title: Trends in maternal and newborn health characteristics and obstetric interventions among Aboriginal and Torres Strait Islander mothers in Western Australia from 1986 to 2009.
abstract: BACKGROUND
  Detailed analyses of long-term trends in Aboriginal maternal and newborn health characteristics are lacking.
  
  
  OBJECTIVE
  To examine trends in maternal and newborn health characteristics for all mothers who were recorded as Aboriginal in the Western Australian Midwives' Notification System from 1986 to 2009.
  
  
  METHODS
  Births were categorised into four-year time intervals (1986-1989, 1990-1993, 1994-1997, 1998-2001, 2002-2005, 2006-2009). Trends in maternal demographic characteristics, pre-existing medical conditions, pregnancy complications and neonatal characteristics were examined.
  
  
  RESULTS
  For 37 424 births recorded from 1986 to 2009, the proportion of births to mothers aged ≤19 years decreased (31-22%, P < 0.001) along with the prevalence of pre-eclampsia (6.8-4.0%, P < 0.001) and antepartum haemorrhage (4.8-3.2%, P < 0.001). There were increases in the prevalence of diabetes in pregnancy (3.8-6.6%, P < 0.001), induction of labour (17.8-21.4%, P < 0.001), elective caesarean (6.6-8.2%, P < 0.001) and emergency caesarean (9.5-14.9%, P < 0.001) deliveries. There were no changes in the overall prevalence of preterm births (15.4-15.9%, P = 0.32). However, increases were observed in the prevalence of medically indicated preterm births with and without prelabour rupture of membranes (1.0-1.7%; P < 0.001 and 3.3-4.3%; P = 0.005, respectively). There were no significant changes in the rates of smoking during pregnancy (51-52% from 1998 to 2009, P = 0.18), small-for-gestational age (16.9-17.2%, P = 0.07), suboptimal-birthweight (20.4-20.1%, P = 0.92), stillbirths (14.7 per 1000-12.1 per 1000, P = 0.22) and neonatal deaths (6.2 per 1000-5.5 per 1000, P = 0.68).
  
  
  CONCLUSIONS
  Encouraging trends include reduced rates of teenage pregnancy, pre-eclampsia and antepartum haemorrhage. The persistent high rates of smoking during pregnancy, preterm births, stillbirths, neonatal deaths and increasing rates of diabetes in pregnancy are of concern.
authors.affiliation: Aboriginal Health Department Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Diouf
authors.affiliation: Aboriginal Health Department Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Lina
authors.initials: L
authors.lastname: Gubhaju
authors.affiliation: Aboriginal Health Department Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.|Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chamberlain
authors.affiliation: Aboriginal Health Department Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Bridgette
authors.initials: B
authors.lastname: Mcnamara
authors.affiliation: National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Grace
authors.initials: G
authors.lastname: Joshy
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Oats
authors.affiliation: Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Subiaco, Western Australia, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Stanley
authors.affiliation: Aboriginal Health Department Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.|Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Eades
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000639:trends; D003710:Demography / Q000639:trends; D003920:Diabetes Mellitus / Q000208:ethnology; D017558:Elective Surgical Procedures / Q000639:trends; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000208:ethnology*; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007230:Infant, Low Birth Weight; D007236:Infant, Small for Gestational Age; D007751:Labor, Induced / Q000639:trends*; D009035:Mothers / Q000706:statistics & numerical data*; D011225:Pre-Eclampsia / Q000208:ethnology; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D047928:Premature Birth / Q000208:ethnology*; D015995:Prevalence; D012907:Smoking / Q000639:trends; D050497:Stillbirth / Q000208:ethnology; D014592:Uterine Hemorrhage / Q000208:ethnology; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal; Western Australia; health; mothers; newborn