scholarly journals Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study: protocol of a pragmatic clinical effectiveness study to improve birth outcomes in Ethiopia

2022 ◽  
Vol 6 (1) ◽  
pp. e001327
Author(s):  
Anne CC Lee ◽  
Firehiwot Workneh Abate ◽  
Luke C Mullany ◽  
Estifanos Baye ◽  
Yoseph Yemane Berhane ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Clinical Effectiveness ◽  
Effectiveness Study ◽  
Infection Management ◽  
Infection Treatment ◽  
Health Centres ◽  
Tract Infections ◽  
To Receive

IntroductionThe WHO Nutrition Target aims to reduce the global prevalence of low birth weight by 30% by the year 2025. The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study will test the impact of packages of pregnancy interventions to enhance maternal nutrition and infection management on birth outcomes in rural Ethiopia.Methods and analysisENAT is a pragmatic, open-label, 2×2 factorial, randomised clinical effectiveness study implemented in 12 rural health centres in Amhara, Ethiopia. Eligible pregnant women presenting at antenatal care (ANC) visits at <24 weeks gestation are enrolled (n=2400). ANC quality is strengthened across all centres. Health centres are randomised to receive an enhanced nutrition package (ENP) or standard nutrition care, and within each health centre, individual women are randomised to receive an enhanced infection management package (EIMP) or standard infection care. At ENP centres, women receive a regular supply of adequately iodised salt and iron–folate (IFA), enhanced nutrition counselling and those with mid-upper arm circumference of <23 cm receive a micronutrient fortified balanced energy protein supplement (corn soya blend) until delivery. In standard nutrition centres, women receive routine counselling and IFA. EIMP women have additional screening/treatment for urinary and sexual/reproductive tract infections and intensive deworming. Non-EIMP women are managed syndromically per Ministry of Health Guidelines. Participants are followed until 1-month post partum, and a subset until 6 months. The primary study outcomes are newborn weight and length measured at <72 hours of age. Secondary outcomes include preterm birth, low birth weight and stillbirth rates; newborn head circumference; infant weight and length for age z-scores at birth; maternal anaemia; and weight gain during pregnancy.Ethics and disseminationENAT is approved by the Institutional Review Boards of Addis Continental Institute of Public Health (001-A1-2019) and Mass General Brigham (2018P002479). Results will be disseminated to local and international stakeholders.Registration numberISRCTN15116516.

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.

Reduction of Neonatal Mortality after Multiple Doses of Bovine Surfactant in Low Birth Weight Neonates with Respiratory Distress Syndrome

PEDIATRICS ◽  
1991 ◽  
Vol 88 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Edward A. Liechty ◽  
Edward Donovan ◽  
Dilip Purohit ◽  
Joseph Gilhooly ◽  
Bernard Feldman ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clinical Care ◽  
Pulmonary Interstitial Emphysema ◽  
Mortality And Morbidity ◽  
Multiple Doses ◽  
To Receive

To determine if outcomes of low birth weight neonates with respiratory distress syndrome can be improved by the administration of multiple doses of bovine surfactant, we conducted two identical multicenter, controlled trials, and the results were combined for analysis. Seven hundred and ninety-eight neonates weighing 600 to 1750 g at birth who had developed respiratory distress syndrome within 6 hours of birth were assigned randomly to receive either 100 mg of phospholipid/kg of Survanta, a modified bovine surfactant (n = 402), or a sham dosing procedure (n = 396). Neonates whose respiratory distress persisted could be given up to three more doses, with all doses to be given in the first 48 hours after birth. Dosing was performed by investigators not involved in the clinical care of the neonates; nursery staff were kept blinded as to the treatment assignment. Fewer Survanta-treated neonates died of any cause (18.4% vs 27.3%, P = .002), died of respiratory distress syndrome (9.0% vs 20.3%, P &lt; .001), and either died or developed bronchopulmonary dysplasia due to respiratory distress syndrome (51.2% vs 64.6%, P &lt; .001). Neonates who received Survanta also had greater improvement in their oxygenation and ventilatory status from baseline to 72 hours than did control neonates. Survanta-treated neonates were at lowered risk for developing pulmonary interstitial emphysema (18.6% vs 39.3%, P &lt; .001) and other pulmonary air leaks (11.5% vs 25.9%, P &lt; .001). We conclude that multiple doses of Survanta given after diagnosis of respiratory distress syndrome reduce mortality and morbidity.

Regional Birth Outcomes after the 2011 Great East Japan Earthquake and Tsunami in Miyagi Prefecture

2018 ◽  
Vol 33 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Junichi Sugawara ◽  
Noriyuki Iwama ◽  
Tetsuro Hoshiai ◽  
Hideki Tokunaga ◽  
Hidekazu Nishigori ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Risk Analysis ◽  
Birth Outcomes ◽  
Birth Rate ◽  
Great East Japan Earthquake ◽  
Miyagi Prefecture ◽  
Preterm Birth Rate ◽  
Regional Risk Analysis

AbstractObjectivesThis study was aimed to analyze post-disaster birth outcomes in coastal and inland regions of Miyagi Prefecture, Japan.MethodsPrimary data sets were compiled from birth records of obstetric facilities and 12,808 patients were analyzed for baseline birth outcomes by region. Regional risk analysis of the low-birth-weight rate and premature birth rate were conducted using multi-level logistic regression analysis.ResultsFrom overall baseline birth outcomes, a preterm birth rate was 4.6% and low-birth-weight rate was 8.8%. Regional analysis revealed that a preterm birth rate was 3.2% (coastal) and 5.0% (inland), respectively, and the rate of low birth weight was 6.5% in the coastal and 8.5% in the inland region. In the risk analysis of low-birth-weight rate and preterm birth rate, the risk in the coastal region could not be considered any higher than in the inland region (adjusted odds ratio 0.91 [0.73-1.14] and 0.85 [0.46-1.59], respectively).ConclusionsThe incidence of preterm birth and low birth weight were not adversely affected by the disaster. Early transfer and intensive medical intervention may have led to those findings. Further survey will be necessary to determine the long-term effects in both mothers and children.SugawaraJ, IwamaN, HoshiaiT, TokunagaH, NishigoriH, MetokiH, OkamuraK, YaegashiN. Regional birth outcomes after the 2011 Great East Japan Earthquake and tsunami in Miyagi Prefecture. Prehosp Disaster Med. 2018;33(2):215–219.

scholarly journals Paternal age and the risk of low birth weight and preterm delivery: a Finnish register-based study

2018 ◽  
Vol 72 (12) ◽  
pp. 1104-1109 ◽  
Author(s):  
Alice Goisis ◽  
Hanna Remes ◽  
Kieron Barclay ◽  
Pekka Martikainen ◽  
Mikko Myrskylä
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Delivery ◽  
Birth Outcomes ◽  
Conclusive Evidence ◽  
Paternal Age ◽  
Adverse Birth Outcomes ◽  
Maternal Characteristics ◽  
Parental Characteristics ◽  
Increased Risk

BackgroundBased on existing studies, there is no conclusive evidence as to whether and why paternal age matters for birth outcomes.MethodsWe used Finnish population registers on 106 652 children born 1987–2000. We first document the unadjusted association between paternal age and the risk of low birth weight (LBW; <2500 g) and preterm birth (<37 weeks’ gestation). Second, we investigate whether the unadjusted association is attenuated on adjustment for child’s, maternal and parental socioeconomic characteristics. Third, by adopting a within-family design which involves comparing children born to the same father at different ages, we additionally adjust for unobserved parental characteristics shared between siblings.ResultsThe unadjusted results show that being born to a father aged 40+, as opposed to a father aged 30–34, is associated with an increased risk of LBW of 0.96% (95% CI 0.5% to 1.3%) and to a younger father (<25) with a 1% (95% CI 0.6% to 1.3%) increased risk. The increased risk at younger paternal ages is halved on adjustment for the child’s characteristics and fully attenuated on adjustment for child/parental characteristics. The increased risk at paternal ages 40+ is partially attenuated on adjustment for maternal characteristics (β=0.62%; 95% CI 0.13% to 1.1%). Adjustment for unobserved parental characteristics shared by siblings further attenuates the 40+ coefficient (β=0.4%; 95% CI −0.5% to −1.2%). Results for preterm delivery are similar.ConclusionsThe results underscore the importance of considering paternal age as a potential risk factor for adverse birth outcomes and of expanding research on its role and the mechanisms linking it to birth outcomes.

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 Dengue during pregnancy and live birth outcomes: a cohort of linked data from Brazil

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e023529 ◽  
Author(s):  
Enny S Paixão ◽  
Oona M Campbell ◽  
Maria Gloria Teixeira ◽  
Maria CN Costa ◽  
Katie Harron ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Live Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Severe Dengue ◽  
Maternal Risk ◽  
Increased Risk

ObjectivesDengue is the most common viral mosquito-borne disease, and women of reproductive age who live in or travel to endemic areas are at risk. Little is known about the effects of dengue during pregnancy on birth outcomes. The objective of this study is to examine the effect of maternal dengue severity on live birth outcomes.Design and settingWe conducted a population-based cohort study using routinely collected Brazilian data from 2006 to 2012.ParticipatingWe linked birth registration records and dengue registration records to identify women with and without dengue during pregnancy. Using multinomial logistic regression and Firth method, we estimated risk and ORs for preterm birth (<37 weeks’ gestation), low birth weight (<2500 g) and small for gestational age (<10thcentile). We also investigated the effect of time between the onset of the disease and each outcome.ResultsWe included 16 738 000 live births. Dengue haemorrhagic fever was associated with preterm birth (OR=2.4; 95% CI 1.3 to 4.4) and low birth weight (OR=2.1; 95% CI 1.1 to 4.0), but there was no evidence of effect for small for gestational age (OR=2.1; 95% CI 0.4 to 12.2). The magnitude of the effects was higher in the acute disease period.ConclusionThis study showed an increased risk of adverse birth outcomes in women with severe dengue during pregnancy. Medical intervention to mitigate maternal risk during severe acute dengue episodes may improve outcomes for infants born to exposed mothers.

scholarly journals Maternal Characteristics and Temporal Trends in Birth Outcomes: Comparison between Spanish and Migrant Mothers

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Carlos Varea ◽  
Cristina Bernis ◽  
Antonio González González
Keyword(s):  
Birth Weight ◽  
Caesarean Section ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Common Factor ◽  
Mode Of Delivery ◽  
Temporal Trends ◽  
Medical Intervention ◽  
Future Research ◽  
Reproductive Pattern

Low birth weight and preterm babies have been increasing in Spain since 1980, coinciding with important changes in the social and demographic structure of childbearing populations—including the contribution of a 25% of foreign mothers—and with increasing medical intervention in births. This study, based on 5,990,613 births, compares the temporary trends in reproductive patterns and birth outcomes in Spanish and foreign mothers during the period 1996–2009 and evaluates for the years 2007 to 2009 the relative contribution of mother's origin and Caesarean section to birth weight variability. Foreign mothers maintain their own reproductive pattern, whereas negative birth outcomes increase in all groups. Results from logistic regression analysis show that besides late maternity and primiparity also Caesarean section increases the risk for low birth weight. The reduction in Caesarean section rates between 2007 and 2009 might explain the reduction of low birth weight detected. A change of tendency simultaneously appears in most maternal and newborn characteristics, and in the mode of delivery in all ethnic groups since 2008. Coincidence in the timing of the change of trends points to a common factor. We suggest that the current world financial crisis could be this common cause, a hypothesis to be contrasted in future research.

scholarly journals Paternal Involvement and Fetal Morbidity Outcomes in HIV/AIDS

2013 ◽  
Vol 9 (1) ◽  
pp. 6-14 ◽  
Author(s):  
Amina P. Alio ◽  
Alfred K. Mbah ◽  
Krupa Shah ◽  
Euna M. August ◽  
Sharon Dejoy ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Propensity Score ◽  
Low Birth Weight ◽  
Propensity Score Matching ◽  
Birth Outcomes ◽  
Paternal Involvement ◽  
Hiv Positive ◽  
Absent Fathers ◽  
Hiv Positive Mothers

Prior research indicates that infants with absent fathers are vulnerable to unfavorable fetal birth outcomes. HIV is a recognized risk factor for adverse birth outcomes. However, the influence of paternal involvement on fetal morbidity outcomes in women with HIV remains poorly understood. Using linked hospital discharge data and vital statistics records for the state of Florida (1998-2007), the authors assessed the association between paternal involvement and fetal growth outcomes (i.e., low birth weight [LBW], very low birth weight [VLBW], preterm birth [PTB], very preterm birth [VPTB], and small for gestational age [SGA]) among HIV-positive mothers ( N = 4,719). Propensity score matching was used to match cases (absent fathers) to controls (fathers involved). Conditional logistic regression was employed to generate adjusted odds ratios (OR). Mothers of infants with absent fathers were more likely to be Black, younger (<35 years old), and unmarried with at least a high school education ( p < .01). They were also more likely to have a history of drug ( p < .01) and alcohol ( p = .02) abuse. These differences disappeared after propensity score matching. Infants of HIV-positive mothers with absent paternal involvement during pregnancy had elevated risks for adverse fetal outcomes (LBW: OR = 1.30, 95% confidence interval [CI] = 1.05-1.60; VLBW: OR = 1.72, 95% CI = 1.05-2.82; PTB: OR = 1.38, 95% CI = 1.13-1.69; VPTB: OR = 1.81, 95% CI = 1.13-2.90). Absence of fathers increases the likelihood of adverse fetal morbidity outcomes in women with HIV infection. These findings underscore the importance of paternal involvement during pregnancy, especially as an important component of programs for prevention of mother-to-child transmission of HIV.

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