scholarly journals Perspective: L-arginine and L-citrulline Supplementation in Pregnancy: A Potential Strategy to Improve Birth Outcomes in Low-Resource Settings

2019 ◽  
Vol 10 (5) ◽  
pp. 765-777 ◽  
Author(s):  
Andrea M Weckman ◽  
Chloe R McDonald ◽  
Jo-Anna B Baxter ◽  
Wafaie W Fawzi ◽  
Andrea L Conroy ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Birth Weight ◽  
Preterm Birth ◽  
Birth Outcomes ◽  
Fetal Growth ◽  
Adverse Birth Outcomes ◽  
Low Resource Settings ◽  
Low Resource ◽  
Arginine Supplementation ◽  
In Pregnancy

ABSTRACT The available data support the hypothesis that L-arginine or L-citrulline supplementation would be suitable for implementation in resource-constrained settings and will enhance placental vascular development and improve birth outcomes. In resource-constrained settings, the rates of adverse birth outcomes, including fetal growth restriction, preterm birth, and low birth weight, are disproportionately high. Complications resulting from preterm birth are now the leading cause of mortality in children <5 y of age worldwide. Despite the global health burden of adverse birth outcomes, few effective interventions are currently available and new strategies are urgently needed, especially for low-resource settings. L-arginine is a nutritionally essential amino acid in pregnancy and an immediate precursor of nitric oxide. During pregnancy, placental and embryonic growth increases the demand for L-arginine, which can exceed endogenous synthesis of L-arginine from L-citrulline, necessitating increased dietary intake. In many low-resource settings, dietary intake of L-arginine in pregnancy is inadequate owing to widespread protein malnutrition and depletion of endogenous L-arginine due to maternal infections, in particular malaria. Here we examine the role of the L-arginine–nitric oxide biosynthetic pathway in pregnancy including placental vascular development and fetal growth. We review the evidence for the relations between altered L-arginine bioavailability and pregnancy outcomes, and strategies for arginine supplementation in pregnancy. Existing studies of L-arginine supplementation in pregnancy in high-resource settings have shown improved maternal and fetal hemodynamics, prevention of pre-eclampsia, and improved birth outcomes including higher birth weight and longer gestation. Arginine supplementation studies now need to be extended to pregnant women in low-resource settings, especially those at risk of malaria.

scholarly journals Mass incarceration and public health: the association between black jail incarceration and adverse birth outcomes among black women in Louisiana

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lauren Dyer ◽  
Rachel Hardeman ◽  
Dovile Vilda ◽  
Katherine Theall ◽  
Maeve Wallace
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Black Women ◽  
Low Birth Weight ◽  
Racial Disparities ◽  
Population Health ◽  
Birth Outcomes ◽  
Mass Incarceration ◽  
Interquartile Range ◽  
Adverse Birth Outcomes

Abstract Background A growing body of evidence is beginning to highlight how mass incarceration shapes inequalities in population health. Non-Hispanic blacks are disproportionately affected by incarceration and criminal law enforcement, an enduring legacy of a racially-biased criminal justice system with broad health implications for black families and communities. Louisiana has consistently maintained one of the highest rates of black incarceration in the nation. Concurrently, large racial disparities in population health persist. Methods We conducted a cross-sectional analysis of all births among non-Hispanic black women in Louisiana in 2014 to identify associations between parish-level (county equivalent) prevalence of jail incarceration within the black population and adverse birth outcomes (N = 23,954). We fit a log-Poisson model with generalized estimating equations to approximate the relative risk of preterm birth and low birth weight associated with an interquartile range increase in incarceration, controlling for confounders. In sensitivity analyses, we additionally adjusted for the parish-level index crime prevalence and analyzed regression models wherein white incarceration was used to predict the risk of adverse birth outcomes in order to quantify the degree to which mass incarceration may harm health above and beyond living in a high crime area. Results There was a significant 3% higher risk of preterm birth among black women associated with an interquartile range increase in the parish-level incarceration prevalence of black individuals, independent of other factors. Adjusting for the prevalence of index crimes did not substantively change the results of the models. Conclusion Due to the positive significant associations between the prevalence of black individuals incarcerated in Louisiana jails and estimated risk of preterm birth, mass incarceration may be an underlying cause of the persistent inequities in reproductive health outcomes experienced by black women in Louisiana. Not only are there economic and social impacts stemming from mass incarceration, but there may also be implications for population health and health inequities, including the persistence of racial disparities in preterm birth and low birth weight.

scholarly journals Maternal exposure to airborne polychlorinated biphenyls (PCBs) and risk of adverse birth outcomes

2021 ◽  
Author(s):  
Ane Bungum Kofoed ◽  
Laura Deen ◽  
Karin Sørig Hougaard ◽  
Kajsa Ugelvig Petersen ◽  
Harald William Meyer ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Sex Ratio ◽  
Polychlorinated Biphenyls ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Maternal Exposure ◽  
Adverse Birth Outcomes ◽  
Secondary Sex Ratio

AbstractHuman health effects of airborne lower-chlorinated polychlorinated biphenyls (LC-PCBs) are largely unexplored. Since PCBs may cross the placenta, maternal exposure could potentially have negative consequences for fetal development. We aimed to determine if exposure to airborne PCB during pregnancy was associated with adverse birth outcomes. In this cohort study, exposed women had lived in PCB contaminated apartments at least one year during the 3.6 years before conception or the entire first trimester of pregnancy. The women and their children were followed for birth outcomes in Danish health registers. Logistic regression was performed to estimate odds ratios (OR) for changes in secondary sex ratio, preterm birth, major congenital malformations, cryptorchidism, and being born small for gestational age. We performed linear regression to estimate difference in birth weight among children of exposed and unexposed mothers. All models were adjusted for maternal age, educational level, ethnicity, and calendar time. We identified 885 exposed pregnancies and 3327 unexposed pregnancies. Relative to unexposed women, exposed women had OR 0.97 (95% CI 0.82, 1.15) for secondary sex ratio, OR 1.13 (95% CI 0.76, 1.67) for preterm birth, OR 1.28 (95% CI 0.81, 2.01) for having a child with major malformations, OR 1.73 (95% CI 1.01, 2.95) for cryptorchidism and OR 1.23 (95% CI 0.88, 1.72) for giving birth to a child born small for gestational age. The difference in birth weight for children of exposed compared to unexposed women was − 32 g (95% CI—79, 14). We observed an increased risk of cryptorchidism among boys after maternal airborne LC-PCB exposure, but due to the proxy measure of exposure, inability to perform dose–response analyses, and the lack of comparable literature, larger cohort studies with direct measures of exposure are needed to investigate the safety of airborne LC-PCB exposure during pregnancy

Association of US state policy orientation with adverse birth outcomes: a longitudinal analysis

2021 ◽  
pp. jech-2020-214858
Author(s):  
Alicia R Riley ◽  
Daniel Collin ◽  
Jacob M Grumbach ◽  
Jacqueline M Torres ◽  
Rita Hamad
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
State Policy ◽  
Fixed Effects ◽  
State Policies ◽  
Adverse Birth Outcomes ◽  
Lower Odds ◽  
Policy Orientation

BackgroundThe current US context is marked by extreme right–left partisanship, which means that state policies tend to bundle together and are not experienced in isolation. While prior work has leveraged abrupt shifts in single policies to examine the effects of state policy on birth outcomes, we examined a holistic measure that captures political polarisation.MethodsData were drawn from national birth certificates for 2003–2017 (N=56 770 470). Outcomes included preterm birth, low birth weight, small-for-gestational age and other perinatal health measures. The primary exposure was a composite index of right–left state policy orientation, generated from historical data on 135 state policies. Multivariable regressions were used to estimate the association between state policy orientation and each outcome, adjusting for relevant covariates.ResultsCompared with infants born in states with right-leaning policy orientations, those born in left-leaning states had lower odds of adverse birth outcomes (eg, low birth weight: OR 0.95 (0.93, 0.97), preterm birth: OR 0.94 (0.92, 0.95)). Subgroup analyses revealed stronger associations for US-born and White mothers. With the inclusion of state fixed effects, left-leaning policy orientation was no longer associated with lower odds of adverse birth outcomes. Models were otherwise robust to alternative specifications.ConclusionWhile left-leaning state policy orientation has protective associations with a range of birth outcomes, the associations may be explained by stable characteristics of states, at least during the study period. Future studies should examine state policy orientation in association with other health outcomes and study periods.

scholarly journals Variations in neonatal mortality, infant mortality, preterm birth and birth weight in England and Wales according to ethnicity and maternal country or region of birth: an analysis of linked national data from 2006 to 2012

2020 ◽  
Vol 74 (4) ◽  
pp. 336-345
Author(s):  
Charles Opondo ◽  
Hiranthi Jayaweera ◽  
Jennifer Hollowell ◽  
Yangmei Li ◽  
Jennifer J Kurinczuk ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Infant Mortality ◽  
Ethnic Groups ◽  
Birth Outcomes ◽  
Neonatal Death ◽  
Ethnic Origin ◽  
Adverse Birth Outcomes ◽  
Country Of Birth ◽  
England And Wales

BackgroundRisks of adverse birth outcomes in England and Wales are relatively low but vary across ethnic groups. We aimed to explore the role of mother’s country of birth on birth outcomes across ethnic groups using a large population-based linked data set.MethodsWe used a cohort of 4.6 million singleton live births in England and Wales to estimate relative risks of neonatal mortality, infant mortality and preterm birth, and differences in birth weight, comparing infants of UK-born mothers to infants whose mothers were born in their countries or regions of ethnic origin, or elsewhere.ResultsThe crude neonatal and infant death risks were 2.1 and 3.2 per 1000, respectively, the crude preterm birth risk was 5.6% and the crude mean birth weight was 3.36 kg. Pooling across all ethnic groups, infants of mothers born in their countries or regions of ethnic origin had lower adjusted risks of death and preterm birth, and higher gestational age-adjusted mean birth weights than those of UK-born mothers. White British infants of non-UK-born mothers had slightly lower gestational age-adjusted mean birth weights than White British infants of UK-born mothers (mean difference −3 g, 95% CI −5 g to −0.3 g). Pakistani infants of Pakistan-born mothers had lower adjusted risks of neonatal death (adjusted risk ratio (aRR) 0.84, 95% CI 0.72 to 0.98), infant death (aRR 0.84, 95% CI 0.75 to 0.94) and preterm birth (aRR 0.85, 95% CI 0.82 to 0.88) than Pakistani infants of UK-born Pakistani mothers. Indian infants of India-born mothers had lower adjusted preterm birth risk (aRR 0.91, 95% CI 0.87 to 0.96) than Indian infants of UK-born Indian mothers. There was no evidence of a difference by mother’s country of birth in risk of birth outcomes among Black infants, except Black Caribbean infants of mothers born in neither the UK nor their region of origin, who had higher neonatal death risks (aRR 1.71, 95% CI 1.06 to 2.76).ConclusionThis study highlights evidence of better birth outcomes among UK-born infants of non-UK-born minority ethnic group mothers, and could inform the design of future interventions to reduce the risks of adverse birth outcomes through improved targeting of at-risk groups.

scholarly journals Fetal growth restriction in a cohort of migrants in Germany

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Juliane Ankert ◽  
Tanja Groten ◽  
Mathias W. Pletz ◽  
Sasmita Mishra ◽  
Gregor Seliger ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Fetal Growth ◽  
Gestational Age ◽  
Fetal Growth Restriction ◽  
Caesarian Section ◽  
Growth Restriction ◽  
Delivery Mode

Abstract Background Migrant women may have an increased risk of adverse birth outcomes. This study analyses the occurrence of low birth weight, preterm birth and intrauterine growth restriction / fetal growth restriction (IUGR/FGR) in pregnant migrants. Method Cross-sectional study of 82 mother-child pairs of pregnant migrants attending medical care in Germany. Results The Median age was 27 years, 49% of patients were of oriental-asian ethnicity and median year of migration was 2015. At least one previous pregnancy was reported in 76% of patients, in 40% the delivery mode was caesarian section. Median gestational age was 39.7 weeks. Preterm birth occurred in 6.1% of pregnancies. Median gestational age for preterm birth was 32.3 weeks. Low birth weight (< 2500 g) occurred in 6.1%. Birth weights below the 10th percentile of birth weight for gestational age were observed in 8.5% of the total cohort. Conclusions Compared to German data no increased occurrence of low birth weight, preterm birth or IUGR/FGR was found. We note that the rate of caesarian section births was higher than in the general population for reasons yet to be identified. The authors propose stratification according to migration status for the national documentation of birth outcomes in Germany.

scholarly journals Atrazine Contamination of Drinking Water and Adverse Birth Outcomes in Community Water Systems with Elevated Atrazine in Ohio, 2006–2008

2018 ◽  
Vol 15 (9) ◽  
pp. 1889 ◽  
Author(s):  
Kirsten Almberg ◽  
Mary Turyk ◽  
Rachael Jones ◽  
Kristin Rankin ◽  
Sally Freels ◽  
...  
Keyword(s):  
Drinking Water ◽  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Very Low Birth Weight ◽  
Monitoring Program ◽  
Water Systems ◽  
Adverse Birth Outcomes ◽  
The U.S

Atrazine, a common water contaminant in the U.S., has been associated with adverse birth outcomes in previous studies. This study aimed to determine if atrazine concentrations in drinking water are associated with adverse birth outcomes including small for gestational age (SGA), term low birth weight (term LBW), very low birth weight (VLBW), preterm birth (PTB), and very preterm birth (VPTB). This study included 14,445 live singleton births from Ohio communities served by 22 water systems enrolled in the U.S. Environmental Protection Agency’s Atrazine Monitoring Program between 2006 and 2008. Mean gestational and trimester-specific atrazine concentrations were calculated. Significantly increased odds of term LBW birth was associated with atrazine exposure over the entire gestational period (OR 1.27, 95% CI 1.10, 1.45), as well as the first (OR 1.20, 95% CI 1.08, 1.34) and second trimesters (OR 1.13, 95% CI 1.07, 1.20) of pregnancy. We observed no evidence of an association between atrazine exposure via drinking water and SGA, VLBW, PTB, or VPTB. Our results suggest that atrazine exposure is associated with reduced birth weight among term infants and that exposure to atrazine in drinking water in early and mid-pregnancy may be most critical for its toxic effects on the fetus.

scholarly journals Pregnant women with COVID-19 and risk of adverse birth outcomes and maternal-fetal vertical transmission: a population-based cohort study in Wuhan, China

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Rong Yang ◽  
Hui Mei ◽  
Tongzhang Zheng ◽  
Qiang Fu ◽  
Yiming Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Population Based ◽  
Adverse Birth Outcomes ◽  
Cesarean Section Delivery ◽  
Increased Risk

Abstract Background The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. However, little is known about the association between pregnant women with COVID-19 and the risk of adverse birth outcomes. Method We conducted a retrospective cohort study based on the Maternal and Child Health Information System (MCHIMS) of Wuhan, China. All pregnant women with singleton live birth recorded by the system between January 13 and March 18, 2020, were included. The adverse birth outcomes were preterm birth, low birth weight, neonatal asphyxia, premature rupture of membrane (PROM), and cesarean section delivery. Multivariate logistic regression was used to evaluate the associations between maternal COVID-19 diagnosis and adverse birth outcomes. Results Out of 11,078 pregnant women, 65 were confirmed with coronavirus disease 2019 (COVID-19). No deaths occurred from these confirmed cases or their newborns. Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of preterm birth (OR 3.34, 95% CI 1.60–7.00) and cesarean section (OR 3.63, 95% CI 1.95–6.76). There was no statistical difference in low birth weight, neonatal asphyxia, and PROM between the mothers with and without COVID-19. Among these newborns that were born to mothers with confirmed COVID-19, none was tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or had abnormal CT results. Only one had diarrhea and three had a fever. Conclusions This population-based cohort study suggests that COVID-19 during the later pregnancy is associated with an increased risk of adverse birth outcomes, including iatrogenic preterm birth and cesarean section delivery. Our data provide little evidence for maternal-fetal vertical transmission of SARS-CoV-2. It is important to monitor the long-term health effects of SARS-CoV-2 infection on pregnant women and their children.

scholarly journals Maternal Dietary Diversity and Dietary Quality Scores in Relation to Adverse Birth Outcomes in Tanzanian Women

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1031-1031
Author(s):  
Isabel Madzorera ◽  
Sheila Isanaka ◽  
Molin Wang ◽  
Gernard Msamanga ◽  
Willy Urassa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Preterm Birth ◽  
Birth Outcomes ◽  
Diet Quality ◽  
Lower Risk ◽  
Dietary Diversity ◽  
Fetal Loss ◽  
Adverse Birth Outcomes ◽  
Very Preterm

Abstract Objectives Preterm birth, small for gestational age (SGA) and low birth weight (LBW) are risk factors for morbidity and mortality among infants. High-quality maternal diets during pregnancy may protect against these adverse birth outcomes. The objective of this research is to prospectively examine the association of maternal dietary diversity and quality during pregnancy with birth outcomes among women in Dar es Salaam, Tanzania. Methods We analyzed data from 7553 HIV-negative pregnant women enrolled in a multivitamin trial at 12–27 weeks gestation. Dietary intake was assessed using 24-hour dietary recalls. Log binomial regression methods were used to assess associations of Minimum Dietary Diversity for Women (MDD-W) and Prime Diet Quality Score (PDQS) with preterm, SGA, LBW, fetal loss, very preterm, severe SGA and very low birth weight (VLBW). Results In the previous 24 hours, 99.9% of women reported consuming grains, roots and tubers, 57.9% meats, 4.7% eggs and 0.5% nuts and seeds. Median MDD-W score was 3.0 ± 1.0. For the PDQS, women consumed at least 4 servings/week of green leafy vegetables (100%) and other vegetables (64.7%) and consumption of refined grains was high (99.6%). Higher MDD-W scores were associated with lower risk of SGA (RR highest vs. lowest quintile 0.74, 95% CI: 0.62, 0.89). Higher PDQS scores were associated with lower risk of preterm birth (RR: 0.55, 95% CI: 0.46, 0.67); LBW (RR: 0.53, 95% CI: 0.40, 0.71); fetal loss (RR: 0.53, 95% CI: 0.34,0.82), very preterm (RR: 0.33, 95% CI: 0.17, 0.64) and VLBW (RR: 0.49, 95% CI: 0.26, 0.92) comparing women in highest vs. lowest quintiles. Conclusions PDQS was inversely associated with preterm, very preterm, LBW, VLBW and fetal loss, and MDD-W was inversely associated with SGA. These findings suggest that in addition to diet diversity, diet quality should be considered as important in understanding dietary risk factors for poor birth outcomes. Funding Sources This work has been supported by the National Institutes of Child Health and Human Development. Co-authors were supported by a grant from the National Institute of Child Health and Human Development and the National Institutes of Health.

Association Between Preconception Care and Birth Outcomes

2018 ◽  
Vol 33 (3) ◽  
pp. 363-371 ◽  
Author(s):  
Zinat Jourabchi ◽  
Sazlina Sharif ◽  
Munn Sann Lye ◽  
Asefzadeh Saeed ◽  
Geok Lin Khor ◽  
...  
Keyword(s):  
Health Care ◽  
Birth Weight ◽  
Preterm Birth ◽  
Maternal Health ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Preconception Care ◽  
Maternal Health Care ◽  
Adverse Birth Outcomes ◽  
Neonatal Complications

Purpose: To evaluate the association between preconception care and the risk of adverse birth outcomes. Design: A quasi-experimental study comparing 2 groups: (1) integrated maternal health care (MHC) program (with preconception care) and (2) standard MHC program (without preconception care). Setting: Maternal health-care clinics in Alvand and Qazvin cities in Qazvin Province, Iran. Participants: A total of 152 and 247 Iranian women aged 16 to 35 years were enrolled in the integrated MHC and standard MHC program, respectively. Measures: The birth outcomes measured included low birth weight, preterm birth, maternal and neonatal complications, and mode of delivery (normal vaginal delivery and cesarean delivery). Analysis: Multiple logistic regression was performed to determine the impact of preconception care and risk of adverse birth outcomes with adjusted odds ratios (ORs) as effect sizes. Results: One hundred forty-seven women in integrated MHC and 218 women in standard MHC completed this study. Preconception care was associated with reduced risk of preterm birth (OR = 0.298; 95% confidence interval [CI] = 0.120-0.743; P = .009), low birth weight (OR = 0.406; 95% CI = 0.169-0.971; P = .043), maternal complication (OR = 0.399; 95% CI = 0.241-0.663; P < .001), and neonatal complications (OR = 0.460; 95% CI = 0.275-0.771; P = .003). Conclusion: The findings of the present study revealed advantages of preconception care with reduced adverse birth outcomes.

1365: Admission for Nephrolithiasis in Pregnancy and Risk of Adverse Birth Outcomes

2007 ◽  
Vol 177 (4S) ◽  
pp. 450-450
Author(s):  
Mia A. Swartz ◽  
Mona T. Lydon-Rochelle ◽  
David Simon ◽  
Jonathan L. Wright ◽  
Michael P. Porter
Keyword(s):  
Birth Outcomes ◽  
Adverse Birth Outcomes ◽  
In Pregnancy
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