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Objective. To evaluate the effect of acupressure administered during the active phase of labor on nulliparous women's ratings of labor pain. Design. Randomized controlled trial. Setting. Public hospital in India. Sample. Seventy-one women randomized to receive acupressure at acupuncture point spleen 6 (SP6) on both legs during contractions over a 30-minute period (acupressure group), 71 women to receive light touch at SP6 on both legs during the same period of time (touch group) and 70 women to receive standard care (standard care group). Methods. Experience of in-labor pain was assessed by visual analog scale at baseline before treatment, immediately after treatment, and at 30, 60 and 120 minutes after treatment. Main outcome measure. Labor pain intensity at different time intervals after treatment compared with before treatment. Results. A reduction of in-labor pain was found in the acupressure group and was most noticeable immediately after treatment (acupressure group vs. standard care group p < 0.001; acupressure group vs. touch group p < 0.001). Conclusion. Acupressure seems to reduce pain during the active phase of labor in nulliparous women giving birth in a context in which social support and epidural analgesia are not available. However, the treatment effect is small which suggests that acupressure may be most effective during the initial phase of labor. [ABSTRACT FROM AUTHOR]

The psychological functioning of fathers with children born after in vitro fertilization (IVF) has received little attention. Among men in general, little is known about predictors of early father–infant relationship (here also defined as attachment). The first aim was to compare IVF fathers and control fathers regarding personality traits, state anxiety, depressive symptoms and early father–infant attachment. The second aim was to assess whether early father–infant relationship is explained by the father’s prenatal relationship with the unborn infant, his personality traits, state anxiety and symptoms of depression. Fifty-three IVF fathers and 36 controls filled in self-rating scales measuring father–infant attachment, personality, anxiety and symptoms of depression at 2 months postpartum. At gestational week 26 their prenatal relationship to the unborn infant was assessed. It was found that IVF fathers rated more somatic and psychic anxiety, indirect aggression and less assertiveness. They were as strongly attached to their infant as the controls. Fathers, who had rated higher attachment to their unborn infant during pregnancy, who were less anxious, more assertive and less irritable, were more attached to their infants than men who had been less attached to their unborn infants and who were more anxious, less assertive and more irritable. In conclusion, although IVF fathers are as strongly attached to their infants as other fathers, they may benefit from emotional support as they have elevated levels of anxiety proneness and indirect aggression. It is important to pay attention during pregnancy to fathers who have a less optimal attachment to their unborn infant and who have high levels of anxiety and irritability, as those three factors are related to a weak emotional father–infant relationship. [ABSTRACT FROM AUTHOR]

Our first aim was to investigate the pattern of prenatal attachment among partners of women who have become pregnant via in vitro fertilization (IVF men) and partners of women who have become pregnant without assisted reproductive technology (ART) (controls). A second aim was to analyse whether there is a correlation between degree of prenatal attachment in gestational week 26 and week 36. The third aim was to relate degree of prenatal attachment rated in gestational week 26 and gestational week 36, respectively, to psychosocial factors, way of conception and personality traits among the two groups of fathers. Fifty-three IVF men from IVF clinics and 37 control men from antenatal clinics in Stockholm were recruited to the study. They completed self-rating scales measuring prenatal attachment, personality, marital relationship, anxiety and depression. The results showed that IVF fathers are attached to their unborn children to the same extent as other fathers. Prenatal attachment increases during pregnancy although individual scores on prenatal attachment seem to be relatively stable. Contributors to prenatal attachment are ambivalence as well as the personality traits detachment and psychastenia. [ABSTRACT FROM AUTHOR]

Background: Investigators have pointed out that long-awaited pregnancies, such as those after in vitro fertilization (IVF), are emotionally vulnerable. In addition, higher pregnancy-related distress has been found among women pregnant after in vitro fertilization compared with women with “naturally” achieved pregnancy. The aim of this study was to compare prenatal attachment among IVF mothers and control mothers (women who conceived naturally), and to study relationships between prenatal attachment and psychosocial variables. Methods: Fifty-six IVF women from IVF clinics and 41 control women from antenatal clinics in Stockholm were assessed in gestational weeks 26 and 36. They completed self-rating scales measuring prenatal attachment, personality, marital relationship, anxiety, and depression. Results: Prenatal attachment increased as the pregnancy progressed in both groups. Prenatal attachment rated in gestational week 26 was significantly associated with that in gestational week 36. Multiple regression analyses showed that, in gestational week 26, prenatal attachment was explained by satisfaction with the partner relationship, whereas in gestational week 36 the factors contributing to high prenatal attachment were low scores of the personality trait detachment, low ambivalence, and younger age. Method of conception was unrelated to prenatal attachment at either assessment time point. Conclusions: In vitro fertilization mothers are attached to their unborn children to the same extent as other mothers. Prenatal attachment increases during pregnancy. At the same time, however, individual scores on prenatal attachment seem to be relatively stable. Significant contributors to prenatal attachment are marital satisfaction, age, ambivalence, and detachment. (BIRTH 33:4 December 2006) [ABSTRACT FROM AUTHOR]

Objective: To assess the emotional impact of infertility after successful IVF and to compare parents who have undergone IVF (IVF parents) and parents who have not undergone IVF (non-IVF parents) regarding parental stress and the marital relationship during the transition to parenthood.Design: A study with qualitative and longitudinal quantitative assessments.Setting: University IVF clinics and antenatal clinics in Stockholm.Patient(s): Fifty-five IVF mothers, 53 IVF fathers, 40 non-IVF mothers, and 36 non-IVF fathers.Intervention(s): IVF parents were interviewed. All subjects completed self-rating scales in early pregnancy and at 2 and 6 months postpartum.Main outcome measure(s): Interviews about perception of infertility and scalar measurement of parental stress and the marital relationship.Result(s): Negative feelings related to infertility were not easily overcome among the IVF parents. Their levels of stress related to parenthood were similar to those of non-IVF parents, and both groups reported decreased satisfaction with the marital relationship during the transition to parenthood.Conclusion(s): The inability to conceive naturally continues to affect the current lives of a proportion of IVF parents. The results suggest that IVF parents may benefit from counseling with regard to the potential long-term impacts of infertility, disclosure issues, and decisions regarding future children. However, levels of parental stress and patterns of partner satisfaction are similar to those of parents with children conceived “naturally.” [Copyright &y& Elsevier]

Background: Little is known as to whether negative experiences associated with infertility and IVF treatment persist after successful treatment. The aim of the study was to compare couples who have conceived after IVF and couples who have conceived naturally regarding personality factors and emotional responses to pregnancy.Methods: Fifty-seven women pregnant after IVF and 55 male partners and 43 women who had conceived naturally and 39 male partners were recruited from university IVF clinics and antenatal clinics in Stockholm. The subjects were interviewed about their socio-demographic background. They completed scales of personality traits, anxiety, emotional responses to pregnancy, marital adjustment and reactions to recalled infertility while in pregnancy week 13 (range 11-17).Results: The results showed that the IVF women had more muscular tension and were more anxious about loosing the pregnancy than the control women. The IVF women with high infertility distress were more anxious about loosing the pregnancy and less ambivalent than the women with lower distress. The IVF men had more somatic anxiety, indirect aggression, guilt, and were more detached and more anxious about loosing the pregnancy and less ambivalent than the control men. The IVF men with high infertility distress were more anxious about the baby not being normal than the men with lower infertility distress.Conclusions: The women and men who had conceived after IVF differed on a number of personality dimensions and emotional responses to the pregnancy from that of the women and the men who had conceived naturally. The results suggest that IVF couples may need additional emotional support in early pregnancy. [ABSTRACT FROM AUTHOR]

Investigates gender differences in psychological reactions to infertility among couples seeking in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment. Factor analysis of the Infertility Reaction Scale for men and women respectively; Comparison between social support received by men and women.

Background: Birth asphyxia is one of the leading causes of intrapartum stillbirth and neonatal mortality worldwide. We sought to explore the experiences of health care workers in managing foetal distress and birth asphyxia to gain an understanding of the challenges in a low-income setting. Methods: We conducted in-depth interviews with 12 midwives and 4 doctors working in maternity units from different health facilities in Northern Uganda in 2018. We used a semi-structured interview guide which included questions related to; health care workers' experiences of maternity care, care for foetal distress and birth asphyxia, views on possible preventive actions and perspectives of the community. Audio recorded interviews were transcribed verbatim and analysed using inductive content analysis. Results: Four categories emerged: (i) Understanding of and actions for foetal distress and birth asphyxia including knowledge, misconception and interventions; (ii) Challenges of managing foetal distress and birth asphyxia such as complexities of the referral system, refusal of referral, lack of equipment, and human resource problems, (iii) Expectations and blame from the community, and finally (iv) Health care worker' insights into prevention of foetal distress and birth asphyxia. Conclusion: Health care workers described management of foetal distress and birth asphyxia as complex and challenging. Thus, guidelines to manage foetal distress and birth asphyxia that are specifically tailored to the different levels of health facilities to ensure high quality of care and reduction of need for referral are called for. Innovative ways to operationalise transportation for referral and community dialogues could lead to improved birth experiences and outcomes. [ABSTRACT FROM AUTHOR]

Background: Birth asphyxia is one of the leading causes of neonatal mortality worldwide. In Uganda, it accounts for 28.9% of all neonatal deaths. With a view to inform policy and practice interventions to reduce adverse neonatal outcomes, we aimed to determine the prevalence and factors associated with birth asphyxia at two referral hospitals in Northern Uganda.Methods: This was a cross-sectional study, involving women who gave birth at two referral hospitals. Women in labour were consecutively enrolled by the research assistants, who also attended the births and determined Apgar scores. Data on socio-demographic characteristics, pregnancy history and care during labour, were obtained using a structured questionnaire. Participants were tested for; i) malaria (peripheral and placental blood samples), ii) syphilis, iii) white blood cell counts (WBC), and iv) haemoglobin levels. The prevalence of birth asphyxia was determined as the number of newborns with Apgar scores < 7 at 5 min out of the total population of study participants. Factors independently associated with birth asphyxia were determined using multivariable logistic regression analysis and a p-value < 0.05 was considered statistically significant.Results: A total of 2,930 mother-newborn pairs were included, and the prevalence of birth asphyxia was 154 [5.3% (95% confidence interval: 4.5- 6.1)]. Factors associated with birth asphyxia were; maternal age ≤ 19 years [adjusted odds ratio (aOR) 1.92 (1.27-2.91)], syphilis infection [aOR 2.45(1.08-5.57)], and a high white blood cell count [aOR 2.26 (1.26-4.06)], while employment [aOR 0.43 (0.22-0.83)] was protective. Additionally, referral [aOR1.75 (1.10-2.79)], induction/augmentation of labour [aOR 2.70 (1.62-4.50)], prolonged labour [aOR 1.88 (1.25-2.83)], obstructed labour [aOR 3.40 (1.70-6.83)], malpresentation/ malposition [aOR 3.00 (1.44-6.27)] and assisted vaginal delivery [aOR 5.54 (2.30-13.30)] were associated with birth asphyxia. Male newborns [aOR 1.92 (1.28-2.88)] and those with a low birth weight [aOR 2.20 (1.07-4.50)], were also more likely to develop birth asphyxia.Conclusion: The prevalence of birth asphyxia was 5.3%. In addition to the known intrapartum complications, teenage motherhood, syphilis and a raised white blood cell count were associated with birth asphyxia. This indicates that for sustained reduction of birth asphyxia, appropriate management of maternal infections and improved intrapartum quality of care are essential. [ABSTRACT FROM AUTHOR]

Objective: The aims of the present study were to investigate risk factors for failed vacuum extraction (VE), and to compare neonatal complications among infants delivered by failed VE with those delivered by successful VE.Methods: Population-based study including all women (and their newborn infants) with singleton pregnancy who gave birth at term by failed VE (n = 4747) or successful VE (n = 83 671) in Sweden between 1999 and 2010. Failed VE was defined as VE followed by an emergency cesarean section (ECS), forceps, or both forceps and ECS. We used logistic regression to examine the association between failed VE in relation to intracranial hemorrhage, subgaleal hemorrhage, Apgar scores <7 at 5 min, and neonatal convulsions.Results: Risk factors for failed VE included occipito posterior position, mid-pelvic fetal station, high birth weight, short maternal stature, epidural analgesia, and induction of labor. Compared with infants born after a successful VE, those delivered by failed VE had a higher risk of subgaleal hemorrhage OR 7.3 CI (5.5-9.7), convulsions OR 1.9 CI (1.4-2.7), and low Apgar OR 2.6 CI (2.3-3.0), but not of ICH.Conclusion: Failed VE is associated with neonatal complications. Fetal head position and station should be carefully assessed prior to the extraction. [ABSTRACT FROM AUTHOR]

Preterm birth is the principal risk factor for neonatal morbidity and mortality. The objective of this study was to investigate the association between antenatal depressive symptoms and preterm birth. The study included a national sample of 2,904 pregnant women who were recruited at their first booked visit to antenatal clinics in Sweden. Data on depressive symptoms, and sociodemographic and reproductive background were collected by questionnaires. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS). The average length of gestation at the time for completion of the questionnaire was 16 weeks. Data on gestational length were extracted from the Swedish Medical Birth Register. Multiple logistic regression analyses were conducted to estimate the risk of preterm birth associated with antenatal depressive symptoms. The presence of antenatal depressive symptoms above a cutoff score of 12 or higher on the EPDS increased the risk for preterm birth (OR: 1.56; 95% CI: 1.03-2.35). Being of age 35 years and over, being a primipara, and having experienced a previous miscarriage were also shown to be significant predictors in a multivariate model. Pregnant women reporting antenatal depressive symptoms are at elevated risk of preterm birth. (BIRTH 38:1 March 2011) [ABSTRACT FROM AUTHOR]

Objective. To investigate the relation between use of epidural analgesia (EDA) and maternal and fetal characteristics. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. All 106,775 primiparous women who in 2002-2005 delivered a singleton infant vaginally at term. Methods. Register study with data from the Medical Birth Registry and the Swedish Register of Education. Main outcome measure. Use of EDA during vaginal delivery. Results. A total of 47,810 women (45%) received EDA during labor. EDA was used more often in women who were either young or short, had a high body mass index or a short education, or gave birth to an infant with high birthweight. After adjustment, the positive correlation with birthweight persisted. The use of EDA was twice as high in women with infant birthweight >4,500 g, 60% higher in those with infants weighing between 4,000 and 4,500 g and 25% lower when infants weighed <3,000 g, when compared to those with newborns weighing between 3,000 and 3,500 g. Conclusion. The woman's need for EDA is strongly related to birthweight. Prolonged duration of labor and instrumental delivery usually ascribed to EDA may be due to large infants. [ABSTRACT FROM AUTHOR]

Background: Emotional reactions of couples were investigated during in vitro fertilization (IVF) at a private clinic in Sweden. The purpose was to compare such reactions between couples who obtained supernumerary embryos that could be cryopreserved and couples without such embryos.Methods: Forty women and men undergoing IVF treatment monitored individually their emotional reactions daily for one complete treatment cycle from the first day of down-regulation until the outcome of treatment was known. Ratings were extracted and analyzed from two separate days; the very first day of treatment and the day of embryo transfer.Results: The group of women (n=16; 40%) with supernumerary embryos suitable for cryopreservation reported a greater increase in optimism than the group (n=24; 60%) without such embryos (p=0.024). Correspondingly, women with supernumerary embryos reported less pessimism than women without such embryos (p=0.014). Among men there was no difference in optimism or pessimism between the groups. The women and men with supernumerary embryos did not differ in distress reactions compared to those women and men without such embryos. There was no correlation between optimism and distress on the day of embryo transfer in women; r=-0.167 and men; r=-0.135 respectively.Conclusion: The presence of frozen embryos increased optimistic and reduced pessimistic feelings about pregnancy among women undergoing IVF treatment. However, the couples' increased optimism on the day of embryo transfer did not seem to reduce their experience of distress. [ABSTRACT FROM AUTHOR]

Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings. Objective: To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda. Methods: A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data. Results: FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30–120) minutes in patients’ records versus 139 (IQR 87–662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different. Conclusions: When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother’s negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality. [ABSTRACT FROM AUTHOR]

Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings. Objective: To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda. Methods: A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data. Results: FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30–120) minutes in patients' records versus 139 (IQR 87–662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different. Conclusions: When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother's negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality. [ABSTRACT FROM AUTHOR]

Introduction: Anti-secretory factor is a protein that regulates secretory and inflammatory processes and preterm birth is associated with inflammation. Therefore, our hypothesis was that anti-secretory factor might play a role in immune reactivity and homeostasis during pregnancy.Material and Methods: Following spontaneous onset of labor and preterm or term delivery, placenta biopsies were collected. The levels of anti-secretory factor and markers of inflammation (CD68, CD163) and vascularization (CD34, smooth muscle actin) were analyzed by immunohistochemistry.Results: The 61 placental biopsies included 31 preterm (<37 weeks of gestation) and 30 term (37-41 weeks) samples. The preterm placentas exhibited lower levels of anti-secretory factor (p = 0.008) and larger numbers of CD68-positive cells (p < 0.001) compared to term. Preterm placentas had blood vessel of smaller diameter (p = 0.036) indicative of immaturity. The level of interleukin-6 in cord blood was higher after very preterm than term birth, suggesting a fetal inflammatory response. The placenta level of anti-secretory factor was positively correlated to the length of gestation (p = 0.025) and negatively correlated to the levels of the inflammatory markers CD68 (p = 0.015) and CD163 (p = 0.028).Conclusions: Preterm delivery is associated with low levels of anti-secretory factor in placenta. Inflammation, a potential trigger of preterm birth, is more pronounced in the preterm placenta and inversely related to the placental level of anti-secretory factor, suggesting both a link and a potential target for intervention. [ABSTRACT FROM AUTHOR]

Background: The modern phenomenon of delayed parenthood applies not only to women but also to men, but less is known about what characterises men who are expecting their first child at an advanced age. This study investigates the sociodemographic characteristics, health behaviour, health problems, social relationships and timing of pregnancy in older first-time fathers. Methods: A cross-sectional study was conducted of 14 832 men who were expecting their first child, based on data from the Norwegian Mother and Child Cohort Study (MoBa) carried out by the Norwegian Institute of Public Health. Data were collected in 2005-2008 by means of a questionnaire in gestational week 17-18 of their partner's pregnancy, and from the Norwegian Medical Birth Register. The distribution of background variables was investigated across the age span of 25 years and above. Men of advanced age (35-39 years) and very advanced age (40 years or more) were compared with men aged 25-34 years by means of bivariate and multivariate logistic regression analyses. Results: The following factors were found to be associated with having the first child at an advanced or very advanced age: being unmarried or non-cohabitant, negative health behaviour (overweight, obesity, smoking, frequent alcohol intake), physical and mental health problems (lower back pain, cardiovascular diseases, high blood pressure, sleeping problems, previous depressive symptoms), few social contacts and dissatisfaction with partner relationship. There were mixed associations for socioeconomic status: several proxy measures of high socioeconomic status (e.g. income >65 000 €, self-employment) were associated with having the first child at an advanced or very advanced age, as were several other proxy measures of low socioeconomic status (e.g. unemployment, low level of education, immigrant background).The odds of the child being conceived after in vitro fertilisation were threefold in men aged 34-39 and fourfold from 40 years and above. Conclusions: Men who expect their first baby at an advanced or very advanced age constitute a socioeconomically heterogeneous group with more health problems and more risky health behaviour than younger men. Since older men often have their first child with a woman of advanced age, in whom similar characteristics have been reported, their combined risk of adverse perinatal outcomes needs further attention by clinicians and researchers. [ABSTRACT FROM AUTHOR]

Problem This study investigates whether affectivity differs between mothers delivering preterm and term and whether maternal and umbilical cord serum cytokines differ between these groups. Further, whether there are associations between mothers' emotions and maternal and cord cytokines at preterm and term birth. Method of study Twenty-seven mothers delivering preterm and 37 mothers delivering at term reported positive/negative affect and previous depressive symptoms during pregnancy. Blood samples from mothers in labor and cord samples (23 preterm and 33 term) were analyzed for cytokines. Results Maternal IL-8 was lower at preterm delivery compared with term. In the preterm group only, associations were found between negative emotions and maternal IL-6, IL-8 and cord IL-6, IL-8, IL-10, IL-13, and IL-18. Conclusion The findings indicate associations in preterm delivery between negative emotions and both maternal and neonate immune activity. Future studies should investigate whether such associations are part of the etiology of preterm delivery. [ABSTRACT FROM AUTHOR]

Background: The modern phenomenon of delayed parenthood applies not only to women but also to men, but less is known about what characterises men who are expecting their first child at an advanced age. This study investigates the sociodemographic characteristics, health behaviour, health problems, social relationships and timing of pregnancy in older first-time fathers.Methods: A cross-sectional study was conducted of 14 832 men who were expecting their first child, based on data from the Norwegian Mother and Child Cohort Study (MoBa) carried out by the Norwegian Institute of Public Health. Data were collected in 2005-2008 by means of a questionnaire in gestational week 17-18 of their partner's pregnancy, and from the Norwegian Medical Birth Register. The distribution of background variables was investigated across the age span of 25 years and above. Men of advanced age (35-39 years) and very advanced age (40 years or more) were compared with men aged 25-34 years by means of bivariate and multivariate logistic regression analyses.Results: The following factors were found to be associated with having the first child at an advanced or very advanced age: being unmarried or non-cohabitant, negative health behaviour (overweight, obesity, smoking, frequent alcohol intake), physical and mental health problems (lower back pain, cardiovascular diseases, high blood pressure, sleeping problems, previous depressive symptoms), few social contacts and dissatisfaction with partner relationship. There were mixed associations for socioeconomic status: several proxy measures of high socioeconomic status (e.g. income >65,000 €, self-employment) were associated with having the first child at an advanced or very advanced age, as were several other proxy measures of low socioeconomic status (e.g. unemployment, low level of education, immigrant background).The odds of the child being conceived after in vitro fertilisation were threefold in men aged 34-39 and fourfold from 40 years and above.Conclusions: Men who expect their first baby at an advanced or very advanced age constitute a socioeconomically heterogeneous group with more health problems and more risky health behaviour than younger men. Since older men often have their first child with a woman of advanced age, in whom similar characteristics have been reported, their combined risk of adverse perinatal outcomes needs further attention by clinicians and researchers. [ABSTRACT FROM AUTHOR]