Objective To assess the main risk factors associated with stillbirth in a multiethnic English maternity population. Design Cohort study.Setting National Health Service region in England.Population 92 218 normally formed singletons including 389 stillbirths from 24 weeks of gestation, delivered during 2009-11.Main outcome measure Risk of stillbirth.

these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people.

Appropriate standards for the assessment of fetal growth and birthweight are central to good clinical care, and have become even more important with increasing evidence that growth-related adverse outcomes are potentially avoidable. Standards need to be evidence based and validated against pregnancy outcome and able to demonstrate utility and effectiveness. A review of proposals by the Intergrowth consortium to adopt their single international standard finds little support for the claim that the cases that it identifies as small are due to malnutrition or stunting, and substantial evidence that there is normal physiologic variation between different countries and ethnic groups. It is possible that the one-size-fits-all standard ends up fitting no one and could be harmful if implemented. An alternative is the concept of country-specific charts that can improve the association between abnormal growth and adverse outcome. However, such standards ignore individual physiologic variation that affects fetal growth, which exists in any heterogeneous population and exceeds intercountry differences. It is therefore more logical to adjust for the characteristics of each mother, taking her ethnic origin and her height, weight, and parity into account, and to set a growth and birthweight standard for each pregnancy against which actual growth can be assessed. A customized standard better reflects adverse pregnancy outcome at both ends of the fetal size spectrum and has increased clinicians' confidence in growth assessment, while providing reassurance when abnormal size merely represents physiologic variation. Rollout in the United Kingdom has proceeded as part of the comprehensive Growth Assessment Protocol (GAP), and has resulted in a steady increase in antenatal detection of babies who are at risk because of fetal growth restriction. This in turn has been accompanied by a year-on-year drop in stillbirth rates to their lowest ever levels in England. A global version of customized growth charts with over 100 ethnic origin categories is being launched in 2018, and will provide an individualized, yet universally applicable, standard for fetal growth.

IMPORTANCE Little evidence exists on whether effects of an early obesity intervention are sustainable.OBJECTIVE To assess the sustainability of effects of a home-based early intervention on children's body mass index (BMI) and BMI z score at 3 years after intervention. DESIGN, SETTING, AND PARTICIPANTSA longitudinal follow-up study of the randomized clinical Healthy Beginnings Trial was conducted with 465 participating mothers consenting to be followed up at 3 years after intervention until their children were age 5 years. This study was conducted in socially and economically disadvantaged areas of Sydney, Australia, from March 2011 to June 2014. INTERVENTIONSNo further intervention was carried out in this Healthy Beginnings Trial phase 2 follow-up study. The original intervention in phase 1 comprised 8 home visits from community nurses delivering a staged home-based intervention, with one visit in the antenatal period and 7 visits at 1, 3, 5, 9, 12, 18, and 24 months after birth. MAIN OUTCOMES AND MEASURES Primary outcomes were children's BMI and BMI z score. Secondary outcomes included dietary behaviors, quality of life, physical activity, and TV viewing time of children and their mothers. RESULTSIn total, 369 mothers and their children completed the follow-up study, a phase 2 completion rate of 79.4% (80.9% for the intervention group and 77.7% for the control group). The differences between the intervention and control groups at age 2 years in children's BMI and BMI z score disappeared over time. At age 2 years, the difference (intervention minus control) in BMI (calculated as weight in kilograms divided by height in meters squared) was −0.41 (95% CI, −0.71 to −0.10; P = .009), but by age 5 years it was 0.03 (95% CI, −0.30 to 0.37). No effects of the early intervention on dietary behaviors, quality of life, physical activity, and TV viewing time were detected at age 5 years. CONCLUSIONS AND RELEVANCEThe significant effect of this early life home-visiting intervention on child BMI and BMI z score at age 2 years was not sustained at age 5 years without further intervention. Obesity prevention programs need to be continued or maintained during the early childhood years. erect against the backboard, and the back of the head, shoulder blades, buttocks, and heels made contact with the backboard of the stadiometer. Two measurements were taken by a research assistant and recorded to the nearest 0.1 cm. A third measure was taken if the first 2 measurements differed by 0.5 cm or more, and the mean of these 2 or 3 values was calculated.b Adjusted for mother's marital status, mother's employment status, and child's BMI (or BMI z score) at 2 years.sumably because obesogenic factors within communities that put families and young children at risk of engaging in weight-related behaviors remain in place. Future research needs to explore early interventions beyond individual behaviors and family conditions that are related to overweight and obesity.Early Childhood Obesity Prevention Trial Effects

The higher sensitivity of the US 16-item food security survey module relative to the single-item Australian tool indicates its potential for use in future Australian surveys of food insecurity.