Risk Factors for Placental Malaria, Sulfadoxine-pyrimethamine Doses, and Birth Outcomes in a Rural to Urban Prospective Cohort Study on the Bandiagara Escarpment and Bamako, Mali

BackgroundMalaria in Mali remains a primary cause of morbidity and mortality, with women at high risk during pregnancy for placental malaria (PM). We evaluated risk for PM and its association with birth outcomes in a rural to urban longitudinal cohort on the Bandiagara Escarpment and the District of Bamako. MethodsWe collected placental samples (N = 317) from 249 mothers who were participants in our longitudinal cohort study. A placental pathologist and research assistant evaluated the samples by histology in blinded fashion to assess PM infection stage and parasite density. We used generalized estimating equations (GEE) to model the odds of PM infection.ResultsPregnancies in Bamako, beyond secondary education, births in the rainy season (instead of the hot dry season), births in later years of the study, and births to women who had > 3 doses of sulfadoxine-pyrimethamine (SP) instead of no doses of SP were associated with reduced odds of experiencing PM (active and past infections combined). We found improved birth outcomes (+ 285 g birth weight, + 2 cm birth length, + 75 g placental weight) for women who had > 3 doses of SP compared to no doses, but did not detect a difference in birth weight or length for women who had 2 instead of > 3 SP doses. However, at 2 instead of > 3 doses placentas were 36 g lighter and the odds of low birth weight (< 2500 g) were 14% higher. Severe parasite densities were significantly associated with decreases in birth weight, birth length, and placental weight, as were chronic PM infections. The women who received no SP during pregnancy (7% of the study total) were younger and lacked primary school education. The women who received ≥ 3 doses of SP came from more affluent families.ConclusionsWomen who received no doses of SP during pregnancy experienced the most disadvantageous birth outcomes in both Bamako and on the Bandiagara Escarpment. Such women tended to be younger and to have had no primary school education. Targeting such women for antenatal care, which is the setting at which SP is most commonly administered in Mali, will have a more positive impact on public health than focusing on the increment from two to three doses of SP.

EFFECT OF ZINK TABLETS INTERVENTION IN ZINC DEFICIENCY OF TRIMESTER III PREGNANT WOMEN TOWARD WEIGHT AND BODY LENGTH OF NEWBORN

Background: According to 2018 World Health Organization (WHO) data globally, an estimated 17.3% of the population has inadequate zinc intake, with estimates ranging from 5.7% in Oceania to 7.6% in Europe, 9.6% in America and the Caribbean, highest in Africa (23.9%) and Asia (19.6%). Zinc is important for the function of a number of enzymes and growth hormones during pregnancy. In pregnant women, the relative zinc concentration decreases up to 35% due to the influence of hormonal changes and the transport of nutrients from mother to baby. Objectives: The purpose of this study was to identify the effect of giving zinc tablets to pregnant women with zinc deficiency in the third trimester on body weight and length of babies born at the Makassar City Health Center. Methods: This type of research is True Experimental with a pretest-posttest design with a control group. The sample in this study was 62 samples of third trimester pregnant women, and the sampling technique used was purposive sampling. Measurement of zinc levels in third trimester pregnant women using the Elisa reader kit at the Research Laboratory of the Hasanuddin University Teaching Hospital. The research instruments were in the form of a research explanation sheet, respondent's consent sheet, respondent's checklist sheet, and the mother's zinc tablet consumption control sheet for 14 days. Results: Judging from the average value of newborns in pregnant women who did not have zinc deficiency, the average value of birth weight in pregnant women with zinc deficiency was 15.70 g/dL and 18.95 g/dL. zinc deficiency with a value (p < 0.05), while pregnant women with zinc deficiency have an average birth length of 10.00 g/dL and mothers who do not have a deficiency of 19.87 g/dL with a value (p < 0.05). So, it can be concluded that giving zinc tablets to pregnant women in the third trimester has an effect on Birth Weight (BBL) and Birth Length (PBL). Conclusion: Giving zinc tablets has an effect on increasing zinc levels in third trimester zinc deficiency pregnant women and increasing birth weight and length of the baby.

Is increased size at birth associated with longevity on the population level? – A historical and comparative analysis of regions in Sweden

Increased population longevity could be influenced by early life factors. Some areas have long-lived populations, also in a historical perspective. We aimed to study these factors in Halland, an area with the highest life expectancy in Sweden. We collected archival data on gestational age and birth characteristics from 995 live singleton full-term births at the Halmstad Hospital, Halland, from the period 1936 to 1938 and compared these to 3364 births from three hospitals in nearby Scania for the period 1935–1945. In addition, data were obtained on maternal and offspring characteristics from the national Swedish Medical Birth Register during 1973–2013. The results show that when controlling for background maternal and offspring characteristics, mean birth weight (BW) and mean birth length were higher in Halland than in Scania, but the proportion of low birth weight (LBW) and small for gestational age (SGA) was lower. However, mean BW for Halland did not differ from the rest of Sweden in recent years 2004–2013. We also conducted a mortality follow-up for children born in Scania, which showed that LBW, being born SGA, or short birth length reduced survival. In conclusion, the high mean life expectancy in Halland compared to the rest of Sweden could have been associated with beneficial early life factors influencing birth size in the past. In more recent decades the mean BW of Halland is not different from the national mean. Thus, longevity could be expected to become more equal to the national mean in the future.

Determinant Factors of Stunting in Under-Five Children

BACKGROUND: The high rate of stunting cases is a serious nutritious problem that still persists in Indonesia. The problem is potentially impactful on the quality of the country’s human resources. AIM: This present study aimed to analyze the determinant factors of stunting cases in 24–59-month-old children in the working area of Puskesmas or Community Health Center in Kota Tengah, Gorontalo. METHOD: The case-control survey analytical research involved a case population of 34 people and a control population of 34 people. All the participants were 24–59 months old. All case populations were treated as the research subject, while the control population was calculated based on the formula. A simple random sampling technique was employed to acquire the sample in the control group. The study involved independent variables of birth length, birth weight, provision of exclusive breastfeeding, and the number of siblings. Meanwhile, the dependent variable was the stunting cases in 24–59-month-old children. The data were analyzed by Chi-square (χ2) and multiple logistic regression statistical tests. RESULTS: The bivariate analysis that used the Chi-square suggested that the birth length (0.001) < (0.05), birth weight (0.003) < (0.05), and provision of exclusive breastfeeding (0.000) < (0.05) were the factors of stunting cases. Meanwhile, parity (1.72) > (0.05) was not a factor of stunting. Moreover, the multivariate analysis involving multiple logistic regression tests indicated that the provision of exclusive breastfeeding (0.006) served as the determinant factor of stunting cases. CONCLUSIONS: The provision of exclusive breastfeeding is the most significant determinant factor of stunting cases.

RISK FACTORS OF STUNTING EVENTS IN TODDLERS AGED 24-59 MONTHS

Background: Stunting is one priority problem in Indonesia. The incidence of stunting in toddlers at the Tambak Wedi Public Health Center Surabaya in 2015 and 2016 were 31.3% and 33%, respectively. This study aims to analyze the risk factors for stunting in toddlers aged 24-59 months in Tambak Wedi Health Center Surabaya. Method: This observational analytic research used cross sectional approach. The population in this study was 220 and the sample size was 110 mothers and toddlers. Samples were selected by proportional cluster random sampling from the population of 220 pairs mothers and toddlers. Independent variables of the mothers include height, upper arm circumference, frequency of ANC visits, weight gain during pregnancy, meanwhile of the toddlers included birth length and birth weight. The dependent variable was stunting. Statistical analysis used chi-square and multiple logistic regression tests. Results: There were 100 pairs of mother and toddlers in the study. Bivariate analysis showed a significant relationship between maternal height (p = 0.025, RR = 0.406), frequency of ANC visits (p = 0.017, RR = 0.382), increase in maternal weight during pregnancy (p = 0.017, RR = 0.328), the baby’s birth length (p = <0.001, RR = 0.256), and the baby's birth weight (p = <0.001, RR = 0.208) with stunting. Multivariate analysis showed maternal height and ANC visit as the significant risk factors of stunting. Conclusion: Maternal height and the frequency of ANC visits were the risk factors for stunting among toddlers aged 24-59 months in Tambak Wedi Public Health Center in Surabaya.

Neonatal Outcomes after Combined Opioid and Nicotine Exposure in Utero: A Scoping Review

Background: The majority of women who are pregnant with opioid use disorder (OUD) also smoke tobacco but are rarely offered tobacco cessation counseling. While the effects of exposure to opioids and nicotine in utero are well-understood separately, understanding the impact of the combined exposure to these substances on neonatal outcomes is lacking. Methods: A scoping review was conducted using PubMed and Scopus databases for studies addressing the combined exposure to opioids and nicotine during pregnancy published between 1 January 1980 and 9 July 2019. A total of 29 papers met the eligibility criteria for inclusion, with nine being identified as clinical trials (three from the MOTHER study) and two as secondary data analysis of clinical trial data. Results: Neonatal outcomes for infants who had a combined exposure to opioids and nicotine in utero indicated a reduction in birth weight and birth length. Findings in infants exposed to both nicotine and opioids were mixed with regard to the duration of neonatal abstinence syndrome (NAS), the likelihood of treatment for NAS, doses of medicine used to treat NAS, and NAS scores when compared with infants who had opioid exposure without nicotine. Conclusions: The combined exposure to nicotine and opioids during pregnancy may lead to a reduction in neonatal birth weight and birth length and more severe NAS signs, compared with opioid use alone, but more research is necessary to identify the minimum dosage and length of nicotine exposure to accurately predict these outcomes.

Effects of n-3 polyunsaturated fatty acid supplementation on pregnancy outcomes: a systematic review and meta-analysis

IntroductionThere are limited studies exploring the effects of n-3 PUFA supplementation on pregnancy outcomes. The goal of this study was to review relevant studies in order to determine the effect of n-3 polyunsaturated fatty acid (n-3 PUFA) supplementation on pregnancy outcomes based on eligible randomized controlled trials (RCTs).Material and methodsQualified studies were searched by keywords in PubMed, the Cochrane library and Embase. Studies from other pertinent sources were also reviewed, and RCTs published before January 2021 were reviewed. For each study, we assessed and synthesized the outcomes by relative risk (RR) or weighted mean difference (WMD) combined with 95% confidence interval (95% CI).ResultsWe included 13 studies with 9069 patients. Compared with the control group, n-3 PUFA significantly decreased the incidence of preterm delivery (RR: 0.898, 95%CI: 0.819~0.984) and low birthweight (RR: 0.797, 95%CI: 0.655~0.970); increased the birth weight (WMD: 99.340, 95%CI: 10.503~188.177) and birth length (WMD: 0.449, 95%CI: 0.236~0.663). There was no significant difference in pregnancy-induced hypertension, preeclampsia, intrauterine growth retardation (IUIG), early preterm delivery, anti-hypertensive therapy, gestational diabetes and head circumference at birth between the two groups.ConclusionsThe available evidence shows that n-3 PUFA is not beneficial in reducing the incidence of maternal pregnancy outcomes such as gestational diabetes mellitus and hypertension; but it is beneficial to neonatal health such as decreasing the incidence of preterm delivery and low birthweight and increasing birth weight and birth length.

Fulfilment of minimum acceptable diet (MAD), short birth length and family income level are associated with stunting in children aged 6-23 months in Central Jakarta

Introduction: Stunting is a condition characterised by retardation in the growth and development of children as a result of chronic inadequate nutritional intake and/or recurrent infectious diseases. This research aims to determine the factors related to stunting occurrence among children aged 6-23 months. Methods: This cross-sectional study was carried out in 2019. The sample was 231 children selected by multistage random sampling technique from 13 Posyandu (integrated healthcare centres) in six administrative villages located across three sub-districts of the Central Jakarta region. Results: The results showed that the prevalence of stunting was 26.0% and minimum acceptable diet (MAD) was only met by 31.6% of the children studied. Chi-square analysis revealed that short birth length (OR=2.176; 95% CI: 1.155–4.098) and family income level (OR=0.388; 95% CI: 0.201–0.749) were significantly associated with stunting. Logistic regression showed that fulfilment of MAD, short birth length (OR=0.471; 95% CI: 0.244–0.909), and family income (OR=0.387; 95% CI: 0.197–0.759) were significant factors for stunting among children 6-23 months in Central Jakarta in 2019, with fulfilment of MAD as a dominant factor (OR=3.29; 95% CI: 1.171–9.241). Conclusion: More efforts need to be done to achieve the recommended MAD for all children aged between 6-23 months and to prevent short birth length. Large scale studies to explore the role of MAD in reducing stunting and qualitative studies to identify the constraints and promoting factors to better infant and young child feeding practices are imperative for programme improvement.

Regional comparative analysis of factors that affect child-birth among women in Ghana after marriage.

Introduction: Infertility or difficulty related to conception and childbirth is still a global health concern including Ghana. Infertility or child-birth associated difficulties after marriage can lead to divorce. However, risk factors associated with child-birth difficulties are often difficult to detect by both the Gynaecologist and the couple involved. This makes proposing solutions to issues related to child-birth usually unsuccessful. Methods: This study seeks to identify risk factors associated with child-birth among married women in Ghana. This was achieved by using a logistic regression model for the dichotomous birth length (birth within 10 months or after 10 months in marriage) variable, adjusting for risk factors of birth length. The data used for the study were obtained from the 2014 Ghana Demographic and Health Survey, consisting of 5,004 complete cases. Statistical analyses were carried out using STATA version 14.1, best-fitting model selected from candidate models using their respective Akaike Information Criterion or Bayesian Information Criterion and the predictive power of such model determined using the Receiver Operating Characteristic curve. Results: Respondents with Akan ethnic background are less likely to deliver their first child after 10 months of marriage, wives who reported that beating is justified if she goes out without her husband's notice are more likely to give birth to their first child after 10 months of marriage, wives who reported that beating is justified when she burns food are less likely to give birth to their first child after 10 months of marriage. A unit increase in the age of respondent at first sex at first cohabitation decreases the likelihood of giving birth to the first child after 10 months in marriage. Rich and middle-class wives are more likely to give birth after 10 months in marriage. Discussion and Conclusions: For wives to conceive within 10 months of marriage, wives and husbands should or are encouraged to have frequent sex, any negative social behaviour or policies must be discouraged. Husbands should openly express their desire and love for their children since this increases the likelihood of wife’s desire to give birth. This leads to frequent sex, which then reduces conception time, and hence, child-birth within the shortest possible time.

Birth weight rather than birth length is associated with childhood behavioural problems in a Czech ELSPAC cohort

Many physical and psychological characteristics are influenced by prenatal development. Some studies have located links between low birth parameters and behavioural problems, with the latter in turn associated with educational progress, career success, overall health, and subsequent life events. However, few studies have investigated whether this association also applies to children in the normal birth growth range. This study thus investigates the relationship between normal-range birth length, weight, and behavioural problems at the age of seven. We use data from the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC) cohort, which provides comprehensive insight into a post-communist country undergoing a period of economic transition. Childhood behavioural problems were measured in 1,796 children using the Strengths and Difficulties Questionnaire. Associations were modelled using weighted logistic regression. Birth weight was found to be linked to the total difficulties score, hyperactivity, and peer relationship problems subscales in a fully adjusted model while birth length was not significantly associated with any subscale in the fully adjusted model. We thus conclude that normal-range birth weight is associated with behavioural problems. It can therefore be assumed that the odds of behavioural problems and their consequences can be mitigated by preventive programs targeting pregnant women and children with lower but still normal weight.