Document Detail

Reduced birthweight in short or primiparous mothers: physiological or pathological?
MedLine Citation:
PMID:  20618317     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Customisation of birthweight-for-gestational-age standards for maternal characteristics assumes that variation in birth weight as a result of those characteristics is physiological, rather than pathological. Maternal height and parity are among the characteristics widely assumed to be physiological. Our objective was to test that assumption by using an association with perinatal mortality as evidence of a pathological effect.
DESIGN: Population-based cohort study.
SETTING: Sweden.
POPULATION: A total of 952 630 singletons born at > or =28 weeks of gestation in the period 1992-2001.
METHODS: We compared perinatal mortality among mothers of short stature (<160 cm) versus those of normal height (> or =160 cm), and primiparous versus multiparous mothers, using an internal reference of estimated fetal weight for gestational age. The total effects of maternal height and parity were estimated, as well as the effects of height and parity independent of birthweight (controlled direct effects). All analyses were based on fetuses at risk, using marginal structural Cox models for the estimation of total and controlled direct effects.
MAIN OUTCOME MEASURES: Perinatal mortality, stillbirth, and early neonatal mortality.
RESULTS: The estimated total effect (HR; 95% CI) of short stature on perinatal death among short mothers was 1.2 (95% CI 1.1-1.3) compared with women of normal height; the effect of short stature independent of birthweight (controlled direct effect) was 0.8 (95% CI 0.6-1.0) among small-for-gestational-age (SGA) births, but 1.1 (95% CI 1.0-1.3) among non-SGA births. Similar results were observed for primiparous mothers.
CONCLUSIONS: The effect of maternal short stature or primiparity on perinatal mortality is partly mediated through SGA birth. Thus, birthweight differences resulting from these maternal characteristics appear not only to be physiological, but also to have an important pathological component.
X Zhang; S L Mumford; S Cnattingius; E F Schisterman; M S Kramer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Intramural; Research Support, Non-U.S. Gov't     Date:  2010-07-07
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  117     ISSN:  1471-0528     ISO Abbreviation:  BJOG     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-20     Completed Date:  2010-11-08     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  England    
Other Details:
Languages:  eng     Pagination:  1248-54     Citation Subset:  AIM; IM    
Department of Pediatrics, McGill University, Faculty of Medicine, Montreal, QC, Canada.
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MeSH Terms
Birth Weight / physiology*
Body Height / physiology*
Educational Status
Gestational Age
Infant, Newborn
Infant, Small for Gestational Age
Maternal Age
Parity / physiology*
Perinatal Mortality
Premature Birth / epidemiology
Stillbirth / epidemiology
Sweden / epidemiology
Grant Support
Z01 HD008761-05/HD/NICHD NIH HHS; Z99 HD999999/HD/NICHD NIH HHS; //Canadian Institutes of Health Research

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