The Effects of Early Childbearing On Schooling over Time

I. Citation
The Effects of Early Childbearing On Schooling over Time
By Sandra L. Hofferth, Lori Reid and Fran L. !ott
The electronic version of this article is the com"lete one and can be fo#nd
online at$ htt"$%%&&&.g#ttmacher.org%"#bs%'o#rnals%(()*+,-."df
II. Study Characteristics
.n recent st#dies, the effects of teenage childbearing on the schooling of
yo#ng &omen have been smaller than those in earlier research. The discre"ancy
has been attrib#ted to the #se in the later st#dies of controls for #nmeas#red
differences bet&een yo#ng &omen &ho start childbearing early and those &ho do
not, b#t co#ld instead reflect changes in the effect of early childbearing over time
III. Methodology / Design
/ata from the 0ational Longit#dinal S#rvey of the Labor !aret
E1"erience of 2o#th and the 3anel St#dy of .ncome /ynamics are #sed to
identify the reasons for this difference. Logistic regression, ordinary least4s5#ares
regression and fi1ed4effects models e1amine the im"act of early childbearing on
rates of high school grad#ation and college attendance, and n#mber of years of
schooling com"leted thro#gh age )+.
IV. esults of the Study
The t&o data sets sho& a significant negative im"act of a teenage birth on
rates and years of com"leted schooling. For e1am"le, teenage mothers com"lete
-.+6).) fe&er years of ed#cation than do &omen &ho delay their first birth #ntil
age (, or older. !oreover, com"ared &ith &omen &ho give birth at age (, or
older, teenage mothers have odds of high school com"letion -,6-)7 as high and
odds of "ostsecondary schooling -86)+7 as high. 9nobserved differences
bet&een yo#ng mothers and their childless "eers red#ce, b#t do not eliminate, the
effects of early births. Effects on high school com"letion declined in recent
"eriods beca#se more yo#ng &omen com"leted high school, regardless of the
timing of their first birth. Ho&ever, the ga" bet&een early and later childbearers
in "ostsecondary school attendance &idened from ): to 88 "ercentage "oints
bet&een the early -+;,s and the early -++,s.
V. !uthor"s Conclusion / ecommendation
<iven the c#rrent im"ortance of a college ed#cation, teenage childbearers
today are at least as disadvantaged as those of "ast generations.
VI. !##licability $ In %ursing Education& %ursing Service or %ursing !ction'
Schooling is critical to a yo#ng &oman=s "ros"ects thro#gho#t her life.
The amo#nt of schooling a &oman obtains affects her occ#"ation, her income, her
chances of marriage, her ris of "overty and &elfare de"endence and, more
generally, the 5#ality of her o&n life and that of her children.
VII. evie(er"s Conclusion / Commentary
>ltho#gh smaller "ro"ortions of yo#ng &omen are becoming teenage
mothers, early childbearing is still an im"ortant iss#e for "olicymaers. One of
every eight births occ#r to a teenager. >nd &hile rates of "ostsecondary
attendance have increased for all mothers, regardless of their age at first birth,
they have risen least for early childbearers. This discre"ancy has increased rather
than red#ced the ga" in schooling by timing of first birth.
VIII. eferences)
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accessed >#g#st --, ),-,
htt"$%%&&&.ncbi.nlm.nih.gov%"#bmed%--@,88(* accessed >#g#st --,
),-,
Evidence*+ased ,ractices to educe Maternal Mortality) ! Systematic evie(
I. Citation
<ina !arie 3iane
/e"artment of Health Science, California State 9niversity, Long Beach,
-)*, Bellflo&er Bo#levard, Long Beach, C> +,@8,, 9S>
>ddress corres"ondence to <ina !arie 3iane, E4mail$ g"ianeAcs#lb.ed#
II. Study Characteristics
To achieve the Borld Health OrganiCationDs !illenni#m /evelo"ment
<oal of red#cing maternal mortality by three45#arters by ),-*, a strong global
commitment is needed to address this iss#e in s#b4Saharan >frica &here the ris
to &omen is greatest. > com"rehensive international effort m#st incl#de both
clinical and comm#nity4based interventions. .n s#b4Saharan >frica &here the
ma'ority of &omen deliver babies at home &itho#t a trained attendant, the
national "lans m#st rely "redominantly on comm#nity4level interventions.
III. Methodology / Design
To find effective interventions and "olicies that co#ld be #sed in s#b4
Saharan >frica, a systematic revie& of "#blished literat#re &as cond#cted. This
"a"er describes the first stage of analysis$ e1amination of the Cochrane revie&s
&ith the s"ecific o#tcome of maternal death. The Cochrane Collaboration
"romotes the search for evidence4based health care by "rod#cing and
disseminating systematic revie&s of clinical trials and other st#dies of
interventions. > search &as cond#cted #sing Ematernal mortalityD as ey &ord and
limited to the "#blication years from -++@ to ),,@, &hich res#lted in (+, titles of
Cochrane revie&s. T&o h#ndred and fifty titles clearly indicated that the
o#tcomes meas#red &ere related to infant or fetal mortality and morbidity and
&ere th#s e1cl#ded from the com"ilation. >fter f#rther screening the abstracts of
the remaining -(+ revie&s, those that re"resented "rotocols rather than act#al
revie&s and revie&s &ith o#tcomes of infant or fetal mortality or morbidity &ere
e1cl#ded. Seventy4si1 f#ll te1t revie&s &ere e1amined. The Cochrane re"orts
clearly indicate the o#tcome of analysis in the inde1, and this allo&ed for the
e1cl#sion of ** revie&s &hich did not incl#de maternal death as a s"ecific
o#tcome. T&o additional revie&s &ere e1cl#ded beca#se they had been
&ithdra&n from the Cochrane database. The res#lts of the remaining -+ Cochrane
revie&s are com"iled belo& and not re4analyCed since strict "rotocols &ere
im"lemented in incl#ding clinical trials in the e1isting analyses.
IV. esults of the Study
> mineral s#""lement Fcalci#m s#""lementsG, a class of dr#gs
Fantihy"ertensiveG and five dr#gs "rescribed for s"ecific high4ris conditions in
"regnant &omen &ere sho&n to red#ce the ris of maternal death. S"ecifically,
calci#m s#""lements given d#ring "regnancy "revented hy"ertensive disorders,
related disorders and #ltimately maternal death. The ris of severe hy"ertension
and s#bse5#ent maternal death &as red#ced by administering any
antihy"ertensive dr#g to "regnant &omen &ith mild to moderate high blood
"ress#re. /e1amethasone, a corticosteroid "rescribed for HELL3 syndrome
FHemolysis, elevated liver enCymes and lo& "lateletsG, red#ced maternal deaths.
Hetanserin and 0ifedi"ine administered for very high blood "ress#re in "regnancy
also red#ced the ris of maternal death. !agnesi#m s#lfate "rescribed for "re4
eclam"sia or eclam"sia significantly red#ced the ris of maternal death. Five of
the Cochrane revie&s demonstrated an increase in ris of maternal death &ith the
administration of "artic#lar dr#gs to high4ris "regnant &omen. S"ecifically,
anti"latelet agents "rescribed for "reventing "re4eclam"sia and its com"lications,
beta4blocers "rescribed for mild hy"ertension, and 3rostaglandins and
!iso"rostol "rescribed for "reventing "ost"art#m hemorrhage all increased the
ris of death to "regnant &omen. The "roced#re amniotomy, &hich is the
intentional artificial r#"t#re of the amniotic membrane d#ring labor, also
increased the ris of maternal death.
V. !uthor"s Conclusion / ecommendation
The dearth of evidence highlights the need for increased foc#s on clinical
and comm#nity4based interventions that are feasible in s#b4Saharan >frica. This
cannot be accom"lished &itho#t a stronger commitment to red#cing maternal
mortality by global health "ractitioners and researchers.
VI. !##licability $ In %ursing Education& %ursing Service or %ursing !ction'
!aternal death is defined as Ethe death of a &oman &hile "regnant or
&ithin 8) days of termination of "regnancy, irres"ective of the d#ration and site
of the "regnancy, from any ca#se related to or aggravated by the "regnancy or its
management b#t not from accidental or incidental ca#ses. The tragedy of a
&oman dying in childbirth e1tends beyond her o&n death, devastating her infant,
her other children, her family and the comm#nity. Commitment is needed among
"#blic health leaders to identify best "ractices in red#cing maternal mortality, and
to f#nd and im"lement "rograms &ith strong evidence of effectiveness in and
translate the best interventions for dissemination comm#nities that are
dis"ro"ortionately affected.
VII. evie(er"s Conclusion / Commentary
To reach the !illenni#m /evelo"ment <oal of red#cing maternal
mortality by three45#arters by ),-*, "#blic health "rograms need to mae
comm#nity&ide and nation&ide "rogress. The evidence base of comm#nity4level
and clinical interventions m#st be "rom"tly develo"ed and disseminated. There is
an #rgent need for more clinical trials and high45#ality, eval#ated, comm#nity
intervention trials e1amining maternal death in lo&4income nations &here the ris
is highest. Fail#re to do so &ill s#b'ect millions of yo#ng &omen and girls to
"remat#re and needless death.
VIII. eferences)
Io#rnal of 3#blic Health J Kol. (-, 0o. -, "". );6(- J
doi$-,.-,+(%"#bmed%fdn,:8 J >dvance >ccess 3#blication + Se"tember ),,@
/o&nloaded from htt"$%%'"#bhealth.o1ford'o#rnals.org accessed I#ly --, ),-,
Metformin in -estational Diabetes Mellitus * ! .ogical !lternative
I. Citation
LO9ELL> 3. >L9.0O, !/
IER.CHO TH>//E9S 3. L90>, !/, F3O<S
/e"artment of Obstetrics and <ynecology,
3hili""ine <eneral Hos"ital, 9niversity of the 3hili""ines !anila
II. Study Characteristics
The #se of metformin in gestational diabetes mellit#s F</!G has become
increasingly acce"ted b#t clinical "ractice is ahead of the evidence. > &ide range
of metabolic and re"rod#ctive benefits have been re"orted from non4randomiCed
trials &ith !etformin.
III. Methodology / Design
Of the -,: &omen enrolled in the randomiCed controlled st#dy, *( &omen
&ere assigned to the !etformin gro#" and *8 to the .ns#lin gro#". Only (,
&omen com"leted the !etformin arm and 8) com"leted the .ns#lin arm of the
st#dy. The ideal analysis &as to "erform eval#ation according to the intention to
treat "rinci"le on the desired n#mber of "o"#lation. Ho&ever, there &as a
decreasing trend in the n#mber of admissions of </! "atients as com"ared to the
average of -;:.* in the 3hili""ine <eneral Hos"ital.
IV. esults of the Study
The maternal o#tcome of fasting blood gl#cose M+* mg%dL and -ho#r "ost
"randial of M-), mg% dL did not differ significantly bet&een gro#"s NF(, 7 in the
!etformin and (-7 in the .ns#lin gro#", F3O,.+*GP. Of the fetal o#tcomes, severe
hy"oglycemia Fgl#cose level M-.; mmol%literG &as less common in the !etformin
gro#". 3reterm birth before () &ees, on the other hand, &as more common in
the .ns#lin gro#". There &ere no adverse events associated &ith !etformin.
V. !uthor"s Conclusion / ecommendation
.n &omen &ith </!, there is no difference in maternal glycemic control
&ith metformin alone or &ith s#""lemental ins#lin com"ared to the #se of ins#lin
only. F#rthermore, !etformin is not associated &ith increased "erinatal
com"lications. /iet thera"y is effective for a significant n#mber of &omen F))7
!etformin vs -87 .ns#linG. .t is im"erative ho&ever, to cond#ct the st#dy having
a greater "o"#lation to verify s#ch res#lts.
VI. !##licability $ In %ursing Education& %ursing Service or %ursing !ction'
<estational diabetes mellit#s F</!G is a com"lication in abo#t *7 of
"regnancies. .t is increasing in "revalence and is associated &ith com"lications of
"regnancy and a long term ris of diabetes in both mother and offs"ring. </!
a""ears to have maternal and neonatal ramifications for "regnancy o#tcomes and
for the later develo"ment of ty"e ) diabetes mellit#s F/!G. The c#rrent
consens#s is that &omen &ith #ne5#ivocal </! have a significant ris of
adverse "erinatal o#tcomes and increased ris of later ty"e develo"ment of ty"e )
/!. Fet#ses from "regnancies &ith </! have a higher ris of macrosomia
Fassociated &ith higher rate of birth in'#riesG, as"hy1ia, neonatal hy"oglycemia
and neonatal hy"erins#linemia. Having st#dies lie this, &o#ld hel" to alleviate
the tension the e1"ectant mother #"on diagnosed of having </!.
VII. evie(er"s Conclusion / Commentary
!etformin is a logical alternative treatment for &omen &ith gestational
diabetes mellit#s, b#t randomiCed trials to assess the efficacy and safety of its #se
for this condition are inade5#ate. Clinicians may remain adamant abo#t #sing
!etformin #ntil s#ch res#lts have been "#blished ho&ever, &e can not disco#nt
the fact that metformin alone or &ith s#""lemental ins#lin, is an effective and safe
treatment o"tion for &omen &ith </! and that metformin has higher
acce"tability than ins#lin beca#se of the ease of administration. F#rther follo&4#"
data to s#""ort aforementioned findings may be "rovided by s#bse5#ent st#dies.
VIII. eference)
/ecember, ),,+ 3hili""ine Io#rnal of Obstetrics Q <ynecology Kol#me
(( F0o. 8G "".-)(4-(,