We examined the influence of duration of exclusive breastfeeding (DEBF) for a mother's earlier children on the DEBF for her later children among multiparous women from the 2002 National Survey of Family Growth. DEBF was categorized as: never breastfed (NBF) (referent); not exclusively breastfed or exclusively breastfed for <4 months (EBF<4); and exclusively breastfed for ≥4 months (EBF≥4). We examined DEBF using weighted percentages and odds ratios (OR) with 95% confidence intervals (CI) from multinomial logistic regression models, adjusting for maternal factors. About 70% of multiparous women (n=2,149) repeated the duration of exclusive breastfeeding of their first child for their second child; 14% of women repeated EBF≥4. Among multiparous women, the adjusted odds ratio for EBF≥4 for second children was 7.2 (95% CI=4.0-12.9) when first children were EBF<4 and 90.7 (95% CI=45.4-181.4) when first children were EBF≥4, relative to NBF first children. In analyses where DEBF of third children was the outcome, odds of EBF≥4 were more strongly influenced by DEBF of second children while the impact of DEBF of first children was not as strong. Older maternal age and being married were related to an increased DEBF. Being married at second birth predicted a change from NBF for first children to EBF≥4 for second children (OR=6.2, 95% CI=2.7-14.2). In conclusion, mothers generally repeated the DEBF of their previous child. For third children, DEBF of the second child was more likely to be repeated than that of the first child.

Previous studies have consistently identified maternal obesity and gestational weight gain as risk factors for macrosomia, but little is known about the effects of central adiposity and body fat distribution. Using self-reported data from the Black Women's Health Study (BWHS), a large follow-up study of U.S. black women, we examined the risk of macrosomia in relation to prepregnancy waist circumference, prepregnancy waist-to-hip ratio, prepregnancy body mass index (BMI), and gestational weight gain. During 1995-2003, BWHS participants ages 21 to 44 years delivered 6,687 full-term singleton births (gestational age >37 weeks). We compared mothers of 691 infants weighing ≥4000g with mothers of 5,996 infants weighing <4000g. Generalized estimating equation models that accounted for more than one birth per mother were used to estimate multivariable odds ratios (OR) and 95% confidence intervals (CI). Independent of prepregnancy BMI, prepregnancy waist circumference was positively associated with risk of macrosomia (OR=1.58, 95% CI 1.07-2.32, for ≥35.0 vs. <27.0 inches (≥88.9 vs. <68.6 cm); Ptrend= 0.04). As expected, prepregnancy BMI was also positively associated with macrosomia (OR=1.74, 95% CI 1.25-2.41 for BMI ≥35.0 vs. 18.5-24.9 kg/m 2 ). Gestational weight gain above the amount recommended by the 2009 Institute of Medicine report was associated with an increased risk of macrosomia and the association was present in each category of prepregnancy , and ≥30.0 kg/m 2 ; P-trend<0.001). Our data suggest that overall obesity, high gestational weight gain, and high waist circumference are independent risk factors for macrosomia among U.S. black women.Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use

PURPOSE To examine the association between prepregnancy depressive symptoms and preterm birth. METHODS The present study is a prospective investigation of prepregnancy depressive symptoms—measured by the Center for Epidemiologic Studies Depression Scale (CES-D)—and risk of preterm birth reported in the Black Women’s Health Study. With data on 2,627 singleton births (175 spontaneous and 163 medically-indicated preterm births and 2,289 term births), we used generalized estimating equation models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for potential confounders. RESULTS Relative to mothers with CES-D scores <16, the multivariable ORs of spontaneous preterm birth for mothers with CES-D scores of 16-22, 23-32, and ≥33 were 1.17 (95% CI=0.78-1.80), 1.20 (95% CI=0.69-2.10), and 2.00 (95% CI=0.94-4.25), respectively (P-trend=0.09). There was little evidence of an association between prepregnancy depressive symptoms and medically-indicated preterm birth. CONCLUSIONS Our data provide some evidence of an increased risk of spontaneous preterm birth among women with high prepregnancy depressive symptoms.

Previous studies have consistently identified maternal obesity and gestational weight gain as risk factors for macrosomia, but little is known about the effects of central adiposity and body fat distribution. Using self-reported data from the Black Women's Health Study (BWHS), a large follow-up study of U.S. black women, we examined the risk of macrosomia in relation to prepregnancy waist circumference, prepregnancy waist-to-hip ratio, prepregnancy body mass index (BMI), and gestational weight gain. During 1995–2003, BWHS participants ages 21 to 44 years delivered 6,687 full-term singleton births (gestational age >37 weeks). We compared mothers of 691 infants weighing ≥4000g with mothers of 5,996 infants weighing <4000g. Generalized estimating equation models that accounted for more than one birth per mother were used to estimate multivariable odds ratios (OR) and 95% confidence intervals (CI). Independent of prepregnancy BMI, prepregnancy waist circumference was positively associated with risk of macrosomia (OR=1.58, 95% CI 1.07–2.32, for ≥35.0 vs. <27.0 inches (≥88.9 vs. <68.6 cm); P-trend= 0.04). As expected, prepregnancy BMI was also positively associated with macrosomia (OR=1.74, 95% CI 1.25–2.41 for BMI ≥35.0 vs. 18.5–24.9 kg/m2). Gestational weight gain above the amount recommended by the 2009 Institute of Medicine report was associated with an increased risk of macrosomia and the association was present in each category of prepregnancy BMI (18.5–24.9, 25.0–29.9, and ≥30.0 kg/m2; P-trend<0.001). Our data suggest that overall obesity, high gestational weight gain, and high waist circumference are independent risk factors for macrosomia among U.S. black women.

PurposeIn May 2012, the Association of Maternal and Child Health (MCH) Programs initiated a project to develop indicators for use at a state or community level to assess, monitor, and evaluate the application of life course principles to public health.DescriptionUsing a developmental framework established by a national expert panel, teams of program leaders, epidemiologists, and academicians from seven states proposed indicators for initial consideration. More than 400 indicators were initially proposed, 102 were selected for full assessment and review, and 59 were selected for final recommendation as Maternal and Child Health (MCH) life course indicators.AssessmentEach indicator was assessed on five core features of a life course approach: equity, resource realignment, impact, intergenerational wellness, and life course evidence. Indicators were also assessed on three data criteria: quality, availability, and simplicity.ConclusionThese indicators represent a major step toward the translation of the life course perspective from theory to application. MCH programs implementing program and policy changes guided by the life course framework can use these initial measures to assess and influence their approaches.

Relative income may be a better predictor of health outcomes than absolute income. We examined two measures of relative income-income incongruity and relative household income-in relation to preterm birth in a study of U.S. Black women. Income incongruity is a measure that compares the median household income of an individual's residential area with that of others who have the same level of marital status and education, but who may live in different areas. Relative household income is a measure that compares an individual's household income with the median household income of her residential area. We used data collected biennially (1997)(1998)(1999)(2000)(2001)(2002)(2003) from participants in the Black Women's Health Study: 6,257 singleton births were included in the income incongruity analyses and 5,182 in the relative household income analyses; 15% of the births were preterm. After adjusting for confounders, we found no overall association of income incongruity or relative household income with preterm birth. For relative household income, but not for income incongruity, there was suggestive evidence that neighborhood composition modified the association with preterm birth: higher relative household income was associated with higher risk of preterm birth in neighborhoods with a high percentage of Black residents, and higher relative household income was associated with lower risk in neighborhoods with a low percentage of Black residents.

This study examines the association between neighborhood socioeconomic status (SES) and preterm birth among U.S. Black women. A composite variable for neighborhood SES, derived from 7 U.S. Census Bureau indicators, was assessed in relation to self-reported preterm birth (505 spontaneous and 452 medically indicated) among 6,390 women in the Black Women's Health Study who delivered singleton births during 1995-2003. The odds ratio (OR) for preterm birth, comparing the lowest (most deprived) to the highest (least deprived) quartiles of neighborhood SES, was 0.98 (95 % CI, 0.80, 1.20) after adjustment for individual-level characteristics. Low neighborhood SES was not associated with spontaneous or medically indicated preterm birth overall or within strata of maternal age, education, or geographic region. The only significant finding was higher odds of medically indicated preterm birth associated with low neighborhood SES among unmarried women. Low neighborhood SES was not materially associated with preterm birth in this study of U.S. Black women.

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