scholarly journals Maternal and Infant Outcomes Among Pregnant Women Treated for Multidrug/Rifampicin-Resistant Tuberculosis in South Africa

Author(s):  
Marian Loveday ◽  
Jennifer Hughes ◽  
Babu Sunkari ◽  
Iqbal Master ◽  
Sindisiwe Hlangu ◽  
...  

Abstract Background Data on safety and efficacy of second-line tuberculosis drugs in pregnant women and their infants are severely limited due to exclusion from clinical trials and expanded access programs. Methods Pregnant women starting treatment for multidrug/rifampicin-resistant (MDR/RR)-tuberculosis at King Dinuzulu Hospital in KwaZulu-Natal, South Africa, from 1 January 2013 to 31 December 2017, were included. We conducted a record review to describe maternal treatment and pregnancy outcomes, and a clinical assessment to describe infant outcomes. Results Of 108 pregnant women treated for MDR/RR-tuberculosis, 88 (81%) were living with human immunodeficiency virus.. Favorable MDR/RR-tuberculosis treatment outcomes were reported in 72 (67%) women. Ninety-nine (91%) of the 109 babies were born alive, but overall, 52 (48%) women had unfavorable pregnancy outcomes. Fifty-eight (54%) women received bedaquiline, and 49 (45%) babies were exposed to bedaquiline in utero. Low birth weight was reported in more babies exposed to bedaquiline compared to babies not exposed (45% vs 26%; P = .034). In multivariate analyses, bedaquiline and levofloxacin, drugs often used in combination, were both independently associated with increased risk of low birth weight. Of the 86 children evaluated at 12 months, 72 (84%) had favorable outcomes; 88% of babies exposed to bedaquiline were thriving and developing normally compared to 82% of the babies not exposed. Conclusions MDR/RR-tuberculosis treatment outcomes among pregnant women were comparable to nonpregnant women. Although more babies exposed to bedaquiline were of low birth weight, over 80% had gained weight and were developing normally at 1 year.

2019 ◽  
Vol 17 (6) ◽  
pp. 884-895 ◽  
Author(s):  
Funanani Mashau ◽  
Esper Jacobeth Ncube ◽  
Kuku Voyi

Abstract The current study aimed to determine the association between trichloroacetic acid (TCAA) levels and adverse pregnancy outcomes among third-trimester pregnant women who were exposed to chlorinated drinking water. A total of 205 pregnant women who participated in the disinfection by-products exposure and adverse pregnancy outcome study in South Africa were randomly asked to participate in this study by providing their morning urine sample voids. Samples were analysed for urinary creatinine and TCAA. Furthermore, participants gave individual data using a structured questionnaire. The mean (median) concentration of creatinine-adjusted urinary TCAA was 2.34 (1.95) μg/g creatinine. Elevated levels of creatinine-adjusted TCAA concentrations showed an increased risk of premature birth, small for gestational age (SGA) and low birth weight. There was no significant statistical correlation observed between creatinine-adjusted TCAA concentrations and the total volume of cold water ingested among the study population. No statistically significant association was observed between creatinine-adjusted urinary TCAA and premature birth, SGA and low birth weight newborns among the study subjects. However, the urinary TCAA concentrations identified in this study suggest potential health risks towards women and foetus. Therefore, further studies are warranted to prevent further adverse pregnancy outcomes.


2019 ◽  
Author(s):  
Xiu xiu Li ◽  
Rui Gao ◽  
Xiaowei Dai ◽  
Hong Liu ◽  
Jinxin Zhang ◽  
...  

Abstract Abstract Objectives Most studies have showed that maternal depression is associated with pregnancy complications. However, there were limited evidences in Chinese population. We examined the associations of the antenatal depression symptoms with pregnancy outcomes, especially for low birth weight. Methods A total of 1377 singleton pregnant women were recruited from Nanshan Maternity & Child Healthcare Hospital of Shenzhen in this prospective cohort study. Depression symptoms were assessed by the Edinburgh postnatal depression scale (EPDS) questionnaire in the second trimester of gestation; cut-points for the indication of antenatal depression were ≥12 scores in this study. Sociodemographic data, life-style and pregnancy outcomes were collected through Shenzhen Maternity & Child Healthcare database. The risks of adverse outcomes in patients with depression were determined by multivariate logistic regression and represented as odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 1377 subjects, the prevalence of antenatal depression was 19.1%. The EPDS scores were 13.8±2.0 and 6.5±2.9 ( P <0.001) in subjects with and without antenatal depression, respectively. After adjustment for maternal age, education, parity, pre-pregnancy body mass index (BMI), residential area, fetal gender, an EPDS score≥12 (versus. <12) was associated with an increased risk for low birth weight (odds ratio: 2.05, 95% CI: 1.12-4.64), but not for preterm birth, large for gestational age, small for gestational age and macrosomia. Conclusion Pregnant women presenting antenatal depressive symptoms are at elevated risk of low birth weight. Mental health problems of pregnancy should be addressed for the prevention of low birth weight.


2020 ◽  
Author(s):  
Xiu xiu Li ◽  
Rui Gao ◽  
Xiaowei Dai ◽  
Hong Liu ◽  
Jinxin Zhang ◽  
...  

Abstract Objectives Most studies have showed that maternal depression is associated with pregnancy complications. However, there were limited evidences in Chinese population. We examined the associations of the antenatal depression symptoms with pregnancy outcomes, especially for low birth weight. Methods A total of 1377 singleton pregnant women were recruited from Nanshan Maternity & Child Healthcare Hospital of Shenzhen in this prospective cohort study. Depression symptoms were assessed by the Edinburgh postnatal depression scale (EPDS) questionnaire in the second trimester of gestation; cut-points for the indication of antenatal depression were ≥12 scores in this study. Sociodemographic data, life-style and pregnancy outcomes were collected through Shenzhen Maternity & Child Healthcare database. The risks of adverse outcomes in patients with depression were determined by multivariate logistic regression and represented as odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 1377 subjects, the prevalence of antenatal depression was 19.1%. The EPDS scores were 13.8±2.0 and 6.5±2.9 ( P <0.001) in subjects with and without antenatal depression, respectively. After adjustment for maternal age, education, parity, pre-pregnancy body mass index (BMI), residential area, fetal gender, an EPDS score≥12 (versus. <12) was associated with an increased risk for low birth weight (odds ratio: 2.05, 95% CI: 1.12-4.64), but not for preterm birth, large for gestational age, small for gestational age and macrosomia. Conclusion Pregnant women presenting antenatal depressive symptoms are at elevated risk of low birth weight. Mental health problems of pregnancy should be addressed for the prevention of low birth weight.


2019 ◽  
Author(s):  
Xiu xiu Li ◽  
Rui Gao ◽  
Xiaowei Dai ◽  
Hong Liu ◽  
Jinxin Zhang ◽  
...  

Abstract Objectives Most studies have showed that maternal depression is associated with pregnancy complications. However, there were limited evidences in Chinese population. We examined the associations of the antenatal depression symptoms with pregnancy outcomes, especially for low birth weight. Methods A total of 1377 singleton pregnant women were recruited from Nanshan Maternity & Child Healthcare Hospital of Shenzhen in this prospective cohort study. Depression symptoms were assessed by the Edinburgh postnatal depression scale (EPDS) questionnaire in the second trimester of gestation; cut-points for the indication of antenatal depression were ≥12 scores in this study. Sociodemographic data, life-style and pregnancy outcomes were collected through Shenzhen Maternity & Child Healthcare database. The risks of adverse outcomes in patients with depression were determined by multivariate logistic regression and represented as odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 1377 subjects, the prevalence of antenatal depression was 19.1%. The EPDS scores were 13.8±2.0 and 6.5±2.9 ( P <0.001) in subjects with and without antenatal depression, respectively. After adjustment for maternal age, education, parity, pre-pregnancy body mass index (BMI), residential area, fetal gender, an EPDS score≥12 (versus. <12) was associated with an increased risk for low birth weight (odds ratio: 2.05, 95% CI: 1.12-4.64), but not for preterm birth, large for gestational age, small for gestational age and macrosomia. Conclusion Pregnant women presenting antenatal depressive symptoms are at elevated risk of low birth weight. Mental health problems of pregnancy should be addressed for the prevention of low birth weight.


2021 ◽  
Vol 10 (19) ◽  
pp. 4495
Author(s):  
Panwad Harn-a-morn ◽  
Prapai Dejkhamron ◽  
Theera Tongsong ◽  
Suchaya Luewan

Objective: The primary objectives of this study are to compare the rates of preterm birth; fetal growth restriction and low birth weight between the following groups: (1) pregnant women treated for thyrotoxicosis and low-risk pregnancies; (2) between pregnant women with thyrotoxicosis with no need of medication and low-risk pregnancies; and (3) between those treated with MMI and PTU. Methods: The medical records of singleton pregnancies with thyrotoxicosis were comprehensively reviewed. Low-risk pregnancies matched for age and parity were randomly recruited as controls. The obstetric outcomes were compared between both groups; the outcomes of various subgroups of the thyrotoxicosis group were also compared. Results: A total of 408 pregnant women with thyrotoxicosis were recruited. Compared with the controls; the women of the thyrotoxicosis group had significantly higher rates of low birth weight (LBW) (23.7% vs. 17.7%; p: 0.036), preterm birth (19.3% vs. 12.3%; p: 0.007), preeclampsia (8.5% vs. 4.4%; p: 0.019) and cesarean section (21.5% vs. 16.0%; p: 0.046). In the thyrotoxicosis group; 67; 127; and 158 patients were treated with MMI; PTU and no anti-thyroid drug (ATD), respectively. All obstetric outcomes were comparable between the women treated with PTU and those with MMI; and between the controlled and uncontrolled groups. However, women who needed ATD had significantly higher rates of LBW and preterm birth than those without medications. Conclusions: Thyrotoxicosis, whether treated or not needing ATDs, was significantly associated with an increased risk of adverse pregnancy outcomes. Also, active disease, indicated by the need for ATD significantly increased the risk of such adverse outcomes; whereas the patients treated with MMI or PTU had comparable adverse outcomes.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fahimeh Ranjbar ◽  
Leila Allahqoli ◽  
Soheila Ahmadi ◽  
Robab Mousavi ◽  
Maryam Gharacheh ◽  
...  

Abstract Background The Covid-19 pandemic response is influencing maternal and neonatal health care services especially in developing countries. However, the indirect effects of Covid-19 on pregnancy outcomes remain unknown. The aim of the present study was to compare pregnancy outcomes before and after the beginning of the Covid-19 pandemic in Iran. Methods We performed a retrospective analysis of the medical records of 2,503 pregnant women with singleton pregnancies, admitted to the maternity department of a women’s hospital in Tehran, Iran, during the pre-Covid-19 pandemic (February 19 to April 19, 2019) and the intra-Covid- 19 pandemic (February 19 to April 19, 2020) period. Results We included 2,503 women admitted to the hospital; 1,287 (51.4 %) were admitted before the Covid-19 lockdown and 1,216 (48.6 %) during the Covid-19 lockdown. There were no significant differences in stillbirth rates (p = 0.584) or pregnancy complications (including preeclampsia, pregnancy-induced hypertension and gestational diabetes) (p = 0.115) between pregnant women in the pre- and intra-pandemic periods. However, decreases in preterm births (p = 0.001), and low birth weight (p = 0.005) were observed in the pandemic period compared to the pre-pandemic period. No significant difference in the mode of delivery, and no maternal deaths were observed during the two time periods. Conclusions In our study we observed a decrease in preterm births and low birth weight, no change in stillbirths, and a rise in the admission rates of mothers to the ICU during the initial Covid-19 lockdown period compared to pre-Covid-19 lockdown period. Further research will be needed to devise plan for immediate post-pandemic care and future health care crises.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Serge Henri Zango ◽  
Moussa Lingani ◽  
Innocent Valea ◽  
Ouindpanga Sekou Samadoulougou ◽  
Biebo Bihoun ◽  
...  

Abstract Background Malaria and curable sexually transmitted infections (STIs) are severe infections associated with poor pregnancy outcomes in sub-Saharan countries. These infections are responsible for low birth weight, preterm birth, and miscarriage. In Burkina Faso, many interventions recommended by the World Health Organization were implemented to control the impact of these infections. After decades of intervention, we assessed the impact of these infections on pregnancy outcomes in rural setting of Burkina Faso. Methods Antenatal care and delivery data of pregnant women attending health facilities in 2016 and 2017 were collected in two rural districts namely Nanoro and Yako, in Burkina Faso. Regression models with likelihood ratio test were used to assess the association between infections and pregnancy outcomes. Results During the two years, 31639 pregnant women received antenatal care. Malaria without STI, STI without malaria, and their coinfections were reported for 7359 (23.3%), 881 (2.8 %), and 388 (1.2%) women, respectively. Low birth weight, miscarriage, and stillbirth were observed in 2754 (10.5 %), 547 (2.0 %), and 373 (1.3 %) women, respectively. Our data did not show an association between low birth weight and malaria [Adjusted OR: 0.91 (0.78 – 1.07)], STIs [Adjusted OR: 0.74 (0.51 – 1.07)] and coinfection [Adjusted OR: 1.15 (0.75 – 1.78)]. Low birth weight was strongly associated with primigravidae [Adjusted OR: 3.53 (3.12 – 4.00)]. Both miscarriage and stillbirth were associated with malaria [Adjusted OR: 1.31 (1.07 – 1.59)], curable STI [Adjusted OR: 1.65 (1.06 – 2.59)], and coinfection [Adjusted OR: 2.00 (1.13 – 3.52)]. Conclusion Poor pregnancy outcomes remained frequent in rural Burkina Faso. Malaria, curable STIs, and their coinfections were associated with both miscarriage and stillbirth in rural Burkina. More effort should be done to reduce the proportion of pregnancies lost associated with these curable infections by targeting interventions in primigravidae women.


2020 ◽  
Author(s):  
Dorothy T Chisare ◽  
Simbarashe Takuva ◽  
Tariro J. Basera ◽  
Natasha Khamisa ◽  
Jacqueline Witthuhn

Abstract Background In Zimbabwe, almost 25% of infants are born with low birth weight (LBW). LBW accounts for over half of the neonatal deaths in the country. Anaemia during pregnancy has been inconsistently associated with an increased risk of LBW. However, very little data is available from countries where HIV prevalence is high, wherein HIV is also known to be a common risk factor to LBW. This study examined the relationship between maternal anaemia and LBW among HIV-infected pregnant women in Zimbabwe. Methods This was a secondary data analysis of the 2015 Zimbabwe Demography and Health Survey. Data for 809 HIV positive women aged 15-49 years and their infants from all live births preceding the survey by 5 years were included in the study. Modified-Poisson regression methods were used to determine the association between anaemia and LBW while adjusting for other risk factors. Results The prevalence of maternal anaemia and LBW among the HIV-infected pregnant women was 42.3% (n=342) and 16.3% (n =132) respectively. The prevalence of LBW was14.6% (n=50) and 17.6% (n=82) among anaemic and non-anaemic HIV positive women respectively (p=0.264). HIV infected pregnant women with anaemia had a 25% less chance of giving birth to infants with LBW compared to HIV infected mothers without anaemia, however, the association was not statistically significant (RR 0.75; 95% CI 0.53- 1.05). Conclusions The findings demonstrate a high prevalence of anaemia and LBW among HIV infected pregnant women. Nonetheless, maternal anaemia was not associated with LBW. There is a need for adapted monitoring of HIV-positive pregnant women and affordable improved nutrition during antenatal care to reduce the risk of LBW infants and maternal anaemia levels. Further research examining the relationship between maternal anaemia and LBW among HIV positive pregnant women whilst factoring in the role of ART and the severity of anaemia is required.


Author(s):  
Monjurul Hoque ◽  
Shahnaz Hoque

Background: Teenage pregnancy is a known risk factor for a negative pregnancy outcome and poses a health risk to teenagers; it is thus considered a public health problem. It is also an indicator of problems with the sexual and reproductive health of a country’s young population. In South Africa, most of the adolescent pregnancies are to be found within the context of unstable relationships with the father of the baby and are unplanned or unwanted.Objectives: This study estimates and compares the incidence of adverse obstetric and perinatal outcomes of teenage women with older women, to identify specific health needs of teenage mothers during pregnancy and delivery.Methods:A retrospective cohort study targeted pregnant women who delivered at Empangeni Hospital from April to December 2005, whilst comparing the obstetric and perinatal outcomes of all teenage (ages < 19 years) pregnant women with those of older pregnant women (ages ≥ 19 years) for this study period. Data were collected from the labour ward delivery registry. Pearson’s chi-square test was performed to measure the level of significance (alpha = 0.05) for association amongst variables. The student t-test was used to find the significance difference between two proportions and the binary logistic regression method was employed to find the significant predictor for outcome variables.Results:There were 7836 deliveries over the study period, of which 1236 (16%) were teenage mothers.The rate of gestational age at delivery (e.g. pre-term delivery of 12%), vaginal and forceps deliveries,foetal presentation at birth, multiple pregnancies, low birth-weight and live births deliveries and mean Apgar scores were similar for both groups. The caesarean delivery rate (20%) and macerated stillbirth rate (1.1%) were significantly lower (p < 0.05) for teenagers than for older women.Conclusion: Although there was a higher rate of teenage pregnancy, it did not appear that it was associated with extra perinatal negative outcome such as preterm delivery, low birth-weight delivery and stillbirth. However, strategies are urgently needed to delay conception and improve the socio-economic development of teenage girls.


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