Assessment of Biomedical Risk Factors Associated with Adverse Pregnancy Outcomes

Background: Globally, the leading cause of death among females aged 15-49 years old is maternal mortality. More than 1,500 women die each day from pregnancy related causes resulting in an estimated 550,000 maternal deaths annually. We identified risk factors associated with adverse pregnancy outcomes.Methods: We conducted a descriptive, cross-sectional study, in which we administered a structured questionnaire through face to face interviews. We also applied the multivariate logistic regression model to determine factors associated with adverse pregnancy outcomes.Results: We enrolled a total of 306 pregnant women of whom 50% (n=153) were 12-19 years old and 50% (n=153) were 20-45 years old. Maternal death occurred only in the 20-45 years old mothers (6/153, 3.9%). In multivariate analysis, living in a rural area (aOR2.00, 95% CI: 1.08 to 3.69, p=0.027), shorter gestational period [32-37 weeks] (aOR4.84, 95% CI: 2.31 to 10.14, p=0.0007), haemoglobin level <10gm% (aOR3.87, 95%CI: 1.79 to 8.39, p=0.001), obesity [BMI ≥ 30 kg/m2] (aOR4.89, 95% CI: 1.38 to 17.37, p=0.014) and moderately high blood pressure [SBP/DBP of 150/100-159/109] (aOR15.15, 95% CI: 1.78 to 128.68, p=0.013) were significantly associated with adverse pregnancy outcomes.Conclusion: In this study, we identified living in a rural area, shorter gestational period, haemoglobin level < 10gm%, obesity, and having moderately high blood pressure to be risk factors for adverse pregnancy outcomes. All the maternal deaths were in the 20-45 years old pregnant mothers. We recommend educating women on these risk factors in order to reduce the burden of adverse pregnancy outcomes.

Download Full-text

Factors associated with sub-microscopic placental malaria and its association with adverse pregnancy outcomes among HIV-negative women in Dar es Salaam, Tanzania: a cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05521-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Aneth Vedastus Kalinjuma ◽

Anne Marie Darling ◽

Ferdinand M. Mugusi ◽

Ajibola Ibraheem Abioye ◽

Fredros O. Okumu ◽

...

Keyword(s):

Birth Weight ◽

Pregnancy Outcomes ◽

Malaria Infection ◽

Placental Malaria ◽

Adverse Pregnancy Outcomes ◽

Placental Infection ◽

Factors Associated ◽

Adverse Pregnancy ◽

Prevention Methods ◽

Dna Pcr

Abstract Background Malaria infection during pregnancy has negative health consequences for both mothers and offspring. Sub-microscopic malaria infection during pregnancy is common in most African countries. We sought to identify factors associated with sub-microscopic placental malaria, and its association with adverse pregnancy outcomes among HIV-negative pregnant women in Dar es Salaam, Tanzania. Methods We recruited a cohort of pregnant women during their first trimester and assessed for the occurrence of placental malaria and pregnancy outcomes. The follow-up was done monthly from recruitment until delivery. Histopathology placental malaria positive results were defined as the presence of malaria pigment or parasitized erythrocytes on the slide (histology-positive (HP)), and the sub-microscopic placental infection was defined as positive Plasmodium falciparum DNA by polymerase chain reaction (DNA PCR) amplification in a negative histopathology test. Adverse pregnancy outcomes investigated included low birth weight (birth weight below 2.5 kg), prematurity (live birth below 37 weeks), and small-for-gestational-age (SGA) (live born with a birth weight below 10th percentile for gestational age and sex). Weighted baseline category logit, log-binomial, and log-Poisson models were used to assess factors associated with placental malaria, and its association with adverse pregnancy outcomes. Results Among 1115 women who had histopathology and DNA PCR performed, 93 (8%) had HP placental infection, and 136 (12%) had the sub-microscopic placental infection. The risk of sub-microscopic placental malaria was greater in women who did not use mosquito prevention methods such as bed nets, fumigation, or mosquito coils (odds ratio (OR) = 1.75; 95% confidence interval (CI): 1.05–2.92; P = 0.03) and in women who were anemic (OR = 1.59; 95% CI: 1.20–2.11; P = 0.001). Women who were underweight had reduced odds of sub-microscopic placental malaria infection (OR = 0.33; 95% CI: 0.17–0.62; P = 0.001). Women who were overweight/obese had 1.48 times higher the odds of HP placental malaria compared to normal weight (OR = 1.48; 95% CI: 1.03–2.11; P = 0.03). HP placental malaria infection was associated with an increased risk of SGA births (RR = 1.30, 95% CI: 0.98–1.72, P = 0.07). In contrast, the sub-microscopic infection was associated with a reduced risk of SGA births (RR = 0.61, 95% CI: 0.43–0.88, P = 0.01). Placental malaria was not associated with low birth weight or prematurity. Conclusion Malaria prevention methods and maternal nutrition status during early pregnancy were important predictors of sub-microscopic placental malaria. More research is needed to understand sub-microscopic placental malaria and the possible mechanisms mediating the association between placental malaria and SGA.

Download Full-text

Association between neighbourhood deprivation, fetal growth, small-for-gestational age and preterm birth: a population-based prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-049075 ◽

2021 ◽

Vol 11 (11) ◽

pp. e049075

Author(s):

Dionne V Gootjes ◽

Anke G Posthumus ◽

Vincent W V Jaddoe ◽

Eric A P Steegers

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Preterm Birth ◽

Fetal Growth ◽

Gestational Age ◽

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Neighbourhood Deprivation ◽

Adverse Pregnancy

ObjectiveTo study the associations between neighbourhood deprivation and fetal growth, including growth in the first trimester, and adverse pregnancy outcomes.DesignProspective cohort study.SettingThe Netherlands, Rotterdam.Participants8617 live singleton births from the Generation R cohort study.ExpositionLiving in a deprived neighbourhood.Main outcome measuresFetal growth trajectories of head circumference, weight and length.Secondary outcomes measuresSmall-for-gestational age (SGA) and preterm birth (PTB).ResultsNeighbourhood deprivation was not associated with first trimester growth. However, a higher neighbourhood status score (less deprivation) was associated with increased fetal growth in the second and third trimesters (eg, estimated fetal weight; adjusted regression coefficient 0.04, 95% CI 0.02 to 0.06). Less deprivation was also associated with decreased odds of SGA (adjusted OR 0.91, 95% CI 0.86 to 0.97, p=0.01) and PTB (adjusted OR 0.89, 95% CI 0.82 to 0.96, p=0.01).ConclusionsWe found an association between neighbourhood deprivation and fetal growth in the second and third trimester pregnancy, but not with first trimester growth. Less neighbourhood deprivation is associated with lower odds of adverse pregnancy outcomes. The associations remained after adjustment for individual-level risk factors. This supports the hypothesis that living in a deprived neighbourhood acts as an independent risk factor for fetal growth and adverse pregnancy outcomes, above and beyond individual risk factors.

Download Full-text

Abstract 376: Adverse Pregnancy Outcomes and Cardiovascular Risks Multi-disciplinary Awareness Project

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.376 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Venkata Sai Gogineni ◽

Ki Park ◽

Denise Manfrini ◽

Robert Egerman ◽

Sharon Aroda ◽

...

Keyword(s):

Risk Factors ◽

Pregnancy Outcomes ◽

Descriptive Analysis ◽

Primary Objective ◽

Adverse Pregnancy Outcomes ◽

Cardiovascular Risks ◽

Cvd Risk ◽

Adverse Pregnancy ◽

Traditional Risk Factors

Background: Cardiovascular disease (CVD) remains the number one cause of death amongst women. There has been much effort put forth over the past decade in reducing both the incidence and prevalence of this disease burden through screening and treating the traditional risk factors. Recent guidelines have shown that adverse pregnancy outcomes (APOs), including pre-eclampsia (PEC), gestational diabetes mellitus (GDM) and pre-term birth (PTB) have been associated with future maternal CVD risk. Much of the current literature focuses almost exclusively on PEC. Our investigation is more comprehensive, covering not only these other APOs but assessing whether providers of multiple specialties in our community are aware of the APO to CVD risk association. The primary objective of this study was to investigate if there exist any knowledge gaps regarding the progression from APO to CVD and if this knowledge varies by specialty. Methods: An anonymous voluntary survey through REDCap© was sent to providers in the fields of Internal medicine (IM, 21%), Family medicine (FM, 26%), Obstetrics-Gynecology (Ob-Gyn, 23%) and Cardiology (30%) who have been in practice for greater than five years in our local Gainesville community. This project was registered as a QI project and descriptive analysis was used to examine the responses. Results: A total of 53 providers responded to the survey. Despite having the majority of patients being women, Ob-Gyn was the least likely amongst all specialties to routinely screen for CV risk factors. However, when addressed, they were the most likely to ask about APOs. Cardiologists, despite declaring to be aware of the association between APOs and CV risk, were least likely to ask about APOs. All specialties recognized PEC and GDM as APOs linked to long-term maternal CV risk but failed to associate PTB as an APO. The majority of providers amongst IM, FM, and Cardiology did not ask about APOs and lacked the knowledge of how often to appropriately screen for secondary risk factors associated with APOs. Additionally, these providers outright admitted that they are not familiar with the current AHA and/or ACOG guidelines for screening and follow-up. Conclusion: Descriptive statistical analysis of our data suggests that there exists a notable knowledge gap between all four specialties investigated in our survey. Education concerning the link between APOs and future maternal CV risk is needed amongst all specialties, especially amongst the providers in Cardiology, IM, and FM. Targeted efforts at our institution to improve awareness of all APOs, their associated secondary risk factors, and appropriate screening is required in all specialties to help reduce CVD morbidity and mortality.

Download Full-text