Understanding the impact of metformin on maternal health and fetal growth in pregnancies complicated by maternal diabetes

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

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Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

Public Health Reviews ◽

10.1186/s40985-020-00147-0 ◽

2020 ◽

Vol 41 (1) ◽

Author(s):

Adweeti Nepal ◽

Santa Kumar Dangol ◽

Anke van der Kwaak

Keyword(s):

Maternal Health ◽

Health Services ◽

Health System ◽

Maternal Health Services ◽

Policy Formulation ◽

Social Accountability ◽

The Social ◽

The Government ◽

The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

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Genomic imbalances in the placenta are associated with poor fetal growth

Molecular Medicine ◽

10.1186/s10020-020-00253-4 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Giulia F. Del Gobbo ◽

Yue Yin ◽

Sanaa Choufani ◽

Emma A. Butcher ◽

John Wei ◽

...

Keyword(s):

Fetal Growth ◽

Sex Chromosome ◽

Copy Number Variants ◽

Placental Insufficiency ◽

Potential Contribution ◽

Genomic Imbalances ◽

Significant Difference ◽

Underlying Causes ◽

Risk Of Disease ◽

The Impact

Abstract Background Fetal growth restriction (FGR) is associated with increased risks for complications before, during, and after birth, in addition to risk of disease through to adulthood. Although placental insufficiency, failure to supply the fetus with adequate nutrients, underlies most cases of FGR, its causes are diverse and not fully understood. One of the few diagnosable causes of placental insufficiency in ongoing pregnancies is the presence of large chromosomal imbalances such as trisomy confined to the placenta; however, the impact of smaller copy number variants (CNVs) has not yet been adequately addressed. In this study, we confirm the importance of placental aneuploidy, and assess the potential contribution of CNVs to fetal growth. Methods We used molecular-cytogenetic approaches to identify aneuploidy in placentas from 101 infants born small-for-gestational age (SGA), typically used as a surrogate for FGR, and from 173 non-SGA controls from uncomplicated pregnancies. We confirmed aneuploidies and assessed mosaicism by microsatellite genotyping. We then profiled CNVs using high-resolution microarrays in a subset of 53 SGA and 61 control euploid placentas, and compared the load, impact, gene enrichment and clinical relevance of CNVs between groups. Candidate CNVs were confirmed using quantitative PCR. Results Aneuploidy was over tenfold more frequent in SGA-associated placentas compared to controls (11.9% vs. 1.1%; p = 0.0002, OR = 11.4, 95% CI 2.5–107.4), was confined to the placenta, and typically involved autosomes, whereas only sex chromosome abnormalities were observed in controls. We found no significant difference in CNV load or number of placental-expressed or imprinted genes in CNVs between SGA and controls, however, a rare and likely clinically-relevant germline CNV was identified in 5.7% of SGA cases. These CNVs involved candidate genes INHBB, HSD11B2, CTCF, and CSMD3. Conclusions We conclude that placental genomic imbalances at the cytogenetic and submicroscopic level may underlie up to ~ 18% of SGA cases in our population. This work contributes to the understanding of the underlying causes of placental insufficiency and FGR, which is important for counselling and prediction of long term outcomes for affected cases.

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Effects of Maternal Diabetes on Fetal Expression of Insulin-Like Growth Factor and Insulin-Like Growth Factor Binding Protein MRNAs in the Rat

Journal of Endocrinology ◽

10.1677/joe.0.147r005 ◽

1995 ◽

Vol 147 (2) ◽

pp. R5-R8 ◽

Cited By ~ 6

Author(s):

Randal D. Streck ◽

Veeraramani S. Rajaratnam ◽

Renata B. Fishman ◽

Peggy J. Webb

Keyword(s):

Growth Factor ◽

Mrna Expression ◽

Fetal Growth ◽

Fetal Liver ◽

Expression Patterns ◽

Maternal Diabetes ◽

Limb Bud ◽

Insulin Like Growth Factor ◽

Igf Binding Proteins ◽

Increased Risk

ABSTRACT Matemal diabetes is associated in humans and rats with an increased risk for fetal growth abnormalities and malformations. Therefore, the effect of maternal diabetes on expression of genes that regulate fetal growth and differentiation is of considerable interest. Developmental growth is regulated in part by the expression and availability of insulin-like growth factors (IGFs). Postnatal expression of a subset of the IGFs and IGF binding proteins (IGFBPs) has been demonstrated to be regulated in response to diabetes and other metabolic conditions. We used in situ hybridization to analyze the effect of maternal diabetes, induced by streptozotocin (STZ) prior to mating, upon prenatal rat IGF and IGFBP mRNA expression. At gestational day (GD) 14, the most striking effect of maternal diabetes on fetal IGF/IGFBP gene expression was a marked increase in the abundance of IGFBP-1 mRNA within the liver primordia of fetuses isolated from diabetic dams compared to age-matched controls. This upregulation cannot be entirely due to the approximately one-half-day delay in fetal development (based on limb bud staging) associated with maternal diabetes, as there was no gross difference in the level of IGFBP-1 mRNA between GD13 and GD14 control fetal livers. In contrast, the fetal mRNA expression patterns of IGF-I, IGF-II and IGFBP-2, -3, -4, -5 and -6 were not grossly altered by maternal diabetes. These data are consistent with the hypothesis that IGFBP-1 produced within the fetal liver and secreted into fetal circulation may play a role in regulating rat fetal growth.

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Harmonizing Methods for Estimating the Impact of Contraceptive Use on Unintended Pregnancy, Abortion, and Maternal Health

Global Health Science and Practice ◽

10.9745/ghsp-d-17-00121 ◽

2017 ◽

Vol 5 (4) ◽

pp. 658-667 ◽

Cited By ~ 2

Author(s):

Ian Askew ◽

Michelle Weinberger ◽

Aisha Dasgupta ◽

Jacqueline Darroch ◽

Ellen Smith ◽

...

Keyword(s):

Maternal Health ◽

Unintended Pregnancy ◽

Contraceptive Use ◽

The Impact

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Maternal Oxidative Stress, Placental Morphometry, and Fetal Growth in Diabetic Rats Exposed to Cigarette Smoke

Reproductive Sciences ◽

10.1177/1933719118815589 ◽

2018 ◽

Vol 26 (9) ◽

pp. 1287-1293 ◽

Cited By ~ 4

Author(s):

Yuri K. Sinzato ◽

Estela M. Bevilacqua ◽

Gustavo T. Volpato ◽

Rogelio E. Hernandez-Pando ◽

Marilza V. C. Rudge ◽

...

Keyword(s):

Oxidative Stress ◽

Cigarette Smoke ◽

Fetal Growth ◽

Fetal Development ◽

Oxidative Stress Biomarkers ◽

Junctional Zone ◽

Pregnant Rats ◽

Stress Biomarkers ◽

Vascular Walls ◽

The Impact

The diabetic syndrome affects pregnancy, contributing to placental functional and structural disruptions and impaired fetal development, with many reports indicating tobacco-associated morbidity and perinatal mortality. In our study, an experimental rat model of diabetes and cigarette smoke exposure in pregnant rats was used to determine the impact of the combination of diabetes and exposure to cigarette smoke during pregnancy on maternal oxidative stress biomarkers and placental and fetal development. Diabetes was induced by streptozotocin, and dams were exposed to cigarette smoke by mainstream smoke generated by a mechanical smoking device and delivered into a chamber. Four groups of dams were studied: nondiabetic (C, control) and diabetic (D) exposed to filtered air and nondiabetic (CS) and diabetic (DS) exposed to cigarette smoke prior to and during pregnancy. Maternal oxidative stress biomarkers, placental morphology, and fetal growth were determined close to term. The combination of diabetes and cigarette smoke resulted in elevated maternal blood glucose levels and increased number of small fetuses. Placentas from the DS group showed increased junctional zone and decreased labyrinthine area. The morphological alterations were characterized by extensive vascular congestion, thickness, and hyalinization of the vascular walls, numerous decidual cells with abundant glycogen, and macrophages with cytoplasmic inclusions of hemosiderin. Additionally, they showed increased glycogen accumulation and junctional zone structural derangement with ectopic giant cells. No alterations were observed in maternal oxidative stress status. Thus, our result suggests that diabetes makes pregnant rats more susceptible to the adverse effects of exposure to cigarette smoke on placental morphometry and fetal growth.

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Maternal Diabetes Mellitus as a Risk Factor for High Blood Pressure in Late Childhood

Hypertension ◽

10.1161/hypertensionaha.118.11761 ◽

2019 ◽

Vol 73 (1) ◽

Cited By ~ 6

Author(s):

Joana Oliveira Miranda ◽

Rui João Cerqueira ◽

Henrique Barros ◽

José Carlos Areias

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Body Mass ◽

Cardiovascular Effects ◽

Maternal Diabetes ◽

Diabetes Mellitus Group ◽

The Impact ◽

Maternal Diabetes Mellitus ◽

Diabetic Mothers

Intrauterine fetal conditions can have lifelong cardiovascular effects. The impact of maternal diabetes mellitus on children’s cardiovascular profile is not well established. The goal of this study was to explore the association between maternal diabetes mellitus and offspring’s blood pressure (BP) ≤10 years of age. Generation XXI is a prospective birth cohort, which enrolled 8301 mother-offspring pairs, including 586 (7.1%) children of diabetic mothers. The associations between maternal diabetes mellitus and BP at 4, 7, and 10 years of age was modeled using linear regression. A mixed-effects model was built to assess differences in BP variation over time. Path analysis was used to quantify effects of potential mediators. Maternal diabetes mellitus was associated with higher BP in offspring at the age of 10 (systolic: β, 1.48; 95% CI, 0.36–2.59; and diastolic: β, 0.86; 95% CI, 0.05–1.71). This association was independent of maternal perinatal characteristics, and it was mediated by child’s body mass index and, to a lesser extent, by gestational age, type of birth, and birth weight (indirect effect proportion, 73%). No significant differences in BP were found at 4 and 7 years of age. Longitudinal analysis showed an accelerated systolic BP increase on maternal diabetes mellitus group (β, 1.16; 95% CI, 0.03–2.28). These finding were especially relevant in males, suggesting sex differences in the mechanisms of BP prenatal programing. Our results provide further evidence that maternal diabetes mellitus is associated with high BP late in childhood, demonstrating a significant role of child’s body mass in the pathway of this association.

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Intervention Time Series Modeling of Infant Mortality: Impact of Free Maternal Health Care

Asian Journal of Probability and Statistics ◽

10.9734/ajpas/2020/v8i430213 ◽

2020 ◽

pp. 38-47

Author(s):

J. Kisabuli ◽

J. Ong'ala ◽

E. Odero

Keyword(s):

Health Care ◽

Time Series ◽

Maternal Health ◽

Infant Mortality ◽

Moving Average ◽

Maternal Health Care ◽

The Sustainable Development ◽

Infant Deaths ◽

Moving Average Model ◽

The Impact

Infant mortality is an important marker of the overall society health. The 3rd goal of the Sustainable Development Goals aims at reducing infant deaths that occur due to preventable causes by 2030. Due to increased infant mortality the Kenyan government introduced Free Maternal Health Care as an intervention towards reducing infant mortality through elimination of the cost burden of accessing medical care by the mother and the infant. The study examines the impact of Free Maternal Health Care on infant mortality using Intervention time series analysis particularly the intervention Box Jenkins ARIMA (Autoregressive Integrated Moving Average) model. There was significant support that Free Maternal Health Care had a significant impact on infant mortality which was estimated to be a decrease of 10.15% in infant deaths per month.

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The Impact of Diabetes on Hippocampus

10.5772/intechopen.99895 ◽

2021 ◽

Author(s):

Saeed Vafaei-Nezhad ◽

Masood Vafaei-Nezhad ◽

Mehri Shadi ◽

Samira Ezi

Keyword(s):

Central Nervous System ◽

Developing Countries ◽

Nervous System ◽

Child Mortality ◽

Maternal Diabetes ◽

Mortality And Morbidity ◽

Increased Risk ◽

The Impact ◽

Diabetic Mothers ◽

Lines Of Evidence

Maternal Diabetes is one of the most common metabolic disorders resulting an increased risk of abnormalities in the developing fetus and offspring. It is estimated that the prevalence of diabetes during pregnancy among women in developing countries is approximately 4.5 percent and this range varies between 1 to 14 percent in different societies. According to earlier studies, diabetes during pregnancy is associated with an increased risk of maternal and child mortality and morbidity as well as major congenital anomalies including central nervous system (CNS) in their offspring. Multiple lines of evidence have suggested that infants of diabetic women are at risk of having neurodevelopmental sequelae. Previous studies reveal that the offspring of diabetic mothers exhibit disturbances in behavioral and intellectual functioning. In the examination of cognitive functioning, a poorer performance was observed in the children born to diabetic mothers when compared with the children of non-diabetic mothers. Therefore, it is important to study the possible effects of maternal diabetes on the hippocampus of these infants.

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AMINOCUANIDINE IMPROVES FETAL GROWTH IN STREPTOZOTOCIN-INDUCED MATERNAL DIABETES

Pediatric Research ◽

10.1203/00006450-198704010-00288 ◽

1987 ◽

Vol 21 (4) ◽

pp. 214A-214A

Author(s):

Robert E Greenberg ◽

Tracy Dunham ◽

James Wogenrich

Keyword(s):

Fetal Growth ◽

Maternal Diabetes

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