Ethnic differences in the sudden infant death syndrome: what we can learn from immigrants to the UK

AIMS: To compare the effect of potential maternal and birth factors on rates of sudden infant death syndrome (SIDS) within and between infants born to mothers of different ethnic groups. METHODS: Routinely collected obstetric, child health data relating to 39,101 residents of three East London Districts born in 1989-1990 were obtained. These were matched with 312 death registration records to validate death and add registered cause of death. Mortality rates were calculated in the usual way, and using life-table methods. RESULTS: These related to six ethnic groups, the largest of which were Anglo-European and Bangladeshi. Low birth-weight was the only factor associated with a greater risk of SIDS in all ethnic groups. Maternal smoking was uncommon amongst all Asian groups and African mothers, and rates of SIDS were uniformly low amongst non-smokers in all ethnic groups except Pakistanis. Adjustment for maternal age, parity, gestational age and birthweight would widen the differences between risk of SIDS observed between Anglo-Europeans and Bangladeshi infants. CONCLUSIONS: The study has demonstrated that local data is more timely and of greater detail than that available nationally. Of the risk factors considered, smoking reported during pregnancy is the most commonly encountered and is particularly associated with deaths attributed to SIDS.     

A record-linkage study on risk factors for cause-specific infant mortality

Infant death certificates were linked with birth certificates for infants born to residents of Tohoku, Tokai and Kyushu regions in 1989 (n = 409, 679, or about one-third of all births in Japan), to examine the effects of variables, as reported on birth certificates, on cause-specific infant mortality. "Certain conditions originating in the perinatal period" and "congenital anomalies" accounted for nearly 90 percent of neonatal deaths, while "congenital anomalies", "injuries and poisoning" and "sudden infant death" were responsible for about 65 percent of postneonatal deaths. Mortality rates for almost all causes of infant deaths, except injuries and poisonings, increased as birth weight decreased not only in the neonatal period but also in the postneonatal period. This suggests that low birth weight places some infants at higher risk of death, and conditions that lead to low birth weight independently contribute to the risk of infant death. Cox's proportional hazards linear model was used to assess the effects of variables on infant mortalities by causes of death. An extremely strong birth weight effect was noted for "certain conditions originating in the perinatal period" and "congenital anomalies". Being a male infant and late order of birth in multiparity were other risk factors for deaths from "congenital anomalies", while being a male infant, resident of Tohoku region and maternal stillbirth experience related to deaths from "certain conditions originating in the perinatal period". Elevated risks of sudden infant death syndrome (SIDS), of which mortality rate in Japan was considerably lower than those in most developed Western countries, i.e. 0.23 per 1,000 live births in 1989, were associated with low birth weight, being a male infant, low maternal age, late order of birth in multiparity and illegitimacy. Low maternal age, late order of birth in multiparity and illegitimacy, also, related significantly to increased risk of infant deaths for "injuries and poisoning". These results suggest the independent contributions of socioeconomic factors to infant mortality, especially postneonatal mortality, from SIDS, "injuries and poisonings".     

The effect of carotid sinus denervation on fetal heart rate variation in normoxia, hypoxia and post-hypoxia in fetal sheep

BACKGROUND: Previous reports documented high rates of tobacco use among Alaska Natives (Eskimos, Indians, and Aleuts). In this population, tobacco use is the leading preventable cause of death. Lung cancer is the leading cause of cancer death among Alaska Natives and tobacco is responsible for over one-third of all cancer deaths in this population. Until recently there has been no systematic surveillance of the prevalence of tobacco use in this high-risk population. Data that did exist were not readily available to those primarily responsible for the health care of this population. This is the first time since 1990 that data on Alaska Natives have been collected in one analysis; this permits a more representative evaluation of tobacco use. METHODS: Data on tobacco use were obtained and analyzed from national and state surveys and selected research projects from 1988 to 1993. RESULTS: Alaska Natives have high prevalence of tobacco use, including both cigarettes and smokeless tobacco. Tobacco use prevalence among Alaska Natives exceeds that of Alaska non-Natives, U.S. whites, and American Indians/Alaska Natives in the United States outside of Alaska. Smoking prevalence among Alaska Native women is twice that of non-Native women in Alaska and nearly twice as high among pregnant Alaska Natives than pregnant non-Natives. Overall, prevalence of smokeless tobacco use was four times higher among Alaska Natives than comparative state and national populations. CONCLUSION: Because this population has such high rates of tobacco use, it is important to public health that monitoring and educational programs be in place and that data specific to Alaska Natives be made available.     

Does passive smoking in early pregnancy increase the risk of small-for-gestational-age infants?

OBJECTIVES: This study tested the hypothesis that women who deliver small-for-gestational-age infants are more often exposed to passive smoking at home or at work. METHODS: Among a 1-year cohort of nulliparous women in the city of Malm?, Sweden 872 (87.7%) women completed a questionnaire during their first prenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n = 826), 6.7% of infants were classified as small for their gestational age. RESULTS: Passive smoking in early pregnancy was shown to double a woman's risk of delivering a small-for-gestational-age infant, independent of potential confounding factors such as age, height, weight, nationality, educational level, and the mother's own active smoking (odds ratio [OR] = 2.7). A stratified analysis indicated interactional effects of maternal smoking and passive smoking on relative small-for-gestational-age risk. CONCLUSIONS: Based on an attributable risk estimate, a considerable reduction in the incidence of small-for-gestational-age births could be reached if pregnant women were not exposed to passive smoking.     

Cocaine and tobacco use and the risk of spontaneous abortion

BACKGROUND: Cigarette smoking and cocaine use may be risk factors for spontaneous abortion, but data supporting such a link are limited. METHODS: We studied the associations between cocaine and tobacco use and spontaneous abortion among pregnant adolescents and women (age range, 14 to 40 years) who sought care at an inner-city emergency department. A total of 400 adolescents and women had spontaneous abortions either at study entry or during follow-up (which lasted until 22 weeks' gestation), and 570 adolescents and women remained pregnant past 22 weeks' gestation. Cocaine use was measured at base line by self-reports and analysis of urine and hair samples. Cigarette smoking was measured by self-reports and urine analysis. RESULTS: The adolescents and women in both groups were predominantly black and of lower socioeconomic status. Among those who had spontaneous abortions, 28.9 percent used cocaine on the basis of hair analysis and 34.6 percent smoked on the basis of a urine cotinine assay, as compared with 20.5 percent and 21.8 percent, respectively, of the adolescents and women who did not have spontaneous abortions. The presence of cocaine in hair samples was independently associated with an increase in the occurrence of spontaneous abortion (odds ratio, 1.4; 95 percent confidence interval, 1.0 to 2.1) after adjustment for demographic and drug-use variables. However, the use of cocaine as measured by self-reports and by urine analysis was not. The presence of cotinine in urine was also independently associated with an increased risk of spontaneous abortion (odds ratio, 1.8; 95 percent confidence interval, 1.3 to 2.6). Twenty-four percent of the risk of spontaneous abortion could be related to cocaine or tobacco use. CONCLUSIONS: Cocaine and tobacco use were common in our study population and were associated with a significant risk of spontaneous abortion.     

Use of leukocyte depletion to decrease injury after lung preservation and rewarming ischemia: an experimental model

The New York City neighborhood of Harlem has mortality rates that are among the highest in the United States. In absolute numbers, cardiovascular disease and cancer account for the overwhelming majority of deaths, especially among men, and these deaths occur at relatively young ages. The aim of this research was to examine self-reported smoking habits according to measures of socioeconomic status among Harlem men and women, in order to estimate the contribution of tobacco consumption to Harlem's remarkably high excess mortality. During 1992-1994, in-person interviews were conducted among 695 Harlem adults aged 18-65 years who were randomly selected from dwelling unit enumeration lists. The self-reported prevalence of current smoking was strikingly high among both men (48%) and women (41%), even among highly educated men (38%). The 21% of respondents without working telephones reported an even higher prevalence of current smoking (61%), indicating that national and state-based estimates which rely on telephone surveys may seriously underestimate the prevalence of smoking in poor urban communities. Among persons aged 35-64 years, the smoking attributable fractions for selected causes of death were larger in Harlem than in either New York City as a whole or the entire United States for both men and women. Tobacco consumption is likely to be one of several important mediators of the high numbers of premature deaths in Harlem.     

Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths

OBJECTIVE: To assess the hazards at an early phase of the growing epidemic of deaths from tobacco in China. DESIGN: Smoking habits before 1980 (obtained from family or other informants) of 0.7 million adults who had died of neoplastic, respiratory, or vascular causes were compared with those of a reference group of 0.2 million who had died of other causes. SETTING: 24 urban and 74 rural areas of China. SUBJECTS: One million people who had died during 1986-8 and whose families could be interviewed. MAIN OUTCOME MEASURES: Tobacco attributable mortality in middle or old age from neoplastic, respiratory, or vascular disease. RESULTS: Among male smokers aged 35-69 there was a 51% (SE 2) excess of neoplastic deaths, a 31% (2) excess of respiratory deaths, and a 15% (2) excess of vascular deaths. All three excesses were significant (P<0.0001). Among male smokers aged >/70 there was a 39% (3) excess of neoplastic deaths, a 54% (2) excess of respiratory deaths, and a 6% (2) excess of vascular deaths. Fewer women smoked, but those who did had tobacco attributable risks of lung cancer and respiratory disease about the same as men. For both sexes, the lung cancer rates at ages 35-69 were about three times as great in smokers as in non-smokers, but because the rates among non-smokers in different parts of China varied widely the absolute excesses of lung cancer in smokers also varied. Of all deaths attributed to tobacco, 45% were due to chronic obstructive pulmonary disease and 15% to lung cancer; oesophageal cancer, stomach cancer, liver cancer, tuberculosis, stroke, and ischaemic heart disease each caused 5-8%. Tobacco caused about 0.6 million Chinese deaths in 1990 (0.5 million men). This will rise to 0.8 million in 2000 (0.4 million at ages 35-69) or to more if the tobacco attributed fractions increase. CONCLUSIONS: At current age specific death rates in smokers and non-smokers one in four smokers would be killed by tobacco, but as the epidemic grows this proportion will roughly double. If current smoking uptake rates persist in China (where about two thirds of men but few women become smokers) tobacco will kill about 100 million of the 0.3 billion males now aged 0-29, with half these deaths in middle age and half in old age.     

The effect of smoking cessation during pregnancy on preterm delivery and low birthweight

BACKGROUND: Evidence exists that maternal cigarette smoking is associated with preterm birth. Our purpose was to investigate the relation between maternal smoking cessation at different points during pregnancy and the preterm delivery rate and low birthweight. METHODS: Data from the 1988 National Health Interview Survey were analyzed. The study included women who gave birth to children within 6 years of the 1988 interview date (N = 4876). Preterm delivery and infant low birthweight were the main outcome measures. These measures were compared with maternal smoking status during pregnancy. Logistic regression models were computed to control for maternal age at the time of birth, parity, race, and total family income. RESULTS: Women who did not smoke cigarettes during pregnancy were less likely to give birth prematurely (5.9% vs 8.2%, P = .003) or give birth to a low-birthweight baby (5.5% vs 8.9%, P < .001) than women who smoked at some time during the year before giving birth. A significant association existed between maternal smoking status and both preterm delivery and low birthweight. Compared with those who smoked beyond the first trimester, those who quit smoking within the first trimester had reductions in the proportion of preterm deliveries (6.7% vs 9.1%) and low birthweight infants (7.9% vs 9.6%). CONCLUSIONS: Low birthweight and preterm delivery are reduced in women who stop smoking in the first trimester of pregnancy.     

Metastatic dermatofibrosarcoma protuberans mimicking meningioma

Relationships between body mass index (BMI) and weight gain with perinatal outcome and birthweight were examined. BMI was calculated on 582 consecutive pregnant women who delivered at or >37 weeks gestational age. Statistical analysis was done using Chi-square tests, analysis of variance, and multiple logistic regression. Of those studied, 13% were underweight, 39% normal, 13% overweight, and 35% obese. Obesity was associated with increasing age (P < .01), multiparity (P < .01), previous cesarean delivery (P < .01), previous macrosomia (P = .01), previous fetal death (P = .03), hypertensive disorders (P < .01), gestational diabetes (P = .02), cesarean delivery (P = .03), and neonatal intensive care unit admission (NICU) (P = .01). The underweight group had the most low birthweight (LBW) infants and the lowest mean birthweight. Ideal weight gain occurred in 31%, inadequate weight gain in 34%, and excessive weight gain in 35%. Inadequate weight gain had increased asthma (P < .05), and hyperemesis (P = .03). Women with ideal weight gain had less smokers (P < .01), fetal distress (P < .05), cesarean delivery (P = .02), and preeclampsia (P < .001). The mean birthweight was highest in the excessive weight gain (P < .01). With multivariate analysis, previous LBW, BMI, and tobacco use were significant predictors of LBW. Normal BMI and ideal weight gain in pregnancy is associated with decreased perinatal complications and an optimum birthweight.     

Neurogenic inflammation in the gastrointestinal tract of the rat

To estimate the risk of repeat low birthweight deliveries among women whose first child was very low birthweight (less than 1500 g), a retrospective cohort of women who had their first and second children in Washington state between 1984 and 1991 was studied. After adjustment for potential confounding factors, a woman whose first infant was very low birthweight experienced an 11.5-fold increased risk of delivering a low birthweight (less than 2500 g) second infant (relative risk 11.5, 95% confidence interval 5.4 to 24.4). Women with a very low birthweight first infant also had a significantly increased risk of repeat very low birthweight infant (p < 0.0001). Women with a previous very low birthweight delivery are at increased risk of repeat low and very low birthweight infants. This high-risk group may benefit from education regarding recurrence risk and modification of factors associated with low birthweight, as well as good prenatal care.     

Influence of barrier occlusiveness on guided bone augmentation. An experimental study in the rat

OBJECTIVE: To investigate the relationships between self-assessed financial difficulties, diet in pregnancy and birthweight. DESIGN: Information on diet composition, difficulty in affording food, smoking habits and parity was collected by self-completion questionnaires at 32 weeks of pregnancy. Information on birthweights was obtained from hospital records. SUBJECTS: A geographically defined population 11833 pregnant women resident in the South-West of England. MAIN OUTCOME MEASURES: Nutrient intakes, food choices and birthweight. RESULTS: Women with greater difficulty in affording food had lower intakes of protein, fibre, vitamin C, niacin, pyridoxine, iron, zinc, magnesium and potassium than did women with little or no difficulty. They were more likely to use cooking and spreading fats with a high saturates content, and less likely to eat fish, fruit, vegetables and salad. In a multivariate analysis including parity and smoking status, financial difficulty was found to have no significant relationship with birthweight. CONCLUSION: The quality of diet in pregnancy falls with increasing difficulty in affording food. However, this does not appear to affect mean birthweight of infants born after 32 weeks gestation.     

Brainstem 3H-nicotine receptor binding in the sudden infant death syndrome

Maternal cigarette smoking during pregnancy has been shown to be a major risk factor for the sudden infant death syndrome (SIDS). We hypothesized that SIDS is associated with altered 3H-nicotine binding to nicotinic receptors in brainstem nuclei related to cardiorespiratory control and/or arousal. We analyzed 3H-nicotine binding in 14 regions in SIDS and control brainstems using quantitative tissue receptor autoradiography. Three groups were analyzed: SIDS (n = 42), acute controls (n = 15), and a chronic group with oxygenation disorders (n = 18). The arcuate nucleus, postulated to be important in cardiorespiratory control and abnormal in at least some SIDS victims, contained binding below the assay detection limits in all (SIDS and control) cases. We found no significant differences among the 3 groups in mean 3H-nicotine binding in the 14 brainstem sites analyzed. When a subset of the cases were stratified by the history of the presence or absence of maternal cigarette smoking during pregnancy, however, we found that there was no expected increase (upregulation) of nicotinic receptor binding in SIDS cases exposed to cigarette smoke in utero in 3 nuclei related to arousal or cardiorespiratory control. This finding raises the possibility that altered development of nicotinic receptors in brainstem cardiorespiratory and/or arousal circuits put at least some infants, i.e. those exposed to cigarette smoke in utero, at risk for SIDS, and underscores the need for further research into brainstem nicotinic receptors in SIDS in which detailed correlations with smoking history can be made.     

Objectively measured tobacco exposure during pregnancy: neonatal effects and relation to maternal smoking

OBJECTIVES: To measure quantitatively and objectively the maternal and fetal tobacco exposure during pregnancy and its neonatal effects. DESIGN: Tobacco exposure was assessed from maternal serum samples, obtained during the first half of pregnancy and from umbilical serum samples obtained at delivery, by measuring the concentration of nicotine metabolite, cotinine. Data on the respective pregnancies and neonates were collected from the Finnish Medical Birth Registry. SETTING: Finland. SUBJECTS: One thousand two hundred and thirty-seven pregnancies and newborns, representing all pregnancies resulting in a liveborn infant during one week in one country. MAIN OUTCOME MEASURES: Gestational age, birthweight and crown-heel length of newborns. RESULTS: Cotinine (> 6 micrograms/l) was detected in either maternal or umbilical serum in 300 pregnancies, and these mothers and newborns were classified as exposed. Important differences occurred between measured exposure and reported smoking behaviour. Of the exposed mothers, 38% were nonsmokers and 3.4% of the nonexposed mothers were smokers. Tobacco exposure was associated with shorter gestational age, reduced birthweight and shorter crown-heel length of the newborns. After correction for parity, gender, and gestational age, the exposed newborns were on average 188 g (95% confidence interval (CI) 123-253 g) lighter and 10 mm (95% CI 7-13 mm) shorter than the nonexposed newborns. One micrograms/ml of cotinine in maternal serum resulted in a mean decrease of 1.29 g (95% CI 0.55-2.02 g) in birthweight and in a mean decrease of 0.059 mm (95% CI 0.035-0.083 mm) in birth length. Maternal cotinine concentrations better explained the neonatal findings than the reported smoking habits. CONCLUSIONS: There is a quantitative dose and effect relation between tobacco exposure and a decrease in the gestational age at birth and size of the neonate. The smoking habit reported by mothers themselves is not an accurate measure of fetal tobacco exposure.     

Maternal attitude toward pregnancy and the risk of neonatal death

OBJECTIVES: Reduced options for fertility control over the past decade have increased the rates of unwanted pregnancy. We evaluated whether a woman's negative attitude toward her pregnancy increased the risk of perinatal mortality, in a large, prospective cohort study. METHODS: The association between attitude toward the pregnancy and perinatal mortality was evaluated in a longitudinal cohort study of 8823 married, pregnant patients enrolled from 1959 to 1966 in the Child Health and Development Studies. RESULTS: Women who reported during the first trimester of prenatal care that the pregnancy was unwanted were more than two times more likely to deliver infants who died within the first 28 days of life than were women reporting accepted pregnancies. A positive attitude toward pregnancy was not associated with fetal death or post-neonatal death. CONCLUSIONS: These data, collected when induced abortions were illegal, may have important implications for the 1990s. If maternal attitude toward the pregnancy is associated with neonatal mortality and abortion laws change such that access is restricted, infant mortality may increase because a greater proportion of births will be unwanted.     

Anxiety, anxiety disorders, tobacco use, and nicotine: A critical review of interrelationships.

Smoking is highly prevalent across most anxiety disorders. Tobacco use increases risk for the later development of certain anxiety disorders, and smokers with anxiety disorders have more severe withdrawal symptoms during smoking cessation than smokers without anxiety disorders. The authors critically examined the relationships among anxiety, anxiety disorders, tobacco use, and nicotine dependence and reviewed the existing empirical literature. Future research is needed to better understand the interrelationships among these variables, including predictors, moderators, and mechanisms of action. Increased knowledge in these areas should inform prevention efforts as well as the development and improvement of smoking cessation programs for those with anxiety and other psychiatric disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

1988 National Maternal and Infant Health Survey: methods and response characteristics

OBJECTIVES: The 1988 National Maternal and Infant Health Survey (NMIHS) was conducted by the National Center for Health Statistics to study factors related to poor pregnancy outcome, such as adequacy of prenatal care; inadequate and excessive weight gain during pregnancy; maternal smoking, drinking, and drug use; and pregnancy and delivery complications. METHODS: The NMIHS is a nationally representative sample of 11,000 women who had live births, 4,000 who had late fetal deaths, and 6,000 who had infant deaths in 1988. Questionnaires were mailed to mothers based on information from certificates of live birth, reports of fetal death, and certificates of infant death. Information supplied by the mother, prenatal care providers, and hospitals of delivery was linked with the vital records to expand knowledge of maternal and infant health in the United States. RESULTS: The response rates in all three components of the NMIHS differed according to the mothers' characteristics. Mothers were more likely to respond if they were 20-39 years of age, were white, were married, had fewer than four children, entered prenatal care early, had more prenatal visits, had more years of education, or resided in the Midwest Region. The percent of respondents was lower for teenage mothers, mothers of races other than white, and mothers with four or more children, little prenatal care, or fewer years of education. Mothers whose infants weighed less than 2,500 grams were less likely to respond in the live-birth and infant-death components than mothers whose infants weighed 2,500 grams or more. CONCLUSIONS: The NMIHS will provide an invaluable tool for researchers and practitioners seeking solutions to perinatal and obstetric problems.     

The unreamed AO femoral intramedullary nail, advantages and disadvantages of a new modular interlocking system. A prospective study of 67 cases

The aim of this study was to investigate associations between sudden infant death syndrome (SIDS) and social factors in the Nordic countries. A case-control study was conducted in Denmark, Norway and Sweden: The Nordic Epidemiological SIDS Study. Parents of 244 SIDS infants and 869 control infants matched on gender, age at death and place of birth filled in questionnaires. The dataset was analysed by conditional logistic regression. In univariate analysis, the following sociodemographic factors were associated with an increased risk of SIDS: low maternal age [odds ratio (OR) 7.8; 2.8-21.5], high birth order (OR 4.4; 2.5-7.5), single motherhood (OR 2.9; 1.7-5.0), low maternal education (OR 4.5; 2.8-7.1), low paternal education (OR 3.0; 1.9-4.7), maternal unemployment (OR 2.4; 1.8-3.4) and paternal unemployment (OR 4.0; 2.7-5.9). In a multivariate analysis where maternal smoking was also included, only paternal unemployment, young maternal age and high birth order remained significantly associated with SIDS. Housing conditions were not associated with SIDS. However, the risk of SIDS was high if the family had lived in their present home for only a few years (OR 2.3; 1.3-4.1). Sociodemographic differences remain a major concern in SIDS in a low-incidence situation and even in an affluent population with adequate health services.     

Exposure of young infants to environmental tobacco smoke: breast-feeding among smoking mothers

OBJECTIVES: This study examined the degree to which breast-feeding and cigarette smoking by mothers and smoking by other household members contribute to the exposure of infants to the products of tobacco smoke. METHODS: The subjects were 330 mother-infant pairs derived from a cohort of 1000 pairs enrolled in a longitudinal study of the pulmonary effects of prenatal and postnatal smoking. The main outcome measure was corrected urinary cotinine levels. RESULTS: Urinary cotinine levels were 10-fold higher in breast-fed infants of smoking mothers than among bottle-fed infants of smoking mothers. Among infants of nonsmoking mothers, urine cotinine levels were significantly increased in infants living in homes with other smokers; in this group there was no significant difference between bottle-fed and breast-fed infants. Infants whose mothers smoked in the same room as the infant had only nonsignificant increases in cotinine levels compared with infants whose mothers restricted their smoking to other rooms. CONCLUSIONS: Breast-fed infants of smoking mothers have urine cotinine levels 10-fold higher than bottle-fed infants whose mothers smoke, suggesting that breast-feeding, rather than direct inhalation of environmental tobacco smoke, is the primary determinant of cotinine levels in infants whose mothers smoke.     

Neurons as well as astrocytes express proteoglycan-type protein tyrosine phosphatase zeta/RPTPbeta: analysis of mice in which the PTPzeta/RPTPbeta gene was replaced with the LacZ gene

Mannan binding lectin (MBL) may be important for innate immunity and some cases of sudden infant death syndrome (SIDS) may be preceded by bacterial infection. Therefore, relative MBL deficiency might be associated with susceptibility to SIDS. We measured MBL concentrations in 46 SIDS infants and 26 controls. The proportion of subjects with low MBL values was similar in the two groups. However, the mean for the SIDS group (3 micrograms/ml) was higher than that of the controls (2.2 micrograms/ml; P < 0.05). We interpret this difference as due to acute phase responses and suggest these findings are consistent with the view that some cot deaths are preceded by bacterial infections.     

Maternal risk factors for preterm birth and low birthweight in Cape Verde

BACKGROUND: Fifteen years after the implementation of an antenatal risk screening program in Cape Verde, the first assessment of an association between maternal obstetric characteristics and preterm birth or low birthweight (LBW) infants was undertaken. METHODS: A cohort of 353 systematically selected antenatal clinic attenders in the county of Praia, Cape Verde, was studied prospectively during the period October 1991 through December 1992. The cohort was followed past the perinatal period and information was obtained according to a pretested structured questionnaire. In the analysis of preterm birth and LBW, multiple logistic regression was listed to estimate the relative risks of ll background variables. RESULTS: The prevalence of preterm birth (<37 gestational weeks) was 12%, and the prevalence of LBW infants was 8%. Low birthweight (<2500 grams) was significantly associated with low maternal age (< or = 19 years, RR=3.7); nulliparity (RR=5.2) and obstetric history of previous LBW infant (RR-6.5). The risk of preterm birth was significantly increased if the woman had an obstetric history of hypertension or convulsions (RR=2.6). CONCLUSIONS: In the setting studied, teenage women and women with previous pregnancy hypertension should be given selective attention in antenatal care to achieve improved pregnancy outcome. Primary prevention is needed to lower the prevalence of teenage pregnancies.