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zoom RSS 米国での出生体重低下傾向は原因不明/米国医療事情

<<   作成日時 : 2010/01/29 20:28   >>

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 出生体重の低下/米国医療事情
 白人女性の子どもでは1990年より3オンス低下している。ハーバードの研究によれば、帝王切開の増加や妊娠合併症では説明できないという。
 Emily Okenによれば、妊娠期間が約2.5日短縮しているという。予定日より超過して生まれる子どもが減り、3週間以上早く生まれる子どもが増加している。
 20世紀には出生体重はかなり増加したが、予期せぬ減少の理由は不明のままである。妊娠期間の短縮を考慮に入れてたとしても出生体重は減少はしているという。
 1990-2005年の約3700万満期産についてのデータを解析したところ、1990-2005年で平均1.83オンス出生体重が減少しており、1995年以降の低下が急速であるという。既婚の教養ある白人で喫煙なく妊婦検診も受けて経腟分娩をした場合では2.78オンス(約80g)も出生体重が減少していた。
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U.S. Birth Weights Falling, But Reasons Unclear
Babies of healthy white women now 3 ounces lighter than in 1990, study finds
By Steven ReinbergHealthDay Reporter
http://health.msn.com/pregnancy/articlepage.aspx?cp-documentid=100253083

画像THURSDAY, Jan. 21 (HealthDay News) -- Babies brought to term by healthy, white mothers in the United States now weigh almost 3 ounces less than they did 20 years ago, and no one knows why, a new report shows.

This finding was not explained by more Cesarean deliveries or by pregnancy complications, say the researchers from Harvard Medical School.

"We [also] found that the length of gestation is shortened by about 2.5 days even in term births," said lead researcher Dr. Emily Oken, an assistant professor of population medicine.

This means that fewer babies are being born after their due date and more babies are being born in the three weeks before their due date, she said.

Although birth weights increased for much of the 20th century, the reasons for the more recent, unexpected decline in average birth weights remain unclear, the researchers said.

The lower birth weight of infants is partially explained by slightly earlier births, she said. "But it wasn't only that. Even when we accounted for these fewer days of shorter length of gestation, birth weight appeared to decline," she said.

The report is published in the February issue of Obstetrics & Gynecology.

For the study, Oken's team collected data on almost 37 million U.S. singleton full-term deliveries between 1990 and 2005.

Earlier studies had found increasing birth weights over the past 50 years due in part to older, heavier women having children and fewer women smoking.

However, in this study the researchers found birth weights declined by an average of 1.83 ounces from 1990 to 2005. The drop in average birth weight picked up speed after 1995, they noted.

Moreover, birth weights dropped among women who were considered at low risk for having small babies.

In fact, mothers who were white, well-educated, married, didn't smoke, received prenatal care and had uncomplicated vaginal deliveries had babies weighing 2.78 ounces less, Oken said.

The reasons for declining birth weight is a mystery, Oken said.

Dr. Peter Bernstein, director of Maternal Fetal Medicine Fellowship Program at Montefiore Medical Center in New York City, said he is actually seeing the opposite trend.

"I was pretty surprised; it has not been my experience over that period of time," he said. "My experience is that babies are getting bigger."

Bernstein admitted that his experience is confined to the Bronx in New York City, where women tend to be more obese and diabetic. "If you look at different populations, you get different results," he said.

However, Bernstein added it's true that babies are being born earlier, which could account for most of the lower birth weights the researchers are reporting.

"The due date used to be 40 weeks; now the average is somewhere in the 39th week," he said.

According to Bernstein, earlier births are due to more Cesarean deliveries. The increase in these deliveries is caused by more complications such as high blood pressure and diabetes, he explained.

However, Cesarean deliveries do not fully explain the decline in birth weights, Oken said.

There are other theories. "Over the second half of the 20th century, birth weight increased," Oken said, "so it is possible that this [recent decline] represents a plateauing of that increase in birth weights that was observed over the last 50 or 70 years, and we are getting back to a steadier state."

In any case, low birth weight is a health concern, the researchers said. Smaller babies face short-term complications, such as increased likelihood of requiring intensive care and a higher risk of death. And they can also be at higher risk for chronic disease as adults, Oken said.

On the other hand, heavier babies are subject to other health problems, such as obesity and its attendant problems, she noted.

More information

For more information on pregnancy, visit the U.S. National Library of Medicine.
SOURCES: Emily Oken, M.D., M.P.H., assistant professor, population medicine, Harvard Medical School, Boston; Peter Bernstein, M.D., director, Maternal Fetal Medicine Fellowship Program, Montefiore Medical Center, New York City; February 2010 Obstetrics & Gynecology

Copyright (c) 2009 ScoutNews, LLC. All rights reserved.

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Trends in Birth Weight and Gestational Length Among Singleton Term Births in the United States: 1990-2005

Donahue, Sara M. A.; Kleinman, Ken P.; Gillman, Matthew W.; Oken, Emily

Obstetrics & Gynecology. 115(2, Part 1):357-364, February 2010.

doi: 10.1097/AOG.0b013e3181cbd5f5
Abstract:

OBJECTIVE: To estimate changes over time in birth weight for gestational age and in gestational length among term singleton neonates born from 1990 to 2005.

METHODS: We used data from the U.S. National Center for Health Statistics for 36,827,828 singleton neonates born at 37-41 weeks of gestation, 1990-2005. We examined trends in birth weight, birth weight for gestational age, large and small for gestational age, and gestational length in the overall population and in a low-risk subgroup defined by maternal age, race or ethnicity, education, marital status, smoking, gestational weight gain, delivery route, and obstetric care characteristics.

RESULTS: In 2005, compared with 1990, we observed decreases in birth weight (-52 g in the overall population, -79 g in a homogenous low-risk subgroup) and large for gestational age birth (-1.4% overall, -2.2% in the homogenous subgroup) that were steeper after 1999 and persisted in regression analyses adjusted for maternal and neonate characteristics, gestational length, cesarean delivery, and induction of labor. Decreases in mean gestational length (-0.34 weeks overall) were similar regardless of route of delivery or induction of labor.

CONCLUSION: Recent decreases in fetal growth among U.S., term, singleton neonates were not explained by trends in maternal and neonatal characteristics, changes in obstetric practices, or concurrent decreases in gestational length.

LEVEL OF EVIDENCE: III

(C) 2010 The American College of Obstetricians and Gynecologists

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