scholarly journals A Strategic Program for Risk Assessment and Intervention to Mitigate Environmental Stressor-Related Adverse Pregnancy Outcomes in the Indian Population

2021 ◽  
Vol 3 ◽  
Author(s):  
Divyanu Jain ◽  
Ajay K. Jain ◽  
Gerlinde A. S. Metz ◽  
Nina Ballanyi ◽  
Abha Sood ◽  
...  
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Pregnancy Outcomes ◽  
Local Level ◽  
Adverse Pregnancy Outcomes ◽  
Environmental Stressors ◽  
World Health ◽  
Strategic Program ◽  
Adverse Pregnancy ◽  
Health Organization

The Problem: Global environmental stressors of human health include, but are not limited to, conflict, migration, war, natural disasters, climate change, pollution, trauma, and pandemics. In combination with other factors, these stressors influence physical and mental as well as reproductive health. Maternal stress is a known factor for adverse pregnancy outcomes such as preterm birth (PTB); however, environmental stressors are less well-understood in this context and the problem is relatively under-researched. According to the WHO, major Indian cities including New Delhi are among the world's 20 most polluted cities. It is known that maternal exposure to environmental pollution increases the risk of premature births and other adverse pregnancy outcomes which is evident in this population.Response to the Problem: Considering the seriousness of this problem, an international and interdisciplinary group of researchers, physicians, and organizations dedicated to the welfare of women at risk of adverse pregnancy outcomes launched an international program named Optimal Pregnancy Environment Risk Assessment (OPERA). The program aims to discover and disseminate inexpensive, accessible tools to diagnose women at risk for PTB and other adverse pregnancy outcomes due to risky environmental factors as early as possible and to promote effective interventions to mitigate these risks. OPERA has been supported by the Worldwide Universities Network, World Health Organization (WHO) and March of Dimes USA.Addressing the Problem: This review article addresses the influence of environmental stressors on maternal-fetal health focusing on India as a model population and describes the role of OPERA in helping local practitioners by sharing with them the latest risk prediction and mitigation tools. The consequences of these environmental stressors can be partially mitigated by experience-based interventions that build resilience and break the cycle of inter- and-transgenerational transmission. The shared knowledge and experience from this collaboration are intended to guide and facilitate efforts at the local level in India and other LMIC to develop strategies appropriate for the jurisdiction for improving pregnancy outcomes in vulnerable populations.

scholarly journals The Effect of Different Treatment Regimens and Multiple Risk Factors on Adverse Pregnancy Outcomes among Syphilis-Seropositive Women in Guangzhou: A Retrospective Cohort Study

2020 ◽  
Vol 2020 ◽  
pp. 1-14 ◽  
Author(s):  
Fang Hu ◽  
Shuai-Jun Guo ◽  
Jian-Jun Lu ◽  
Sui Zhu ◽  
Ning-Xuan Hua ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnancy Outcomes ◽  
Congenital Syphilis ◽  
Adverse Pregnancy Outcomes ◽  
World Health ◽  
Chinese Government ◽  
Treatment Regimens ◽  
Recommended Treatment ◽  
Adverse Pregnancy ◽  
Health Organization

Background. To eliminate mother-to-child transmission of syphilis, the Chinese government recommends a treatment regimen that slightly differs from the World Health Organization- (WHO-) recommended treatment. However, little is known about their difference in efficacy. This study is aimed at comparing the effect of China-recommended and WHO-recommend treatment regimens on adverse pregnancy outcomes (APOs) and at examining associated risk factors of APOs among syphilis-seropositive women. Methods. Using the syphilis registry data, we retrospectively collected data from 4488 syphilis-infected pregnant women in Guangzhou during 2011-2018. Multivariate analyses were used to investigate the association between treatment regimens and APOs (ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth or low birth weight, newborn smaller than gestational age, congenital syphilis, and infant death) and the association between risk factors and APOs. Results. Of 3474 participants, 27.3% had at least one APO. Compared to those receiving WHO-recommended treatment, women who received China-recommended treatment were less likely to have APOs (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.38-0.57), whereas those who received no treatment had 1.6 times higher odds of experiencing APOs. One common risk factor across different APOs was high levels of log2-transformed toluidine red unheated serum test (TRUST) titers before treatment (OR 1.14, 95% CI 1.10-1.19). China-recommended treatment was effective in reducing APOs for those with TRUST≥1:8 (OR 0.21, 95% CI 0.14-0.29) and those with TRUST<1:8 (OR 0.62, 95% CI 0.50-0.77). Conclusions. Syphilis-seropositive women receiving China-recommended treatment had lower odds of APOs, especially when TRUST titers before treatment were high. Findings can be used to guide health professionals to reduce APOs among syphilis-infected mothers and promote nationwide use of China-recommended treatment.

scholarly journals Climate change is a major stressor causing poor pregnancy outcomes and child development

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1222
Author(s):  
David M. Olson ◽  
Gerlinde A.S. Metz
Keyword(s):  
Climate Change ◽  
Mental Health ◽  
At Risk ◽  
Pregnancy Outcomes ◽  
Allostatic Load ◽  
Developmental Trajectories ◽  
Adverse Pregnancy Outcomes ◽  
Ecological Resilience ◽  
Adverse Pregnancy ◽  
Climate Crisis

The climate crisis is the existential threat of our times and for generations to come. This is no longer a threat but a reality affecting us, our children, and the generations that follow. Pregnant mothers, their fetuses, and their children are among those at greatest risk in every population and every jurisdiction. A timely consideration is the health of racialized groups who are particularly vulnerable owing to the confluence of several risk factors that are compounded by climate change. Included among these are Indigenous communities that are the most directly threatened by climate change. This review discusses the main health challenges faced by mothers, fathers, and their children during the climate crisis, focusing on mental health as a causal factor. Exploration of this topic includes the role of prenatal maternal and paternal stresses, allostatic load, and the effect of degradation of the environment and ecosystems on individuals. These will be examined in relation to adverse pregnancy outcomes and altered developmental trajectories of children. The climate crisis is a health threat multiplier that amplifies the health inequities of the most at-risk populations and individuals. It accelerates the increase in allostatic load of those at risk. The path of tragedy begins with an accumulating allostatic load that overwhelms both individual and socio-ecological resilience. This can lead to worse mental health including depression and anxiety and, in the case of pregnant women and their children, more adverse pregnancy outcomes and impaired developmental trajectories for their newborn children. We argue that there is an urgent need to develop new (or re-discover or re-purpose existing) tools that will predict communities and individuals who are experiencing the highest levels of climate-related hazards and intervene to reduce stress and increase resilience in pre-conceptual women and men, pregnant and post-partum women, and their young children.

scholarly journals 390: Serum screening for aneuploidy generates an enriched population at risk for adverse pregnancy outcomes

2011 ◽  
Vol 204 (1) ◽  
pp. S159
Author(s):  
Kristen Quinn ◽  
Veronique Tache ◽  
Andrew Hull ◽  
Louise Laurent ◽  
Douglas Woelkers
Keyword(s):  
At Risk ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Population At Risk ◽  
Serum Screening ◽  
Adverse Pregnancy

scholarly journals Nutritional status of pregnant women: prevalence and associated pregnancy outcomes

2001 ◽  
Vol 35 (6) ◽  
pp. 502-507 ◽  
Author(s):  
Luciana Bertoldi Nucci ◽  
Maria Inês Schmidt ◽  
Bruce Bartholow Duncan ◽  
Sandra Costa Fuchs ◽  
Eni Teresinha Fleck ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Nutritional Status ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Educational Level ◽  
Adverse Pregnancy Outcomes ◽  
World Health ◽  
Prepregnancy Weight ◽  
Adverse Pregnancy ◽  
The Impact

INTRODUCTION: Although obesity is well recognized as a current public health problem, its prevalence and impact among pregnant women have been less investigated in Brazil. The objective of the study was to evaluate the impact of pre-obesity and obesity among pregnant women, describing its prevalence and risk factors, and their association with adverse pregnancy outcomes. METHODS: A cohort of 5,564 pregnant women, aged 20 years or more, enrolled at aproximately 20 to 28 weeks of pregnancy, seen in prenatal public clinics of six state capitals in Brazil were followed up, between 1991 and 1995. Prepregnancy weight, age, educational level and parity were obtained from a standard questionnaire. Height was measured in duplicate and the interviewer assigned the skin color. Nutritional status was defined using body mass index (BMI), according to World Health Organization (WHO) criteria. Odds ratios and 95% confidence interval were calculated using logistic regression. RESULTS: Age-adjusted prevalences (and 95% CI) based on prepregnancy weight were: underweight 5.7% (5.1%-6.3%), overweight 19.2% (18.1%-20.3%), and obesity 5.5% (4.9%-6.2%). Obesity was more frequently observed in older black women, with a lower educational level and multiparous. Obese women had higher frequencies of gestational diabetes, macrosomia, hypertensive disorders, and lower risk of microsomia. CONCLUSIONS: Overweight nutritional status (obesity and pre-obesity) was seen in 25% of adult pregnant women and it was associated with increased risk for several adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia.

scholarly journals Are Newborns of Immigrant Mothers More at Risk of Poorer Perinatal Health Than Those of Natives-born Mothers? One Size Does Not Fit All. A Population-based Study, Montreal, Quebec.

2021 ◽  
Author(s):  
Mouctar Sow ◽  
Myriam De Spiegelaere ◽  
Marie-Pierre Sylvestre ◽  
Marie-France Raynault
Keyword(s):  
At Risk ◽  
Pregnancy Outcomes ◽  
Immigrant Women ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Perinatal Health ◽  
Income Quintile ◽  
Low Ses ◽  
Immigrant Mothers ◽  
Adverse Pregnancy

Abstract Background The risk of unfavourable pregnancy outcomes for immigrant mothers varies according to their birthplace, socioeconomic status (SES) and comparison group. This study aims to identify the characteristics of Montreal newborns who are more or less at risk of LBW, prematurity and SGA, according to the mother's birthplace and SES. Methods The analysis focuses on all singleton live births in Montreal between 2003 and 2012 (N=214,620). Logistic regression models were estimated using generalized estimating equations in order to: 1) compare the risk of adverse pregnancy outcomes between Canadian-born and immigrant mothers. The latter were categorised into 8 groups according to world regions; 2) estimate the odds ratio of the association between adverse pregnancy outcomes and the mother's SES (education and income quintile) for each group. Results The risk of LBW, prematurity and SGA vary considerably depending on the mother’s birthplace. For these three outcomes, mothers from the Caribbean and South Asia have a higher prevalence than all other groups. Three other groups compare favourably to Canadian-born mothers: mothers from North Africa, Europe & the USA, and Central and West Asia. The association between SES and unfavourable pregnancy outcomes varies from one group of mothers to another. Among Canadian-born mothers, there is a classic health gradient, with low SES mothers being particularly vulnerable. While income is not associated with the risk of adverse outcomes among immigrant mothers, education is for many groups. The association is however weaker than for Canadian-born mothers. Conclusions It is important to assess the influence of both immigration and SES to better identify the children who are most at risk of experiencing perinatal health concerns. In Montreal, some immigrant women are particularly vulnerable, but so are socioeconomically disadvantaged native Canadian women. Conversely, North African-born mothers with low SES present a particularly low risk. It has also been found that a high level of education reduces the risk among several groups of immigrant women, as opposed to findings in other contexts.

scholarly journals FP337ARE WOMEN WITH A SOLITARY KIDNEY AT RISK FOR ADVERSE PREGNANCY OUTCOMES?

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii181-iii181
Author(s):  
Giorgina Barbara Piccoli ◽  
Rossella Attini ◽  
Gianfranca Cabiddu ◽  
Silvia Parisi ◽  
Marta Nazha ◽  
...  
Keyword(s):  
At Risk ◽  
Pregnancy Outcomes ◽  
Solitary Kidney ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Pregnancy

scholarly journals Measles and Pregnancy: Immunity and Immunization—What Can Be Learned from Observing Complications during an Epidemic Year

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Rosalia Ragusa ◽  
Armando Platania ◽  
Mario Cuccia ◽  
Gaetano Zappalà ◽  
Gabriele Giorgianni ◽  
...  
Keyword(s):  
Health Care ◽  
At Risk ◽  
Immune Response ◽  
Pregnant Women ◽  
Health Care Workers ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Measles Outbreak ◽  
Care Workers ◽  
Adverse Pregnancy

Measles is a highly contagious airborne disease. Unvaccinated pregnant women are not only at risk of infection but also at risk of severe pregnancy complications. As measles causes a dysregulation of the entire immune system, we describe immunological variations and how immune response mechanisms can lead to adverse pregnancy outcomes. We evaluated data during the measles outbreak reported in the province of Catania, Italy, from May 2017 to June 2018. We controlled hospital discharge records for patients admitted to hospital obstetric wards searching the measles diagnostic code. We have indicated the case as “confirmed” when the IgM was found to be positive with the ELISA method. We registered 843 cases of measles and 51% were females (430 cases). 24 patients between the ages of 17 and 40 had measles while they were pregnant. Adverse pregnancy outcomes included 2 spontaneous abortions, 1 therapeutic abortion, 1 foetal death, and 6 preterm deliveries. Respiratory complications were more prevalent in pregnant women (21%) than in nonpregnant women with measles (9%). 14 health care workers (1.7%) were infected with measles, and none of these had been previously vaccinated. Immune response mechanisms were associated with adverse pregnancy outcomes in women with measles. To reduce the rate of measles complications, gynaecologists should investigate vaccination history and antibody test results in all women of childbearing age. During a measles outbreak, gynaecologists and midwives should be active proponents of vaccination administration and counteract any vaccine hesitancy not only in patients but also among health care workers.

scholarly journals The safety of isoniazid tuberculosis preventive treatment in pregnant and postpartum women: systematic review and meta-analysis

2020 ◽  
Vol 55 (3) ◽  
pp. 1901967
Author(s):  
Yohhei Hamada ◽  
Carmen Figueroa ◽  
Mario Martín-Sánchez ◽  
Dennis Falzon ◽  
Avinash Kanchar
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Current Knowledge ◽  
Preventive Treatment ◽  
Adverse Pregnancy Outcomes ◽  
World Health ◽  
Current Evidence ◽  
Drug Discontinuation ◽  
Adverse Pregnancy ◽  
In Pregnancy

BackgroundThe World Health Organization (WHO) recommends tuberculosis (TB) preventive treatment for high-risk groups. Isoniazid preventive therapy (IPT) has been used globally for this purpose for many years, including in pregnancy. This review assessed current knowledge about the safety of IPT in pregnancy.MethodsWe searched PubMed, Embase, CENTRAL, Global Health Library and HIV and TB-related conference abstracts, until May 15, 2019, for randomised controlled trials (RCTs) and non-randomised studies (NRS) where IPT was administered to pregnant women. Outcomes of interest were: 1) maternal outcomes, including permanent drug discontinuation due to adverse drug reactions, any grade 3 or 4 drug-related toxic effects, death from any cause and hepatotoxicity; and 2) pregnancy outcomes, including in utero fetal death, neonatal death or stillbirth, preterm delivery/prematurity, intrauterine growth restriction, low birth weight and congenital anomalies. Meta-analyses were conducted using a random-effects model.ResultsAfter screening 1342 citations, nine studies (of 34 to 51 942 participants) met inclusion criteria. We found an increased likelihood of hepatotoxicity among pregnant women given IPT (risk ratio 1.64, 95% CI 0.78–3.44) compared with no IPT exposure in one RCT. Four studies reported on pregnancy outcomes comparing IPT exposure to no exposure among pregnant women with HIV. In one RCT, adverse pregnancy outcomes were associated with IPT exposure during pregnancy (odds ratio (OR) 1.51, 95% CI 1.09–2.10), but three NRS showed a protective effect.ConclusionsWe found inconsistent associations between IPT and adverse pregnancy outcomes. Considering the grave consequences of active TB in pregnancy, current evidence does not support systematic deferral of IPT until postpartum. Research on safety is needed.

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