Food insecurity as a risk factor for preterm birth: a prospective facility-based cohort study in rural Haiti

IntroductionHaiti has an estimated neonatal mortality rate of 32/1000 live births, the highest in the Western Hemisphere. Preterm birth and being born small for gestational age (SGA) are major causes of adverse neonatal outcomes worldwide. To reduce preterm birth and infants born SGA, it is important to understand which women are most at risk and how risk varies within countries. There are few studies estimating the prevalence and risk factors for these conditions in Haiti, particularly in rural regions.MethodsWe conducted a prospective cohort study of pregnant women at a rural tertiary care centre in Haiti from May to December 2017. We collected data during interviews and from the medical record. We built multivariable models to identify risk factors for preterm birth and being born SGA among women who had a facility-based delivery.Results1089 pregnant women delivered at the hospital and were included in this analysis. Median gestational age at delivery was 38 weeks (IQR 36–40). In multivariable analyses, risk factors for preterm birth included maternal age <20 years (adjusted OR (AOR) 1.76, 95% CI 1.14 to 2.72) and >34 years (AOR 1.46, 95% CI 1.01 to 2.11) and severe hunger in the household (AOR 1.57, 95% CI 1.09 to 2.26). Risk factors for SGA were age >34 years (AOR 1.76, 95% CI 1.18 to 2.59), twin pregnancy (AOR 3.28, 95% CI 1.20 to 8.95) and first pregnancy (AOR 1.57, 95% CI 1.12 to 2.23). Number of prior abortions was associated with reduced risk for SGA (AOR 0.41, 95% CI 0.17 to 0.97).ConclusionsFood insecurity as a risk factor for preterm birth stands out as an important addition to the understanding of the risk of neonatal morbidity and mortality. This association highlights a potentially important intervention target to improve birth outcomes and suggests that food support has an important role to play for pregnant women who are food insecure in low-income settings.

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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.

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Frequency of Placenta Previa in Multigravida at Tertiary Care Hospital

TAJ Journal of Teachers Association ◽

10.3329/taj.v25i0.37560 ◽

2018 ◽

Vol 25 ◽

pp. 59-63

Author(s):

Mst Rokeya Khatun ◽

KS Nasrin Lina ◽

S Gul Nahar

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Gestational Age ◽

Placenta Previa ◽

Tertiary Care ◽

Previous History ◽

Pelvic Surgery ◽

Treatment Modalities ◽

Care Hospital ◽

Current Frequency

Background: Placenta previa is a localization of placenta in the lower uterine segment, near or over the internal os. Multigravida is one of the risk factors of placenta previa. The aim of study is to look for current frequency of placenta previa in multigravida, so that further improvement in diagnosis and treatment modalities can be made in order to decrease the morbidity & mortality related to it in this group.Objective: To determine the frequency of various grades of placenta previa in multigravida at a tertiary care center.Methodology: This is a cross sectional study conducted from December 2014 to June 2015 at the department of Gynecology and Obstetrics, Rajshahi Medical College Hospital. A total of 208 patients enrolled in the study with non -probability purposive sampling technique. All pregnant women with singleton pregnancy of 25-35 years of age in their second or more pregnancy with gestational age ≥ 34 weeks were included. Exclusion criteria observed for patients with multifetal pregnancy, previous history of cesarean section, dilatation and curettage, cervical cone biopsy, myomectomy or any pelvic surgery. All pregnant women had trans-abdominal ultrasound. The presence or absence of placenta previa was reported by an experienced sonologist. The data was analyzed using SPSS version 12.Results: Among the total recruited patients, mean age of these multigravidas was 30.1±5.6 years. The mean parity of our population was 4.02±1.2. The gestational age noted was 38±1.4 weeks as mean.. The frequency of placenta previa was 13 (6.3%) and type IV was the most common type.Conclusion: It is concluded from this study that the frequency of placenta previa in patients of multigravida was 6.3% and apart from other risk factors, multigravidity is an independent risk factor for placenta previa.TAJ 2012; 25: 59-63

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Local incidence of Jarisch–Herxheimer reaction in pregnancy following penicillin treatment for syphilis: A case series

Official Journal of the Association of Medical Microbiology and Infectious Disease Canada ◽

10.3138/jammi-2021-0001 ◽

2021 ◽

pp. e20210001

Author(s):

Amreet Dhaliwal ◽

Alison A Lopez ◽

Jared Bullard ◽

Vanessa Poliquin

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Gestational Age ◽

Tertiary Care ◽

Case Series ◽

Retrospective Chart Review ◽

Antimicrobial Treatment ◽

Care Centre ◽

Tertiary Care Centre ◽

Gestational Age At Delivery

Background: The literature suggests that the Jarisch–Herxheimer (J-H) reaction following antimicrobial treatment of syphilis is common and may precipitate uterine activity. Local practice is to transfer syphilitic parturients beyond gestational age of viability from rural locations to a tertiary care centre for treatment. Study objectives were to delineate local incidence and risk factors for the J-H reaction among pregnant women receiving treatment for syphilis. Methods: A retrospective chart review was conducted on pregnant women diagnosed with syphilis and treated during pregnancy at a tertiary care centre between 2012 and 2018. J-H reaction was defined as having ≥1 of the following symptoms within 24 hours of antibiotic treatment: fever (temperature ≥38°C), clinical description of a painful or itchy skin lesion, headache, hypotension (systolic BP <90), uterine contractions, or fetal heart rate decelerations. Descriptive statistical analysis was performed with mean and median used as measures of central tendency for continuous and categorical data, respectively. Results: Fifty-eight charts were eligible for inclusion. Mean maternal age was 25.1 (SD 5.6) years, and mean gestational age was 20.4 (SD 9.5) weeks when syphilis was diagnosed. One patient (1/58, 1.7%) met J-H reaction criteria. Mean gestational age at delivery was 37.1 (SD 3.4) weeks. One stillbirth (1.7%) was identified. Conclusions: The J-H reaction is less common at our centre than the literature suggests. Further research is important to identify risk factors associated with J-H reaction to optimize resource allocation in the context of treatment of syphilis during pregnancy.

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Promoter Methylation Changes in the Placental DIO3 and CRH Genes Are Involved in the Second Trimester Maternal Depression Induced Preterm Birth and Small for Gestational Age Birth

10.21203/rs.3.rs-209636/v1 ◽

2021 ◽

Author(s):

Jianhui Yang ◽

Yumin Zhang ◽

Jiahui Deng ◽

Xuemei Lin ◽

Lili Xie ◽

...

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Pregnant Women ◽

Maternal Depression ◽

Gestational Age ◽

Small For Gestational Age ◽

Depression Scale ◽

Hypertensive Disorder ◽

Second Trimester ◽

Promoter Regions

Abstract Background Recent studies suggest that the incidence of preterm birth and SGA birth related to maternal depression, but the mechanism is unclear. The aim of this study was to explore the placental epigenetic changes involved in maternal depression induced preterm birth and small for gestational age birth. Methods Three hundred forty-five pregnant women were enrolled in this cohort study. Maternal depression in the second and third trimesters was assessed using a self-rating depression scale (SDS). We selected placental samples from pregnant women with depression and an equivalent number for samples from pregnant women without depression. Methylation of the promoter regions of the placental DIO3 and CRH genes was determined using next generation sequencing based on bisulfite sequencing PCR (NGS-BSP). Results There were 97 (28.1%) and 95 (27.5%) pregnant women who had depression in the second trimester and third trimester, respectively. The risk factors of preterm birth were older maternal age (RR = 1.43, 95%CI = 1.01–2.03), uterine infection (RR = 129.31, 95%CI = 2.16-7725.55), and maternal depression in the second trimester (RR = 79.97, 95%CI = 3.57-1792.56). The risk factors of SGA birth were low maternal BMI (RR = 0.71, 95%CI = 0.54ཞ0.92), hypertensive disorder complicating pregnancy (HDCP, RR = 4.7, 95%CI = 1.18ཞ18.72), and maternal depression in the second trimester (RR = 3.71, 95%CI = 1.31ཞ12.16). Pregnant women with depression had higher placental methylation of CRH and DIO3 genes, and there was a correlation between placental methylation of CRH and DIO3 genes. Conclusion Our study suggested that the changes in the promoter region of the placental DIO3 and CRH genes were involved in maternal depression in the second trimester induced preterm birth and small for gestational age birth.

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Assessment of knowledge and risk factors about gestational diabetes mellitus among pregnant women in a tertiary care hospital

International Journal of Review in Life Sciences ◽

10.26452/ijrls.v10i3.1287 ◽

2020 ◽

Vol 10 (3) ◽

pp. 60-68

Author(s):

Priyanka G ◽

Preethu Elsa Prasad ◽

Muhammad Sabith ◽

Rafiunnissa ◽

Parthasarathy G

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Risk Factor ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Health Outcomes ◽

Pregnant Women ◽

Disease Risk ◽

Tertiary Care ◽

Care Hospital

Proper Gestational diabetes mellitus (GDM) management is important for better health outcomes. Knowledge and education are key components for better treatment and diabetes control. In patients with GDM, poor health literacy may be there which is associated with poor diabetic control and require educational program to improve health outcomes. A risk factor is any characteristic of an individual that can increase the likelihood of developing a disease. Risk factor assessment is usually recommended in many populations in early pregnancy. The prospective study was conducted for 6 months to assess knowledge and risk factors associated with gestational diabetes in 58 pregnant women using KAP questionnaire from WINGS project. The study found that knowledge among non GDM patients was poor when compared to GDM patients. Family history and obesity were found to be the major risk factors for development of gestational diabetes. So the future direction should focus on early prediction and effective preventive measures before GDM develops. Therefore a need for patient counseling is essential to reduce the GDM patients in future.

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Association between vomiting in the first trimester and preterm birth: a retrospective birth cohort study in Wuhan, China

BMJ Open ◽

10.1136/bmjopen-2017-017309 ◽

2017 ◽

Vol 7 (9) ◽

pp. e017309 ◽

Cited By ~ 3

Author(s):

Ronghua Hu ◽

Yawen Chen ◽

Yiming Zhang ◽

Zhengmin Qian ◽

Yan Liu ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Pregnant Women ◽

Gestational Age ◽

Outcome Measure ◽

Central City ◽

First Trimester ◽

Birth Cohort Study ◽

Obese Women ◽

Overweight Women

ObjectiveAlthough vomiting in the first trimester has been reported to be associated with preterm birth (PTB), findings supporting this association remain inconsistent. Our aim was to assess the association between vomiting and PTB, as well as evaluate if the association is modified by pre-pregnancy body mass index (BMI).DesignA retrospective cohort study.SettingWuhan, a central city of China.ParticipantsA total of 317 463 pregnant women who had a live, singleton newborn from 1 January 2010 to 23 May 2016 were enrolled in our study.Main outcome measurePTB was defined as gestational age <37 gestational weeks. Gestational age was calculated using reports from mothers based on the first day of their last menstrual period. An ultrasound was routinely used to determine gestational age before 12 gestational weeks.ResultsOf the 317 463 pregnant women, 29.88% (94 857) experienced vomiting in the first trimester and 5.00% (15 889) experienced a PTB. Vomiting in the first trimester increased the risk for PTB and the multivariable adjusted OR was 1.05 (95% CI 1.02 to 1.09). In the stratified analyses, the association of vomiting in the first trimester was significant among underweight women (adjusted OR=1.08, 95% CI 1.04 to 1.17) and normal pre-pregnancy BMI women (adjusted OR=1.06, 95% CI 1.02 to 1.11), but not in overweight women (adjusted OR=1.01, 95% CI 0.90 to 1.14) and obese women (adjusted OR=0.93, 95% CI 0.73 to 1.19).ConclusionsOur study indicates that vomiting in the first trimester was associated with PTB. Additionally, women with underweight and normal pre-pregnancy BMI who experienced vomiting are more likely to have a PTB.

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Biological and Psychosocial Factors, Risk Behaviors, and Perinatal Asphyxia in a University Hospital: Matched Case–Control Study, Cali, Colombia (2012–2014)

Frontiers in Public Health ◽

10.3389/fpubh.2021.535737 ◽

2021 ◽

Vol 9 ◽

Author(s):

Javier Torres-Muñoz ◽

Javier Enrique Fonseca-Perez ◽

Katherine Laurent

Keyword(s):

Social Support ◽

Risk Factor ◽

Pregnant Women ◽

Psychosocial Factors ◽

Risk Behaviors ◽

Gestational Age ◽

Low Income ◽

Perinatal Asphyxia ◽

University Hospital ◽

Biological Variables

Introduction: Perinatal asphyxia is one of the main causes of morbidity and mortality in newborns. It generates high costs, both social and economic, and presents modifiable risk factors.Objective: To determine the biological and psychosocial factors and risk behaviors associated with the development of perinatal asphyxia (Sarnat II-III) in newborns from low socioeconomic status in a tier III university hospital in the city of Cali, Colombia.Materials and Methods: With a case and control design, 216 patients were studied (54 cases/162 controls) (1 case/3 matched controls). The cases were defined as newborns with modified or severe perinatal asphyxia (Sarnat II-III) between 2012 and 2014, with gestational age ≥ 36 weeks, with neurological signs not attributable to other causes, multiorgan compromise, advanced reanimation, and presence of a sentinel event. For the analysis, conditional logistic regression models were developed to evaluate association (OR), considering that the cases and controls had been paired by the birth and gestational age variables.Results: The final model showed that, from the group of biological variables, meconium amniotic fluid was identified as a risk factor (OR 15.28, 95%CI 2.78–83.94). Induction of labor lowered the risk of perinatal asphyxia by 97% (OR 0.03, 95%CI 0.01–0.21), and monitoring of fetal heart rate was associated with lower odds by 99% (OR 0.01, 95%CI 0.00–0.31) of developing perinatal asphyxia in the newborn. Regarding social variables, the lack of social support was identified as a risk factor for the development of perinatal asphyxia (OR 6.44, 95%CI 1.16–35.66); in contrast, secondary education lowered the odds of developing perinatal asphyxia by 85% when compared with pregnant women who only had primary school education (OR 0.15, 95%CI 0.03–0.77).Conclusion: Assessment of biological and psychosocial factors and social support is important in pregnant women to determine the risk of developing perinatal asphyxia in a low-income population.

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The sFlt-1 to PlGF Ratio in Pregnant Women with Rheumatoid Arthritis: Impact of Disease Activity and Sulfasalazine Use

Rheumatology ◽

10.1093/rheumatology/keab372 ◽

2021 ◽

Author(s):

Rugina I Neuman ◽

Hieronymus T W Smeele ◽

A H Jan Danser ◽

Radboud J E M Dolhain ◽

Willy Visser

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Disease Activity ◽

Pregnant Women ◽

Gestational Age ◽

Third Trimester ◽

Low Disease Activity ◽

The Third ◽

Observational Prospective Cohort Study ◽

Plgf Ratio

Abstract Objectives An elevated sFlt-1/PlGF-ratio has been validated as a significant predictor of preeclampsia, but has not been established in women with rheumatoid arthritis (RA). We explored whether the sFlt-1/PlGF-ratio could be altered due to disease activity in RA, and could be applied in this population to predict preeclampsia. Since sulfasalazine has been suggested to improve the angiogenic imbalance in preeclampsia, we also aimed to examine whether sulfasalazine could affect sFlt-1 or PlGF levels. Methods Making use of a nationwide, observational, prospective cohort study on pregnant women with RA, sFlt-1 and PlGF were measured in the third trimester. A total of 221 women, aged 21–42 years, were included, with a median gestational age of 30 + 3 weeks. Results No differences in sFlt-1 or PlGF were observed between women with high, intermediate or low disease activity (p= 0.07 and p= 0.41), whereas sFlt-1 and PlGF did not correlate with DAS28-CRP score (r=-0.01 and r=-0.05, respectively). Four (2%) women with a sFlt-1/PlGF-ratio ≤38 developed preeclampsia in comparison to three (43%) women with a ratio > 38, corresponding to a negative predictive value of 98.1%. Sulfasalazine users (n = 57) did not show altered levels of sFlt-1 or PlGF in comparison to non-sulfasalazine users (n = 164, p= 0.91 and p= 0.11). Conclusion Our study shows that in pregnant women with RA, the sFlt-1/PlGF-ratio is not altered due to disease activity and a cut-off ≤38 can be used to exclude preeclampsia. Additionally, sulfasalazine use did not affect sFlt-1 or PlGF levels in this population.

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Morbidity in Late Preterm Birth: A Retrospective Cohort Study Assessing the Role of Immaturity versus Antecedent Factors

Neonatology ◽

10.1159/000515089 ◽

2021 ◽

pp. 1-8

Author(s):

Melissa Lorenzo ◽

Megan Laupacis ◽

Wilma M. Hopman ◽

Imtiaz Ahmad ◽

Faiza Khurshid

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Preterm Delivery ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Late Preterm ◽

Multiple Gestation ◽

Late Preterm Birth ◽

Apnea Of Prematurity

Introduction: Late preterm infants (LPIs) are infants born between 340/7 and 366/7 weeks gestation. Morbidities in these infants are commonly considered a result of prematurity; however, some research has suggested immaturity may not be the sole cause of morbidities. We hypothesize that antecedents leading to late preterm birth are associated with different patterns of morbidities and that morbidities are the result of gestational age superimposed by the underlying etiologies of preterm delivery. Methods: This is a retrospective cohort study of late preterm neonates born at a single tertiary care center. We examined neonatal morbidities including apnea of prematurity, hyperbilirubinemia, hypoglycemia, and the requirement for continuous positive airway pressure (CPAP). Multivariable logistic regression analysis was performed to estimate the risk of each morbidity associated with 3 categorized antecedents of delivery, that is, spontaneous preterm labor, preterm premature rupture of membranes (PPROM), and medically indicated birth. We calculated the predictive probability of each antecedent resulting in individual morbidity across gestational ages. Results: 279 LPIs were included in the study. Decreasing gestational age was associated with significantly increased risk of apnea of prematurity, hyperbilirubinemia, and requirement of CPAP. In our cohort, the risk of hypoglycemia increased with gestational age, with the greatest incidence at 360−6 weeks. There was no significant association of risk of selected morbidities and the antecedents of late preterm delivery, with or without adjustment for gestational age, multiple gestation, small for gestational age (SGA), antenatal steroids, and delivery method. Discussion and Conclusion: This study found no difference in morbidity risk related to 3 common antecedents of preterm birth in LPIs. Our research suggests that immaturity is the primary factor in determining adverse outcomes, intensified by factors resulting in prematurity.

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A Food Insecurity Systematic Review: Experience from Malaysia

Nutrients ◽

10.3390/nu13030945 ◽

2021 ◽

Vol 13 (3) ◽

pp. 945

Author(s):

Norhasmah Sulaiman ◽

Heather Yeatman ◽

Joanna Russell ◽

Leh Shii Law

Keyword(s):

Risk Factors ◽

Food Insecurity ◽

Coping Strategies ◽

Low Income ◽

Meta Analysis ◽

Welfare Recipient ◽

Vulnerable Groups ◽

Household Food Security ◽

Household Food Insecurity ◽

Household Food

Living free from hunger is a basic human right. However, some communities still experience household food insecurity. This systematic literature review explored different aspects of household food insecurity in Malaysia including vulnerable groups, prevalence, risk factors, coping strategies, and the consequences of food insecurity. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Thirty-three relevant articles were selected from scientific databases such as CINAHL, Pubmed and Google Scholar, scrutiny of reference lists, and personal communication with experts in the field. The prevalence of household food insecurity in Malaysia was unexpectedly reported as high, with affected groups including Orang Asli, low-income household/welfare-recipient households, university students, and the elderly. Demographic risk factors and socioeconomic characteristics included larger household, living in poverty, and low education. Coping strategies were practices to increase the accessibility of food in their households. Consequences of household food insecurity included psychological, dietary (macro- and micronutrient intakes), nutritional status, and health impacts. In conclusion, this review confirmed that household food insecurity in Malaysia continues to exist. Nevertheless, extensive and active investigations are encouraged to obtain a more holistic and comprehensive picture pertaining to household food security in Malaysia.

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