Attitudes to viability of preterm infants and their effect on figures for perinatal mortality.

Fenton, Andy; Field, David; Mason, Elizabeth; Clarke, M

doi:10.1136/bmj.300.6722.434

Cited by 59 publications

(25 citation statements)

References 2 publications

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“…Stillborn babies less than 24 weeks are not registered as deaths, whereas live births are, even though these neonates are generally not resuscitated. Hospitals vary in their propensity to search for life signs 10 . As births to certain ethnic groups were concentrated in particular hospitals, this could produce spurious differences in preterm delivery.…”

Section: Methodsmentioning

confidence: 99%

The risk of preterm delivery in women from different ethnic groups

Aveyard

Cheng

Manaseki

et al. 2002

BJOG

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Objective To examine whether routinely measured variables explained the increased risk of preterm delivery in some UK ethnic groups. Design Cross sectional study of deliveries recorded in the Child Health Record System. Setting North Birmingham, UK.Population All North Birmingham women delivering singletons, 1994-1997 inclusive. Method Logistic regression.Main outcome measures Odds ratio (OR) and 95% confidence interval (CI) for preterm delivery, defined as less than 37 weeks, less than 34 weeks and less than 28 weeks, unadjusted and adjusted for maternal age, an area-based socio-economic status measure, and marital status, year of birth, fetal sex and past obstetric history. Results For Afro-Caribbean women, the ORs (95% CIs) were: for delivery less than 37 weeks, 1.44 (1.26 -1.64) unadjusted and 1.22 (1.07 -1.41) adjusted; for delivery less than 34 weeks, 1.55 (1.25 -1.92) unadjusted and 1.29 (1.02 -1.61) adjusted; for delivery less than 28 weeks, 1.66 (1.08 -2.55) unadjusted and 1.32 (0.84 -2.06) adjusted. For African women, the risk of delivery less than 37 weeks was not significantly raised; for delivery less than 34 weeks, the OR (95% CI) was 1.88 (0.99 -3.58) unadjusted and 1.78 (0.93 -3.40) adjusted; for delivery less than 28 weeks, the OR (95% CI) was 4.02 (1.60 -10.12) unadjusted and 4.10 (1.66 -10.16) adjusted. In Afro-Caribbeans, deprivation and marital status explained the differences between the unadjusted and adjusted ORs. There was a linear relation between deprivation and preterm delivery for all ethnic groups, except for Asians. Conclusions Factors associated with deprivation and marital status explain about half of the excess of preterm births in Afro-Caribbeans, but not Africans. The risk of preterm delivery might not be related to deprivation in Asians.

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Section: Methodsmentioning

confidence: 99%

The risk of preterm delivery in women from different ethnic groups

Aveyard

Cheng

Manaseki

et al. 2002

BJOG

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“…Since the 1980s, advances in neonatal care have dramatically improved the chances of survival for infants born very preterm (Tin et al, 1997). Thus, infants delivered at gestations below 28 weeks (the gestational age cut-off for inclusion in the study as a late foetal death) may now be more likely to be considered viable, actively resuscitated, and registered as live births, when previously they might have been unregistered foetal losses (Fenton et al, 1990). This might be expected to result in an artefactual increase in live births at very low birthweight.…”

Section: Changes In Registration and Clinical Practicementioning

confidence: 98%

Trends in birthweight in the north of England

Bell

2008

Human Fertility

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This article describes trends in population birthweight distribution in the north of England between 1982 and 2000, and reviews the international literature on recent birthweight trends in industrialized populations. Two contrasting trends were observed: an increase in low birthweight from 7.0% to 7.7% of all births, and an increase in births weighing 3500 g or more, consistent with an increase in mean birthweight. The rate of multiple births increased over the study period, and multiple births accounted for about half of the increase in low birthweight. Multiple births are rising due to increasing maternal age, and the development and use of assisted reproductive technologies. Low birthweight increased in both multiple and singleton births, due entirely to increased low-birthweight live births. There was a substantial reduction in low-birthweight stillbirths. The rise in low-birthweight live births is multifactorial, but changes in registration practice and increased elective delivery are likely contributory factors. The increase in high birthweights is likely to reflect reductions in smoking during pregnancy, and increased maternal height and weight. The dramatic recent rise in maternal body mass index (BMI) at booking is likely to have a substantial impact on birthweight and adverse perinatal outcomes in coming decades.

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“…All countries use some threshold, in terms of gestational age or birthweight, for registering stillbirths, and some use a threshold for registering live births, and hence deaths among them, as well. Despite the fact that in the 1980s and 1990s these criteria shifted to lower gestational age and birthweight cutoff points in several countries, they still differ substantially between countries 7,8 . Although many studies have now pointed to this problem, its quantitative impact on comparisons of published perinatal mortality rates is largely unknown 9 , except for a study from the late 1980s focusing on the effect of introducing a common lower threshold for birthweight 10 .…”

Section: Introductionmentioning

confidence: 99%

Comparability of published perinatal mortality rates in Western Europe: the quantitative impact of differences in gestational age and birthweight criteria

Graafmans

Richardus

Macfarlane³

et al. 2001

BJOG

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). Two methods, one direct and one indirect, were used for adjusting these officially published rates for differences in registration laws or publication practices. For the indirect method adjustment factors were derived from an analysis of a large Finnish database using different cutoff points for gestational age and birthweight. For the direct method a common cutoff point was imposed for birthweight (1000g) and gestational age (28 completed weeks) on national perinatal mortality data, obtained from civil registration or hospital/obstetrics databases in each country. Results The published perinatal mortality rates ranged from 5.4 per 1000 total births in Sweden and Finland to 9.7 in Greece and Northern Ireland. The indirect adjustment method showed that some countries apply cutoff points for registration or publication of perinatal mortality which may raise the perinatal mortality rate by up to 17% above the most commonly used threshold for including live and stillbirths. The direct adjustment method showed that a common lower limit of 1000g for birthweight or 28 weeks for gestational age would reduce the perinatal mortality rate, but by a differing extent ranging from 14% to 40%. Both adjustment methods reduced the contrast between the countries' perinatal mortality rates, and changed their rank order. Conclusion These quantitative results confirm that international differences in countries' published perinatal mortality rates partly reflect differences between countries' criteria for registration and publication of perinatal deaths.

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Attitudes to viability of preterm infants and their effect on figures for perinatal mortality.

Cited by 59 publications

References 2 publications

The risk of preterm delivery in women from different ethnic groups

The risk of preterm delivery in women from different ethnic groups

Trends in birthweight in the north of England

Comparability of published perinatal mortality rates in Western Europe: the quantitative impact of differences in gestational age and birthweight criteria

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