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 Associating antiretroviral therapy initiated before or during pregnancy with placenta pathology in HIV infected women

2020 ◽  
Author(s):  
Nadia M Ikumi ◽  
Thokozile R Malaba ◽  
Komala Pillay ◽  
Marta C Cohen ◽  
Hlengiwe P Madlala ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnancy Outcome ◽  
Preterm Delivery ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Fixed Dose ◽  
Adverse Birth Outcomes ◽  
Art Initiation ◽  
Cell Counts ◽  
Increased Risk

ABSTRACTBackgroundAntiretroviral therapy (ART) is universally recommended for all HIV-infected pregnant women to improve survival and to reduce mother-to-child HIV transmission. With widespread use of ART in areas of high HIV prevalence, there is concern that prolonged in-utero ART exposure may result in adverse birth outcomes, such as preterm delivery and low birthweight infants. Underlying drivers of these effects may be found in the placenta.ObjectiveWe examined whole placentas from live births to seek an association between timing of ART initiation and pregnancy outcome.Study DesignThis was a nested sub-study in a larger cohort of HIV-infected women recruited in a large primary care antenatal clinic in Cape Town, South Africa. Whole placentas (n=130) were collected at delivery and examined for histopathology from two ART groups. The stable group (n=53) initiated ART prior to pregnancy and the initiating group (n=77) started ART at a median of 15 weeks gestation. Adverse birth outcomes were defined by preterm delivery (PTD; n=9), small-for-gestational age (SGA; n=12) and low birthweight (LBW; n=11) in the two groups. Wilcoxon rank-sum and t-tests were used to measure differences in placental histopathology by ART group. Binomial and univariate linear regression models, chi-squared or Fisher’s exact test were used to quantify associations between placenta histopathology and maternal factors including ART timing and the association with pregnancy outcome.ResultsWomen in the stable group were significantly older (median [IQR] 33 years [28 - 37] vs 28 [25 - 32]; p=0.003), had higher CD4 cell counts 455 cells/ml [381 - 602] vs 369.5 [251 - 534.5], p=0.04) and were less likely to be prehypertensive or hypertensive at first antenatal care visit (p=0.03) than women in the initiating group. Overall, 119 (91%), women were on a fixed dose regimen of Tenofovir (TDF) + Lamivudine (3TC) + Efavirenz (EFV) and only 3 (2%; all in the stable group) were on a protease inhibitor (PI)-based regimen with no difference between the groups. Overall, nearly a third of placentas were small, although the fetal-placenta weight ratio was in the normal range for most women. Meconium exposure and chorioamnionitis was seen in 19% and 15% of placentas, respectively. Apart from maternal vascular malperfusion (MVM) and decidual arteriopathy, histopathology obervations did not differ significantly between stable and initiating groups. Placentas from the stable group showed increased MVM (39.6% vs 19.4%, p=0.01) and decidual arteriopathy (11.3% vs 1.3%, p=0.02), with a trend of decreased placental weight (392g vs 422g, p=0.09). MVM, in turn, was significantly associated with PTD and LBW (p=0.002 and p<0.0001) and association with SGA was borderline significant (p=0.09).ConclusionART initiation prior to pregnancy was associated with an increased risk of maternal vascular malperfusion and decidual arteriopathy, suggestive of placental dysfunction. The association between MVM with PTD and LBW suggests that a placenta-mediated mechanism may link the putative association between ART and adverse birth outcomes.

scholarly journals Hemoglobin concentrations and adverse birth outcomes in South Asian pregnant women: findings from a prospective Maternal and Neonatal Health Registry

2020 ◽  
Vol 17 (S2) ◽  
Author(s):  
Sumera Aziz Ali ◽  
Shiyam Sunder Tikmani ◽  
Sarah Saleem ◽  
Archana B. Patel ◽  
Patricia L. Hibberd ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Birth Outcomes ◽  
South Asian ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Birth Outcomes ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
Health Registry ◽  
The Relationship

Abstract Background While the relationship between hemoglobin (Hb) concentrations and pregnancy outcomes has been studied often, most reports have focused on a specific Hb cutoff used to define anemia. Fewer studies have evaluated pregnancy outcomes across the entire range of Hb values. Moreover, to date, most studies of the relationship of Hb concentrations to pregnancy outcomes have been done in high-income countries. Thus, we have sought to determine the relationship between the range of maternal Hb concentrations and adverse birth outcomes among South Asian pregnant women. Methods For this study, we used data collected from two South Asian countries (Pakistan – Sindh Province and two sites in India - Belagavi and Nagpur) in a prospective maternal and newborn health registry study. To assess the association between Hb concentrations and various maternal and fetal outcomes, we classified the Hb concentrations into seven categories. Regression analyses adjusting for multiple potential confounders were performed to assess adverse pregnancy outcomes across the range of Hb concentrations. Findings Between January 2012 and December 2018, 130,888 pregnant women were enrolled in the South Asian sites had a Hb measurement available, delivered and were included in the analyses. Overall, the mean Hb concentration of pregnant women from the sites was 9.9 g/dL, 10.0 g/dL in the Indian sites and 9.5 g/dL in the Pakistan site. Hb concentrations < 7 g/dL were observed in 6.9% of the pregnant Pakistani women and 0.2% of the Indian women. In both the Pakistani and Indian sites, women with higher parity and women with no formal education had lower Hb concentrations. In the Pakistani site, women > 35 years of age, women with ≥4 children and those who enrolled in the third trimester were more likely to have Hb concentrations of < 7 g/dL but these associations were not found for the Indian sites. When adjusting for potential confounders, for both India and Pakistan, lower Hb concentrations were associated with stillbirth, preterm birth, lower mean birthweight, and increased risk of low birthweight. In the Pakistani site, there was evidence of a U-shaped relationship between Hb concentrations and low birth weight, and neonatal mortality, and in India with hypertensive disease. Interpretation This study documented the relationship between maternal Hb concentrations and adverse pregnancy outcomes in women from the Pakistani and Indian sites across the range of Hb values. Both low and high Hb concentrations were associated with risk of at least some adverse outcomes. Hence, both low and high values of Hb should be considered risk factors for the mother and fetus.

scholarly journals Health Selection into Eviction: Adverse Birth Outcomes and Children’s Risk of Eviction through Age 5

2021 ◽  
Author(s):  
Gabriel L Schwartz ◽  
Kathryn M Leifheit ◽  
Lisa F Berkman ◽  
Jarvis T Chen ◽  
Mariana C Arcaya
Keyword(s):  
Birth Outcomes ◽  
Low Birthweight ◽  
Proportional Hazards ◽  
Birth Outcome ◽  
Rental Housing ◽  
Fold Increase ◽  
Adverse Birth Outcomes ◽  
Future Health ◽  
Increased Risk ◽  
Hospital Stays

Abstract Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. In this paper, we test whether infants experiencing an adverse birth outcome—low birthweight or prematurity, as well as lengthy hospital stays—are more likely to be evicted in early childhood, through age 5. We analyze 5,655 observations contributed by 2,115 participants in the Fragile Families and Child Wellbeing Study—a national, randomly sampled cohort of infants born in large US cities between 1998 and 2000—living in rental housing at baseline. We fit proportional hazards models using piecewise logistic regression, controlling for an array of confounders and applying inverse probability of selection weights. We find that being born low birthweight/preterm is associated with a 1.74-fold increase in children’s hazard of eviction (95%CI=1.02,2.95), while lengthy neonatal hospital stays were independently associated with a relative hazard of 2.50 (CI=1.15,5.44) compared to uncomplicated births. Given recent findings that unstable housing during pregnancy is associated with adverse birth outcomes, our results suggest eviction and health may be cyclical and co-constitutive. Children experiencing adverse birth outcomes are vulnerable to eviction and require additional supports.

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 Maternal and Neonatal Outcomes Associated with Psychostimulant Use in Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ximena Camacho ◽  
Alys Havard ◽  
Helga Zoega ◽  
Margaret Wilson ◽  
Tara Gomes ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Cohort Analysis ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
The Usa ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes. Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers. ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)). Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.

Being a refugee or having a refugee status? Birthweight and gestational age outcomes among offspring of immigrant mothers in Sweden

2018 ◽  
Vol 47 (7) ◽  
pp. 730-734 ◽  
Author(s):  
Sol Juárez ◽  
Eleonora Mussino ◽  
Anders Hjern
Keyword(s):  
Birth Outcomes ◽  
Gestational Age ◽  
Low Birthweight ◽  
Reference Group ◽  
Multinomial Regression ◽  
Refugee Status ◽  
Residence Permit ◽  
Swedish Population ◽  
Migration Status ◽  
Migratory Status

Aims: to evaluate whether the information on refugee status based on the residence permit is a useful source of information for perinatal health surveillance. Methods: Using the Swedish population registers (1997-2012), we use multinomial regression models to assess the associations between migration status (refugee and non-refugee) and birth outcomes derived from birthweight and gestational age: low birthweight (LBW) (<2500 g), macrosomia (≥4000 g); preterm: (<37 w) and post-term (≥42 w). The Swedish-born population was used as a reference group. Results: Compared to the Swedish-born population, an increased OR (odds ratio) of LBW and post-term was found among migrants with and without refugee status (respectively: OR for refugees: 1.47 [95% CI: 1.33-1.63] and non-refugees:1.27 [95% CI: 1.18-1.38], for refugees: 1.41 [95% CI: 1.35-1.49] and non-refugees:1.04 [95% CI: 1.00-1.08]) with statistically significant differences between these two migrant categories. However, when looking at specific regions of origin, few regions show differences by refugee status. Compared to Swedes, lower or equal ORs of preterm and macrosomia are observed regardless of migratory status. Conclusions: Small or no differences were observed in birth outcomes among offspring of women coming from the same origin with different migratory status, compared to their Swedish counterparts. This suggests that information on migration status is not a relevant piece of information to identify immigrant women at higher risk of experiencing adverse reproductive outcomes. Our results however might be explained by the large proportion of women coming to Sweden for family reunification who are classified as non-refugee migrants.

Association of Triglyceride-glucose Index and the Risk of Incident Diabetes: a Secondary Analysis Based on a Chinese Cohort Study

2020 ◽  
Author(s):  
Xiaoli Li ◽  
Guilong Li ◽  
Tiantian Cheng ◽  
Jing Liu ◽  
Guangyao Song ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Incident Diabetes ◽  
Family History Of Diabetes ◽  
Tyg Index ◽  
Fasting Plasma ◽  
Increased Risk ◽  
The Relationship

Abstract BackgroundTriglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance. However, study on the relationship between TyG index and incident diabetes remains limited. This study aimed to investigate the association between TyG index and incident diabetes in a large cohort of Chinese population.MethodsThe present study was a retrospective cohort study using healthy screening programme data in China. A total of 201,298 subjects free of baseline diabetes were included who received a health check with all medical records from 2010 to 2016. TyG index was calculated as Ln[fasting triglyceride level (mg/dl) x fasting plasma glucose (mg/dl)/2]. Diagnosis of diabetes was based on fasting plasma glucose ≥ 7.00 mmol/L and/or self-reported diabetes. Cox proportion-hazard model was used to assess the relationship between TyG index at baseline and the risk of incident diabetes. It should be noted that the data was uploaded to the DATADRYAD website, and we only used this data for secondary analysis.ResultsDuring a mean follow-up of 3.12 years of 201,298 individuals aged ≥ 20 years old, 3389 subjects developed diabetes. After adjusting for age, sex, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, low density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, serum creatinine, smoking, drinking and family history of diabetes, multivariate cox hazards regression analysis indicated that TyG index was positive correlation with the risk of developing diabetes in Chinese population (HR, 3.34; 95% CI, 3.11 to 3.60). The risk of incident diabetes increased with increasing TyG index. Subjects with TyG index in the fourth quartile were 6.26 times more likely to develop diabetes than the lowest quartile (P trend < 0.001). Subgroup analysis showed the stronger association was observed in the population with age < 40, BMI (≥ 18.5, < 24 kg/m2), SBP < 140 mmHg or females (all P for interaction < 0.0001).Conclusions TyG index was independently correlated with the increased risk of diabetes in Chinese adults, suggesting that TyG index may be a useful marker for identifying individuals at high risk of developing diabetes.

scholarly journals Low Birthweight Is Associated with Higher Risk of High Blood Pressure in Chinese Girls: Results from a National Cross-Sectional Study in China

2019 ◽  
Vol 16 (16) ◽  
pp. 2898
Author(s):  
Xijie Wang ◽  
Yanhui Dong ◽  
Zhiyong Zou ◽  
Jun Ma ◽  
Zhaogeng Yang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Low Birthweight ◽  
Cross Sectional Study ◽  
Anthropometric Parameters ◽  
Cross Sectional ◽  
School Based ◽  
Chi Squared ◽  
Chinese Girls ◽  
The Relationship

Objective: To investigate the relationship between low birthweight (LBW) and blood pressure and to assess whether LBW leads to a higher risk of high blood pressure (HBP) by gender in Chinese students aged 6–18 years. Also, to investigate whether the association was affected by childhood obesity. Methods: Data was obtained from a baseline dataset of a national school-based program. Anthropometric parameters, including height, weight, and blood pressure, were measured, while birthweight and other characteristics were obtained from questionnaires. Stratified chi-squared tests were used to compare the prevalence of HBP between LBW and normal birthweight (NBW) groups in each age and sex category. Multivariable logistic regressions were conducted to estimate the HBP risks in each birthweight group. Results: Both systolic and diastolic blood pressure showed a U-shaped relationship with increased birthweight. Compared to NBW groups, LBW girls showed a higher HBP risk, with an odds ratio of 1.29 (95% confidence interval (CI): 1.02, 1.64, p = 0.033), regardless of their current body mass index status, while no significant association in boys was found. Conclusions: Low birthweight is associated with higher HBP risk in adolescent girls, regardless of their childhood BMI status.

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