Neville Butler

Smoking in Pregnancy and Subsequent Child Development

A national sample of several thousand children has been followed longitudinally from birth. At the ages of 7 and 11 years physical and mental retardation due to smoking in pregnancy has been found, and this deficit increases with the number of cigarettes smoked after the fourth month of pregnancy. Children of mothers who smoked 10 or more cigarettes a day are on average 1·0 cm shorter and between three and five months retarded on reading, mathematics, and general ability compared with the offspring of non-smokers, after allowing for associated social and biological factors.

Cigarette Smoking in Pregnancy: Its Influence on Birth Weight and Perinatal Mortality

In a British population cigarette smoking during pregnancy increased the late fetal plus neonatal mortality rate by 28% and reduced birth weight by 170 g, and these differences persist even after allowing for a number of “mediating” maternal and social variables. A change in smoking habit by the end of the fourth month of pregnancy places a mother in the risk category appropriate to her changed habit. This evidence should have important implications for health education aimed at getting pregnant mothers to give up smoking.

Febrile convulsions in a national cohort followed up from birth. I--Prevalence and recurrence in the first five years of life.

Of 13 135 children followed up from birth to the age of 5 years, 303 (2.3%) had febrile convulsions. Prior neurological abnormality had been noted in 13. Of the 290 remaining children, 57 (20%) presented with a complex convulsion, and 103 children (35%) went on to have further febrile convulsions. The risk of further febrile convulsions varied with the age at first convulsion and the presence of a history of convulsive disorders in relatives. There were no significant differences between the sexes.

A national study of asthma in childhood.

A history of asthma was obtained in 3.5% of a representative national sample of children aged 11 years. A further 8.8% had a history of wheezy bronchitis. In the 12 months before the interview, 2% had experienced attacks of asthma and a further 2.9% attacks of wheezy bronchitis. Both conditions were significantly more common among boys than girls, and a history of asthma was reported more frequently among children from non-manual than from manual social classes. Children with frequent attacks of wheezing had lower mean relative weights. A history of eczema and hay fever was more frequently discovered in children with reported asthma than in those with wheezy bronchitis, whereas migraine or recurrent headaches, recurrent abdominal pain, and recurrent throat or ear infections were more commonly associated with wheezy bronchitis than with asthma. The modified Rutter home behaviour scale, which reflects the parental view of the childs behaviour, was significantly raised among children with a history of wheezing, but their school behaviour as judged by the Bristol social adjustment guide showed no such difference. In spite of increased absence from school because of illness, no differences were found in educational attainment between children with a history of asthma or wheezy bronchitis and those with neither condition.

Febrile convulsions in a national cohort followed up from birth. II--Medical history and intellectual ability at 5 years of age.

Three hundred and three children with febrile convulsions were identified in a national birth cohort of 13 135 children followed up from birth to the age of 5 years. Breech delivery (p less than 0.05) was the only significantly associated prenatal or perinatal factor. There were no associations with socioeconomic factors. Excluding the 13 known to be neurologically abnormal before their first febrile convulsion, children who had had a febrile convulsion did not differ at age 5 from their peers who had not had febrile convulsions in their behaviour, height, head circumference, or performance in simple intellectual tests.

Differences in risk factors for partial and no immunisation in the first year of life: prospective cohort study

Abstract Objective To compare demographic, social, maternal, and infant related factors associated with partial immunisation and no immunisation in the first year of life in the United Kingdom. Design Prospective cohort study. Setting Sample of electoral wards in England, Wales, Scotland, and Northern Ireland, stratified by measures of ethnic composition and social disadvantage. Participants 18 488 infants born between September 2000 and January 2002, resident in the UK and eligible to receive child benefit (a universal benefit available to all families) at age 9 months. Main outcome measure Immunisation status at 9 months of age, defined as fully immunised, partially immunised, or not immunised. Results Overall in the UK, 3.3% of infants were partially immunised and 1.1% were unimmunised; these rates were highest in England (3.6% and 1.3%, respectively; P < 0.01). Residence in ethnic or disadvantaged wards, larger family size, lone or teenaged parenthood, maternal smoking in pregnancy, and admission to hospital by 9 months of age were independently associated with partial immunisation status. In contrast, a higher proportion of mothers of unimmunised infants were educated to degree level or above (1.9%), were older (3.1%), or were of black Caribbean ethnicity (4.7%). Conclusions Mothers of unimmunised infants differ in terms of age and education from those of partially immunised infants. Interventions to reduce incomplete immunisation in infancy need different approaches.

Evidence for increasing prevalence of diabetes mellitus in childhood.

The prevalence of diabetes mellitus among the cohort of children in the Child Health and Education Study studied at age 10 was 1.3/1000. Comparison with prevalences found in the two previous British birth cohort studies suggested that the prevalence of diabetes is doubling roughly every decade. The data suggested that childhood diabetics are a socially advantaged group. These findings have important implications and should be taken into account by health service planners if the needs of these children are to be met in the future.

BREAST-FEEDING, BRONCHITIS, AND ADMISSIONS FOR LOWER-RESPIRATORY ILLNESS AND GASTROENTERITIS DURING THE FIRST FIVE YEARS

Abstract The possible influence of breast-feeding on reported bronchitis and on admissions to hospital for lower-respiratory illness and gastroenteritis during the first five years was assessed in a longitudinal national British study of 13 135 children. Breast-feeding was found to have no significant association with rates of bronchitis or admission to hospital with lower-respiratory illness after allowance was made for influences associated with both lower-respiratory illness and likelihood of breast-feeding (maternal smoking, family social status, and birthweight). Admissions to hospital for gastroenteritis in the first year were marginally less likely in breast-fed infants.

Educational attainment of 10-year-old children with treated and untreated visual defects

Children with visual defects who took part in a 10‐year survey were compared with their peers on measures of intelligence, reading, mathematics and sporting ability. Results are consistent with earlier findings of increased intelligence among children with myopia and slightly reduced intelligence among children with ambylopia. Those with other visual defects had normal intelligence scores. Once intelligence had been taken into account, only children with mild hypermetropia were underachieving at reading. Those with severe myopia were reading better than expected. None of the children could be shown to be over‐ or underachieving at maths, any variation being due to intelligence. The mothers of children with visual defects perceived them to be less able at sport.

Plus ça change: predictors of birthweight in two national studies

Summary. The 16 989 singleton births in one week of March, 1958, studied by the British Perinatal Mortality Survey, were subjected to an analysis of covariance, which showed that major factors associated with birthweight of the infant were: maternal height, history of smoking in pregnancy, parity and history of pre‐eclampsia during the pregnancy. The same analysis was repeated on the data collected on 16 792 singletons born 12 years later in one week of April, 1970 and studied by the British Births Survey. In spite of major changes in obstetric practice and in the maternal population, the same factors were shown to be highly significant and the magnitude of the associations had changed little.