Neonatal health is of major concern to parents, midwives, physicians and society as a whole, yet a prospective population-based birth cohort to collect comprehensive data on multiple issues including medical, social, environmental and genetic aspects remains to be established in Germany. The survey of newborns in Pomerania (SNiP) described in this paper attempts to take up this goal. The objectives of SNiP are to establish (a) a population-based birth cohort providing detailed information about neonatal health, morbidity and mortality, (b) a biobank with newborn DNA and serum from cord blood, placenta tissue samples and DNA obtained from oral mucosal swabs of the mothers, (c) a prospective study design by re-examination of the SNiP population prior to attendance at primary school. From March 2003 until November 2008 all childbearing mothers in a well-defined region in North-Eastern Germany were asked to participate with their newborns. Detailed data on health status of the newborn, pregnancy, medical and family history, socio-economic status and maternal life style were obtained via face-to-face interview, standardised questionnaires and medical records. Placental tissue samples, cord blood plasma and DNA were continuously collected; sampling of maternal DNA from mouth swabs started in 2007. As a result, during the study period n = 6747 births and n = 6828 babies were enrolled. A population coverage of 95% was achieved. The active participation rate was 75%. A non-responder analysis revealed no meaningful selection bias. Thus, SNiP is a population-based, representative study in Germany that is able to describe the health and living conditions of newborns and their families comprehensively. It can contribute to existing knowledge and to similar cohort studies since data are accessible by researchers.

Background: A substantial number of women smoke while pregnant. The majority of those who quit return to smoking within 12 months. The aim of this study is to estimate smoking rates and to measure the urge to smoke and the motivation to change smoking behavior among women who recently delivered.Methods: Data presented stem from two studies. Study 1 is an epidemiological survey investigating the health of neonates. Study 2 presents screening data of an efficacy trial for a smoking cessation and relapse prevention intervention. Participants were recruited on maternity wards within 7 days after delivery.Results: Five hundred fifty-three (29.1%) women were never smokers, 145 (7.6%) were former smokers, 492 (25.9%) abstained during pregnancy, and 712 (37.4%) smoked throughout pregnancy. Of the smokers, 69% did not intend to quit smoking within the next 6 months. Of the women who quit during pregnancy, 80% did not want to resume smoking within the next 6 months or after weaning.Conclusions: Smoking and relapse rates indicate a need for increased efforts to reduce smoking during pregnancy and postpartum. Reported intention to quit or resume does not reflect the high number of relapses. Indicators for relapse need to be found.

OBJECTIVES:Women's overall quality of life prior to delivery and the changes expected by the mothers within the near future have been analyzed addressing items like employment, finances, housing and relationships to family, friends and neighbours.METHODS:Population based women were asked to answer a questionnaire (Survey of Neonates in Pomerania - SNIP) during their stay at the hospital after delivery. The area studied is North-East Germany.RESULTS:The study included 1553 women with 1122 questionnaires (72.3%) analyzed. Positive assessment concerning the quality of life was observed in 91.2% without expecting serious worsening after delivery. Negative assessments were found within the categories employment (23.3%) and finances (26.3%). Worsening was expected within employment (34%), finances (52.1%) and shortening of spare time (39.6%). Within all other categories no changes or even an improvement after delivery were expected. The overall assessment was correlated to the mothers' social relationship.CONCLUSION:Most women stated their own quality of life as positive, none expected serious worsening. Employment, finances and social bindings are factors with strong relationship on the mothers' self-assessment.

Einleitung und Fragestellung: Die Erstinfektion mit Toxoplasma gondii während der Schwangerschaft führt in 40% d.F. zur konnatalen Toxoplasmose mit Gefahr schwerer ZNS-Schäden, sowie gehäuften Früh- und Totgeburten. In Deutschland wird das Screening auf Toxoplasmose nicht mehr als generelle Leistung der Schwangerenvorsorge von den Krankenkassen übernommen. Populationsbasierte Untersuchungen zum Einfluss sozio-ökonomischer Faktoren auf die Effizienz des Toxoplasmosescreenings während der Schwangerschaft fehlen. Material und Methoden: Eingeschlossen wurden 2744 werdende Mütter bei denen im Zeitraum von Mai 2002 bis Juni 2005 im Rahmen des populationsbasierten Survey of Neonates in Pommerania (SNiP) auf Basis der Einträge in den Mutterpass und in die Krankenakten der Geburtskliniken Daten zum Screening auf Toxoplasmose erfasst werden konnten. Die statistischen Analysen erfolgten in SPSSÒ mittels Chi2-Test.

AIM:To correlate findings of hip ultrasound on day 4-10 of life with sex, intrauterine position and a positive family history for congenital hip anomalies.METHODS:The SNiP-study ( Survey of Neonates In Pommerania) registered 2256 neonates (2030 term, 226 preterm) between May 2002 and March 2004. Hip ultrasound results of 1043 term and since October 2003 33 preterm neonates were analysed. Time of ultrasound was day 4-10 after birth. Preterm neonates were examined when reaching their corrected term gestational age. Ultrasound was applied with a 7.5 MHz linear scanner and results were classified according to Graf. Chi-square and Fishers exact test were used for statistical analysis.RESULTS:4.9 % of the screened hips were classified as IIc or higher, 3.1 % were unilateral and 1.7 % bilateral. Incidence was significantly higher (p < 0.023) in females (6.6 %) than in males (3.2 %). There was no significant difference in intrauterine position or positive family history for hip anomalies with 3.7 % for mothers, 1.2 % of fathers and 2.4 % of siblings positive. There was a higher incidence for congenital hip dysplasia in preterms with 6.1 %, which is not significant due to the limited number.DISCUSSION:Current screening methods miss up to 18 % of newborns with severe hip dysplasia. We were able to demonstrate that screening for congenital hip dysplasia with ultrasound is a diagnostic tool even during the first days of life. There is a significantly higher incidence of congenital hip dysplasia in females, but in contrast to other studies we found no significant difference in intrauterine position or familial history. Earlier diagnosis and therapy on the base of relevant risk factors might correspond with an improved prognosis and outcome. Further studies are warranted to evaluate the significance in preterm neonates.

Einleitung: Das Auftreten angeborener Fehlbildungen, insbesondere des ZNS kann durch die rechtzeitige Einnahme von Folsäure vermindert werden. Für alle Frauen im gebärfähigen Alter wird daher die zusätzliche Einnahme von 400 ug pro Tag empfohlen. Frauen, die bereits ein Kind mit einem Neuralrohrdefekt empfangen haben, sollten 4mg pro Tag einnehmen. Eigene Untersuchungen des Geburtenjahrgangs 2003/2004 zeigten den Einfluss sozioökonomischer Faktoren bei Geburtsvorbereitung und Durchführung der Folsäureprophylaxe. Zur Verifizierung dieser Beobachtung wurden jetzt 2 Geburtsjahrgänge der populationsbasierten Studie "Survey of Neonates in Pomerania" (SNiP) analysiert.

Fragestellung: Analyse struktureller Faktoren innerhalb des Perinatalzentrums und deren Einfluss auf Morbidität und Mortalität von Früh- und Neugeborenen.

Einleitung: Das Aufteten bestimmter angeborener Fehlbildungen kann durch die rechtzeitige Einnahme von Folsäure vermindert werden. Frauen im gebärfähigen Alter wird eine zusätzliche Einnahme von 400mg/d empfohlen. Frauen, die bereits ein Kind mit einem Neuralrohrdefekt haben, sollten 4mg/d einnehmen. Wir untersuchten den Einfluss von Bildungsstand, Erwerbstätigkeit und monatlichem Einkommen auf die Planung der Schwangerschaft, geburtsvorbereitende Maßnahmen und die Inanspruchnahme der Folsäureprophylaxe.

Recent reports have demonstrated that mice lacking the transcription factor Cited2 die in utero showing various cardiac malformations. We present for the first time functionally relevant mutations of CITED2 in patients with congenital heart defects (CHDs). CITED2 encodes a CREBBP/EP300 interacting transcriptional modulator of HIF1A and TFAP2. To study the potential impact of sequence variations in CITED2 for CHDs in humans, we screened a cohort of 392 well, characterized patients and 192 control individuals using DHPLC, sequencing, and Amplifluor (TM) genotyping techniques. We identified 15 CITED2 nucleotide alterations. Seven of these alterations were found only in CHD patients and were not detected in controls, including three mutations leading to alterations of the amino acid sequence (p.Ser170_Gly178de1, p.Gly178_Ser179ins9, and p.Ser198_Gly199del). All three of these amino acid changing mutations cluster in the serine,glycine rich junction of the protein, to which no functionality had heretofore been assigned. Here we show that these mutations significantly reduce the capacity of CITED2 to transrepress HIF1A, and that the p.Ser170_Gly178deI mutation significantly diminishes TFAP2C coactivation. This reveals a modifying role for the serine-glycine-rich region in CITED2 function. In summary, the observation of these mutations in patients with septal defects indicates that CITED2 has a causative impact in the development of CHD in humans. Hum Murat 26(6), 575-582, 2005. (c) 2005 Wiley-Liss, Inc.

Einleitung: Hauptziel der Studie ist die Erhebung von Prävalenzdaten zu neonataler Morbidität und Mortalität und deren Korrelation mit anamnestischen, phäno- und genotypischen Daten.

Problemstellung: Bestehen Korrelationen zwischen dem sonographischen Hüftbefund zum Zeitpunkt der U2, familiärer Vorbelastung, Geschlecht und dem Lagetyp bei Geburt?

Hintergrund: In Deutschland wird zur Prophylaxe kongenitaler Fehlbildungen allen Frauen im gebärfähigen Alter die tägliche Supplementation von 400µg Folsäure empfohlen. Die tatsächliche Inanspruchnahme liegt aber bundesweit wesentlich niedriger. Wir untersuchten Prädiktoren des Einnahmeverhaltens bei Müttern in Ostvorpommern. Methoden: SNiP ist eine prospektive populationsbasierte informed consent Geburtskohorte in Ostvorpommern mit einer Geburtenzahl von 1300/a. Via Krankenakten, Face-to-face Interview und einem Selbstausfüllbogen werden Daten zu Gesundheitsstatus des Neugeborenen sowie zu Schwangerschafts- Familien-, und Sozialanamnese erhoben. Wir analysierten 527 konsekutive Geburten auf systematische Zusammenhänge zwischen Einnahmeverhalten und Planung der Schwangerschaft, Bildungsstand, Erwerbstätigkeit und Haushaltseinkommen. Ergebnisse: 78 % der Mütter nahmen zu irgendeinem Zeitpunkt der Schwangerschaft Folsäure ein, aber nur 10 % gemäß den Empfehlungen. 69 % der Schwangerschaften waren geplant. Obwohl die empfehlungsgemäße Folsäureneinnahme mit Planung der Schwangerschaft und ansteigenden Bildungsstand zunimmt, ist lediglich zwischen der Gruppe der Erwerbstätigen und Nicht-Erwerbstätigen ein signifikanter Unterschied mit 17% vs. 8% zuungunsten der Nicht-Erwerbstätigen festzustellen (Binomialtest; p=0,017). Diskussion: Ostvorpommern ist eine Region mit einer hohen Arbeitslosenquote (22%) und zählt zu den wirtschaftlichen Problemgebieten Deutschlands. Unsere Untersuchungen zeigen, dass dies auch auf gesundheitsvorsorgende Aspekte einen unmittelbaren Einfluss hat, da vor allem in der Gruppe der Nicht-Erwerbstätigen Mütter die Folsäureprophylaxe mangelhaft ist. Allerdings zeigt sich auch insgesamt eine unzureichende Folsäureprophylaxe, die weit unterhalb der wünschenswerten Inanspruchnahme liegt.

Einleitung: Durch perikonzeptionelle Einnahme von Folsäure kann das Auftreten kongenitaler Fehlbildungen vermindert werden. Für alle Frauen im gebärfähigen Alter wird eine zusätzliche tägliche Supplementation von 400µg Folsäure vor der Konzeption empfohlen. Mütter von Indexpatienten sollten bei erneutem Kinderwunsch 4mg Folsäure pro Tag supplementieren. Wir untersuchten die Fragestellung, ob Bildungsstand, Erwerbstätigkeit und Planung der Schwangerschaft mit der Folsäureeinnahme korreliert.

Background/Aims: Origin of sex difference in urinary osmolality. Methods: In 495 healthy children aged 4.0-14.9 years participating in the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study (247 boys, 248 girls), the water intake recorded in 24-hour weighed dietary records along with urinary volume, osmolality and free water reserve in 24-hour urine samples from the same day as the dietary record were determined. Results: Boys showed a significantly higher energy intake, total water intake, urinary osmolality and osmolar load than girls but no increase in urinary volume. When referred to energy intake, mean urinary volume and mean free water reserve were significantly higher in girls than boys. Girls could have a preference for food with a higher water density and lower non-renal water losses. Conclusion: German girls of the DONALD study displayed a lower urinary osmolality than German boys due to a relatively higher urinary volume. The sex difference could be caused by a higher water density of the ingested food (ml/kcal) and a lower insensible water loss (ml/kcal) in girls than boys. Copyright (C) 2002 S. Karger AG, Basel.