Changes in Maternal Characteristics in Nova Scotia, Canada from 1988 to 2001

By Fell, Deshayne B.; Joseph, K. S. et al. | Canadian Journal of Public Health, May/June 2005 | Go to article overview

Changes in Maternal Characteristics in Nova Scotia, Canada from 1988 to 2001


Fell, Deshayne B., Joseph, K. S., Dodds, Linda, Allen, Alexander C., et al., Canadian Journal of Public Health


ABSTRACT

Background: Maternal characteristics such as age, parity, smoking status, pre-pregnancy weight and pregnancy weight gain have changed in many industrialized countries in recent years. Many of these changes have not been adequately described at a population level. The purpose of this study was to describe recent trends in selected maternal characteristics in Nova Scotia.

Methods: Data from a population-based perinatal database were used to examine changes in maternal age, parity, smoking, pre-pregnancy weight, delivery weight and pregnancy weight gain among all deliveries between 1988 and 2001.

Results: The proportion of deliveries to women ≥35 years increased by 84% over the study period from 7.0% in 1988-1991 to 12.9% in 1998-2000, while deliveries to women ≥40 years increased by more than 1 00%. The number of nulliparous women ≥35 years also increased significantly. The overall prevalence of smoking decreased from 32.7% in 1988-1991 to 25.1% in 1998-2001, however the prevalence of smoking among women <20 years did not change over the study period and was almost 50%. The proportion of women with a pre-pregnancy weight of ≥90 kilograms (kg) increased by 165% from 4.1% in 1988-1991 to 10.7% in 1998-2001. The proportion of women with pregnancy weight gain of <7 kg and ≥1 8 kg increased by 37% and 13%, respectively.

Conclusion: Dramatic changes have occurred in several important maternal characteristics and there is evidence of ongoing change. Continuation of these trends is likely to impact on future obstetric practice and perinatal health.

MeSH terms: Maternal age; parity; smoking; body weight; trends

The distribution of maternal characteristics has changed in many industrialized countries over the past few decades. Maternal age has increased.1-4 In Canada, 30% of all live births in 1997 were to women 30-34 years, a 58% increase over 1981.3 In the US, the birth rate to women 40-44 years increased by 44% from 5.5 per 1,000 in 1990 to 7.9 per 1,000 in 2000.4 Smoking rates during pregnancy have decreased in many,3"9 but not all,10 industrialized countries. In Canada, maternal smoking decreased from 23.5% in 1994-1995 to 19.4% in 1998-1999.3 The prevalence of obesity among women of reproductive age has been increasing in Canada,11 the US9,12,13 and other countries.9 This has been reflected in increased maternal pre-pregnancy weight and delivery weight.14-17 Although mean pregnancy weight gain has been relatively stable since the 1980s, women are increasingly gaining below and above recommended guidelines.4,13,18 In the US, the proportion of women who gained <7 kilograms (kg) increased from 9.4% to 11.6% between 1989 and 2000, as did the proportion gaining ≥21 kg (from 9.1% to 12.4%).4

While maternal characteristics are known determinants of obstetric practice14,17,19-24 and perinatal morbidity and mortality,4,5,9,17,18,20,21 recent changes have not been adequately described at a population level. The present study was undertaken to describe changes in selected characteristics of women who gave birth during the 14-year period, 1988 to 2001.

METHODS

The study population included all women resident in Nova Scotia, Canada who delivered a live birth or stillbirth between 1988 and 2001. Data for the study were obtained from the population-based Nova Scotia Atlee Perinatal Database (NSAPD). Maintained by the Reproductive Care Program of Nova Scotia, the NSAPD has collected detailed information on all deliveries in the province since 1988. NSAPD data are abstracted from standardized clinical forms and hospital records by trained health records personnel. The NSAPD contains information on labour and delivery and infant outcomes, as well as maternal information on lifestyle and other characteristics. Validation studies25,26 and ongoing quality assurance studies have found the information in the database to be reliable.

The maternal characteristics studied were age, parity, smoking, pre-pregnancy weight, delivery weight, and pregnancy weight gain. …

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