Gap slowly closing in stillbirths
A QUEENSLAND-based study has found the gap in stillbirth rates between Indigenous and non-Indigenous women is narrowing, and that in Indigenous women the continuing increased risk is largely due to potentially preventable causes. The retrospective cohort study, published in the BJOG, was based on data collected between 1995 and 2011 on all singleton births of at least 20 weeks of gestation or at least 400 g birthweight. There were 881 211 births (including 5425 stillbirths) during the study period — 49 450 births (5.6%) to Indigenous women and 831 761 (94.4%) to non-Indigenous women. The researchers found that the stillbirth rate in Queensland during the study period was steady at around 6.2 per 1000 ongoing pregnancies. Stillbirth rates for Indigenous women decreased by 31.9% from 13.3 to 9.1 per 1000 of ongoing pregnancies during the study period, while in non-Indigenous women rates were steady at around 5.9. The difference in overall stillbirth rates between Indigenous and non-Indigenous women reduced by 57.3% from 7.5 to 3.2 per 1000 ongoing pregnancies. The biggest drop in stillbirth rates was among Indigenous women living in remote areas, which fell by 49.9% compared with a drop of 10.2% for those living in urban areas and a 29.2% drop in regional areas. For non-Indigenous women stillbirths increased by 0.9% in urban areas and 11.4% in regional areas, but decreased by 39.2% for those living in remote areas. The researchers wrote that they found an increased risk of stillbirth due to maternal conditions, perinatal infection, spontaneous preterm birth, hypertension, fetal growth restriction, antepartum haemorrhage and unexplained antepartum fetal death among Indigenous women compared with non-Indigenous women. “Most of these categories of stillbirth are potentially amenable to interventions in the pre-pregnancy and antenatal periods”, they wrote. “High-quality antenatal care at all levels using culturally appropriate service delivery models that incorporate diabetes management, smoking cessation, [sexually transmissible infection] screening and treatment, folic acid and fetal growth monitoring hold some promise of helping to improve pregnancy outcomes for indigenous women.”
Melatonin not effective for postoperative delirium
A RANDOMISED controlled trial from the Netherlands, published in CMAJ, has found that for vulnerable elderly patients undergoing surgery for hip fracture, melatonin is not effective in preventing postoperative delirium. The trial included 378 patients aged 65 years or older scheduled for acute hip surgery who received melatonin 3 mg or placebo for 5 consecutive days, starting within 24 hours after admission. They were monitored for incidence and duration of delirium within 8 days of admission. The researchers observed no effect of melatonin on the incidence of delirium — 55 of 186 patients (29.6%) for the melatonin group v 49 of 192 (25.5%) for the placebo group. A smaller proportion of patients taking melatonin than those taking placebo experienced a long-lasting episode (more than 2 days) of delirium (25.5% v 46.9%), although the median duration of delirium (2 days) was the same for both groups. The researchers wrote that although melatonin did not decrease the incidence of delirium, the lower proportion of patients with a long-lasting episode of delirium among those who received melatonin represented “a reduced duration of unpleasant delirious experiences for these patients”. They suggested that melatonin supplementation should be investigated in other populations with disturbances of the circadian sleep–wake cycle and a high incidence of delirium, such as patients in intensive care units.
Higher infant mortality with unplanned births
A 15-YEAR study of all births in Norway has found rates of perinatal mortality and early neonatal mortality (ENM) in unplanned, out-of-institution births are more than twice the rate for all other births. The research, published in ACTA Obstetricia et Gynecologica, included data from 892 137 births with a gestational age of 22 weeks or more, including 6062 unplanned, out-of-institution births (about seven in every 1000/year) defined as unplanned at home, during transportation or unspecified. In the unplanned birth group there was a lower proportion of live births across all birthweight (BW) categories. However, births with extremely low BW had significantly higher ENM rates than other births. Maternal risk factors included young age, multiparity and living in a rural municipality. The researchers wrote that the association of unplanned births with higher mortality rates was strong, saying there were probably many underlying causes. “One possible explanation is higher underlying morbidity among unplanned births”, they wrote. “Our data do not allow us to draw a conclusion about this, but unplanned births are undoubtedly a risk group and further studies are warranted.”
Sugar drinks in infancy linked to obesity
RESEARCHERS have found that children who drink sugar-sweetened beverages (SSBs) during infancy are 71% more likely to be obese by 6 years of age compared with babies who had no SSBs. The longitudinal analysis, published in Pediatrics, also showed that the risk of obesity at 6 years was 92% higher if SSBs were introduced before 6 months of age. The study included 1189 children who participated in the US Infant Feeding Practices Study who were followed up at 6 years of age. To ascertain SSB consumption mothers were asked: “In the past 7 days, how often was your baby fed sweet drinks: juice drinks, soft drinks, soda, sweet tea, Kool-Aid (Kraft foods, West Plains, NY), etc?” The mothers also measured the children’s weight and height. The researchers found that, overall, the prevalence of any SSB intake during infancy (age 1–12 months) was 25.9%, and the prevalence of obesity at age 6 years was 10.8%. Both prevalence of SSB intake during infancy and obesity at 6 years old significantly varied by age at which solid food was introduced, breastfeeding duration, maternal age, race/ethnicity, maternal education, marital status and income-to-poverty ratio. Another study in the same issue found SSB intake during infancy significantly increased the likelihood that children would consume one or more SSBs a day at 6 years of age.
High risk of melanoma for airline crew
A SYSTEMATIC review and meta-analysis involving more than 250 000 people has found that pilots and air crew have twice the incidence of melanoma compared with the general population. The review, published in JAMA Dermatology, of 19 studies published between 1990 and 2013 reporting data from 1943 to 2008, included more than 266 431 participants from 11 countries. Fifteen of the papers reported data on pilots and four on cabin crew. The researchers found the standardised incidence ratio of participants in any flight-based occupation was 2.21 — 2.22 for pilots and 2.09 for cabin crew. The standardised mortality ratio of participants in any flight-based occupation was 1.42 — 1.83 for pilots and 0.90 for cabin crew. The researchers speculated that cosmic radiation could be a risk factor, saying “UV radiation is a known risk factor for melanoma, and the cumulative exposure of pilots and cabin crew compared with the general population has not been assessed”. They wrote that their findings had “important implications for occupational health and protection of this population”.