Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia (original) (raw)
Related papers
Australian and New Zealand Journal of Public Health, 2006
To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women. Methods: The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004-2006 (retrospective cohort) and 2009-2011 (prospective cohort). Demographic, pregnancy characteristics, labour and birth outcomes were described. Multivariate logistic regression analysis was conducted and adjusted odds ratios were reported. Results: The preterm birth rate was 19.4%, low birthweight rate was 17.4% and small for gestational age rate was 16.3%. Risk factors for preterm birth were teenage motherhood, previous preterm birth, smoker status not recorded, inadequate antenatal visits, having pregnancy-induced hypertension, antepartum haemorrhage or placental complications. After adjusting for gender and birth gestation, the only significant risk factor for low birthweight was first time mother. The only significant risk factor for small for gestational age baby was women having their first baby. Conclusions: Rates of these events are high and have changed little over time. Some risk factors are modifiable and treatable but need early, high quality, culturally responsive women centred care delivered in the remote communities themselves. A different approach is recommended.
Maternal and Child Health Journal, 2012
This paper aims to describe delivery and birth outcomes of Aboriginal infants and their mothers in an urban setting on the east coast of Australia. The paper uses a causal pathway approach to consider the role of risk and protective factors for low birthweight. All mothers who delivered at Campbelltown Hospital between October 2005 and May 2007 were eligible. The study included 1,869 non-Aboriginal infants and 178 Aboriginal infants and their mothers. Information on delivery and birthweight was extracted from electronic medical records. Risk factors for poor outcomes were explored using regression and causal pathway analysis. Mothers of Aboriginal infants were younger than mothers of non-Aboriginal infants, and were more likely to be single, less educated, unemployed prior to pregnancy, and live in a disadvantaged neighbourhood. Health and service use was similar. They were significantly more likely to have a vaginal delivery than mothers of non-Aboriginal infants (77% cf 62.5%; v 1 2 = 14.6, P \ 0.001) and less likely to receive intervention during delivery. Aboriginal infants (3,281.1 g) weighed 137.5 g (95%CI: 54-221 g; P = 0.001) less then non-Aboriginal infants (3,418.7 g). Gestational age, and single mother with incomplete education, prior unemployment, smoking, and living in a disadvantaged neighbourhood were associated with lower birthweight. Maternal vulnerability had a cumulative impact on birthweight. A causal pathway analysis demonstrated the associations between risk factors.
PLOS ONE, 2019
Objective To examine health outcomes in Australian Aboriginal and Torres Strait Islander children experiencing perinatal risk and identify protective factors in the antenatal period. Methods Baby/Child cohorts of the Longitudinal Study of Indigenous Children, born 2001-2008, across four annual surveys (aged 0-8 years, N = 1483). Children with 'mild' and 'moderateto-high' perinatal risk were compared to children born normal weight at term for maternalrated global health and disability, and body-mass-index measured by the interviewer. Results Almost one third of children had experienced mild (22%) or moderate-to-high perinatal risk (8%). Perinatal risk was associated with lower body-mass-index z-scores (regression coefficients adjusted for pregnancy and environment factors: mild =-0.21, 95% CI =-0.34,-0.07; moderate-to-high =-0.42, 95% CI =-0.63,-0.21). Moderate-to-high perinatal risk was associated with poorer global health, with associations becoming less evident in models adjusted for pregnancy and environment factors; but not evident for disability. A range of protective factors, including cultural-based resilience and smoking cessation, were associated with lower risk of adverse outcomes. Conclusions Perinatal risks are associated with Australian Aboriginal and Torres Strait children experiencing adverse health particularly lower body weight. Cultural-based resilience and
Journal of Pregnancy and Child Health, 2015
The life expectancy of Indigenous Australians is amongst the lowest of any population group within developed nations and chronic diseases collectively account for over 80% of the gap in life expectancy between Indigenous and non-Indigenous Australians. The Gomeroi gaaynggal cohort is a prospective, longitudinal maternal-infant cohort established to examine the origins of chronic disease in Indigenous Australians. This study aimed to determine the major antenatal factors associated with adverse birth outcomes (preterm delivery, low birth weight) and other pregnancyrelated complications (gestational diabetes and hypertensive disorders of pregnancy) in Indigenous Australian women. Pregnant women who identified as Indigenous Australians or pregnant non-Indigenous women giving birth to an Indigenous infant were eligible to participate in the cohort (n=227). Physical measurements and biological sample collection (including blood and urine) were undertaken up to 3 times in pregnancy. Median weight and BMI of the cohort was 80.7 kg and 30.3 kg/m 2 at enrolment (median 23 weeks gestation). 43% reported smoking cigarettes during pregnancy. Of the 158 women in whom pregnancy outcomes were known, 43% had an uncomplicated pregnancy, 13.9% delivered preterm, 14.6% delivered a small-for-gestational age infant, 10% developed a hypertensive disorder of pregnancy, and 6.3% developed gestational diabetes. In addition, many women showed evidence of underlying renal dysfunction (proteinuria or albuminuria). The ratio of male to female offspring in this cohort was 1.38. Eightyseven percent of preterm infants were male, as were 83.3% of babies from women with gestational hypertension. This skewed sex distribution was far higher than for those who had a healthy pregnancy outcome (59%). This study demonstrates that key factors including maternal obesity, exposure to cigarette smoke and underlying renal impairment, influence pregnancy outcome. Preliminary findings from this study also suggest that more male babies are born early and from complicated pregnancies in this Indigenous cohort.
Midwifery, 2014
Objective: there is a significant gap in pregnancy and birth outcomes for Australian Aboriginal and Torres Strait Islander women compared with other Australian women. The provision of appropriate and high quality antenatal care is one way of reducing these disparities. The aim of this study was to assess adherence to antenatal guidelines by clinicians and identify factors affecting the quality of antenatal care delivery to remote dwelling Aboriginal women. Setting and design: a mixed method study drew data from 27 semi-structured interviews with clinicians and a retrospective cohort study of Aboriginal women from two remote communities in Northern Australia, who gave birth from 2004-2006 (n ¼412). Medical records from remote health centres and the regional hospital were audited. Measurements and findings: the majority of women attended antenatal care and adherence to some routine antenatal screening guidelines was high. There was poor adherence to local guidelines for followup of highly prevalent problems including anaemia, smoking, urinary tract infections and sexually transmitted infections. Multiple factors influenced the quality of antenatal care. Key conclusions and implications for practice: the resourcing and organisation of health services and the beliefs, attitudes and practices of clinicians were the major factors affecting the quality of care. There is an urgent need to address the identified issues in order to achieve equity in women's access to high quality antenatal care with the aim of closing the gap in maternal and neonatal health outcomes.
Birth, 2017
Background: The teenage pregnancy rate is high among Indigenous Australian women, yet little is known about their pregnancy outcomes. Moreover, against a background of extreme social disadvantage, the relative importance of age as a risk factor for adverse outcomes among Indigenous pregnancies is unclear. We compared perinatal outcomes for Indigenous teenagers (<20 years) with adult Indigenous women (20-34 years), and described outcomes in subgroups of teenagers. Methods: Data were analyzed for 2421 singleton births to Indigenous women aged <35 years in Australia's Northern Territory from 2003 to 2005. Regression was used to assess the effect of young maternal age on normal birth, healthy baby, preterm birth, low birthweight, special care admission, and mean birthweight, adjusting for covariates. Results: Three-quarters of teenagers and 62% of adult mothers lived in remote areas. Smoking rates were around 50% in both groups. Teenagers were more likely to have a normal birth than adults (adjusted odds ratio 1.78 [95% CI 1.35-2.34]). The groups did not differ for healthy baby, preterm birth, or low birthweight. Babies of teenagers weighed 135 g less than those of adults; however, adjustment for covariates eliminated this difference. Examination of teenage subgroups (≤16 years and 17-19 years) revealed risk behaviors being higher for 17-19 years olds than for the younger group, and more prevalent among urban-based mothers. Discussion: Young maternal age is not a risk factor for adverse perinatal outcomes among Indigenous women. Rather, they are having babies in disadvantaged circumstances within a system challenged to support them socially and clinically.
EClinicalMedicine
Background: Prevention of avoidable preterm birth in Aboriginal and Torres Strait Islander (Indigenous) families is a major public health priority in Australia. Evidence about effective, scalable strategies to improve maternal and infant outcomes is urgently needed. In 2013, a multiagency partnership between two Aboriginal Community Controlled Health Organisations and a tertiary maternity hospital co-designed a new service aimed at reducing preterm birth: 'Birthing in Our Community'. Methods: A prospective interventional cohort study compared outcomes for women with an Indigenous baby receiving care through a new service (n = 461) to women receiving standard care (n = 563), January 2013-December 2017. The primary outcome was preterm birth (b 37 weeks gestation). One to one propensity score matching was used to select equal sized standard care and new service cohorts with similar distribution of characteristics. Conditional logistic regression calculated the odds ratio with matched samples. Findings: Women receiving the new service were less likely to give birth to a preterm infant than women receiving standard care (6•9% compared to 11.6%). After controlling for confounders, the new service significantly reduced the odds of having a preterm birth (unmatched, n = 1024: OR = 0•57, 95% CI 0•37, 0•89; matched, n = 690: OR = 0•50, 95% CI 0•31, 0•83). Interpretation: The short-term results of this service redesign send a strong signal that the preterm birth gap can be reduced through targeted interventions that increase Indigenous governance of, and workforce in, maternity services and provide continuity of midwifery carer, an integrated approach to supportive family services and a community-based hub.
International Journal of Environmental Research and Public Health
While much is known about the health implications of low birthweight for infants and adults, there is limited information about the health implications in childhood, particularly for Indigenous children. The aim of this systematic review was to assess associations between low birthweight (LBW) and/or small for gestational age (SGA) and the developmental, physical or mental health outcomes for Australian, Canadian and New Zealand Indigenous children (5–12 years), including the potential mediating role of cultural connections. The review was guided by an Aboriginal Advisory Group established to guide the Aboriginal Families Study. Four databases were investigated with pre-determined inclusion/exclusion criteria. The search identified 417 articles after independent screening by two authors. Eight studies assessing six child outcomes were included. The review identified limited evidence, although the review suggested possible links between LBW and/or SGA and childhood asthma, lower body...