The objective of this study was to determine whether women who have experienced an unexplained stillbirth have a higher risk of adverse perinatal outcomes in subsequent births. We compared 316 subsequent births to women with a previous unexplained stillbirth, with 3160 births to women with no previous history of stillbirth, matched by year of birth, in the period 1987-1997, from the South Australian perinatal database, using logistic regression analysis. There was no increase in the rate of stillbirth and no statistically significant increase in the rate of perinatal death (OR 1.62 [95%CI 0.63-4.20]) or neonatal death, although larger studies are needed to confirm this. However, after adjusting for age, parity, and hospital category of birth, women who had a previous stillbirth had increased incidences in subsequent births of abnormal glucose tolerance or gestational diabetes (a fourfold increase); induction of labour and elective Caesarean section; fetal distress and postpartum haemorrhage; and forceps and emergency Caesarean delivery and preterm birth, which were independent of induction of labour. Gestational age at birth and birthweight were also significantly reduced, suggesting a need for close monitoring of their future pregnancies.

Aboriginal teenagers need special attention. Support in particular is needed for Aboriginal health workers in preconceptional counselling and health promotion programs that build the capacity of the community, eg concerning proper nutrition during pregnancy, smoking cessation, breastfeeding, SIDS prevention, support for early and regular attendance for antenatal care in friendly and culturally appropriate environments. Outreach services and sexual health services for young Aboriginal people also need expansion.

Objectives To determine the contribution of maternal smoking to preterm birth (< 37 weeks' gestation), small for gestational age (SGA, birthweight < 10th percentile for gestational age) and low birthweight (< 2500 g) among Aboriginal and non‐Aboriginal births in South Australia. Design Retrospective cohort analysis of population‐based perinatal data. Setting The State of South Australia, population 1.5 million. Participants 36059 women (of whom 851 were Aboriginal women) who had singleton births in 1998–1999. Main outcome measures Relative risks and population‐attributable risks of preterm birth, SGA and low birthweight from smoking in the second half of pregnancy, by age and Aboriginality. Results Aboriginal women had a higher rate of smoking in pregnancy than non‐Aboriginal women (57.8% v 24.0% at the first antenatal visit) and high rates for all age groups, while the rates decreased with age among non‐Aboriginal women. Heavy smoking increased with age, and Aboriginal women were heavier smokers. Women who smoked had elevated relative risks of preterm birth (1.64), SGA (2.28) and low birthweight (2.52), and all these showed a dose–response relationship. Among Aboriginal (versus non‐Aboriginal) births, population‐attributable risks were significantly higher for SGA (48% v 21%, and 59% for births to Aboriginal teenagers), low birthweight (35% v 23%) and preterm birth (20% v 11%). Conclusions Health promotion programs, with a focus on smoking cessation and reducing uptake of smoking, need to be implemented in an appropriate cultural context, especially among young Aboriginal women. Such a program is being developed in South Australia.

No abstract

Births to South Australian teenage women are associated with social disadvantage and relatively poor perinatal outcomes, although these have improved. Current strategies are aimed at reducing the incidence of unplanned teenage pregnancy and improving support for pregnant teenagers.

Objectives: To eval uate a South Ausueaan ca mpai gn to prom ote and implemen t knowled ge that takmg adeq uate totateztonc ace in tho perrconcephona l per iod can red uce the risk 01ha ving a baby wll h a neu ral lube detect . Des ign s nd s etting:The ca mpaign, co nd ucted In Octo be r 1994 -Aug us1 1995.tar geted women 01repr od uctive age and health prote ssronars. Evaluat ion was by computer-assisted telephon e interviews undertak en by random dIalling th roug hout the State before and alter the cam paign, and by sett-a dmenste red que snc nnaircs 10 heall h prctess.onars and women ," the postnatal per iod .Partic ipants: Women 01reprod uctive ag e and four group s 01heallh profe ssionals. Ma in outcome measures : Know ledge about folate . tcrete-nch l ood s and the cencc ncepncnar per iod : oerncpanon of health prof essionals in advising wom en abo ut tcrete: usc at peric onceptiona l folic acid s upplements; sales ot lolic acid tab let s; and prevalence of neural l ube defect s , Resuffs : Signi fica nt increas es in know ledge about tota te followed the ca mpaign . Heallh professiona ls and women in the pos tnata l period had highe r in itial leve ls of know ledge about fo late , whic h also Increased signlli canUy. The propo rtion s of womon lak ing penconcap trcnal tone acid supplements , and of healt h professiona ls adVISing women pl ann ing a pregnancy abou t folate , also increased signi fican tly, and tone acid taoiet sales dou bled Total p revalence 01neural tube det ects declined between 1966 a nd 1999 1rom a ba seli ne 012.0 per 1000 births to 1.1 per 1000 births (Po isson regression, P= 0 .03 ; ave rag e decline of 1.0%, per year). Conclusi on s : A sho rt educ atio nal campaign with a Iimifed budg et ($40000) can promote rotate success l ully, but eue rnauve st rateqies such a s lood tc ruucanon ale like ly to be needed to ac hieve adeq uate oe rtccn ceo uc nar tctat e intake lo r a very high propo rtion of women.

The introduction of maternal serum screening in South Australia has resulted in increased use of any prenatal testing for Down's syndrome from about 7% (mainly older women having amniocentesis or chorionic villus sampling) to 84% of women (about 8% having direct amniocentesis or chorionic villus sampling and 76% having maternal serum screening first). This has resulted in a significant fall in the birth prevalence of Down's syndrome. maternal serum screening was the first indication of Down's syndrome for about half the terminations of pregnancy for Down's syndrome in 1993-1996, including three quarters of those in younger women.

Objective-To determine trends in total prevalence ofneural tube defects in South Australia during 1966-91, the impact of prenatal diagnosis on birth prevalence, and the effectiveness ofprenatal screening for neural tube defects in 1986-91.