In addition to established risks associated with pre- pregnancy overweight or obesity, there has been increased interest in the potential adverse consequences of excess weight gain in pregnancy, irrespective of the woman ’ s size at the start of pregnancy [18,19]. Given that more than one-third of mothers gain excess weight during pregnancy [20-22], two key issues from a health policy perspective, are (i) to determine whether there is a link between exces- sive weight gain and adversepregnancyoutcomes includ- ing hypertensive disorder of pregnancy, gestational diabetes, caesarean delivery, premature birth, birth weight and placenta weight and (ii) whether this excessive weight gain increased health care utilization. A recent study based on the Danish National Birth cohort (a very large sample of nearly 61,000 mothers and their infants) found that independent of pre-pregnancy BMI, excess weight gain in pregnancy was associated with increased risk of large for gestational age infants, caesarean section delivery, low apgar score and postnatal weight retention in the mother . These adverse perinatal outcomes might be expected to result in excess health care utilization associated with gestational weight gain. However, to our knowledge no previous study has examined whether excess weight gain in pregnancy is associated with increased length of postna- tal hospital stay. Given the independent association of weight gain in pregnancy with adverse perinatal outcomes reported in the Danish National Birth cohort our hypoth- esis is that independent of their BMI at the start of preg- nancy, women who gain more weight in pregnancy will experience greater adversepregnancyoutcomes and will have longer postnatal hospital stays than women who gain less weight in pregnancy. Furthermore, we hypothesise that the association between excessive weight gain and postnatal hospital stay will be mediated (and hence attenu- ate towards the null) by complications of pregnancy and caesarean section delivery.
Background/Aims: Obesity along with high pre- pregnancy body mass index (PP-BMI) is known to cause many adversepregnancyoutcomes. In Thai- land, there is not much study showing both the pre- valence and complications of these conditions. The objectives of this study were to estimate the preva- lence of pre-pregnancy overweight and obesity and their impacts on adversepregnancyoutcomes. Me- thods: This study was a cross sectional study. Data were collected retrospectively from hospital electronic database along with manual retrieval from medical charts and labor records. Data of all delivery women from 1 st February 2011 to 31 st August 2012 were col- lected. When excluded cases with incomplete data and those without PP-BMI, 5420 cases were into ana- lysis. Descriptive and inferential data analyses were used with both univariate and multivariate methods. Results: The proportion of pregnant women with overweight and obesity were 11.1% and 3.9%. After multiple logistic regression analysis was done, women in obesity group were correlated with having 1, 2 and 3 complications. They were also correlated with pre- eclampsia, gestational diabetes, cesarean section, high- er birth weight group and long neonatal length. Con- clusions: This Thai prevalence of obesity in preg- nancy should alarm health care providers to be more prepared, for a future health problem of the country. Many complications that come with obese pregnant women that were reported in western countries also happen in Thai population. Decreasing body weight before conception, giving correct health education, well planned pregnancy; antenatal lifestyle interven- tion and even gestational weight gain restricttion could help avoiding these uneventful morbidities.
The relation between the socioeconomic status (SES), migration and perinatal health varies depending on health issue, socioeconomic indicator, migrant and com- parative groups, and adjustment variables considered [4, 5, 10, 11]. Studies carried out on the subject can be divided into two types, mainly: a) those which focus on the influence of ethnic or geographical origin (place of birth) on perinatal health, by adjusting for socioeco- nomic factors [5, 10, 12–15] and b) those which identify socioeconomic factors that influence perinatal health specifically among migrants [4, 16–19]. There are many studies using the first approach, showing different re- sults, sometimes contradictory ones. Although certain groups of migrants or ethnic groups have a higher risk of suffering adversepregnancyoutcomes, other groups show more favourable perinatal health indicators even if they are socioeconomically vulnerable. The example of mothers of Mexican origin living in the United States, also known as the Mexican paradox, is the most cited . In Belgium, mothers from Maghreb are in a similar situation. They show lower rates of low birth weight and preterm births despite a low SES [13, 20, 21]. In a previ- ous study, we analysed in detail the risk of adverse preg- nancy outcomes according to the place of birth of mothers residing in Brussels .
When the putative interaction between baseline BMI category and inter-pregnancy change in BMI category were examined, statistically significant interactions (weight change effects differing between the four baseline BMI categories) were evident for the risk of some of the most prevalent adversepregnancyoutcomes, namely emergency caesarean section (P = 0.012), LGA (P = 0.009) and placen- tal weight >90 th centile (P = 0.004). On this basis and cognizant that this initial approach may miss detecting interactions for less prevalent outcomes we further sub- divided the data and compared the effects of weight change between pregnancies on second pregnancy pri- mary complication risk for women who had a BMI less than 25 (median 22.4, IQR 21.0 to 23.6) with those who had a BMI above 25 (median 27.5, IQR 26.0 to 30.0) at first pregnancy. This equated to 65 versus 35% of the study population, respectively (Table 3). Data are shown for those adverseoutcomes where weight change was associated with significant linear trends across the BMI change spectrum and/or adjusted odds ratios in at least one baseline BMI category. Women who were over- weight at baseline and who had a modest (median 1.9, IQR 1.4 to 2.4) or large (median 4.5, IQR 3.7 to 6.0) gain in BMI between pregnancies had a two and three fold higher risk of pre-eclampsia at the second pregnancy com- pared with overweight women who were BMI stable (me- dian 0.1, IQR −0.4 to 0.5). No such relationship was evident in women with baseline BMI less than 25 units (healthy weight). In contrast an 80% greater risk of spontaneous pre- term labour was evident in women who lost weight be- tween pregnancies and who had a baseline BMI less than 25 units but not in women who were overweight at base- line. Similarly, both inter-pregnancy weight loss and weight gain heightened the risk of requiring an emergency section in women who had a baseline BMI less than 25 only, with the highest overall risk in the largest BMI gain category. The direction of the association between weight change and the remaining adverseoutcomes shown, namely gesta- tional hypertension and both birth weight extremes was
Background: Abuse and violence against women constitute a global public health problem and are particularly important among women of reproductive age. The literature is not conclusive regarding the impact of violence against pregnant women on adversepregnancyoutcomes, such as preterm birth, small for gestational age and postpartum depression. Most studies have been conducted on relatively small samples of high-risk women. Our objective was to investigate what dimensions of violence against pregnant women were associated with preterm birth, small for gestational age and postpartum depression in a nationally representative sample of Canadian women. Methods: We analysed data of the Maternity Experiences Survey, a nationally representative survey of Canadian women giving birth in 2006. The comprehensive questionnaire included a 19-item section to collect information on different dimensions of abuse and violence, such as type, frequency, timing and perpetrator of violence. The survey design is a stratified simple random sample from the 2006 Canadian Census sampling frame. Participants were 6,421 biological mothers (78% response rate) 15 years and older who gave birth to a singleton live birth and lived with their infant at the time of the survey. Logistic regression was used to compute Odds Ratios. Survey weights were used to obtain point estimates and 95% confidence intervals were obtained with the jacknife method of variance estimation. Covariate control was informed by use of directed acyclic graphs.
Despite unprecedented access to prenatal care, high rates of low birth weight, preterm birth and consequent infant morbidity and mortality persist . One proposed solution is improving the health of women prior to pregnancy or before pregnancy is recognized, i.e preconception health . Preconception care has been defined by the CDC’s Select Panel on Preconception Care as, “a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management. Certain steps should be taken before conception or early in pregnancy to have a maximal effect on health outcomes” . One aim is to improve birth outcomes for high risk women through interconception care by providing interventions to women who have experienced a previous pregnancy with an adverse outcome such as neonatal death, fetal loss, low birth weight, or preterm birth . This is based on the knowledge that prior adverseoutcomes are important risk factors for future adverse poor outcomes . Despite these recommendations, few clinical programs for these populations have been published. One exception is a description of an Interpregnancy Care (IPC) program in which women who had delivered a very low birth weight (<1500 gram) live birth or stillbirth received 24 months of primary care, oral health care, case management and community outreach [3,4]. Key components were the combination of primary care, care coordination and social support to manage conditions linked to adversepregnancyoutcomes, having participants develop a reproductive life plan and through their community support personnel, “Resource Mothers”, acquire vocationally oriented life skills.
In this surveillance study conducted in an area with high seasonal malaria transmission, 4.2% of the pregnancies resulted in pregnancy loss (combined miscarriage, peri- natal death and late neonatal death) mostly due to still- births and early neonatal deaths. Adversepregnancyoutcomes were analyzed in relation to multiple factors such as, maternal age, gravidity, number of ANC visits, malaria prevention (SP-IPTp and ITN), known risk fac- tors and delivery mode. The main risk factors for these 3 adversepregnancyoutcomes included low gravidity (pri- migravid women) and young age. The Global Network’s Maternal Newborn Health Registry conducted in 7 countries (including 2 sites in sub-Saharan Africa) re- ported that overall early neonatal death rate was 20.6 per 1000 live births and neonatal death (during the first 28 days) was 25.7 per 1000 live births . Major risk factors associated with neonatal death included PTD and LBW births . In the same population, the average stillbirth rate was 28.9 per 1000 births . Similar to neonatal death, increased risk of stillbirth was associated with PTD and LBW. Complicated delivery, male fetus, multiple gestation and congenital anomalies were add- itional risk factors of stillbirth . Adolescents living in sub-Saharan Africa and Latin America were at a higher risk of pregnancy resulting in perinatal death compared to women aged 20–35 years . In the current study, Table 5 Univariate logistic regression analysis of maternal
performed by the site principal investigator on a random selection of charts with and without complications. For 82% of the charts reviewed, no discrepancies were found. For those charts with discrepancies between the two ab- stractions, these differences were generally minor and not related to the primary adversepregnancyoutcomes. Preterm births were those delivered prior to 37 weeks, and further classified as spontaneous if after spontaneous onset of labor or premature rupture of membranes. Hypertensive disease of pregnancy included preeclampsia with and with- out severe features, super-imposed preeclampsia, eclamp- sia, and gestational hypertension, as defined according to established criteria . Gestational diabetes mellitus was defined by one of the following glucose tolerance testing (GTT) criteria: fasting 3-h 100 g GTT with two abnormal values [fasting 95 mg/dL or greater, 1-h 180 mg/dL or greater, 2-h 155 mg/dL or greater, 3-h 140 mg/dL or greater]; 2) fasting 2-h 75 g GTT with one abnormal value [fasting 92 mg/dL or greater, 1-h 180 mg/dL or greater, 2-h 153 mg/dL or greater]; or 3) nonfasting 50-g GTT 200 mg/ dL or greater if no fasting 3-h or 2-h GTT was performed . If no GTT data were available, the clinical diagnosis from chart abstraction was used for GDM classification. Small-for-gestational-age (SGA) birthweight was defined as <5th percentile for gestational age at delivery based on Alexander fetal growth curves . Analysis was restricted to pregnancies carried 20 or more weeks of gestation. Women with pre-existing diabetes were identified via chart abstraction of the medical record from the delivery hospitalization (n = 151) and were excluded from analysis of gestational diabetes.
Background/Aims: It is known that high pre-preg- nancy body mass index (BMI) and high gestational weight gain both can cause many adversepregnancyoutcomes. High pre-delivery BMI (PD-BMI), though theoretically could do similar effects, is rarely been studied. The objectives of this study were to show the distribution of PD-BMI of the delivery women and to identify its correlation with adversepregnancy out- comes. Methods: This study was a cross sectional study. Data were collected retrospectively from hos- pital electronic database of Lampang Regional Hos- pital (LPH) along with manual retrieval from medical charts and labor records. Data of all pregnant women who delivered at labor room were collected from 1st February 2011 to 31st August 2012. After preterm and multifetal pregnancies were excluded, 4999 cases were into the analysis. Descriptive and inferential data analyses were used with both univariate and multivariate methods. Results: In this group of women, 93.9% were in the PD-BMI range of 20.0 - 34.9 kg/m 2 . After multivariate analysis was used,
Ante-natal sexual taboos, which prohibit couples from having sexual intercourse from the second trimester of pregnancy, were also established in the study. In African societies, abstinence from sexual intercourse during pregnancy and for some period after childbirth is a com- mon phenomenon, and is believed to be associated with contamination that might be harmful to the unborn baby or the husband and that the mother is considered to be too fragile to have sex [19, 24, 25]. These women may not justify sexual abstinence during pregnancy in biomedical terms, but scientifically the latent function of this custom is to prevent the transmission of sexually transmitted infections (STIs) to a pregnant woman. STIs, including HIV/AIDS, among pregnant women are common in Kenya [26–28] and have been associated with a number of adversepregnancyoutcomes, such as spontaneous abortion, ectopic pregnancy, pre-term de- livery, low birthweight, stillbirth, postpartum sepsis, and congenital infection , thus justifying the custom. However, encouraging sexual abstinence during preg- nancy might result in men seeking extra-marital sex and might thereby increase the spread of STIs. Some preg- nant women in this study opt to use condoms during sexual intercourse to overcome the complications, a practice that needs to be encouraged.
June 1, 2016, in which pregnancyoutcomes in pregnant women with HIV initiating antiretroviral therapy (ART) before conception were compared with those in women beginning ART after conception. We found 11 studies including 19 189 women with HIV, 10 232 of whom started ART before conception and 8957 of whom started ART after conception. ART use during pregnancy has been associated with increased risk of adverse birth outcomes, such as preterm delivery and low birthweight, when compared with use of less complex regimens such as zidovudine prophylaxis in some studies in both low- income and high-income countries. The results of some studies have suggested that adversepregnancyoutcomes could be speciﬁ cally associated with protease inhibitor use during pregnancy, but data from large studies in Botswana and Tanzania suggest such outcomes could also be linked to nevirapine-based or efavirenz-based ART. Very few data are available to allow comparison of pregnancyoutcomes in women initiating ART before conception with outcomes in those beginning ART after conception. Until 2013, in low-income settings, where the largest proportion of women living with HIV are, WHO guidelines recommended use of lifelong ART during pregnancy only for pregnant women with low CD4 cell counts or advanced disease. Thus, the number of women who conceived while taking ART was low. In high-income settings, ART was recommended for all pregnant women, but until 2015, many women with high CD4 cell counts
Martin and Herrmann in 1977 first reported that repeated exposure to semen from the biological father of the baby is associated with a reduced risk of preeclampsia (Marti and Herrmann, 1977). This was subsequently confirmed by other epidemiological studies which demonstrated that the duration of sexual cohabitation before conception was inversely related to the incidence of preeclampsia (Robillard et al., 1994, Einarsson et al., 2003, Saftlas et al., 2014) but refuted by another (Ness et al., 2004). We previously investigated the association between the duration of sexual relationship and its effects on gestational hypertension (GHT), preeclampsia and small for gestational age (SGA) pregnancies in a subset of the SCOPE (Screening fOr Pregnancy Endpoints study) cohort and found that a short duration of sexual relationship was more common among women who developed preeclampsia as well as among those women in the subgroup with SGA and abnormal uterine artery Doppler (Kho et al., 2009). In this study, we aim to investigate the above association in the entire SCOPE cohort and also that between a short duration of sexual relationship and other adversepregnancyoutcomes potentially associated with abnormal placentation namely spontaneous preterm birth (sPTB). Abnormal uterine artery Doppler waveform is a surrogate marker of impaired utero-placental perfusion.
Preconception interventions have been shown to im- prove the maternal health status and, in some cases, have been demonstrated to be effective in limiting the incidence of adversepregnancyoutcomes (APOs) [1, 2]. Until now, preconception health has mainly targeted women. Paternal preconception health has mainly been addressed as an opportunity to preserve the quality of germ cells and fertility, to improve men’s health before conception and to facilitate a better maternal health sta- tus during pregnancy [3–5]. Recently, paternal precon- ception health and lifestyles have been also correlated to the occurrence of malformations and birth defects in the offspring. Specifically, paternal preconception smoking, exposure to environmental substances, medication use, overweight and advanced age have been proved to be as- sociated with low birth weight, congenital cardiac and anorectal malformations, infant cancers and neural tube defects (NTD) [6–12]. It has been proposed that pro- spective fathers should be targeted in preconception in- terventions as well as future mothers [3–5, 13, 14]. Nevertheless, to our knowledge, no actual intervention targeting prospective fathers has ever been reported in the medical literature.
Background/Aims: Excessive gestational weight gain was known to be associated with adversepregnancyoutcomes. It increased the complications during pre- gnancy, delivery and postpartum period. Nevertheless, there are studies reporting the incompliance of preg- nant women with recommendations of weight gain. The objectives of this study were to estimate the pre- valence of high gestational weight gain and to identify the increased adversepregnancyoutcomes in these women. Methods: This was a cross sectional study. Data were collected retrospectively from hospital elec- tronic database of Lampang Regional Hospital (LPH) along with manual retrieval from medical charts and labor records. Data of all pregnant women who de- livered at labor room of LPH were collected from 1st February 2011 to 31st August 2012. After preterm and multifetal pregnancies were excluded, 4747 cases were brought to the study. This study used the new weight gain recommendation from the Institute of Medicine and National Research Council to classify pregnant women by pre-pregnancy body mass index. Data were analyzed by univariate and multivariate analysis. Results: The proportions of pregnant women with different level of weight gain were 28.4%, 38.5% and 33.1% for low, normal and high weight gain. Af- ter multivariate analysis was done to control the con- founders, women with high weight gain were signifi- cantly correlated with having preeclampsia, higher birth weight group, cesarean section and long neona- tal length with relative risk (RR) and 95% confidence interval (95% CI) of 4.84 (2.31 - 10.16), 3.94 (3.24 - 4.79), 2.12 (1.82 - 2.47) and 2.33 (1.90 - 2.86). Conclu- sions: There were more than half of pregnant women that were prone to have inappropriate weight gain. Many complications from high weight gain that have
Some studies suggest an association between abnormal PCI and adversepregnancyoutcomes in singleton preg- nancies including small for gestational age (SGA) in- fants, preterm birth, perinatal death, intrauterine fetal death, and intrapartum complications including emer- gency cesarean delivery (CD) [6–8]. There are also con- flicting results where studies found that SGA infants were more commonly associated with abnormal PCI but the difference was not statistically significant [9, 10], and there were no differences in the risk of preterm birth and intrauterine fetal death between abnormal and nor- mal PCI .
Of the three adversepregnancyoutcomes selected for this study, SGA may be the preferable outcome to study because by definition it adjusts for gestational age. How- ever, our findings still showed some degree of effect mod- ification by gestational age when studying the association between inadequate/no PNC and SGA, so the results should be interpreted with caution. After controlling for maternal age, parity, and within-mother dependency, women receiving inadequate/no PNC were up to 40% more likely to have a SGA birth compared to women receiving other categories of care. This result is consistent with the findings of a New Zealand study that less fre- quent attendance at PNC was associated with SGA . The reason for the observed association between inade- quate PNC and SGA births is not fully understood. How- ever, it is likely that women who do not receive adequate PNC are less likely to receive appropriate treatment or pre- ventive care. SGA births are associated with several poten- tially modifiable risk factors, such as low pre-pregnancy weight, low gestational weight gain, cigarette smoking, and recreational drug use [37,38]. Several of these risk fac- tors may be mitigated or prevented with quality PNC. As with most research, this study has limitations. First, administrative data are prone to a certain degree of coding errors and incomplete data, which may be random or con- tain systematic biases. The number and timing of PNC vis- its was estimated from hospital discharge abstracts and physician claims files, and the accuracy of our estimates may be affected by several factors, such as missing PNC records or receipt of PNC from non-physician providers. We were unable to differentiate missing data from no care using this approach. As well, inaccurate ascertainment of gestational age may affect assignment to a PNC utilization category or determination of a preterm or SGA birth. We compared the rate of adverse birth outcomes among women with inadequate/no PNC to the remainder of the population. However, Kotelchuck suggests there is a U- shaped relationship between PNC and birth outcomes, in which women with both fewer and greater number of vis- its than expected are at higher risks of having poorer birth outcomes , so perhaps limiting the reference group to women with adequate care should be considered in future research. Our analysis was limited to singleton live births; therefore, multiple births were not represented. In addi- tion, a limitation of both PNC utilization indices is that they only reflect the quantity of PNC; they indicate noth-
Among endometrial changes and mechanisms linked to the adversepregnancyoutcomes in diabetic mice and women are impaired spiral artery remodeling and trophoblast invasion defects during gestation [48, 49]. In an attempt to elucidate how tacrolimus restored vas- cular adaptation to pregnancy in the obese and diabetic mice, we examined uterine arterial physiology, spiral artery remodeling and late gestational (GD 18.5) placen- tal cytokines during pregnancy in the HFD-dNONcNZO dams. Incomplete spiral artery remodeling with lumen stenosis has been recognized among ominous patho- physiological signs of poor placentation in GDM [50, 51], This heralding histopathological sign was evident in the placentas of HFD-dNONcNZO dams expressing higher levels of pro-inflammatory cytokines that include TNFα, IL16 and IL23 (Additional file 1: Table S4). This is consistent with the reported human and non-human primate data that the placenta develops exaggerated pro- inflammatory response to obesity, which contributes to or results from placental vascular insufficiency [52, 53]. Therefore, important implications came from findings of restricted uterine artery pulsatility and poor umbilical flow dynamics during gestation in the HFD-dNONcNZO dams. Vascular indices (RI and/or PI) are used to inves- tigate impedance of the vascular bed distal to the vessel being examined, and a large quantity of continuous for- ward flow is generally observed throughout the diastole in low-resistance arterial waveforms . Contrary to this, higher vascular indices are characteristics of vas- cular flow supplying high-resistance and leaky vascular beds . Through mechanisms linked to chronic sys- temic hyperglycemia, local inflammation and the release of pro-inflammatory and pro-angiogenic molecules such as vascular endothelial growth factor (VEGF), advanced glycation end-products (AGE) and alterations to de novo
and 3) a possible oral microbial pathogen transmission, with subsequent colonization, in the vaginal microbiome resulting from sexual practices. The medical and dental public health communities should address intervention strategies aimed at controlling oral inflammatory disease, which will lessen the systemic inflammatory burden and suppress the potential for adversepregnancyoutcomes.
The transit of periodontal pathogens, pro-inflammatory cytokines, and prostaglandins from periodontal pockets to the fetal-placental unit suggests a plausible hypothesis for the association between periodontal disease and complica- tions of pregnancy, as premature births and low birth weight. This possibility resulted in a series of epidemio- logical and interventional studies, conducted in the last 20 years, to investigate the association between periodontal disease and adversepregnancyoutcomes (APO), with conflicting results [9–14]. Systematic reviews and meta- analyses suggested this diversity might be, in part, due to methodological inconsistencies which also difficult compar- isons between studies. Alternative explanations include variations in the populations assessed, the presence of a range of potential confounding factors, variations in the case-definition of periodontitis across studies, relative ob- stetric risk, and other factors which are known to influence the prevalence of APO, irrespective of oral status [4, 15].
Bivariate analyses of outcomes by cooking fuel use were calculated for categorical variables using Pear- son chi-squared test or Fischer’s exact test when there were fewer than 5 women within a category, and Students T-test for continuous variables. To fur- ther analyze the association between cooking fuel use and adversepregnancyoutcomes, multivariate logistic or linear regression models were created. Po- tential confounders were selected a priori using pre- vious literature on this cohort and then bivariate analysis, resulting in models being adjusted for: socio-economic status, maternal age, maternal BMI, and parity. Complete case analysis was performed, as there was little missing data and data that was miss- ing was considered missing completely at random. When the linearity of the logit assumption was vio- lated (BMI and maternal age) a sensitivity, analysis was conducted by transforming these continuous variables into categorical variables (BMI: < 18, 18 to 24.9, 25–29, and > 30, Maternal age: 18–24, 25-28, 29–31, > 32). All analysis was performed using R version 3.5.2, with the base R package (version 3.6.0), lmtest, and mlogit packages [27–29].