Obstetric medication versus residential area as perinatal risk factors for subsequent adult drug addiction in offspring

Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life

OBJECTIVE

To test the hypothesis that noxious stimulation at birth may increase the long-term risk for developing psychosomatic or functional disorders during later life.

STUDY DESIGN

Matched case-control study using sibling controls. The birth records were retrieved for the offspring of 494 mothers who, after uncomplicated pregnancies, had delivered two or more children with birth weights at least 2500 g, if at least one child was exposed to a perinatal complication or birth asphyxia. Among their offspring (N=1110), the 108 cases hospitalized for functional intestinal symptoms were identified from nationwide hospital discharge records. Of these, 96 cases were compared with 116 unaffected sibling controls.

RESULTS

Functional intestinal symptoms occurred more commonly among the 1110 subjects (9.5%) than in the general population (3.4%, chi(2)=124, P<10(-6)). Gastric suction at birth occurred more frequently among the cases compared with their siblings (22.9% vs 11.2%). There were no differences in the number of cases and controls exposed to perinatal trauma or birth asphyxia. Multivariate logistic regression analyses showed that gastric suction at birth was associated with functional intestinal disorders during later life (odds ratio, 2.99; 95% confidence interval, 1.32-6.79; P=.009), whereas maternal, perinatal, or other confounding variables were not significant.

CONCLUSIONS

Noxious stimulation caused by gastric suction at birth may promote the development of long-term visceral hypersensitivity and cognitive hypervigilance, leading to an increased prevalence of functional intestinal disorders in later life.

Obstetric care and proneness of offspring to suicide as adults: case-control study

OBJECTIVE

To investigate any long term effects of traumatic birth and obstetric procedures in relation to suicide by violent means in offspring as adults.

DESIGN

Prospective case-control study.

SETTING

Stockholm, Sweden.

SUBJECTS

242 adults who committed suicide by violent means from 1978 to 1995, and who were born in one of seven hospitals in Stockholm during 1945-80, matched with 403 biological siblings born during the same period and at the same group of hospitals.

MAIN OUTCOME MEASURES

Adverse and beneficial perinatal factors expressed as relative risks (odds ratios) and 95% confidence intervals, derived from logistic regression of cases matched with their siblings.

RESULTS

For multiple birth trauma the estimated relative risks of offspring subsequently committing suicide by violent means were 4.9 (95% confidence interval 1.8 to 13) for men and 1.04 (0.2 to 4.6) for women. In mothers who received multiple opiate treatment during delivery, the estimated relative risk of offspring subsequently committing suicide was equal for both sexes (0.26, 0.09 to 0.69).

CONCLUSION

Minimising pain and discomfort to the infant during birth seems to be of importance in reducing the risk of committing suicide by violent means as an adult.

Labor analgesia and infant brain development

A large percentage of newborns are exposed to pharmacological agents that affect the brain in connection with pain management during labor. The two most commonly used agents are meperidine, administered intravenously or intramuscularly, and bupivacaine, administered by the epidural route. Over the years, infant behavioral assessments have been used in the neonatal nursery to identify labor analgesia regimens with minimal impact on neonatal status. However, considerable controversy has centered on the general issue of possible harm to the neonate from use of analgesia and anesthesia in obstetrics. Due to limitations on experiments in the obstetric situation and a lack of suitable animal models, the broader issues concerning the effects of these agents on the developing brain and possible long-term consequences for infant adaptive functioning have received little attention. A series of studies has recently been completed using a rhesus monkey model for administration of labor analgesia under controlled experimental conditions and long-term behavioral evaluation of infants. Most of the assessments, including those of cognitive function, were not influenced by perinatal analgesia. However, these studies have confirmed the neonatal depressant effects of meperidine and have suggested that the course of behavioral maturation during certain periods of infancy is influenced by both meperidine and bupivacaine administration at birth. These effects could occur as a result of effects on vulnerable brain processes during a sensitive period, interference with programming of brain development by endogenous agents, or alteration in early experiences.

Racial differences in the patterns of preterm delivery in central North Carolina, USA

In order to assess racial differences in rates of idiopathic preterm labour, preterm premature rupture of membranes, and medically indicated preterm delivery, the authors analysed data on 388 preterm (< 37 completed weeks of gestation) births (7.9% of all births) occurring between 1 September 1988 and 31 August 1989, in three central North Carolina counties. The crude relative risk (RR) of preterm birth among black women compared with white women was 2.6 [95% confidence interval (CI) 2.1, 3.1]. With adjustment for age, gravidity, marital status, education, and county of residence, the estimated relative risk for black women compared with white women was 2.1 (95% CI 1.1, 4.1) for medically indicated preterm delivery, 1.6 (95% CI 1.1, 2.3) for preterm birth as a result of preterm labour, and 1.9 (95% CI 1.2, 3.1) for preterm premature rupture of membranes. Compared with white women, black women were at the highest risk of a preterm birth before 34 weeks of gestation (RR = 2.9; 95% CI 1.8, 4.7). The risk of medically indicated preterm delivery at 36 weeks was considerably higher for black women than for white women (RR = 3.4; 95% CI 1.1, 10.2). For a better understanding and ultimately a reduction of the risk for preterm delivery among black women, investigation of specific aetiological pathways and gestational age groups may be required.

Endogenous opiates: 1993

This paper is the sixteenth installment of our annual review of research concerning the opiate system. It is restricted to papers published during 1993 that concern the behavioral effects of the endogenous opiate peptides, and does not include papers dealing only with their analgesic properties. The specific topics this year include stress; tolerance and dependence; eating; drinking; gastrointestinal, renal, and hepatic function; mental illness and mood; learning, memory, and reward; cardiovascular responses; respiration and thermoregulation; seizures and other neurological disorders; electrical-related activity; general activity and locomotion; development; immunological responses; and other behaviors.