This annual report - Taranaki District Health Board

with a review of interventions aimed at socially disadvantaged and vulnerable womenin general and then reviews interventions for a number of specific risk factors (youngmaternal age, alcohol, other drug and tobacco use in pregnancy, family violence andwomen with mental illness). The publications included in the review were identifiedusing the search methodology outlined in Appendix 1, and as a consequence thecontent reflects interventions for which higher quality published evidence (e.g.systematic reviews of multiple studies) was available.Adversities During Pregnancy and Pregnancy OutcomeIn New Zealand a range of factors have been identified which may increase the risk ofadverse outcomes for women and their young children. Family Start, an intensive supportprogramme targeted at families vulnerable to adverse outcomes, has developed a range ofreferral criteria including: young parental age with additional challenges, mental healthissues, family violence issues, and difficulties with drugs, alcohol or gambling [144,145]. Avariety of social adversities are also identified as indicators of potential need, such as alack of support networks, a lack of financial and material resources and frequent changesof address.The sections which follow consider a selected group of these factors and their potentialimpact on pregnancy outcome. The issues reviewed are: socioeconomic deprivation,young maternal age, family violence, substance use and mental illness. The adversepregnancy outcomes discussed in this chapter are defined in box 1. While it is recognisedthat this is not a comprehensive list of all adversities experienced by pregnant women andtheir babies, the sections which follow aim to provide an overview of some of the factorsmore commonly associated with poorer pregnancy outcome. Each section begins with adiscussion of definitions and any available information on the prevalence of the adversefactor in the New Zealand context. The literature on the associations between the factorand birth outcomes is then reviewed, before the section concludes with a brief discussionon the pathways linking the factor with adverse pregnancy outcomes.Box 1. Adverse pregnancy and infant outcomes [138,141,146,147,148]Stillbirth: the death of a fetus at 20 weeks gestation or beyond, or weighing at least 400g if the gestation isunknown. Stillbirth does not include termination of pregnancy.Fetal death: the death of a fetus at 20 weeks gestation or beyond, or weighing at least 400g if the gestation isunknown, includes stillbirth and termination of pregnancy.Neonatal mortality: the death of any baby showing signs of life at 20 weeks gestation or beyond, or weighingat least 400g if the gestation is unknown, within the first 28 days after birth.Perinatal mortality: fetal deaths and early neonatal deaths, within 7 days of birth, of any baby born alive orborn dead at 20 weeks gestation or beyond, or weighing at least 400g if the gestation is unknown.Preterm birth: gestational age at birth of less than 37 completed gestational weeks. Preterm birth is theleading cause of infant mortality in industrialized countries and is associated with neurocognitive,pulmonary, and ophthalmologic morbidity. Caring for preterm infants incurs substantial healthcare costs.Low birthweight (LBW): birth weight of less than 2500 g. LBW is associated with an increased risk ofneonatal morbidity and mortality, neurodevelopmental disabilities, and cardiovascular disease atadulthood.Intra-uterine growth retardation (IUGR)/fetal growth retardation (FGR): failure to reach growth potentialSmall for gestational age (SGA): birthweight below the 10 th percentile using sex adjusted population growthcharts (includes ‘constitutionally small’ babies, i.e. not growth restricted). SGA is associated with stillbirth,preterm labour and neonatal morbidity and mortality.Sudden infant death syndrome (SIDS): the sudden death of an infant under one year of age, which isunexplained after the review of the clinical history, examination of the circumstances of death, and postmortemexamination.Sudden Unexpected Death in Infancy (SUDI): an umbrella term that includes both explained andunexplained causes of sudden unexpected death in infants under one year of age.In-Depth Topic: Adversity in Pregnancy - 278