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 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 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 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

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.

scholarly journals Maternal exposure to Wenchuan earthquake and prolonged risk of offspring birth outcomes: a natural experiment study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Qiguo Lian ◽  
Jiaying Ni ◽  
Jun Zhang ◽  
Julian Little ◽  
Shan Luo ◽  
...  
Keyword(s):  
Wenchuan Earthquake ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Maternal Exposure ◽  
Adverse Birth Outcomes ◽  
Reproductive Outcomes ◽  
2008 Wenchuan Earthquake ◽  
The 2008 Wenchuan Earthquake ◽  
Stratified Analysis

Abstract Background The prolonged effects of disasters on reproductive outcomes among the survivors are less studied, and the findings are inconsistent. We examined the associations of maternal exposure to the 2008 Wenchuan earthquake years before conception with adverse birth outcomes. Methods We included 73,493 women who delivered in 96 hospitals in 24 provinces and autonomous regions from the 2015/16 China Labor and Delivery Survey. We weighted the multivariable logistic models based on the combination of coarsened exact matching (CEM) weight and survey weight, and performed sex-stratified analysis to test whether associations of maternal earthquake exposure with adverse birth outcomes (Stillbirth, preterm birth [PTB], low birthweight [LBW], and small for gestational age [SGA]) varied by sex. Results The bivariate models showed that the weighted incidence of each adverse birth outcome was higher in exposed group than unexposed group: stillbirth (2.00% vs. 1.33%), PTB (14.14% vs. 7.32%), LBW (10.82% vs. 5.76%), and SGA (11.32% vs. 9.52%). The multivariable models showed maternal earthquake exposure was only associated significantly with a higher risk of PTB in offspring among all births (adjusted risk ratio [aRR](95%CI):1.25(1.06–1.48), P = 0.010). The sex-stratified analysis showed the association was significant among male births (aRR (95%CI): 1.40(1.12–1.75),P = 0.002),but unsignificant among female births. The sensitivity analysis reported similar findings. Conclusions The 2008 Wenchuan earthquake exposure has a long-term effect on PTB. Maternal acute exposure to disasters could be a major monitor for long-term reproductive outcomes. More attention should be paid to the underlining reasons for disaster-related adverse birth outcomes.

scholarly journals Influence of Prenatal Exposure to Mercury, Perceived Stress, and Depression on Birth Outcomes in Suriname: Results from the MeKiTamara Study

2020 ◽  
Vol 17 (12) ◽  
pp. 4444
Author(s):  
Anisma R. Gokoel ◽  
Wilco C. W. R. Zijlmans ◽  
Hannah H. Covert ◽  
Firoz Abdoel Wahid ◽  
Arti Shankar ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Prenatal Exposure ◽  
Perceived Stress ◽  
Apgar Score ◽  
Low Birthweight ◽  
Depression Scale ◽  
Study Cohort ◽  
Adverse Birth Outcomes ◽  
Probable Depression

Prenatal exposure to mercury, stress, and depression may have adverse effects on birth outcomes. Little is known on the influence of chemical and non-chemical stressors on birth outcomes in the country of Suriname. We assessed the influence of prenatal exposure to mercury, perceived stress, and depression on adverse birth outcomes in 1143 pregnant Surinamese women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between mercury (≥1.1 μg/g hair, USEPA action level/top versus bottom quartile), probable depression (Edinburgh Depression Scale ≥12), high perceived stress (Cohen’s Perceived Stress Scale ≥20), and adverse birth outcomes (low birthweight (<2500 g), preterm birth (<37 completed weeks of gestation), and low Apgar score (<7 at 5 min)) were assessed using bivariate and multivariate logistic regressions. Prevalence of elevated mercury levels, high perceived stress, and probable depression were 37.5%, 27.2%, and 22.4%, respectively. Mercury exposure was significantly associated with preterm birth in the overall study cohort (OR 2.47; 95% CI 1.05–5.83) and perceived stress with a low Apgar score (OR 9.73; 95% CI 2.03–46.70). Depression was not associated with any birth outcomes. These findings can inform policy- and practice-oriented solutions to improve maternal and child health in Suriname.

scholarly journals Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study

2016 ◽  
Vol 4 (29) ◽  
pp. 1-76 ◽  
Author(s):  
Paul Aylin ◽  
Phillip Bennett ◽  
Alex Bottle ◽  
Stephen Brett ◽  
Vinnie Sodhi ◽  
...  
Keyword(s):  
Observational Study ◽  
Pregnant Women ◽  
Spontaneous Abortion ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Attributable Risk ◽  
Adverse Birth Outcomes ◽  
Inpatient Stay ◽  
Underlying Condition ◽  
Obstetric Surgery

BackgroundPrevious research suggests that non-obstetric surgery is carried out in 1–2% of all pregnancies. However, there is limited evidence quantifying the associated risks. Furthermore, of the evidence available, none relates directly to outcomes in the UK, and there are no current NHS guidelines regarding non-obstetric surgery in pregnant women.ObjectivesTo estimate the risk of adverse birth outcomes of pregnancies in which non-obstetric surgery was or was not carried out. To further analyse common procedure groups.Data SourceHospital Episode Statistics (HES) maternity data collected between 2002–3 and 2011–12.Main outcomesSpontaneous abortion, preterm delivery, maternal death, caesarean delivery, long inpatient stay, stillbirth and low birthweight.MethodsWe utilised HES, an administrative database that includes records of all patient admissions and day cases in all English NHS hospitals. We analysed HES maternity data collected between 2002–3 and 2011–12, and identified pregnancies in which non-obstetric surgery was carried out. We used logistic regression models to determine the adjusted relative risk and attributable risk of non-obstetric surgical procedures for adverse birth outcomes and the number needed to harm.ResultsWe identified 6,486,280 pregnancies, in 47,628 of which non-obstetric surgery was carried out. In comparison with pregnancies in which surgery was not carried out, we found that non-obstetric surgery was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that for every 287 pregnancies in which a surgical operation was carried out there was one additional stillbirth; for every 31 operations there was one additional preterm delivery; for every 25 operations there was one additional caesarean section; for every 50 operations there was one additional long inpatient stay; and for every 39 operations there was one additional low-birthweight baby.LimitationsWe have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Many spontaneous abortions will not be associated with a hospital admission and, therefore, will not be included in our analysis. A spontaneous abortion may be more likely to be reported if it occurs during the same hospital admission as the procedure, and this could account for the associated increased risk with surgery during pregnancy. There are missing values of key data items to determine parity, gestational age, birthweight and stillbirth.ConclusionsThis is the first study to report the risk of adverse birth outcomes following non-obstetric surgery during pregnancy across NHS hospitals in England. We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Our observational study can never attribute a causal relationship between surgery and adverse birth outcomes, and we were unable to determine the risk of not undergoing surgery where surgery was clinically indicated. We have some reservations over associations of risk factors with spontaneous abortion because of potential ascertainment bias. However, we believe that our findings and, in particular, the numbers needed to harm improve on previous research, utilise a more recent and larger data set based on UK practices, and are useful reference points for any discussion of risk with prospective patients. The risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery is relatively low, confirming that surgical procedures during pregnancy are generally safe.Future workFurther evaluation of the association of non-obstetric surgery and spontaneous abortion. Evaluation of the impact of non-obstetric surgery on the newborn (e.g. neonatal intensive care unit admission, prolonged length of neonatal stay, neonatal death).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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