depression as a risk factor for short IPI. Puerto Rican women in the United States experience disparities in adverse birth outcomes and have the highest birth rates. Methods: We analyzed the association between prenatal depressive symptoms and IPI in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women in Western Massachusetts (2006-2011). Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) in early, mid, and late pregnancy. We calculated follow-up time as the difference between the date of delivery of the index pregnancy and the last menstrual period of the subsequent pregnancy using medical records and billing data. We defined short IPI as ≤18 months. Results: Of 1262 eligible women, 35% (n = 440) had at least probable minor depression (EPDS scores ≥13) and 25% (n = 315) had probable major depression (EPDS scores ≥15). Participants were followed for a median of 3.7 years (interquartile range = 1.4-6.0 years) and 240 (20.6%) participants experienced a short IPI. After adjusting for risk factors, women with probable minor depression (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] = 1.02-1.88) and probable major depression (aOR = 1.42, 95% CI = 1.02-1.97) during pregnancy had increased odds of short IPI. Conclusions: Prenatal depressive symptoms were common in this Puerto Rican population and were associated with a modest increase in odds of short IPI. Further examination of the pathways through which mental health may affect IPI in vulnerable populations is warranted.
Assuntos
Depressão Pós-Parto/etnologia , Depressão/etnologia , Depressão/etiologia , Hispânico ou Latino/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Intervalo entre Nascimentos , Depressão/psicologia , Depressão Pós-Parto/diagnóstico , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Massachusetts/epidemiologia , Gravidez , Estudos Prospectivos , Porto Rico/etnologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Preterm birth and low birthweight contribute substantially to the disproportionately high infant mortality rates experienced by Puerto Ricans in the United States. The purpose of this study was to examine whether the timing and pattern of prenatal psychosocial stress increased risk of adverse birth outcomes in this high-risk population. MATERIALS AND METHODS: Proyecto Buena Salud was a prospective cohort study conducted from 2006 to 2011 among predominantly Puerto Rican women. Participants (n = 1,267) were interviewed in early, mid-, and late pregnancy. We evaluated associations between early and mid-pregnancy stress (Perceived Stress Scale) and preterm birth and low birthweight, and stress at each pregnancy time point and small for gestational age (SGA). RESULTS: Elevated levels of perceived stress in mid-pregnancy increased risk for preterm birth and low birthweight in adjusted analyses, with a linear trend observed for each increasing quartile of stress (ptrend = 0.01). Women in the highest quartile of stress experienced three times the risk for preterm birth (odds ratio [OR] = 3.50, confidence interval [95% CI]: 1.38-8.87) and low birthweight (OR = 3.53, 95% CI = 1.27-9.86) compared with women in the lowest quartile. Early pregnancy stress was not associated with preterm birth or low birthweight. Increase in stress from early to late pregnancy increased risk for SGA (OR = 1.90, 95% CI = 1.01-3.59); no associations were found between stress at any timepoint and SGA. CONCLUSION: Elevated levels of mid-pregnancy perceived stress increased risk for preterm birth and low birthweight, and an increase in stress over the course of pregnancy increased risk for SGA in a population of predominantly Puerto Rican women.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Resultado da Gravidez/etnologia , Nascimento Prematuro/etnologia , Estresse Psicológico/etnologia , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Estudos Prospectivos , Porto Rico/etnologia , Estresse Psicológico/psicologia , Estados Unidos/epidemiologiaRESUMO
Objectives To examine associations between depression and preterm birth and small-for gestational age (SGA) among women of predominantly Puerto Rican descent, a population who experiences disparities in adverse birth outcomes and one of the highest infant mortality rates in the United States. Methods Proyecto Buena Salud (PBS) was a prospective cohort study conducted from 2006 to 2011 at a large tertiary care center in Western Massachusetts. Caribbean Islander (i.e., Puerto Rican and Dominican Republic) women were interviewed in early, mid and late pregnancy. Among 1262 participants, associations between depression, assessed using the Edinburgh Postnatal Depression Scale, and risk of preterm birth and small-for-gestational age (SGA) were evaluated. Results Women with at least probable minor depression [odds ratio (OR) = 1.77 (95% confidence interval (CI) = 1.02, 3.07)] or probable major depression [OR = 1.82 (95% CI = 1.01, 3.25)] in mid-pregnancy had an increased risk of SGA compared to non-depressed women in adjusted analyses. Borderline significant associations were observed between increasing levels of depressive symptom scores in early and mid-pregnancy [OR = 1.05 (95% CI = 1.00, 1.11) and OR = 1.04 (95% CI = 1.00, 1.09), respectively] and each additional trimester of exposure to probable major depression across mid- to late pregnancy [OR = 1.66 (95% CI = 1.00, 2.74)] and SGA. Late pregnancy depression was not associated with SGA; depression during pregnancy was not associated with preterm birth. Conclusions for Practice In this population of predominantly Puerto Rican women, mid-pregnancy depression increased risk for SGA. Findings can inform culturally appropriate, targeted interventions to identify and treat pregnant women with depression.
Assuntos
Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/epidemiologia , Hispânico ou Latino/psicologia , Complicações na Gravidez/etiologia , Gravidez/psicologia , Gestantes/psicologia , Nascimento Prematuro/etiologia , Adulto , República Dominicana , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Complicações na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Nascimento Prematuro/epidemiologia , Diagnóstico Pré-Natal , Estudos Prospectivos , Porto Rico , Medição de Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologiaRESUMO
Objectives To prospectively evaluate the association between gestational weight gain (GWG), prepregnancy body mass index (BMI), and hypertensive disorders of pregnancy using the revised Institute of Medicine (IOM) Guidelines. Methods We examined these associations among 1359 participants in Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011 among women from the Caribbean Islands. Information on prepregnancy BMI, GWG, and incident diagnoses of hypertension in pregnancy were based on medical record abstraction. Results Four percent (n = 54) of women were diagnosed with hypertension in pregnancy, including 2.6 % (n = 36) with preeclampsia. As compared to women who gained within IOM GWG guidelines (22.8 %), those who gained above guidelines (52.5 %) had an odds ratio of 3.82 for hypertensive disorders (95 % CI 1.46-10.00; ptrend = 0.003) and an odds ratio of 2.94 for preeclampsia (95 % CI 1.00-8.71, ptrend = 0.03) after adjusting for important risk factors. Each one standard deviation (0.45 lbs/week) increase in rate of GWG was associated with a 1.74 odds of total hypertensive disorders (95 % CI 1.34-2.27) and 1.86 odds of preeclampsia (95 % CI 1.37-2.52). Conclusions for Practice Findings from this prospective study suggest that excessive GWG is associated with hypertension in pregnancy and could be a potentially modifiable risk factor in this high-risk ethnic group.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Hipertensão Induzida pela Gravidez/etnologia , Hipertensão/etnologia , Obesidade/complicações , Aumento de Peso , Adolescente , Adulto , Índice de Massa Corporal , Feminino , Humanos , Hipertensão/etiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Estudos Prospectivos , Porto Rico/epidemiologia , Fatores de RiscoRESUMO
OBJECTIVE: Prior studies of the association between physical activity and hypertensive disorders of pregnancy have been conflicting; the majority focused on leisure-time activity only, did not use physical activity questionnaires validated for pregnancy, and were conducted in primarily non-Hispanic white populations. METHODS: We prospectively evaluated this association among 1240 Hispanic women in Proyecto Buena Salud. The Pregnancy Physical Activity Questionnaire, validated for use in pregnancy, was used to assess pre- and early pregnancy sports/exercise, household/caregiving, occupational and transportation activity. Diagnoses of hypertensive disorders of pregnancy were based on medical record abstraction and confirmed by the study obstetrician. RESULTS: A total of 49 women (4.0%) were diagnosed with a hypertensive disorder of pregnancy, including 32 women (2.6%) with pre-eclampsia. In age-adjusted analyses, high levels of early pregnancy household/caregiving activity were associated with reduced risk of total hypertensive disorders (OR = 0.4, 95% CI 0.1-0.9) and pre-eclampsia (OR = 0.3, 95% CI 0.1-0.9) relative to low levels; however, these findings were no longer statistically significant in multivariable models. Pre-pregnancy activity and pattern of activity from pre- to early-pregnancy were not significantly associated with risk. Finally, sedentary behavior was not significantly associated with hypertensive disorders. CONCLUSION: Findings from this prospective study of Hispanic women were consistent with those of prior prospective cohorts indicating that physical activity prior to and during early pregnancy does not significantly reduce risk of hypertensive disorders of pregnancy.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Hipertensão Induzida pela Gravidez/epidemiologia , Comportamento Sedentário , Adolescente , Adulto , República Dominicana/etnologia , Exercício Físico , Feminino , Humanos , Massachusetts/epidemiologia , Análise Multivariada , Gravidez , Estudos Prospectivos , Porto Rico/etnologia , Adulto JovemRESUMO
The aim of this study is to prospectively examine the association between maternal depressive symptoms in early pregnancy and risk of abnormal glucose tolerance (AGT) and impaired glucose tolerance (IGT) in mid-pregnancy. We evaluated this association among 934 participants in Proyecto Buena Salud, a prospective cohort study of Hispanic (predominantly Puerto Rican) women in Western Massachusetts. Depressive symptoms were assessed in early pregnancy using the 10-item Edinburgh Postnatal Depression Scale. Scores ≥13 indicated at least probable minor depression and scores ≥15 indicated probable major depression. AGT and IGT were diagnosed using American Diabetes Association criteria. In early pregnancy, 247 (26.5 %) participants experienced at least minor depression and 163 (17.4 %) experienced major depression. A total of 123 (13.2 %) were classified with AGT and 56 (6.0 %) were classified with IGT. In fully-adjusted models, the odds ratio for AGT associated with minor depression was 1.20 (95 % CI 0.77-1.89) and for major depression was 1.34 (95 % CI 0.81-2.23). The odds ratio for IGT associated with minor depression was 1.22 (95 % CI 0.62-2.40) and for major depression was 1.53 (95 % CI 0.73-3.22). We did not observe an association with continuous screening glucose measures. Findings in this prospective cohort of Hispanic women did not indicate a statistically significant association between minor or major depression in early pregnancy and AGT or screening glucose values in mid-pregnancy. Due to the small number of cases of IGT, our ability to evaluate the association between depression and IGT risk was constrained.
Assuntos
Glicemia/metabolismo , Depressão/etnologia , Diabetes Gestacional/etnologia , Intolerância à Glucose/etiologia , Hispânico ou Latino/psicologia , Adulto , Depressão/diagnóstico , Depressão/psicologia , Diabetes Gestacional/psicologia , República Dominicana/etnologia , Feminino , Teste de Tolerância a Glucose/métodos , Hispânico ou Latino/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Modelos Logísticos , Massachusetts/epidemiologia , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Porto Rico/etnologia , Fatores de Risco , Estresse Psicológico/epidemiologia , Estresse Psicológico/etnologia , Inquéritos e QuestionáriosRESUMO
PURPOSE: Prior studies of the association between physical activity and risk of hypertensive disorders of pregnancy have been conflicting, failed to assess total physical activity, and included few Hispanic women, the largest minority group in the United States with the highest birth rates. METHODS: We examined this association among 1043 participants in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of predominantly Puerto Rican prenatal care patients conducted from 2000 to 2004 in western Massachusetts. Physical activity before and in early pregnancy was assessed by bilingual interviewers using a modified version of the Kaiser Physical Activity Survey. RESULTS: Fifty women (4.8%) were diagnosed with hypertensive disorders of pregnancy and 30 (2.9%) with preeclampsia. In multivariable analyses, there was a statistically significant trend of decreasing risk of hypertensive disorders with increasing sports/exercise in early pregnancy (P(trend) = 0.04). High levels of early pregnancy active living activity (odds ratio (OR) = 0.4, 95% confidence interval (CI) = 0.1-1.1, P(trend) = 0.07) and household/care giving activity (OR = 0.4, 95% CI = 0.1-1.3, P(trend) = 0.07) were associated with a 60% reduction in risk of hypertensive disorders relative to low levels; however, these associations were of marginal statistical significance. High levels of total physical activity (OR = 0.3, 95% CI = 0.1-1.0, P(trend) = 0.06) in early pregnancy were associated with a 70% reduction in the risk of hypertensive disorders relative to low levels; however, this association was also of marginal statistical significance. Prepregnancy physical activity was not associated with hypertensive disorders. CONCLUSIONS: These results in a Hispanic population, although based on small numbers of cases, corroborate previous studies suggesting that recreational activity in early pregnancy reduces the risk of hypertensive disorders of pregnancy.
Assuntos
Exercício Físico/fisiologia , Hispânico ou Latino , Hipertensão Induzida pela Gravidez/prevenção & controle , Complicações na Gravidez/etnologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etnologia , Massachusetts , Pré-Eclâmpsia , Gravidez , Estudos Prospectivos , Porto Rico/etnologia , Comportamento de Redução do Risco , Adulto JovemRESUMO
To estimate the association between multiple domains of physical activity and risk of small-for-gestational-age (SGA) birth. We utilized data from 1,040 participants in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of predominantly Puerto Rican prenatal care patients in Massachusetts. Physical activity was assessed by bilingual interviewers using a modified version of the Kaiser physical activity survey in early (mean = 15 weeks) and mid pregnancy (mean = 28 weeks). Physical activity (i.e., sports/exercise, household, occupational, and active living) in pre, early and mid pregnancy was categorized in quartiles. SGA was classified as <10th percentile of birth weight for gestational age. Pre- and early-pregnancy physical activity were not associated with SGA. In multivariable analyses, women with high total activity in mid-pregnancy had a decreased risk of SGA [risk ratio (RR) = 0.42; 95% confidence interval (CI) 0.21-0.82; p(trend) = 0.003] as compared to those with low total activity. Findings were similar for high household activity (RR = 0.69; 95% CI = 0.34-1.40; p(trend) = 0.26), active living (RR = 0.63; 95% CI = 0.35-1.13; p(trend) = 0.04), and occupational activity (RR = 0.79, 95% CI = 0.47-1.34; p(trend) = 0.26). High levels of sports/exercise were associated with an increased SGA risk without a significant dose-response association (RR = 2.14, 95% CI 1.04-4.39; p(trend) = 0.33). Results extend prior studies of physical activity and SGA to the Hispanic population.
Assuntos
Exercício Físico , Recém-Nascido Pequeno para a Idade Gestacional , Complicações na Gravidez/etnologia , Atividades Cotidianas , Adolescente , Adulto , Estudos de Coortes , Parto Obstétrico , Feminino , Hispânico ou Latino , Humanos , Recém-Nascido , Atividades de Lazer , Massachusetts , Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , Porto Rico/etnologia , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: Prepregnancy body mass index (BMI) and gestational weight gain have been associated with hypertensive disorders of pregnancy, but previous studies have included few Latinas, a group at increased risk. STUDY DESIGN: We examined these associations in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 women conducted from 2000 to 2004. RESULTS: In multivariable analysis, obese women (BMI > 29.0 kg/m(2)) had 2.5 times the risk of hypertensive pregnancy (95% confidence interval [CI], 1.3-4.8) and 2.7 times the risk of preeclampsia (95% CI, 1.2-5.8), compared with women whose BMI was 19.8 to 26.0 kg/m(2). Women with excessive gestational weight gain had a 3-fold increased risk of a hypertensive disorder of pregnancy (95% CI, 1.1-7.2) and a 4-fold risk of preeclampsia (95% CI, 1.2-14.5), compared with women achieving weight gain guidelines. CONCLUSION: These findings suggest prepregnancy obesity and excessive weight gain are associated with hypertension in pregnancy in a Latina population and could be potentially modifiable risk factors.
Assuntos
Hipertensão Induzida pela Gravidez/etiologia , Obesidade/complicações , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Coortes , Feminino , Hispânico ou Latino , Humanos , Gravidez , Porto Rico/etnologia , Fatores de Risco , Aumento de Peso , Adulto JovemRESUMO
BACKGROUND: Few studies have examined predictors of meeting health guidelines in pregnancy among Latina women. OBJECTIVE: We assessed dietary behaviors, physical activity, and cigarette smoking in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 prenatal care patients. DESIGN: Self-reported information on lifestyle factors, demographics, medical history, and physical activity was collected by bilingual interviewers during pregnancy. Fruit/vegetable intake was determined by summing the reported consumption of specific fruit and vegetables on a food-frequency questionnaire designed for this population and then adjusted for reported total daily servings. RESULTS: Approximately 13% of women met physical activity guidelines [>or=10 metabolic equivalents (MET)-h/wk], 19% met fruit/vegetable guidelines (7 servings/d), 21% of women smoked, and 1.4% consumed alcohol during pregnancy. In multivariate analyses, Spanish-language preference, an indicator of less acculturation, was associated with an approximately 40% less likelihood of both smoking [odds ratio (OR): 0.6; 95% CI: 0.4, 0.8] and meeting physical activity guidelines (OR: 0.6; 95% CI: 0.3, 1.0). College education was associated with a 2-fold greater likelihood of meeting fruit/vegetable guidelines (OR: 2.2; 95% CI: 1.1, 4.3) and a lower likelihood of smoking (OR: 0.2; 95% CI: 0.1, 0.4). A history of adverse pregnancy outcome was associated with a >4-fold greater likelihood of meeting physical activity guidelines. Smoking in pregnancy was associated with a decreased likelihood of meeting the fruit/vegetable guidelines (RR: 0.5; 95% CI: 0.3, 0.9). CONCLUSION: Factors related to engagement in prenatal health behaviors should be addressed in the design of targeted intervention strategies in this underserved and rapidly growing population.
Assuntos
Exercício Físico , Comportamento Alimentar , Gravidez/fisiologia , Fumar/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos de Coortes , Feminino , Frutas , Humanos , Entrevistas como Assunto , Paridade , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Cuidado Pré-Natal , Porto Rico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Verduras , Aumento de PesoRESUMO
PURPOSE: Studies of smoking during pregnancy and preterm birth among Hispanic women are sparse. Our goal was to evaluate the effect of cigarette smoking during pre-pregnancy, early pregnancy, and mid pregnancy on preterm birth among Hispanic women, the fastest growing ethnic group in the United States. METHODS: We evaluated data from a prospective cohort study of 1,041 Hispanic (predominantly Puerto Rican) women recruited between 2000 and 2004 in Springfield, Massachusetts. At recruitment (mean = 15 weeks), women reported their smoking since pregnancy awareness (early pregnancy) and in the year prior to pregnancy (pre-pregnancy). Mid pregnancy smoking was collected at a second interview (mean = 28 weeks). RESULTS: Smoking in pre-pregnancy was not associated with preterm birth. After adjustment for age, parity, education, and illicit drug use, women who smoked in early pregnancy had 1.6 times the risk of preterm birth (95% confidence interval [CI], 1.0-2.7) compared with nonsmokers. Women who smoked in mid pregnancy had 2.1 times the risk of preterm birth (95% CI, 1.0-4.2) compared with nonsmokers with a trend of increased risk of preterm birth with increasing levels of smoking (p trend, 0.03). CONCLUSIONS: Smoking in early or mid pregnancy increased the risk of spontaneous preterm birth in a Hispanic population.
Assuntos
Nascimento Prematuro/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , Índice de Massa Corporal , Escolaridade , Feminino , Humanos , Massachusetts/epidemiologia , Idade Materna , Paridade , Pobreza , Gravidez , Nascimento Prematuro/etnologia , Nascimento Prematuro/etiologia , Estudos Prospectivos , Porto Rico/etnologia , Fatores de Risco , Fumar/efeitos adversos , Fumar/etnologiaRESUMO
Factors influencing gestational weight gain are incompletely understood, particularly among Hispanic women. We assessed medical, sociodemographic, behavioral, and psychosocial predictors of overall gestational weight gain, as well as gains below, within, or above the range recommended by the Institute of Medicine (IOM) within a prospective study of 770 Hispanic (predominantly Puerto Rican) prenatal care patients at a large tertiary care facility in Western Massachusetts. One third of women gained within the recommended range, 22% gained below, and 45% gained above the range. In multivariate analysis, women in the highest category of BMI (P(trend)<0.001) and parity (P(trend)<0.001) gained on average 9 lbs less than those in the lowest category. Increasing time in residence in the continental United States (P(trend)<0.01) as well as a number of prenatal care visits (P(trend)=0.03) were positively associated with weight gain. Overweight women (odds ratio (OR)=2.2, 95% confidence interval (CI) 1.3, 3.8) and those over age 30 years (OR=2.5, 95% CI 1.2, 5.0) were more likely to gain above the IOM range as compared to normal-weight women and those aged 20-24, respectively. Women with <10 years of residence in the United States were 50% less likely to gain above the IOM range as compared to third-generation women (95% CI 0.3, 0.9). Findings identify determinants of gestational weight gain which can form the basis of targeted interventions in this rapidly growing ethnic group.