scholarly journals Burden of soil-transmitted helminth infection in pregnant refugees and migrants on the Thailand-Myanmar border: Results from a retrospective cohort

2021 ◽  
Vol 15 (3) ◽  
pp. e0009219 ◽  
Author(s):  
Tobias Brummaier ◽  
Nay Win Tun ◽  
Aung Myat Min ◽  
Mary Ellen Gilder ◽  
Laypaw Archasuksan ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Research Unit ◽  
Migrant Population ◽  
Maternal Anaemia ◽  
Concentration Method ◽  
Faecal Samples

Background Soil-transmitted helminth (STH) infections are widespread in tropical and subtropical regions. While many STH infections are asymptomatic, vulnerable populations such as pregnant women face repercussions such as aggravation of maternal anaemia. However, data on prevalence and the effect of STH infections in pregnancy are limited. The aim of this analysis was to describe the burden of STH infections within and between populations of pregnant women from a local refugee camp to a mobile migrant population, and to explore possible associations between STH infection and pregnancy outcomes. Methodology This is a retrospective review of records from pregnant refugee and migrant women who attended Shoklo Malaria Research Unit antenatal care (ANC) clinics along the Thailand-Myanmar border between July 2013 and December 2017. Inclusion was based on provision of a stool sample during routine antenatal screening. A semi-quantitative formalin concentration method was employed for examination of faecal samples. The associations between STH mono-infections and maternal anaemia and pregnancy outcomes (i.e., miscarriage, stillbirth, preterm birth, and small for gestational age) were estimated using regression analysis. Principal findings Overall, 12,742 pregnant women were included, of whom 2,702 (21.2%) had a confirmed infection with either Ascaris lumbricoides, hookworm, Trichuris trichiura, or a combination of these. The occurrence of STH infections in the refugee population (30.8%; 1,246/4,041) was higher than in the migrant population (16.7%; 1,456/8,701). A. lumbricoides was the predominant STH species in refugees and hookworm in migrants. A. lumbricoides and hookworm infection were associated with maternal anaemia at the first ANC consultation with adjusted odds ratios of 1.37 (95% confidence interval (CI) 1.08–1.72) and 1.65 (95% CI 1.19–2.24), respectively. Pregnant women with A. lumbricoides infection were less likely to miscarry when compared to women with negative stool samples (adjusted hazard ratio 0.63, 95% CI 0.48–0.84). STH infections were not significantly associated with stillbirth, preterm birth or being born too small for gestational age. One in five pregnant women in this cohort had STH infection. Association of STH infection with maternal anaemia, in particular in the event of late ANC enrolment, underlines the importance of early detection and treatment of STH infection. A potential protective effect of A. lumbricoides infection on miscarriage needs confirmation in prospective studies.

scholarly journals Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stephanie Polus ◽  
Jacob Burns ◽  
Sabine Hoffmann ◽  
Tim Mathes ◽  
Ulrich Mansmann ◽  
...  
Keyword(s):  
Time Series ◽  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Preterm Births ◽  
Interrupted Time Series ◽  
Federal States ◽  
Very Preterm ◽  
The Impact

AbstractIn 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation.

scholarly journals Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 157-166 ◽  
Author(s):  
Sonia Johnson ◽  
Becky Liu ◽  
Erkan Kalafat ◽  
Basky Thilaganathan ◽  
Asma Khalil
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Risk Ratio ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Gestational Hypertension ◽  
White Coat Hypertension ◽  
Chronic Hypertension ◽  
Increased Risk ◽  
Risk Of Preeclampsia

The aim of this meta-analysis is to investigate whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes. Medline, EMBASE, www.Clinicaltrials.gov , and Cochrane Library databases were searched electronically in December 2019. The outcomes were compared between pregnant women with WCH and normotensive controls, women with chronic hypertension, gestational hypertension or any hypertensive disorder of pregnancy. Twelve studies were eligible for inclusion in the systematic review. Women with WCH enrolled below 20 weeks had a significantly increased risk of preeclampsia (pooled risk ratio [RR], 5.43 [95% CI, 2.00–14.71]). Furthermore, women with WCH had increased risk of delivering a small-for-gestational-age newborn (RR, 2.47 [95% CI, 1.21–5.05], P =0.013) and preterm birth (RR, 2.86 [95% CI, 1.44–5.68], P =0.002). The risk of preeclampsia (risk ratio, 0.43 [95% CI, 0.23–0.78], P =0.005), small-for-gestational-age (RR, 0.46 [95% CI, 0.26–0.82], P =0.008), preterm birth (RR, 0.47 [95% CI, 0.31–0.71], P <0.001) were significantly lower with WCH compared with women with gestational hypertension. Women with WCH delivered ≈1 week later compared with women with chronic hypertension (mean difference, 1.06 weeks [95% CI, 0.44–1.67 weeks]; P <0.001). WCH is associated with a worse perinatal and maternal outcome than normotension, but better outcomes than gestational hypertension and chronic hypertension. Therefore, diagnosis of WCH should be ascertained in pregnant women presenting with hypertension. When the diagnosis is confirmed, these women require monitoring for developing preeclampsia, small-for-gestational-age and preterm birth.

scholarly journals Pre-conceptional intake of folic acid supplements is inversely associated with risk of preterm birth and small-for-gestational-age birth: a prospective cohort study

2015 ◽  
Vol 115 (3) ◽  
pp. 509-516 ◽  
Author(s):  
Ju-Sheng Zheng ◽  
Yuhong Guan ◽  
Yimin Zhao ◽  
Wei Zhao ◽  
Xuejuan Tang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Folic Acid ◽  
Preterm Birth ◽  
Birth Cohort ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Lower Risk ◽  
Folic Acid Supplementation ◽  
Acid Supplementation

AbstractAssociations of folic acid supplementation with risk of preterm birth (PTB) and small-for-gestational-age (SGA) birth were unclear for the Chinese populations. The aim of the present study was to investigate the associations in a large Chinese prospective cohort study: the Jiaxing Birth Cohort. In the Jiaxing Birth Cohort, 240 954 pregnant women visited local clinics or hospitals within their first trimester in Southeast China during 1999–2012. Information on anthropometric parameters, folic acid supplementation and other maternal characteristics were collected by in-person interviews during their first visit. Pregnancy outcomes were recorded during the follow-up of these participants. Multinomial logistic regression was used to examine the association of folic acid supplementation with pregnancy outcomes. The prevalence of folic acid supplementation was 24·9 % in the cohort. The prevalence of PTB and SGA birth was 3·48 and 9·2 %, respectively. Pre-conceptional folic acid supplementation was associated with 8 % lower risk of PTB (relative risk (RR) 0·92; 95 % CI 0·85, 1·00; P=0·04) and 19 % lower risk of SGA birth (RR 0·81; 95 % CI 0·70, 0·95; P=0·008), compared with non-users. Higher frequency of pre-conceptional folic acid use was associated with lower risk of PTB (Ptrend=0·032) and SGA birth (Ptrend=0·046). No significant association between post-conceptional initiation of folic acid supplementation and either outcome was observed. In conclusion, the present study suggests an association between pre-conceptional, but not post-conceptional, folic acid supplementation and lower risk of PTB and SGA birth in the Jiaxing Birth Cohort. Further research in other cohorts of large sample size is needed to replicate these findings.

scholarly journals Gestational Weight Gain During the Second and Third Trimesters and Adverse Pregnancy Outcomes, Results From a Prospective Pregnancy Cohort in Urban Tanzania

2021 ◽  
Author(s):  
Jiaxi Yang ◽  
Molin Wang ◽  
Deirdre K. Tobias ◽  
Janet W. Rich-Edwards ◽  
Anne Marie Darling ◽  
...  
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Gestational Weight ◽  
Pregnancy Cohort ◽  
Adverse Pregnancy

Abstract Background Appropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort. Methods We used data from a randomized clinical trial conducted among pregnant women recruited by 27 weeks of gestation in Dar es Salaam, Tanzania (N = 1,230). Women’s gestational weight was measured at baseline and at monthly antenatal visits. Weekly GWG rate during the second and third trimesters was calculated and characterized as inadequate, adequate, or excessive, in conjunction with measured or imputed early-pregnancy BMI status according to the 2009 Institute of Medicine (IOM) GWG guidelines. We used multivariable Poisson regression with a sandwich variance estimator to calculate risk ratios (RR) for associations of GWG with low birth weight, preterm birth, small for gestational age (SGA), and large for gestational age (LGA). Degree of appropriate GWG defined using additional metrics (i.e., percentage of adequacy, z-score) and potential effect modification by maternal BMI were additionally evaluated. Results According to the IOM guidelines, 517 (42.0%), 270 (22.0%), and 443 (36.0%) women were characterized as having inadequate, adequate, and excessive GWG, respectively. Overall, compared to women with adequate GWG, women with inadequate GWG had a lower risk of LGA births (RR=0.54, 95% CI: 0.36 - 0.80) and a higher risk of SGA births (RR=1.32, 95% CI: 0.95 - 1.81). ­­Women with inadequate GWG as defined by percentage of GWG adequacy had a higher risk of LBW (OR=1.93, 95% CI: 1.03 - 3.63). In stratified analyses by early-pregnancy BMI, excessive GWG among women with normal BMI was associated with a higher risk of preterm birth (RR=1.59, 95% CI: 1.03 - 2.44). Conclusions A comparatively high percentage of excessive GWG was observed among healthy pregnant women in Tanzania. Both inadequate and excessive GWGs were associated with elevated risks of poor pregnancy outcomes. Future studies among diverse SSA populations are warranted to confirm our findings, and clinical recommendations on optimal GWG should be developed to promote healthy GWG in SSA settings. Trial registration This trial was registered as “Prenatal Iron Supplements: Safety and Efficacy in Tanzania” (NCT01119612; http://clinicaltrials.gov/show/NCT01119612).

scholarly journals 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

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.

scholarly journals Adverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset

2021 ◽  
Author(s):  
Heidi Preis ◽  
Brittain Mahaffey ◽  
Susmita Pati ◽  
Cassandra Heiselman ◽  
Marci Lobel
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Maternal Stress ◽  
High Stress ◽  
Perinatal Outcomes ◽  
Well Being ◽  
Prenatal Maternal Stress ◽  
Adverse Perinatal Outcomes

Abstract Background High stress prenatally contributes to poor maternal and infant well-being. The coronavirus disease 2019 (COVID-19) pandemic has created substantial stress for pregnant women. Purpose To understand whether stress experienced by women pregnant at the beginning of the pandemic was associated with a greater prevalence of adverse perinatal outcomes. Methods Pregnant women across the USA aged ≥18 years old enrolled in a prospective cohort study during the pandemic onset (T1) in April–May 2020. This report focuses on the 1,367 participants who gave birth prior to July–August 2020 (T2). Hierarchical logistic regression models predicted preterm birth, small for gestational age infants, and unplanned operative delivery from T1 stress, sociodemographic, and medical factors. Results After controlling for sociodemographic and medical factors, preterm birth was predicted by high prenatal maternal stress, delivering an infant small for gestational age was predicted by interpersonal violence and by stress related to being unprepared for birth due to the pandemic, and unplanned cesarean or operative vaginal delivery was predicted by prenatal appointment alterations, experiencing a major stressful life event, and by stress related to being unprepared for birth due to the pandemic. Independent of these associations, African American women were more likely than other groups to deliver preterm. Conclusion Pregnant women who are experiencing high stress during the COVID-19 pandemic are at risk of poorer perinatal outcomes. A longitudinal investigation is critical to determine whether prenatal maternal stress and resulting outcomes have longer-term consequences for the health and well-being of children born in the midst of the current pandemic.

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

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