BackgroundObesity in pregnant women is a major problem affecting both the mother and her offspring. Literature on the effect of obesity on preterm birth is inconsistent and few studies have investigated the influence of weight gain during pregnancy. This study examined the effect of maternal pre-pregnancy BMI and weight gain during pregnancy on preterm birth.MethodsData from the Collaborative Perinatal Project (CPP) on 45,824 pregnant women with singleton, live-born infants with no sever congenital anomalies was analyzed. Primary outcome variables included preterm (< 37 weeks of gestation), categorized into spontaneous preterm with and without premature rupture of membrane (PROM) and indicated preterm. Maternal BMI was categorized into underweight (BMI < 18.50), normal weight (BMI =1 8.50 – 24.99), overweight (BMI = 25.00 – 29.99), and obese (BMI ≥ 30.00). Multinomial regression analysis was conducted and OR and 95% CI were calculated.ResultsThe rate of spontaneous preterm birth with PROM among overweight women decreased with increasing weight gain but increased among women who had excessive weight gain. Similarly, a U-shaped rate of spontaneous preterm birth with and without PROM was observed in obese women. Gaining less weight was protective of spontaneous preterm with and without PROM among overweight and obese women compared to normal weight women. Among underweight women, gaining < 7 kg or 9.5-12.7 kg was associated with increased odds of indicated preterm birth. Appreciable differences were also observed in the association between pre-pregnancy BMI, gestational weight gain and the subtypes of preterm births among African Americans and Caucasian Americans.ConclusionReduced weight gain during pregnancy among overweight and obese women is associated with reduced spontaneous preterm birth with and without PROM. Health care professionals and public health workers should be aware of this risk and adhere to the 2009 IOM guideline that recommended reduced weight gain during pregnancy for obese and overweight women.

No abstract

Youth violence disproportionately affects inner city, urban minority communities in the USA. This article illustrates the use of surveillance data to inform and evaluate community action directed at this serious problem. Community efforts in response to surveillance data indicating high rates of violence surrounding convenience stores with unrestricted alcohol beverage licenses provided a natural experiment to examine the impact of imposing licensing restrictions on intentional injury rates. Rates of ambulance pickups for intentional injuries in the 15- to 24-year-old population in five census tracts where alcoholic beverage sales were restricted were compared to five census tracts with similar demographic characteristics near stores where restrictions were not instituted. Time periods included an 18-month baseline period, a 6-month period during which restrictions were in effect in the intervention communities, and an 18-month period following lifting of this restriction resulting from legal action by store owners. The monthly average rate of ambulance pickups for violent injuries showed a significantly greater baseline-to-intervention phase decrease in the intervention communities (i.e., from 19.6 to 0 per 1,000) than in the control communities (i.e., 7.4 to 3.3 per 1,000). This rate subsequently increased to 11.4 in the intervention communities after the restriction was removed. This study illustrates the potential value of surveillance data for guiding community mobilization efforts and for evaluating the impact of such efforts. It also demonstrates the potential impact of restricting inexpensive, single-serve alcoholic beverages on rates of violence.

Objectives Poor pregnancy and birth outcomes are major problems in the United States, and maternal smoking during pregnancy has been identified as one of the most preventable risk factors associated with these outcomes. This study examines less explored risk factors of smoking among underserved African American pregnant women. Methods A cross-sectional survey was conducted at an outpatient obstetrics-gynecology clinic of an inner-city university hospital in Virginia from March 2009 through January 2011 in which pregnant women (N=902) were interviewed at their first prenatal care visit. Survey questions included items related to women’s sociodemographic characteristics as well as their pregnancy history; criminal history; receipt of social services; child protective services involvement; insurance status; and history of substance abuse, domestic violence, and depression. Multiple logistic regression was conducted to calculate odds ratios and 95% confidence intervals depicting the relationship between these factors and smoking during pregnancy. Results The analysis reported that maternal age [OR= 1.08, 95%CI=1.05–1.12], less than high school education [OR=4.30, 95%CI=2.27–8.14], unemployed [OR=2.33, 95%CI=1.35–4.04], criminal history [OR=1.66, 95%CI=1.05–2.63], receipt of social services [OR=2.26, 95%CI=1.35–3.79] alcohol use [OR=2.73, 95%CI=1.65–4.51] and illicit drug use [OR=1.97, 95%CI=1.04–3.74] during pregnancy were statistically significant risk factors associated with smoking during pregnancy. Conclusions In addition to the well known risk factors, public health professionals should be aware that criminal history and receipt of social services are important factors associated with smoking during pregnancy. Social service providers such as WIC and prisons and jails may offer a unique opportunity for education and cessation interventions during the preconception or interconception period.