scholarly journals Adolescent, Pregnant, and HIV-Infected: Risk of Adverse Pregnancy and Perinatal Outcomes in Young Women from Southern Mozambique

2021 ◽  
Vol 10 (8) ◽  
pp. 1564
Author(s):  
Clara Pons-Duran ◽  
Aina Casellas ◽  
Azucena Bardají ◽  
Anifa Valá ◽  
Esperança Sevene ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Maternal Morbidity ◽  
Low Birthweight ◽  
Negative Binomial ◽  
Perinatal Outcomes ◽  
Sub Saharan Africa ◽  
P Value ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Impact

Sub-Saharan Africa concentrates the burden of HIV and the highest adolescent fertility rates. However, there is limited information about the impact of the interaction between adolescence and HIV infection on maternal health in the region. Data collected prospectively from three clinical trials conducted between 2003 and 2014 were analysed to evaluate the association between age, HIV infection, and their interaction, with the risk of maternal morbidity and adverse pregnancy and perinatal outcomes in women from southern Mozambique. Logistic regression and negative binomial models were used. A total of 2352 women were included in the analyses; 31% were adolescents (≤19 years) and 29% HIV-infected women. The effect of age on maternal morbidity and pregnancy and perinatal adverse outcomes was not modified by HIV status. Adolescence was associated with an increased incidence of hospital admissions (IRR 0.55, 95%CI 0.37–0.80 for women 20–24 years; IRR 0.60, 95%CI 0.42–0.85 for women >25 years compared to adolescents; p-value < 0.01) and outpatient visits (IRR 0.86, 95%CI 0.71–1.04; IRR 0.76, 95%CI 0.63–0.92; p-value = 0.02), and an increased likelihood of having a small-for-gestational age newborn (OR 0.50, 95%CI 0.38–0.65; OR 0.43, 95%CI 0.34–0.56; p-value < 0.001), a low birthweight (OR 0.40, 95%CI 0.27–0.59; OR 0.37, 95%CI 0.26–0.53; p-value <0.001) and a premature birth (OR 0.42, 95%CI 0.24–0.72; OR 0.51, 95%CI 0.32–0.82; p-value < 0.01). Adolescence was associated with an increased risk of poor morbidity, pregnancy and perinatal outcomes, irrespective of HIV infection. In addition to provision of a specific maternity care package for this vulnerable group interventions are imperative to prevent adolescent pregnancy.

scholarly journals Impact of the Length of Interpregnancy Interval on Obstetric Outcomes

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S S T Mohammed ◽  
S A Ashoush ◽  
K H Sweedan ◽  
R R Ali
Keyword(s):  
Risk Factor ◽  
Pregnancy Outcomes ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Obstetric Outcomes ◽  
Fetal Survival ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Impact

Abstract Background Inter-pregnancy interval (IPI) is defined as the period between the last delivery and conception of the current pregnancy. Both short and long intervals between pregnancies have been associated with an increased risk of variable adverse outcomes, such as preterm birth, low birth weight (LBW), small size for gestational age, and perinatal death. Aim of the Work To assess the impact of IPI as a risk factor for adverse pregnancy and perinatal outcomes. Patients and Methods This study was held in Ain Shams University Maternity Hospital on 1719 patients ranging between the ages of 18-35 years. They were divided into three groups according to the length of their IPI [444 patients in group p1 (6-18 months), 847 patients in group p2 (18-48) and 428 patients in group p3 (&gt; 48 months)]. The aim of this study was to assess the impact of IPI as a risk factor for adverse pregnancy and perinatal outcomes. Results The incidence of LBW among patients with IPI 6-18 months was 11.5%, 12.5% among those with IPI 18-48 months and 16.8% among those with IPI &gt; 48 months. It was also found that the rate of short IPI decreases with age, being more common among the younger age, lower parity groups. The incidence of gestational DM increased with longer IPI. Parity, previous miscarriages, cesarean sections and preterm labor were all significantly associated with the length of IPI. Conclusion This study confirms that both shorter and longer IPIs are associated with increased risks of adverse pregnancy outcomes. This study provides critical information relevant for improving pregnancy outcomes and fetal survival.

scholarly journals Maternal factors of newborn low birthweight in malaria endemic settings of Nanoro, rural Burkina Faso

2020 ◽  
Author(s):  
Moussa Lingani ◽  
Serge H. Zango ◽  
Innocent Valéa ◽  
Daniel Valia ◽  
Maïmouna Sanou ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Intermittent Preventive Treatment ◽  
Sub Saharan Africa ◽  
Bed Nets ◽  
P Value ◽  
Maternal Factors ◽  
Cross Sectional ◽  
Increased Risk

Abstract Background. In sub-Saharan Africa, the intermittent preventive treatment of malaria in pregnancy using sulphadoxine pyrimethamine (IPTp-SP) strategy is recommended to limit malaria adverse effects on birth outcomes. Ten year after IPTp-SP was adopted in Burkina Faso, we assessed the magnitude and maternal factors of low birthweight (LBW) in Nanoro.Methods. A secondary analysis of data from a cross-sectional study was carried out in women who gave birth at Nanoro peripheral health centers using a binary multivariate logistic regression. Maternal socio-demographic factors, gyneco-obstetrical history and relevant medical characteristics were evaluated to identify associated factors. A p-value less than 0.05 was considered statistically significant.Results. Of 291 delivery records examined, 14 % of women received three or more doses of SP while 80% used bed nets the night before their admission for delivery. Malaria was detected in 36.1% and anemia in 52.9% of women. The average neonate birthweight was 2933 g and 12 % were born with a low birthweight. By multivariate analysis, first delivery (OR = 8.84, [95% CI: 3.72-21.01]), and being multiparous with history of stillbirth (OR = 5.03, [95% CI: 1.54-16.40]) were significantly associated with an increased risk of LBW.Conclusion. LBW was still prevalent in rural Nanoro and the uptake of three or more doses of SP for the IPTp was low. In addition, to improving the coverage of the 3-dose IPTp-SP, it may be necessary to target interventions aiming to reduce maternal anemia such as adequate nutrients uptake to mitigate the issue of adverse birth outcomes.

scholarly journals Maternal Factors of Newborn Low Birthweight in Malaria Endemic Settings of Nanoro, Rural Burkina Faso

2020 ◽  
Author(s):  
Moussa Lingani ◽  
Henri S. Zango ◽  
Innocent Valéa ◽  
Daniel Valia ◽  
Maïmouna Sanou ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Low Birthweight ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Sub Saharan Africa ◽  
Bed Nets ◽  
P Value ◽  
Maternal Factors ◽  
Cross Sectional ◽  
Increased Risk

Abstract Background. In sub-Saharan Africa, the intermittent preventive treatment of malaria in pregnancy with sulphadoxine pyrimethamine (IPTp-SP) strategy is recommended to limit malaria consequences on birth outcomes. Ten year after IPTp-SP was adopted in Burkina Faso, we assessed the magnitude of low birthweight (LBW) and its maternal factors in Nanoro.Methods. A secondary analysis of data from a cross-sectional study was carried out in women who gave birth at Nanoro peripheral health centers using a binary multivariate logistic regression. Maternal socio-demographic factors, gyneco-obstetrical history and relevant medical characteristics were evaluated to identify associated factors. A p-value less than 0.05 was considered statistically significant.Results. Of 291 delivery records examined, 14 % of women received three or more doses of SP while 80% used bed nets the night before their admission for delivery. Malaria was detected in 36.1% and anemia in 52.9% of women. The average neonate birthweight was 2933 g and 12 % of them were born with a low birthweight. After multivariate analysis, first delivery (OR = 8.84, [95% CI: 3.72-21.01]), and being multiparous with history of stillbirth (OR = 5.03, [95% CI: 1.54-16.40]) were significantly associated with an increased risk of LBW.Conclusion. LBW is still prevalent in rural Nanoro and the uptake of three or more doses of SP for the IPTp was low. In addition, to improving the coverage of IPTp-SP to improve birthweight, an extension of the target of antenatal care to other known causes of LBW including curable sexually transmitted infections may be necessary.

scholarly journals Sub-optimal Intermittent Preventive Treatment in pregnancy (IPTp) is associated with an increased risk of submicroscopic P. falciparum infection in pregnant women: a prospective cohort study in Benin

2020 ◽  
Author(s):  
Cornélia P A Hounkonnou ◽  
Nicaise Tuikue Ndam ◽  
Nadine Fievet ◽  
Manfred Accrombessi ◽  
Emmanuel Yovo ◽  
...  
Keyword(s):  
Gestational Age ◽  
Negative Binomial ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Sub Saharan Africa ◽  
Increased Risk ◽  
Sub Saharan ◽  
The Impact ◽  
In Pregnancy

Abstract Background Harmful maternal and neonatal health outcomes result from malaria in pregnancy, the prevention of which primarily relies on intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP). WHO recommends IPTp-SP in sub-Saharan Africa, but implementation is highly heterogeneous and often sub-optimal in terms of the number of doses and their timing. In this study, we assessed the impact of this heterogeneity on malaria in pregnancy, mainly with respect to submicroscopic Plasmodium falciparum infections. Methods We used data from 273 Beninese women followed throughout pregnancy. Screening for P. falciparum infections, using both microscopy- and polymerase chain reaction (PCR) -based methods, was performed monthly, and information on IPTp-SP dose was collected. Gestational age was estimated by repeated ultrasound scans. Using a negative binomial model, we investigated the effect of IPTp-SP doses and timing, after 17 weeks of gestation, on the number of P. falciparum infections, focusing on submicroscopic infections detectable only by PCR. Results At least two IPTp-SP doses were taken by 77.3% of the women. The median gestational age at first IPTp-SP dose was 22 weeks. A late first IPTp-SP dose (&gt;21.2 weeks) was marginally associated with an increased number of P. falciparum infections (adjusted incidence rate ratio [aIRR] =1.3; p=0.098). The number of IPTp-SP doses was not associated with the number of submicroscopic infections (aIRR=1.2, p=0.543). Conclusion A late first IPTp-SP dose fail to provide optimal protection against P. falciparum, especially submicroscopic infections. This highlights the need for a new antimalarial drug for IPTp that could be taken early in pregnancy.

scholarly journals A prospective study on evaluation of maternal and foetal outcomes of hypothyroidism with levothyroxine and prevalence of hypothyroidism in pregnancy in a tertiary care teaching hospital in Kerala

2020 ◽  
Vol 9 (3) ◽  
pp. 392
Author(s):  
Shajil A. Justin ◽  
Merin S. Johnson
Keyword(s):  
Universal Screening ◽  
Tertiary Care ◽  
Perinatal Outcomes ◽  
Thyroid Stimulating Hormone ◽  
Antenatal Visit ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Impact ◽  
Levothyroxine Treatment ◽  
In Pregnancy

Background: Pregnancy influences a profound alteration in thyroid function and hypothyroidism has a massive impact on adverse pregnancy outcomes. An appropriate treatment with appropriate dose of levothyroxine is much essential during pregnancy. The present study evaluates the effect of levothyroxine dose in preventing maternal and foetal outcomes and the prevalence of hypothyroidism among pregnant women.Methods: 1500 antenatal women with singleton gestation attending outpatient of Obstetrics and Gynaecology Department, were analysed. Apart from routine obstetrical investigations, thyroid stimulating hormone (TSH) tests were done at the first antenatal visit. Patients were followed up till delivery after levothyroxine treatment. Their obstetrical and perinatal outcomes were noted. TSH estimation was done 3 days after delivery in new-borns to screen for neonatal thyroid disorders.Results: The prevalence of hypothyroidism was 10.54%. The common adverse maternal and foetal complications were preeclampsia (15.19%) and low birth weight babies (17.72%) respectively. The mean age of pregnant women was 26.66 years. As age advances there is an increased risk of developing hypothyroidism in pregnancy. Levothyroxine 25 μg daily was highly prescribed in 63.92% hypothyroid patients.Conclusions: Overall, the prevalence of hypothyroidism was high. Since maternal and foetal complications were higher in patients with hypothyroidism, levothyroxine treatment had decreased the risk of maternal and foetal outcome. Pre-pregnancy screening should be implemented at least in patients with high risk factors for thyroid dysfunction. Universal screening for new-borns is also recommended to detect hypothyroidism. Expert decisions and cost-effectiveness studies will promulgate the impact of universal screening.

756 The Moderating Influence of Depression on Insomnia and Suicidal Ideation in a Military Sample

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A294-A295
Author(s):  
Emma Palermo ◽  
Jennifer Goldschmied ◽  
Elaine Boland ◽  
Elizabeth A Klingaman ◽  
Philip Gehrman ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Suicidal Ideation ◽  
Research University ◽  
Negative Binomial ◽  
Suicide Attempts ◽  
Risk And Resilience ◽  
Depression Severity ◽  
Significant Interaction Effect ◽  
Increased Risk ◽  
The Impact

Abstract Introduction Military personnel are at an increased risk for suicide compared to the general population, making it important to develop a deeper understanding of which factors contribute to this elevated risk. Given that suicidal ideation (SI) is one of the strongest predictors of suicide attempts, understanding factors that underlie SI may improve prevention efforts. Insomnia and depression both serve as independent risk factors for SI, and therefore the aim of this study was to examine the extent to which depressive symptoms moderate the association between insomnia and SI. Methods Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS). Soldiers (n=21,450) completed questions related to suicidal ideation (5 items), depressive symptoms (9 items), and insomnia (5 items) based on symptom presence in the past 30 days. Items in each domain were summed to create a total severity score. GEE models using a negative binomial linking function were conducted to examine the impact of depression, insomnia, and their interaction on SI. Results Both depression (χ2 =117.56, p&lt;0.001) and insomnia (χ2=11.79, p=0.0006) were found to have significant main effects on SI, and there was a significant interaction effect (χ2=4.52, p=0.0335). Follow up simple effects revealed that insomnia was no longer significantly associated with SI when depression severity was low, but was associated with SI in the presence of greater depression severity (χ2=2.91, p=0.0882). Conclusion In a large sample of Army soldiers, depression significantly moderated the association between SI and insomnia, such that insomnia seems to amplify the effects of depression on SI. These findings highlight the importance of addressing insomnia severity as a mean of reducing SI in those with depression, potentially allowing for intervention prior to a suicide attempt. Support (if any) Perlis: K24AG055602 & R01AG041783. This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan- http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.

scholarly journals Neurodevelopment in Children Exposed to Zika Virus: What Are the Consequences for Children Who Do Not Present with Microcephaly at Birth?

Viruses ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1427
Author(s):  
Paula Sobral da Silva ◽  
Sophie Eickmann ◽  
Ricardo Ximenes ◽  
Celina Martelli ◽  
Elizabeth Brickley ◽  
...  
Keyword(s):  
Neurological Examination ◽  
Zika Virus ◽  
Control Group ◽  
P Value ◽  
Zikv Infection ◽  
Clinical Neurological Examination ◽  
Cognitive Delay ◽  
Increased Risk ◽  
Neurodevelopmental Impairment ◽  
The Impact

The relation of Zika virus (ZIKV) with microcephaly is well established. However, knowledge is lacking on later developmental outcomes in children with evidence of maternal ZIKV infection during pregnancy born without microcephaly. The objective of this analysis is to investigate the impact of prenatal exposure to ZIKV on neuropsychomotor development in children without microcephaly. We evaluated 274 children including 235 ZIKV exposed and 39 controls using the Bayley-III Scales of Infant and Toddler Development (BSIDIII) and neurological examination. We observed a difference in cognition with a borderline p-value (p = 0.052): 9.4% of exposed children and none of the unexposed control group had mild to moderate delays. The prevalence of delays in the language and motor domains did not differ significantly between ZIKV-exposed and unexposed children (language: 12.3% versus 12.8%; motor: 4.7% versus 2.6%). Notably, neurological examination results were predictive of neurodevelopmental delays in the BSIDIII assessments for exposed children: 46.7% of children with abnormalities on clinical neurological examination presented with delay in contrast to 17.8% among exposed children without apparent neurological abnormalities (p = 0.001). Overall, our findings suggest that relative to their unexposed peers, ZIKV-exposed children without microcephaly are not at considerably increased risk of neurodevelopmental impairment in the first 42 months of life, although a small group of children demonstrated higher frequencies of cognitive delay. It is important to highlight that in the group of exposed children, an abnormal neuroclinical examination may be a predictor of developmental delay. The article contributes to practical guidance and advances our knowledge about congenital Zika.

scholarly journals The impact of antenatal care on under‐five mortality in Ethiopia: a difference‐in‐differences analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Samuel Oduse ◽  
Temesgen Zewotir ◽  
Delia North
Keyword(s):  
Antenatal Care ◽  
Child Survival ◽  
First Trimester ◽  
Sub Saharan Africa ◽  
P Value ◽  
Difference In Differences ◽  
Under Five ◽  
Care Services ◽  
Sub Saharan ◽  
The Impact

Abstract Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

scholarly journals Association between Malaria Infection and Early Childhood Development Mediated by Anemia in Rural Kenya

2020 ◽  
Vol 17 (3) ◽  
pp. 902
Author(s):  
Erin M. Milner ◽  
Patricia Kariger ◽  
Amy J. Pickering ◽  
Christine P. Stewart ◽  
Kendra Byrd ◽  
...  
Keyword(s):  
At Risk ◽  
Social Development ◽  
Malaria Infection ◽  
Sub Saharan Africa ◽  
Gross Motor ◽  
Children Under Five ◽  
Under Five ◽  
Increased Risk ◽  
Social Delay ◽  
The Impact

Malaria is a leading cause of morbidity and mortality among children under five years of age, with most cases occurring in Sub-Saharan Africa. Children in this age group in Africa are at greatest risk worldwide for developmental deficits. There are research gaps in quantifying the risks of mild malaria cases, understanding the pathways linking malaria infection and poor child development, and evaluating the impact of malaria on the development of children under five years. We analyzed the association between malaria infection and gross motor, communication, and personal social development in 592 children age 24 months in rural, western Kenya as part of the WASH Benefits environmental enteric dysfunction sub-study. Eighteen percent of children had malaria, 20% were at risk for gross motor delay, 21% were at risk for communication delay, and 23% were at risk for personal social delay. Having a positive malaria test was associated with increased risk for gross motor, communication, and personal social delay while adjusting for child characteristics, household demographics, study cluster, and intervention treatment arm. Mediation analyses suggested that anemia was a significant mediator in the pathway between malaria infection and risk for gross motor, communication, and personal social development delays. The proportion of the total effect of malaria on the risk of developmental delay that is mediated by anemia across the subscales was small (ranging from 9% of the effect on gross motor development to 16% of the effect on communication development mediated by anemia). Overall, malaria may be associated with short-term developmental delays during a vulnerable period of early life. Therefore, preventative malaria measures and immediate treatment are imperative for children’s optimal development, particularly in light of projections of continued high malaria transmission in Kenya and Africa.

scholarly journals The Impact of Potassium Channel Gene Polymorphisms on Antiepileptic Drug Responsiveness in Arab Patients with Epilepsy

2018 ◽  
Vol 8 (4) ◽  
pp. 37 ◽  
Author(s):  
Laith AL-Eitan ◽  
Islam Al-Dalalah ◽  
Afrah Elshammari ◽  
Wael Khreisat ◽  
Ayah Almasri
Keyword(s):  
Potassium Channel ◽  
Disease Susceptibility ◽  
Case Control ◽  
P Value ◽  
Myoclonic Seizure ◽  
Increased Risk ◽  
Epileptic Patients ◽  
Drug Responsiveness ◽  
The Impact ◽  
Increased Susceptibility

This study aims to investigate the effects of the three potassium channel genes KCNA1, KCNA2, and KCNV2 on increased susceptibility to epilepsy as well as on responsiveness to antiepileptic drugs (AEDs). The pharmacogenetic and case-control cohort (n = 595) consisted of 296 epileptic patients and 299 healthy individuals. Epileptic patients were recruited from the Pediatric Neurology clinic at the Queen Rania Al Abdullah Hospital (QRAH) in Amman, Jordan. A custom platform array search for genetic association in Jordanian-Arab epileptic patients was undertaken. The MassARRAY system (iPLEX GOLD) was used to genotype seven single nucleotide polymorphisms (SNPs) within three candidate genes (KCNA1, KCNA2, and KCNV2). Only one SNP in KCNA2, rs3887820, showed significant association with increased risk of susceptibility to generalized myoclonic seizure (p-value < 0.001). Notably, the rs112561866 polymorphism of the KCNA1 gene was non-polymorphic, but no significant association was found between the KCNA1 (rs2227910, rs112561866, and rs7974459) and KCNV2 (rs7029012, rs10967705, and rs10967728) polymorphisms and disease susceptibility or drug responsiveness among Jordanian patients. This study suggests that a significant association exists between the KCNA2 SNP rs3887820 and increased susceptibility to generalized myoclonic seizure. However, the present findings indicate that the KCNA1 and KCNV2 SNPs do not influence disease susceptibility and drug responsiveness in epileptic patients. Pharmacogenetic and case-control studies involving a multicenter and multiethnic approach are needed to confirm our results. To improve the efficacy and safety of epilepsy treatment, further studies are required to identify other genetic factors that contribute to susceptibility and treatment outcome.

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