Carcaterísticas maternas e desfechos adversos perinatais relacionados ao baixo peso ao nascer

Objetivo: Avaliar as características maternas e desfechos adversos perinatais relacionados ao baixo peso ao nascer. Métodos: Trata-se de um estudo caso controle, realizado na Maternidade Darcy Vargas em Joinville–SC, período de março de 2018 a fevereiro de 2019 através de amostra randomizada composta de 722 puérperas que realizaram o acompanhamento pré-natal exclusivamente em Atenção Primária à Saúde, divididas em 2 grupos: pacientes com recém-nascidos de baixo peso e pacientes com recém-nascidos de peso normal. No cálculo de razão de chance, os valores foram considerados significativos quando P<0,05. Adotou-se prematuridade como fator de confusão. Resultados: Dividiu-se a população em dois grupos, pacientes com recém-nascidos de baixo peso (33/4,57%) e com recém-nascidos de peso normal (689/95,43%). Características maternas diferiram quanto ao número de pessoas na casa, o número de consultas, o uso de tabaco e drogas na gestação e incidência de doença hipertensiva específica da gestação. Após o cálculo de razão de chance ajustado, observou-se que o fumo aumenta a chance de baixo peso ao nascer em 6,5 vezes (IC95% 1,375-31,250). Os recém-nascidos foram diferentes no capurro, peso, Apgar de 1º e 5º minuto, prematuridade, necessidade de UTI neonatal e Apgar baixo de 1º minuto. No cálculo de razão de chance ajustado, o baixo peso aumentou a chance de UTI neonatal em 5,3 vezes (IC95% 1,039-27,523). Conclusão: O fumo durante a gestação eleva a chance de baixo peso ao nascer em 6,5 vezes. Ademais, o baixo peso ao nascer eleva em 5,3 vezes as chances de internação em UTI neonatal. Objective: To assess maternal characteristics and adverse outcomes related to low birth weight. Methods: This is a case control study, carried out at Maternidade Darcy Vargas in Joinville-SC, from March 2018 to February 2019 through a random sample composed of 722 puerperal women who underwent prenatal care exclusively in Primary Health Care, divided into 2 groups: patients with low birth weight newborns and patients with normal weight newborns. In calculating the odds ratio, values were considered significant when P <0.05. Prematurity was adopted as a confounding factor. Results: The population was divided into two groups, patients with low birth weight newborns (33 / 4.57%) and normal weight newborns (689 / 95.43%). Maternal characteristics differed in terms of the number of people in the household, the number of consultations, the use of tobacco and drugs during pregnancy and the incidence of pregnancy-specific hypertensive disease. After calculating the adjusted odds ratio, it was observed that smoking increases the chance of low birth weight 6.5 folds (95% CI 1.375-31.250). The newborns were different in capurro, weight, 1st and 5th minute Apgar, prematurity, need for neonatal ICU and low 1st minute Apgar. In the adjusted odds ratio calculation, low weight increased the chance of neonatal ICU 5.3 folds (95% CI 1.039-27.523). Conclusion: Smoking during pregnancy increases the chance of low birth weight 6.5 folds. Furthermore, low birth weight increases the chances of admission to the neonatal ICU 5.3 folds.

Download Full-text

Stunting at birth and associated factors among newborns delivered at the University of Gondar Comprehensive Specialized Referral Hospital

PLoS ONE ◽

10.1371/journal.pone.0245528 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245528

Author(s):

Almaz Tefera Gonete ◽

Bogale Kassahun ◽

Eskedar Getie Mekonnen ◽

Wubet Worku Takele

Keyword(s):

Logistic Regression ◽

Birth Weight ◽

Low Birth Weight ◽

Short Stature ◽

Odds Ratio ◽

Associated Factors ◽

Adjusted Odds Ratio ◽

Referral Hospital ◽

Factors Associated ◽

The University

Background Stunting at birth is a chronic form of undernutrition majorly attributable to poor prenatal nutrition, which could persist in children’s later life and impact their physical and cognitive health. Although multiple studies have been conducted in Ethiopia to show the magnitude of stunting and factors, all are concentrated on children aged between 6 to 59 months. Therefore, this study was done to determine the prevalence and associated factors of stunting at birth among newborns delivered at the University of Gondar Comprehensive Specialized Referral Hospital, Northwest, Ethiopia. Methods An institution-based cross-sectional study was conducted from February 26th to April 25th/2020. A systematic random sampling technique was used, to select a total of 422 newborn-mother pairs. The binary logistic regression was employed to identify factors associated with stunting and all independent variables were entered into the multivariable logistic regression model to adjust for confounders. Variables that had significant association were identified based on p-value < 0.05 and the adjusted odds ratio with its respective 95% confidence interval was applied to determine the strength as well as the direction of the association. Results About 30.5% (95% CI: 26.3%, 35.1%) of newborns were stunted at birth. Being male [Adjusted odds ratio (AOR) = 2.9(1.62, 5.21)], newborns conceived in Kiremt(rainy season) [AOR = 2.7(1.49, 4.97)], being low birth weight [AOR = 3.1(1.64, 6.06)] were factors associated with stunting at birth. Likewise, newborns born to short stature mothers [AOR = 2.8(1.21, 6.62)] and chronically malnourished mothers [AOR = 15.3(8.12, 29.1)] were at greater risk of being stunted. Conclusion Just under a third of newborns are stunted at birth, implying a pressing public health problem. Newborns born to chronically malnourished and short stature mothers were more stunted. Besides, stunting was prevalently observed among male neonates, newborns conceived in Kiremet, and being low birth weight. Thus, policymakers and nutrition programmers should work on preventing maternal undernutrition through nutrition education to reduce the burden of low birth weight and stunting. Further, paying due attention to newborns conceived in Kiremet season to improve nutritional status is recommended.

Download Full-text

Abstract MP031: Birth Weight, Genetic-Susceptibility and Adulthood Risk of Type 2 Diabetes

Circulation ◽

10.1161/circ.125.suppl_10.amp031 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Yanping Li ◽

Qibin Qi ◽

Tsegaselassie Workalemahu ◽

Frank B Hu ◽

Lu Qi

Keyword(s):

Type 2 Diabetes ◽

Birth Weight ◽

Low Birth Weight ◽

Genetic Susceptibility ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Diabetes Risk ◽

High Birth Weight ◽

Genotype Score

Background: Both stressful intrauterine milieus and genetic susceptibility have been linked to later life diabetes risk. The present study aims to examine the interaction between low birth weight, a surrogate measure of stressful intrauterine milieus, and genetic susceptibility in relation to risk of type 2 diabetes in adulthood. Methods: The analysis included two independent, nested case-control studies of in total 2591 cases of type 2 diabetes and 3052 healthy controls from prospective cohorts: the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). We developed 2 genotype scores using susceptibility loci recently identified through Genome Wide Association Studies: 1) an ‘obesity genotype score’ based on 32 BMI-predisposing single nucleotide polymorphisms (SNPs); and 2) a ‘diabetes genotype score’ based on 35 diabetes-predisposing SNPs. Results: Both the obesity genotype score and diabetes genotype score showed consistently significant association with risk of type 2 diabetes in NHS and HPFS ( P for trend < 0.01). In the pooled sample of the two cohorts, we found significant interaction between birth weight and obesity genotype score in relation to type 2 diabetes ( P for interaction=0.017). In low birth weight individuals (≤ 2.5 kg), the multivariable-adjusted odds ratio (OR) was 2.55 (95% confidence interval [CI]: 1.34–4.84) in the comparison of the highest with the lowest quartile of the obesity genotype score, while the OR was 1.27 (95%CI: 1.04–1.55) among individuals with birth weight above 2.5kg. Diabetes genotype score also showed stronger association with type 2 diabetes risk in individuals with low birth weight than those with high birth weight. Comparing individuals of the highest with the lowest quartile of the diabetes genotype score, the multivariable-adjusted odds ratio was 3.80 (95%CI: 1.76–8.24) among individuals with low birth weight and was 2.27 (95%CI: 1.82–2.83) among those with high birth weight. However, test for interaction was marginal ( P =0.16). Conclusion: Our data suggest low birth weight and genetic susceptibility to obesity may synergistically affect adulthood risk of type 2 diabetes.

Download Full-text

Perinatal Factors Associated with Infant Maltreatment

Clinical medicine Pediatrics ◽

10.4137/cmped.s980 ◽

2008 ◽

Vol 1 ◽

pp. CMPed.S980 ◽

Cited By ~ 2

Author(s):

Takeo Fujiwara ◽

Makiko Okuyama ◽

Haley Tsui ◽

Karestan C. Koenen

Keyword(s):

At Risk ◽

Chronic Disease ◽

Birth Weight ◽

Low Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Z Score ◽

Increased Risk

Background The association between birth outcomes and child maltreatment remains controversial. The purpose of this study is to test whether infants without congenital or chronic disease who are low birth weight (LBW), preterm, or small for gestational age (SGA) are at an increased risk of being maltreated. Methods A hospital-based case-control study of infants without congenital or chronic diseases who visited the National Center for Child Health and Development, Tokyo, between April 1, 2002 and March 31, 2005 was conducted. Cases (N = 35) and controls (N = 29) were compared on mean birth weight, gestational age, and z-score of birth weight. Results SGA was significantly associated with infant maltreatment after adjusting for other risk factors (adjusted odds ratio: 4.45, 95% CI: 1.29–15.3). LBW and preterm births were not associated with infant maltreatment. Conclusion Infants born as SGA are 4.5 times more at risk of maltreatment, even if they do not have a congenital or chronic disease. This may be because SGA infants tend to have poorer neurological development which leads them to be hard-to-soothe and places them at risk for maltreatment. Abbreviations SCAN, Suspected Child Abuse and Neglect; LBW, low birth weight; ZBW, z-score of birth weight adjusted for gestational age, sex, and parity; SGA, small for gestational age; SD, standard deviation; OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; IPV, intimate partner violence.

Download Full-text

Desfechos Adversos Perinatais Associados A Escolaridade Materna

STUDIES IN EDUCATION SCIENCES ◽

10.54019/sesv3n1-004 ◽

2022 ◽

Vol 3 (1) ◽

pp. 49-60

Author(s):

Bianca Elicker Rosin ◽

André Luís Marcelo Albuquerque ◽

Rodrigo Ribeiro e Silva ◽

João Pedro Ribeiro Baptista ◽

Carla Gisele Vaichulonis ◽

...

Keyword(s):

Higher Education ◽

Birth Weight ◽

Secondary Education ◽

Low Birth Weight ◽

Cesarean Section ◽

Primary Education ◽

Odds Ratio ◽

Cesarean Sections ◽

Cross Sectional ◽

Neonatal Icu

Objective: To compare different levels of education with adverse perinatal outcomes in low-risk patients. Methodology: Cross-sectional study, puerperae were randomly selected, usual risk, attended in the public network, with single gestation. The evaluated puerperae were divided into 3 groups, according to education: primary or less, secondary and higher or more. The outcomes evaluated were cesarean section, neonatal ICU, low 1st minute Apgar, prematurity, and low birth weight. The calculation of the odds ratio had a 95% confidence interval. Results: the population was divided into 3 groups, 187 (52.9%) puerperal women with primary education or less, 437 (60.5%) patients with secondary education and 98 (13.6%) patients with higher education or more. Maternal characteristics differed in terms of age, previous pregnancies, normal deliveries, previous cesarean sections, age of 1st pregnancy, number of prenatal visits, income, number of people living in the household, and tobacco use. In the newborn profile, there was a difference only regarding cesarean sections. After calculating the odds ratio, it was seen that patients with primary education or less had a lower propensity to perform a cesarean section (0.511 95%CI 0.290-0.900), as well as patients with secondary education (0.530 95%CI 0.322-0.873), both compared to the population with higher education or more. In the other outcomes, no significance was observed. Conclusion: Primary and secondary education proved to be protective factors for cesarean section. No difference was found regarding prematurity, low birth weight, need for neonatal ICU and low 1st minute Apgar score.

Download Full-text

FEATURES OF REPRODUCTIVE HEALTH OF WOMEN WITH LOW BIRTH WEIGHT AND OVERWEIGHT AT BIRTH

Technology transfer innovative solutions in medicine ◽

10.21303/2585-663.2020.001480 ◽

2020 ◽

pp. 17-20

Author(s):

Nataliia Nestertsova ◽

Larysa Nazarenko

Keyword(s):

Birth Weight ◽

Growth Factor ◽

Low Birth Weight ◽

Nutritional Support ◽

Normal Weight ◽

Menstrual Disorders ◽

Perinatal Risk ◽

Low Weight ◽

Increased Risk ◽

Intrauterine Programming

The aim of the study was to clarify obstetric and perinatal risk in women born with low or overweight. Materials and methods. 343 women with birth weight abnormalities were examined. From them 3 groups are made, according to criterion “weight of the woman at a birth”: I – 107 women with low weight at a birth, II – 126 with excess, III – 110 people with normal weight. The anamnesis, in particular, family and own perinatal, as well as nutritional support, anthropometric data, the structure of pregnancy complications, the rate of growth and development of the fetus, perinatal results were determined. Levels of eicosapentaenoic and docosahexaenoic acids were determined as markers of nutritional support of the organism, as indicators of angiogenesis were determined – concentration of vascular endothelial growth factor and placental growth factor in blood, morpho-functional studies of placenta were performed. Results. Women born underweight are more likely to have menstrual disorders (every 4), infertility (every 10), miscarriage (every 5) and gynecological diseases. The pathology of gestation in such women and their mothers is similar in spectrum, which is an example of intrauterine programming. The implementation of this program is facilitated by negative factors of nutritional provision: inadequate breastfeeding, economical type of nutrition in favor of restricting protein foods and deviations in the process of angiogenesis. Conclusions. The importance of perinatal history as a factor that determines the increased risk of menstrual disorders, the frequency of infertility, the pathological course of gestation during pregnancy, the predisposition to placental insufficiency and the birth of a child with low weight. Women born with low birth weight and overweight are a contingent of increased perinatal risk, which is associated with a complicated own perinatal history on the background of obstetric pathology in their mothers. This fact complements the concept of intrauterine programming.

Download Full-text

Kangaroo Method Treatment Increases Baby's Body Temperature With Low Birth Weight

South East Asia Nursing Research ◽

10.26714/seanr.2.4.2020.48-53 ◽

2020 ◽

Vol 2 (4) ◽

pp. 48

Author(s):

Fenny Dwi Kurniasih ◽

Heryanto Adi Nugroho ◽

Chanif Chanif

Keyword(s):

Birth Weight ◽

Body Temperature ◽

Low Birth Weight ◽

Perinatal Period ◽

Normal Weight ◽

The Body ◽

Study Approach ◽

Low Weight ◽

Post Test

Birth weight is less than 2500 grams which contribute to infant mortality especially during the perinatal period, one of the interventions that can be done with kangaroo method, this method can make the baby's body temperature stable because the baby who is in the care of the kangaroo method will feel like it exists in the uterus of the mother, in addition to the treatment of kangaroo methods aimed at helping to accelerate the process of increasing the baby's body temperature as well as being able to stabilize the body temperature in babies who experience low birth weight. The design of the study used is a descriptive method with a case study approach of nursing care using a pre and post-test design conducted on 2 respondents. Before being given the kangaroo method 1 respondent and respondent 2 experienced low weight measured using observation sheet for 3 days while after being given kangaroo method respondent 1 and respondent 2 experienced weight gain measured using observation sheet for 3 days characterized by normal weight. Kangaroo treatment therapy method can increase body temperature in babies with low birth weight in the perinatology room of K.R.M.T Wongsonegoro Hospital Semarang.

Download Full-text

Relationships between maternal characteristics and infant birth weight

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-05-2017-0081 ◽

2019 ◽

Vol 32 (4) ◽

pp. 688-697

Author(s):

Maryam Javadi ◽

Sima Rafiei ◽

Fariba Zahedifar ◽

Ameneh Barikani

Keyword(s):

Physical Activity ◽

Birth Weight ◽

Low Birth Weight ◽

Pregnant Women ◽

Gestational Age ◽

Normal Weight ◽

Maternal Weight ◽

Content Type ◽

Maternal Characteristics ◽

Infant Birth

Purpose Nowadays, the importance of infant birth weight (IBW) as a key factor in determining the future of physical and mental development of children is a growing concern. The purpose of this paper is to investigate the relationship between maternal characteristics and IBW among pregnant women who were referred to health centers in Qazvin city in the year 2016. Design/methodology/approach A descriptive-analytical study was conducted among pregnant women in 28–36 weeks of gestation who referred to healthcare centers and facilities affiliated by the Qazvin University of Medical Sciences in April–June 2016. The associations between maternal physical activity, mothers’ socioeconomic status and birth weight were examined by SPSS Software Package version 16 through linear and logistic regression tests. Findings Linear regression modeling suggested that maternal weight (p=0.001), income (p=0.04), gestational age of delivery (p=0.00) and pre-pregnancy BMI (p=0.02) were positively associated with birth weight, while occupational and heavy physical activity (p=0.003 and 0.008, respectively) were negatively associated with IBW. In this study, low birth weight infants are compared to those with normal weight belonged to mothers who have spent more time in doing heavy physical activities (OR=1.11, 95% CI 1.01–1.23). Also infants with low birth weight compared to others in the normal weight category were born from mothers with lower pre-pregnancy BMI (OR=0.65, 95% CI 0.62–0.78), gestational age of delivery (OR=0.82, 95% CI 0.79–0.86), maternal weight (OR=0.86, 95% CI 0.84–0.88) and income (OR=0.79, 95% CI 0.69–0.83). Practical implications The study findings revealed that certain maternal characteristics could play a significant role in IBW. Despite the importance, in most of developing countries (particularly Iran), future mothers are not advised about an appropriate weight gain during pregnancy or the optimal level of physical activity in such a period of time. Therefore, counseling pregnant women and giving them proper information on appropriate perinatal care would be helpful in order to have pregnancies with optimal outcomes. Originality/value The authors applied several statistical methods to analyze IBW among mothers with different maternal characteristics and predict birth weight based on contributing factors.

Download Full-text

Measures of association in epidemiological studies: smoking mothers and low birth weight children in the city of Campina Grande – PB

Acta Scientiarum Health Sciences ◽

10.4025/actascihealthsci.v38i2.30526 ◽

2016 ◽

Vol 38 (2) ◽

pp. 179

Author(s):

Tarsyla Medeiros de Albuquerque ◽

Gabriela Albuquerque Batista de Araujo ◽

Bruno Leão Caminha ◽

Marta Lucia de Albuquerque ◽

Mácio Augusto de Albuquerque

Keyword(s):

Birth Weight ◽

Relative Risk ◽

Low Birth Weight ◽

Confidence Intervals ◽

Odds Ratio ◽

Epidemiological Studies ◽

Measures Of Association ◽

Smoking During Pregnancy ◽

Live Births ◽

The City

The aim of this study was to present and describe the essential aspects, and to discuss the use of measures of association, relative risk and odds ratio, including formulas for calculating confidence intervals of obtained data from a cohort study of underweight live births of mothers who smoked during pregnancy, whose deliveries were performed in hospitals and maternity wards located in Campina Grande, state Pernambuco. Smoking during pregnancy was analyzed as a potential risk factor for low birth weight among 3612 newborns. In assessing the association of outcome, there were no large numeric differences between the estimates of the relative risk, odds ratios and confidence intervals obtained. It is an acceptable approximation to the relative risk and the odds ratio. It is up to the researcher to choose the most appropriate technique to its subject matter and should be determined according to the surveyed data.

Download Full-text

Determinants of low birth weight among live birth newborns delivered at public hospitals in Gamo Gofa Zone, South Ethiopia: Unmatched case control study

SAGE Open Medicine ◽

10.1177/2050312120940544 ◽

2020 ◽

Vol 8 ◽

pp. 205031212094054

Author(s):

Alemu Basazin Mingude ◽

Woiynshet Gebretsadik ◽

Dresilgn Misker ◽

Gashaw Garedew Woldeamanuel

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Public Hospitals ◽

Upper Arm ◽

Arm Circumference ◽

Mid Upper Arm Circumference ◽

Control Study

Background: Birth weight is one of the major determinants of perinatal survival, infant morbidity, and mortality. There are only few published reports on assessment of low birth weight in Ethiopia and the determinants of low birth weight have not been well characterized. Objective: The aim of this study was to assess determinants of low birth weight among live birth newborns delivered at public hospitals in Gamo Gofa Zone, South Ethiopia. Methods: Institution-based case control study was conducted from February 25 to April 25, 2018 and consecutively selected 60 cases and 240 controls were enrolled in this study. The data were collected using face-to-face interview and review of medical records. Moreover, we have measured the newborns’ birth weight using a standard weight scale and mother’s mid-upper arm circumference using a standard World Health Organization mid-upper arm circumference measuring tape. Statistical analysis of the data was done using SPSS version 21. Results: A total of 300 newborns were included in the study. Late antenatal care booking (adjusted odds ratio = 1.87, confidence interval = [1.32–2.6]), birth interval <2 years (adjusted odds ratio = 0.385, confidence interval = [0.176–0.83]), anemia (adjusted odds ratio = 4.4, confidence interval = [1.84–10.5]), mid-upper arm circumference <23 cm (adjusted odds ratio = 7.99, confidence interval = [3.5–20.3]), nutritional counseling (adjusted odds ratio = 5.85, confidence interval = [2.14–14.8]), and husband smoking (adjusted odds ratio = 4.73; confidence interval = [1.42–15.7]) were found to be determinant factors of low birth weight. Conclusion: Most of the determining factors of low birth weight were preventable. Therefore, clinical and public health interventions should target on those determinant factors to prevent its adverse effects.

Download Full-text

Determinants of neonatal sepsis among neonates delivered in Southwest Ethiopia 2018: A case-control study

SAGE Open Medicine ◽

10.1177/20503121211027044 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110270

Author(s):

Dejene Edosa Dirirsa ◽

Bekem Dibaba Degefa ◽

Alemayehu Dessale Gonfa

Keyword(s):

Logistic Regression ◽

Birth Weight ◽

Low Birth Weight ◽

Confidence Interval ◽

Neonatal Sepsis ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Southwest Ethiopia ◽

Sexually Transmitted ◽

History Of

Introduction: Neonatal sepsis is one of the principal causes of neonatal morbidity and mortality. In spite of interventions with different preventive methods, the burden of neonatal sepsis is being reported in different parts of Ethiopia. For further interventions, identifying its determinants is found to be essential. Objective: The study aimed to assess the determinants of neonatal sepsis among neonates delivered in Southwest Ethiopia in 2018. Methods: A hospital-based case-control study was conducted in Southwest Ethiopia from May 2018 to August 2018. Systematic random sampling technique was used to select study participants; Cases were neonates diagnosed with sepsis and controls were neonates without sepsis. Data were entered into Epi info version 7.2 and analyzed using Statistical Package for Social Sciences version 23. Bi-variable logistic regression was used to identify determinants of neonatal sepsis and those variables with a p-value < 0.05 in the multivariable logistic regression analysis were considered as significantly associated at a 95% confidence interval. Results: The findings from the multivariable logistic regression revealed that history of meconium-stained amniotic fluid (adjusted odds ratio [95% confidence interval] = 9.2 [1.1, 19.8]), history of foul-smelling liquor (adjusted odds ratio [95% confidence interval] = 5.2 [1.2, 22.3]), history of maternal sexually transmitted infection/urinary tract infection (adjusted odds ratio [95% confidence interval[ = 4.7 [1.1, 19.7]), history of vascular catheter (adjusted odds ratio [95% confidence interval] = 4.7 [1.11, 20]), and low birth weight (adjusted odds ratio [95% confidence interval] = 5.3 [1.3, 28.9]) were identified as determinants of neonatal sepsis. Conclusion: Generally, history of meconium-stained amniotic fluid, foul-smelling liquor, maternal history of the sexually transmitted disease, urinary tract infection, low birth weight, and the vascular catheter was identified as determinants of neonatal sepsis. Health education should be provided for pregnant mothers regarding health care-seeking behavior. Similarly, diagnoses and care should be accessible on time for foul-smelling liquor, premature rupture of membrane, and low birth weight.

Download Full-text