scholarly journals Cohort Profile: Prematurity Immunology in HIV-infected Mothers and their infants Study (PIMS)

2020 ◽  
Author(s):  
Thokozile R Malaba ◽  
Clive M Gray ◽  
Landon Myer ◽  
Marie-Louise Newell ◽  
Keyword(s):  
Immune Responses ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Mononuclear Cells ◽  
Clinical Care ◽  
Blood Pressure Measurement ◽  
Hiv Care ◽  
Adverse Birth Outcomes ◽  
Clinical Records ◽  
The Relationship

AbstractPurposePIMS, is a prospective cohort study in South Africa investigating the association between antiretroviral therapy (ART) use, preterm delivery (PTD)and small-for gestational age (SGA) live births. PIMS main hypotheses are that ART initiation in pregnancy and ART-induced hypertension are associated with PTD and SGA respectively and that reconstitution of cellular immune responses in women on ART from before pregnancy results in increases in PTD of appropriate-for-gestational age (AGA) infants.ParticipantsPregnant women (n=3972) aged ≥18 years regardless of HIV status recruited from 2015 to 2016 into the overall PIMS cohort (2517 HIV-uninfected, 1455 HIV-infected). A nested cohort contained 551 HIV-infected women who were ≤24 weeks’ GA on ultrasound: 261 initiated ART before pregnancy, 290 initiated during pregnancy.Findings to dateWomen in the overall cohort were followed antenatally through to delivery using routine clinical records; further women in the nested cohort were actively followed up until 12 months postpartum, with data were collected on maternal health (HIV care and ART use, clinical care and inter-current clinical history). Other procedures conducted on the nested cohort included physical examinations (anthropometry, blood pressure measurement), assessment of fetal growth (ultrasound), maternal and infant phlebotomy for storage of plasma, RNA and peripheral blood mononuclear cells, collection of delivery specimens (placenta and cord blood), and infant 12 month developmental assessment. Preliminary findings have contributed to our understanding of risk factors for adverse birth outcomes, and the relationship between pregnancy immunology, HIV/ART and adverse birth outcomes.Future plansUsing specimens collected from HIV-infected study participants throughout pregnancy and first year of life, the PIMS provides a valuable platform for answering a variety of research questions focused on temporal changes of immunology markers in women whose immune status is altered by HIV infection, and how ART initiated during pregnancy affects immune responses. The relationship between these immunological changes with adverse birth outcomes as well as possible longer-term impact of exposure to ART in fetal and early life will be explored. Additionally, further active and passive follow-up of mothers and their infants is planned at school-going age and beyond to chart growth, morbidity and development, as well as changes in family circumstances.

scholarly journals Cohort profile: Prematurity Immunology in Mothers living with HIV and their infants Study (PIMS)

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047133
Author(s):  
Thokozile R Malaba ◽  
Landon Myer ◽  
Clive Gray ◽  
Marie-Louise Newell
Keyword(s):  
Immune Responses ◽  
Birth Outcomes ◽  
Mononuclear Cells ◽  
Clinical Care ◽  
Blood Pressure Measurement ◽  
Hiv Care ◽  
Adverse Birth Outcomes ◽  
Clinical Records ◽  
Living With Hiv ◽  
The Relationship

PurposePrematurity Immunology in Mothers living with HIV and their infants Study (PIMS) is a prospective cohort study in South Africa investigating the association between antiretroviral therapy (ART) use, preterm delivery (PTD) and small-for-gestational age (SGA) live births. PIMS main hypotheses are that ART initiation in pregnancy and ART-induced hypertension are associated with PTD and SGA respectively and that reconstitution of cellular immune responses in women on ART from before pregnancy results in increases in PTD of GA infants.ParticipantsPregnant women (n=3972) aged ≥18 years regardless of HIV status recruited from 2015 to 2016 into the overall PIMS cohort (2517 HIV-negative, 1455 living with HIV). A nested cohort contained 551 women living with HIV who were ≤24 weeks’ GA on ultrasound: 261 initiated ART before pregnancy, 290 initiated during the pregnancy.Findings to dateWomen in the overall cohort were followed antenatally through to delivery using routine clinical records; further women in the nested cohort were actively followed up until 12 months post partum, with data collected on maternal health (HIV care and ART use, clinical care and intercurrent clinical history). Other procedures conducted on the nested cohort included physical examinations (anthropometry, blood pressure measurement), assessment of fetal growth (ultrasound), maternal and infant phlebotomy for storage of plasma, RNA and peripheral blood mononuclear cells, collection of delivery specimens (placenta and cord blood) and infant 12-month developmental assessment. Preliminary findings have contributed to our understanding of risk factors for adverse birth outcomes, and the relationship between pregnancy immunology, HIV/ART and adverse birth outcomes.Future plansUsing specimens collected from study participants living with HIV throughout pregnancy and first year of life, the PIMS provides a valuable platform for answering a variety of research questions focused on temporal changes of immunology markers in women whose immune status is altered by HIV infection, and how ART initiated during the pregnancy affects immune responses. The relationship between these immunological changes with adverse birth outcomes as well as possible longer-term impact of exposure to ART in fetal and early life will be explored. Additionally, further active and passive follow-up of mothers and their infants is planned at school-going age and beyond to chart growth, morbidity and development, as well as changes in family circumstances.

scholarly journals The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment

2018 ◽  
Vol 2 ◽  
pp. 25 ◽  
Author(s):  
Marcela C. Castillo ◽  
Nurain M. Fuseini ◽  
Katelyn Rittenhouse ◽  
Joan T. Price ◽  
Bethany L. Freeman ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Clinical Care ◽  
Adverse Outcomes ◽  
Sub Saharan Africa ◽  
Growth Monitoring ◽  
Adverse Birth Outcomes ◽  
Prevention Study ◽  
Background Rate

Background: Sub-Saharan Africa bears a disproportionate burden of preterm birth and other adverse outcomes. Not only is the background rate of preterm birth higher than in North America and Europe, but many facilities lack essential equipment and personnel resources to care for preterm neonates. A better understanding of the demographic, clinical, and biologic underpinnings of preterm birth is urgently needed to plan interventions and inform new discovery.  Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective antenatal cohort established at the Women and Newborn Hospital of the University Teaching Hospital (UTH) in Lusaka, Zambia. We recruit pregnant women from the antenatal clinics of district health centers and the UTH for study participation. Women undergo ultrasound examination to determine eligibility by gestational age criteria. Enrolled participants receive routine antenatal and postnatal care, lab testing, midtrimester cervical length measurement, serial fetal growth monitoring and careful assessment of birth outcomes.  Results: Between August 2015 and September 2017, we screened 1784 women, of whom 1450 (81.2%) met inclusion criteria and were enrolled. The median age at enrollment of study participants is 27 years (IQR 23–32). Participants are enrolled at a median gestational age of 16 weeks (IQR 13–18). Among all parous participants (N=866; 64%), 21% (N=182) reported a prior miscarriage, 49% (N=424) reported a prior preterm birth, and 13% (N=116) reported a prior stillbirth. The HIV seroprevalence in our cohort is 24%. Discussion: We have established a large antenatal cohort to characterize the epidemiological and biological determinants of adverse birth outcomes in Lusaka, Zambia. Findings from this cohort will help guide future studies, clinical care, and policy in the prevention and treatment of adverse birth outcomes.

scholarly journals The relationship between markers of antenatal iron stores and birth outcomes differs by malaria prevention regimen—a prospective cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Holger W. Unger ◽  
Valentina Laurita Longo ◽  
Andie Bleicher ◽  
Maria Ome-Kaius ◽  
Stephan Karl ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Gestational Age ◽  
Malaria Infection ◽  
Low Birthweight ◽  
Malaria Prevention ◽  
Antenatal Visit ◽  
Adverse Birth Outcomes ◽  
Iron Stores ◽  
Twofold Increase ◽  
The Relationship

Abstract Background Iron deficiency (ID) has been associated with adverse pregnancy outcomes, maternal anaemia, and altered susceptibility to infection. In Papua New Guinea (PNG), monthly treatment with sulphadoxine-pyrimethamine plus azithromycin (SPAZ) prevented low birthweight (LBW; <2500 g) through a combination of anti-malarial and non-malarial effects when compared to a single treatment with SP plus chloroquine (SPCQ) at first antenatal visit. We assessed the relationship between ID and adverse birth outcomes in women receiving SPAZ or SPCQ, and the mediating effects of malaria infection and haemoglobin levels during pregnancy. Methods Plasma ferritin levels measured at antenatal enrolment in a cohort of 1892 women were adjusted for concomitant inflammation using C-reactive protein and α-1-acid glycoprotein. Associations of ID (defined as ferritin <15 μg/L) or ferritin levels with birth outcomes (birthweight, LBW, preterm birth, small-for-gestational-age birthweight [SGA]) were determined using linear or logistic regression analysis, as appropriate. Mediation analysis assessed the degree of mediation of ID-birth outcome relationships by malaria infection or haemoglobin levels. Results At first antenatal visit (median gestational age, 22 weeks), 1256 women (66.4%) had ID. Overall, ID or ferritin levels at first antenatal visit were not associated with birth outcomes. There was effect modification by treatment arm. Amongst SPCQ recipients, ID was associated with a 81-g higher mean birthweight (95% confidence interval [CI] 10, 152; P = 0.025), and a twofold increase in ferritin levels was associated with increased odds of SGA (adjusted odds ratio [aOR] 1.25; 95% CI 1.06, 1.46; P = 0.007). By contrast, amongst SPAZ recipients, a twofold increase in ferritin was associated with reduced odds of LBW (aOR 0.80; 95% CI 0.67, 0.94; P = 0.009). Mediation analyses suggested that malaria infection or haemoglobin levels during pregnancy do not substantially mediate the association of ID with birth outcomes amongst SPCQ recipients. Conclusions Improved antenatal iron stores do not confer a benefit for the prevention of adverse birth outcomes in the context of malaria chemoprevention strategies that lack the non-malarial properties of monthly SPAZ. Research to determine the mechanisms by which ID protects from suboptimal foetal growth is needed to guide the design of new malaria prevention strategies and to inform iron supplementation policy in malaria-endemic settings. Trial registration ClinicalTrials.gov NCT01136850.

scholarly journals Exploring the Relationships in Prenatal Weight Gain, Birth Outcomes, and Postnatal Growth up to 2 Years of Age Using a Longitudinal Cohort in Niger

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1021-1021
Author(s):  
Kristin Kohlmann ◽  
Ousmane Guindo ◽  
Issaka Soumana ◽  
Rebecca Grais ◽  
Sheila Isanaka
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Postnatal Growth ◽  
Adverse Birth Outcomes ◽  
The Relationship ◽  
Over Time

Abstract Objectives The first 1000 days of life, from conception until a child's second birthday, is a crucial period during which life-long foundations for good health, growth, and development are established. It has been shown that poor maternal weight gain can contribute to adverse birth outcomes, such as low birth weight, small for gestational age, and prematurity, and such adverse birth outcomes can place children at greater risk for developing wasting and stunting as they age. While it has been suggested that the development of wasting and stunting may be related, the relative impact of poor birth outcomes on weight and height attainment over time is not clear. The objective of this study is to use recently collected longitudinal data to explore the inter-relationships between prenatal weight gain, birth outcomes, and postnatal risk of both wasting and stunting over time. Methods Using longitudinal data nested within a large randomized trial conducted in Madarounfa, Niger, we describe prenatal weight gain, the risk of adverse birth outcomes (preterm, small for gestational age, and low birthweight) and postnatal child growth (weight and length/height) up to 2 years of age. We use binomial regression to examine the relationship between prenatal weight gain and adverse birth outcomes. We use generalized estimating equations to examine the risk of wasting and stunting over time and evaluate potential effect modification of postnatal growth by birth outcomes. Results We followed 2796 mother-child pairs from pregnancy through 2 years of age. We found that 55.9% of the children were born preterm, 6.4% were born small for gestational weight, and 6.8% were born with low birth weight. Using longitudinal analysis, we are examining the relationship between the risk of wasting and stunting over time. Conclusions This analysis will provide evidence to describe the inter-relationships between prenatal weight gain, adverse birth outcomes, and risk of both wasting and stunting over time, with special attention to the inter-relationships between prenatal and postnatal growth. Funding Sources Médecins Sans Frontières-Operational Center Geneva and the Kavli Foundation, Norway.

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

scholarly journals Blood pressure trajectories during pregnancy and associations with adverse birth outcomes among HIV-infected and HIV-uninfected women in South Africa: a group-based trajectory modelling approach

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Thokozile R. Malaba ◽  
◽  
Annibale Cois ◽  
Hlengiwe P. Madlala ◽  
Mushi Matjila ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Care Facility ◽  
Adverse Birth Outcomes ◽  
Multinomial Regression ◽  
Increased Risk ◽  
Trajectory Group ◽  
The Relationship ◽  
Trajectory Modelling

Abstract Background High blood pressure (BP) late in pregnancy is associated with preterm delivery (PTD); BP has also been associated with HIV and antiretroviral therapy (ART), but whether the relationship between BP assessed longitudinally over pregnancy and PTD and low birthweight (LBW) is modified by HIV/ART is unclear. We hypothesise the presence of distinctive BP trajectories and their association with adverse birth outcomes may be mediated by HIV/ART status. Methods We recruited pregnant women at a large primary care facility in Cape Town. BP was measured throughout pregnancy using automated monitors. Group-based trajectory modelling in women with ≥3 BP measurements identified distinct joint systolic and diastolic BP trajectory groups. Multinomial regression assessed BP trajectory group associations with HIV/ART status, and Poisson regression with robust error variance was used to assess risk of PTD and LBW. Results Of the 1583 women in this analysis, 37% were HIV-infected. Seven joint trajectory group combinations were identified, which were categorised as normal (50%), low normal (25%), high normal (20%), and abnormal (5%). A higher proportion of women in the low normal group were HIV-infected than HIV-uninfected (28% vs. 23%), however differences were not statistically significant (RR 1.27, 95% CI 0.98–1.63, reference category: normal). In multivariable analyses, low normal trajectory (aRR0.59, 0.41–0.85) was associated with decreased risk of PTD, while high normal (aRR1.48, 1.12–1.95) and abnormal trajectories (aRR3.18, 2.32–4.37) were associated with increased risk of PTD, and abnormal with increased risk of LBW (RR2.81, 1.90–4.15). Conclusions While HIV/ART did not appear to mediate the BP trajectories and adverse birth outcomes association, they did provide more detailed insights into the relationship between BP, PTD and LBW for HIV-infected and uninfected women.

scholarly journals Geospatial analysis of exposure to violent crime during pregnancy and adverse birth outcomes: Evidence from São Paulo’s Western Region Birth Cohort

2020 ◽  
Author(s):  
Angelica Carreira dos Santos ◽  
Alexandra Brentani ◽  
Günther Fink
Keyword(s):  
Socioeconomic Status ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Violent Crime ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Violence Exposure ◽  
Western Region ◽  
Adverse Birth Outcomes ◽  
Violent Crimes

Abstract Background Low birth weight and prematurity remain leading causes of infant mortality and morbidity globally. Although an extensive literature has highlighted the importance of socioenvironmental characteristics for birth outcomes, the role of indirect violence on health remains fairly understudied. Methods Using geocoded birth records from the ongoing Western Region Birth Cohort ( Região Oeste Coorte – ROC-Cohort) of infants born between 2012-2014 and geocoded crime reports, we assessed the associations between exposure to violent crimes during pregnancy within a 1-km radius of mother’s residence and low birth weight, preterm delivery, and being born small-for-gestational-age. Violent crime exposure was categorized into quintiles. Multivariate logistic regressions were used to examine the associations between violence exposure and birth outcomes. Models were adjusted for sex, maternal age and education, socioeconomic status, and risk factors such as hypertension, diabetes, smoking, and drinking during pregnancy. ResultsAmong the 5,268 infants included, the average crime exposure during the first two trimesters of pregnancy ranged from 0.44 violent crimes in the least exposed quintile to 12.74 crimes in the most exposed. Compared to children with the lowest violence exposure, children in the highest exposure quintile were at higher odds of being born small-for-gestational-age (1.41[1.06-1.89]), preterm (1.35[1.01-1.80]), and low birth weight (1.42[1.03-1.98]). While socioeconomic status and maternal education were positively associated with lower violence exposure, no associations were found between these characteristics and the birth outcomes. Conclusions Higher exposure to external violent crimes in the close vicinity are associated with substantial increases in the odds of adverse birth outcomes. Policies to improve neighborhood safety can contribute not only to the short-term well-being of populations but may also have large social, economic, and health benefits in the long run.

scholarly journals Longitudinal Changes in the Relationship Between Hemoglobin A1c and Glucose Tolerance Across Pregnancy and Postpartum

2020 ◽  
Vol 105 (5) ◽  
pp. e1999-e2007 ◽  
Author(s):  
P Kaitlyn Edelson ◽  
Kaitlyn E James ◽  
Aaron Leong ◽  
Juliana Arenas ◽  
Melody Cayford ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Gestational Age ◽  
Hemoglobin A1c ◽  
Longitudinal Changes ◽  
Glucose Levels ◽  
Pregnancy And Postpartum ◽  
Clinical Records ◽  
The Relationship ◽  
Average Glucose ◽  
Hba1c Levels

Abstract Objective To characterize the relationship between hemoglobin A1c (HbA1c) levels and glucose tolerance across pregnancy and postpartum. Design and Participants In a longitudinal study of pregnant women with gestational diabetes risk factors (N = 102), we performed oral glucose tolerance testing (OGTT) and HbA1c measurements at 10–15 weeks of gestation, 24–30 weeks of gestation (N = 73), and 6–24 weeks postpartum (N = 42). Complete blood counts were obtained from clinical records. We calculated HbA1c-estimated average glucose levels and compared them with mean OGTT glucose levels (average of fasting, 1- and 2-hour glucose levels). Linear mixed effects models were used to test for longitudinal changes in measurements. Results Mean OGTT glucose increased between 10–15 and 24–30 weeks of gestation (β = 8.1 mg/dL, P = .001), while HbA1c decreased during the same time period (β = –0.13%, P &lt; .001). At 10–15 weeks of gestation and postpartum the discrepancy between mean OGTT glucose and HbA1c-estimated average glucose was minimal (mean [standard deviation]: 1.2 [20.5] mg/dL and 0.16 [18.1] mg/dL). At 24–30 weeks of gestation, the discrepancy widened (13.2 [17.9] mg/dL, β = 12.7 mg/dL, P &lt; .001, compared to 10–15 weeks of gestation, with mean OGTT glucose being higher than HbA1c-estimated average glucose). Lower hemoglobin at 24–30 weeks of gestation was associated with a greater discrepancy (β = 6.4 mg/dL per 1 g/dL lower hemoglobin, P = .03 in an age- and gestational age-adjusted linear regression model). Conclusions HbA1c accurately reflects glycemia in the 1st trimester, but underestimates glucose intolerance in the late 2nd trimester. Lower hemoglobin level is associated with greater underestimation. Accounting for gestational age and maternal hemoglobin may improve the clinical interpretation of HbA1c levels during pregnancy.

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