51
|
Masalin S, Kautiainen H, Gissler M, Pennanen P, Eriksson JG, Laine MK. Impact of smoking on gestational diabetes mellitus and offspring birthweight in primiparous women. Acta Obstet Gynecol Scand 2020; 99:1632-1639. [PMID: 32463146 DOI: 10.1111/aogs.13924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Smoking has been shown to affect glucose homeostasis and increase the risk for type 2 diabetes mellitus. Further, gestational diabetes mellitus (GDM) and smoking are known to influence offspring birthweight. The effect of smoking on glucose homeostasis in pregnancy is less studied and the findings are inconsistent. The aim of this study was to evaluate the effect of smoking on risk for GDM and to evaluate the impact of smoking and GDM on offspring birthweight. MATERIAL AND METHODS This is an observational cohort study encompassing 4111 Finnish primiparous women from the city of Vantaa, Finland, who delivered a singleton child between 2009 and 2015. Data were obtained from Finnish national registers. Study participants had complete oral glucose tolerance test results and were divided into three groups according to smoking status: non-smokers (I), smokers who quit during first trimester (II), and smokers who continued after first trimester (III). RESULTS Prevalence of GDM was 19.8%, 24.3%, and 26.6% in non-smokers, those who quit, and those who continued after the first trimester, respectively (P = .004 for differences between groups). The odds ratio for GDM in smokers who continued after the first trimester compared with non-smokers was 1.65 (95% CI 1.09-2.57) after adjustments for age, prepregnancy body mass index, education, and cohabitation. In women without GDM, offspring birthweight was lowest in those who continued smoking after the first trimester (P = .010 for differences between groups). In women with GDM, smoking status did not influence offspring birthweight. CONCLUSIONS Smoking during pregnancy is associated with an increased risk for GDM. Offspring birthweight is lowest in women who continue smoking after the first trimester. If pregnancy is complicated by GDM, offspring birthweight is not influenced by smoking.
Collapse
Affiliation(s)
- Senja Masalin
- Department of Gynecology and Obstetrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | | | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| |
Collapse
|
52
|
Grzeskowiak LE, Grieger JA, Andraweera P, Knight EJ, Leemaqz S, Poston L, McCowan L, Kenny L, Myers J, Walker JJ, Dekker GA, Roberts CT. The deleterious effects of cannabis during pregnancy on neonatal outcomes. Med J Aust 2020; 212:519-524. [PMID: 32452049 DOI: 10.5694/mja2.50624] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/07/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate whether cannabis use during pregnancy is associated with adverse neonatal outcomes that are independent of cigarette smoking. DESIGN Prospective cohort study. SETTING Adelaide (Australia), Auckland (New Zealand), Cork (Ireland), and Leeds, London and Manchester (United Kingdom). PARTICIPANTS 5610 pregnant nulliparous women with low risk pregnancies recruited for the Screening for Pregnancy Endpoints (SCOPE) study, November 2004 - February 2011. At 14-16 weeks of pregnancy, women were grouped by self-reported cannabis use. MAIN OUTCOME MEASURES Infant birthweight, head circumference, birth length, gestational age, and severe neonatal morbidity or mortality. RESULTS 314 women (5.6%) reported using cannabis in the 3 months before or during their pregnancy; 97 (31%) stopped using it before and 157 (50%) during the first 15 weeks of pregnancy, while 60 (19%) were still using cannabis at 15 weeks. Compared with babies of mother who had never used cannabis, infants of those who still used it at 15 weeks had lower mean values for birthweight (adjusted mean difference [aMD], -127 g; 95% CI, -238 to -17 g), head circumference (aMD, -0.5 cm; 95% CI, -0.8 to -0.1 cm), birth length (aMD, -0.8 cm; 95% CI, -1.4 to -0.2 cm), and gestational age at birth (aMD, -8.1 days; 95% CI, -12.1 to -4.0 days). The differences for all outcomes except gestational age were greater for women who used cannabis more than once a week than for those who used it less frequently. CONCLUSIONS Continuing to use cannabis during pregnancy is an independent risk factor for poorer neonatal outcomes.
Collapse
Affiliation(s)
- Luke E Grzeskowiak
- Robinson Research Institute, University of Adelaide, Adelaide, SA.,Adelaide Medical School, University of Adelaide, Adelaide, SA
| | - Jessica A Grieger
- Robinson Research Institute, University of Adelaide, Adelaide, SA.,Adelaide Medical School, University of Adelaide, Adelaide, SA
| | - Prabha Andraweera
- Robinson Research Institute, University of Adelaide, Adelaide, SA.,Adelaide Medical School, University of Adelaide, Adelaide, SA
| | - Emma J Knight
- Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - Shalem Leemaqz
- Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - Lucilla Poston
- Women's Health Academic Centre and King's Health Partners, King's College London, London, United Kingdom
| | | | - Louise Kenny
- University of Liverpool, Liverpool, United Kingdom
| | - Jenny Myers
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, United Kingdom
| | - James J Walker
- Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Gustaaf A Dekker
- Robinson Research Institute, University of Adelaide, Adelaide, SA.,Adelaide Medical School, University of Adelaide, Adelaide, SA
| | - Claire T Roberts
- Robinson Research Institute, University of Adelaide, Adelaide, SA.,Adelaide Medical School, University of Adelaide, Adelaide, SA
| |
Collapse
|
53
|
Koullali B, van Zijl MD, Kazemier BM, Oudijk MA, Mol BWJ, Pajkrt E, Ravelli ACJ. The association between parity and spontaneous preterm birth: a population based study. BMC Pregnancy Childbirth 2020; 20:233. [PMID: 32316915 PMCID: PMC7175552 DOI: 10.1186/s12884-020-02940-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background Preterm birth is the leading cause of perinatal mortality and neonatal morbidity worldwide. Many factors have been associated with preterm birth, including parity. The aim of the present study was to investigate associations between parity and risk of spontaneous preterm birth. Methods We conducted a retrospective study including live singleton births (≥22 weeks) of women with a first, second, third, fourth or fifth pregnancy in The Netherlands from 2010 through 2014. Our primary outcome was risk of spontaneous preterm birth < 37 weeks. Secondary outcomes were spontaneous preterm birth < 32 and < 28 weeks. Results We studied 802,119 pregnancies, including 30,237 pregnancies that ended spontaneously < 37 weeks. We identified an increased risk for spontaneous preterm birth < 37 weeks in nulliparous women (OR 1.95, 95% CI 1.89–2.00) and women in their fifth pregnancy (OR 1.26, 95% CI 1.13–1.41) compared to women in their second pregnancy. Similar results were seen for spontaneous preterm birth < 32 and < 28 weeks. Conclusion Our data show an independent association between nulliparity and spontaneous preterm birth < 37, < 32 and < 28 weeks. Furthermore, we observed an increased risk for spontaneous preterm birth in women in their fifth pregnancy, with highest risk for preterm birth at early gestational age.
Collapse
Affiliation(s)
- Bouchra Koullali
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Maud D van Zijl
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Brenda M Kazemier
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Ben W J Mol
- Department of Obstetrics and Gynecology, School of Medicine, Monash University, Melbourne, Australia
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Anita C J Ravelli
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| |
Collapse
|
54
|
Garrison-Desany HM, Nawa N, Kim Y, Ji Y, Susan Chang HY, Hong X, Wang G, Pearson C, Zuckerman BS, Wang X, Surkan PJ. Polydrug Use During Pregnancy and Preterm Birth in a Low-Income, Multiethnic Birth Cohort, Boston, 1998-2018. Public Health Rep 2020; 135:383-392. [PMID: 32311304 DOI: 10.1177/0033354920915437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The opioid epidemic in the United States increasingly affects women of reproductive age and has resulted in a rise in concurrent polydrug use. The objective of this study was to investigate the effect of this polydrug use on preterm birth in a multiethnic birth cohort. METHODS We analyzed data from 8261 mothers enrolled in the Boston Birth Cohort from 1998 to 2018 in Boston, Massachusetts. We grouped substances used during pregnancy based on their primary effects (stimulant or depressant) and assessed independent and combined associations with smoking on preterm birth. RESULTS Of 8261 mothers, 131 used stimulant drugs and 193 used depressant drugs during pregnancy. The preterm birth rate was 27.5% (2271 of 8261) in the sample. Mothers who smoked had 35% increased odds of preterm birth across adjusted models. Mothers who used stimulant drugs without smoking were not at increased risk of preterm delivery compared with mothers who used neither (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.19-1.98), whereas mothers who used depressant drugs without smoking had more than twice the odds of having preterm delivery (OR = 2.31; 95% CI, 1.19-4.44), and infants were at risk of a 1-week reduction in gestational age (OR = -1.05; 95% CI, -2.07 to -0.03). Concurrently smoking and using depressant drugs was associated with increased odds of preterm birth (OR = 1.83; 95% CI, 1.28-2.61), as was concurrently smoking and using stimulant drugs (OR = 1.73; 95% CI, 1.14-2.59). CONCLUSIONS Using stimulant drugs and depressant drugs during pregnancy is a risk factor for preterm birth. The individual and combined effects of using these drugs with smoking must be considered together to reduce the risk of preterm birth in the United States.
Collapse
Affiliation(s)
- Henri M Garrison-Desany
- 25802 Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,1466 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nobutoshi Nawa
- 25802 Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yoona Kim
- 25802 Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,1466 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yuelong Ji
- 25802 Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hsing-Yuan Susan Chang
- 25802 Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiumei Hong
- 25802 Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Guoying Wang
- 25802 Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen Pearson
- 1836 Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Barry S Zuckerman
- 1836 Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Xiaobin Wang
- 25802 Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,25802 Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela J Surkan
- 25802 Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,1466 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
55
|
Claire R, Chamberlain C, Davey M, Cooper SE, Berlin I, Leonardi‐Bee J, Coleman T. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2020; 3:CD010078. [PMID: 32129504 PMCID: PMC7059898 DOI: 10.1002/14651858.cd010078.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tobacco smoking in pregnancy causes serious health problems for the developing fetus and mother. When used by non-pregnant smokers, pharmacotherapies (nicotine replacement therapy (NRT), bupropion, and varenicline) are effective for increasing smoking cessation, however their efficacy and safety in pregnancy remains unknown. Electronic cigarettes (ECs) are becoming widely used, but their efficacy and safety when used for smoking cessation in pregnancy are also unknown. OBJECTIVES To determine the efficacy and safety of smoking cessation pharmacotherapies and ECs used during pregnancy for smoking cessation in later pregnancy and after childbirth, and to determine adherence to smoking cessation pharmacotherapies and ECs for smoking cessation during pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 May 2019), trial registers, and grey literature, and checked references of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) conducted in pregnant women, comparing smoking cessation pharmacotherapy or EC use with either placebo or no pharmacotherapy/EC control. We excluded quasi-randomised, cross-over, and within-participant designs, and RCTs with additional intervention components not matched between trial arms. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. The primary efficacy outcome was smoking cessation in later pregnancy; safety was assessed by 11 outcomes (principally birth outcomes) that indicated neonatal and infant well-being. We also collated data on adherence to trial treatments. We calculated the risk ratio (RR) or mean difference (MD) and the 95% confidence intervals (CI) for each outcome for each study, where possible. We grouped eligible studies according to the type of comparison. We carried out meta-analyses where appropriate. MAIN RESULTS We included 11 trials that enrolled a total of 2412 pregnant women who smoked at enrolment, nine trials of NRT and two trials of bupropion as adjuncts to behavioural support, with comparable behavioural support provided in the control arms. No trials investigated varenicline or ECs. We assessed four trials as at low risk of bias overall. The overall certainty of the evidence was low across outcomes and comparisons as assessed using GRADE, with reductions in confidence due to risk of bias, imprecision, and inconsistency. Compared to placebo and non-placebo (behavioural support only) controls, there was low-certainty evidence that NRT increased the likelihood of smoking abstinence in later pregnancy (RR 1.37, 95% CI 1.08 to 1.74; I² = 34%, 9 studies, 2336 women). However, in subgroup analysis by comparator type, there was a subgroup difference between placebo-controlled and non-placebo controlled RCTs (test for subgroup differences P = 0.008). There was unclear evidence of an effect in placebo-controlled RCTs (RR 1.21, 95% CI 0.95 to 1.55; I² = 0%, 6 studies, 2063 women), whereas non-placebo-controlled trials showed clearer evidence of a benefit (RR 8.55, 95% CI 2.05 to 35.71; I² = 0%, 3 studies, 273 women). An additional subgroup analysis in which studies were grouped by the type of NRT used found no difference in the effectiveness of NRT in those using patches or fast-acting NRT (test for subgroup differences P = 0.08). There was no evidence of a difference between NRT and control groups in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care, caesarean section, congenital abnormalities, or neonatal death. In one study infants born to women who had been randomised to NRT had higher rates of 'survival without developmental impairment' at two years of age compared to the placebo group. Non-serious adverse effects observed with NRT included headache, nausea, and local reactions (e.g. skin irritation from patches or foul taste from gum), but data could not be pooled. Adherence to NRT treatment regimens was generally low. We identified low-certainty evidence that there was no difference in smoking abstinence rates observed in later pregnancy in women using bupropion when compared to placebo control (RR 0.74, 95% CI 0.21 to 2.64; I² = 0%, 2 studies, 76 women). Evidence investigating the safety outcomes of bupropion use was sparse, but the existing evidence showed no difference between the bupropion and control group. AUTHORS' CONCLUSIONS NRT used for smoking cessation in pregnancy may increase smoking cessation rates in late pregnancy. However, this evidence is of low certainty, as the effect was not evident when potentially biased, non-placebo-controlled RCTs were excluded from the analysis. Future studies may therefore change this conclusion. We found no evidence that NRT has either positive or negative impacts on birth outcomes; however, the evidence for some of these outcomes was also judged to be of low certainty due to imprecision and inconsistency. We found no evidence that bupropion may be an effective aid for smoking cessation during pregnancy, and there was little evidence evaluating its safety in this population. Further research evidence on the efficacy and safety of pharmacotherapy and EC use for smoking cessation in pregnancy is needed, ideally from placebo-controlled RCTs that achieve higher adherence rates and that monitor infants' outcomes into childhood. Future RCTs of NRT should investigate higher doses than those tested in the studies included in this review.
Collapse
Affiliation(s)
- Ravinder Claire
- University of NottinghamDivision of Primary CareRoom 1502, Tower Building, University ParkNottinghamNottinghamshireUKNG7 2RD
| | | | - Mary‐Ann Davey
- Monash UniversityDepartment of Obstetrics and Gynaecology246 Clayton RoadClaytonVictoriaAustralia3168
| | - Sue E Cooper
- University of NottinghamDivision of Primary CareRoom 1502, Tower Building, University ParkNottinghamNottinghamshireUKNG7 2RD
| | - Ivan Berlin
- Sorbonne Université, Faculté de medicine‐Hopital Pitie‐SalpetriereDepartment of Pharmacology47‐83 bd de l’HopitalParisFrance75013
| | - Jo Leonardi‐Bee
- University of NottinghamCentre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2Nottingham City HospitalHucknall RoadNottinghamUKNG5 1PB
| | - Tim Coleman
- University of NottinghamDivision of Primary CareRoom 1502, Tower Building, University ParkNottinghamNottinghamshireUKNG7 2RD
| | | |
Collapse
|
56
|
Murphy M, McHugh S, O'Keeffe LM, Greene RA, Corcoran P, Kearney PM. Preventive health counselling during antenatal care using the pregnancy risk assessment monitoring system (PRAMS) in Ireland. BMC Pregnancy Childbirth 2020; 20:98. [PMID: 32046675 PMCID: PMC7014605 DOI: 10.1186/s12884-020-2756-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/21/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Maternal behaviours during pregnancy have short- and long-term consequences for maternal and infant health. Pregnancy is an ideal opportunity to encourage positive behaviour change. Despite this, limited information exists about the nature and content of lifestyle advice provided by healthcare professionals during antenatal care. Pregnancy Risk Assessment Monitoring System (PRAMS) Ireland is based on the Centers for Disease Control and Prevention (CDC) developed PRAMS that monitors maternal behaviours and experiences before, during and after pregnancy. The aim of the study was to assess the prevalence of preventive health counselling during pregnancy. METHODS Secondary data analysis of the PRAMS Ireland study. Using hospital discharge records, a sampling frame of 2424 mother-infant pairs was used to alternately sample 1212 women whom had recently given birth. Preventive health counselling was defined as advice during antenatal care on smoking, alcohol, infant feeding and weight gain. Self-reported maternal behaviours (smoking/alcohol cessation, gestational weight gain, infant feeding). Univariate and multivariable analyses were conducted, adjusting for maternal characteristics. RESULTS Among 718 women (61% response rate), the reported counselling rates were 84.8% for breastfeeding (n = 592), 48.4% for alcohol (n = 338), 47.6% for smoking (n = 333) and 31.5% for weight gain (n = 218). Women who smoked pre-pregnancy (23.7%, n = 170) were more likely to receive counselling on its effects compared to non-smokers (Adjusted Odds Ratio (AOR) 2.72 (95% Confidence Interval (CI), 1.84-4.02)). In contrast, women who did not breastfeed (AOR 0.74, 95%CI 0.44-1.26) and those who reported alcohol consumption pre-pregnancy (AOR 0.94, 95%CI 0.64-1.37) were not more likely to receive counselling on these topics. CONCLUSION Pregnancy is an ideal opportunity to encourage positive behaviour change. Preventive health counselling during pregnancy is not routinely provided and rates vary widely depending on the health behaviour. This study suggests that additional strategies are needed to promote positive behaviour before and during the unique opportunity provided by pregnancy.
Collapse
Affiliation(s)
- Marion Murphy
- School of Medicine, University College Cork, Cork, Ireland
| | - Sheena McHugh
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Linda M O'Keeffe
- Bristol Medical School, Oakfield House, MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Richard A Greene
- School of Medicine, University College Cork, Cork, Ireland.,National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Ireland.
| |
Collapse
|
57
|
Tran DT, Preen DB, Einarsdottir K, Kemp-Casey A, Randall D, Jorm LR, Choi SKY, Havard A. Use of smoking cessation pharmacotherapies during pregnancy is not associated with increased risk of adverse pregnancy outcomes: a population-based cohort study. BMC Med 2020; 18:15. [PMID: 32019533 PMCID: PMC7001233 DOI: 10.1186/s12916-019-1472-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Varenicline, bupropion and nicotine replacement therapy (NRT) are three effective pharmacotherapies for smoking cessation, but data about their safety in pregnancy are limited. We assessed the risk of adverse perinatal outcomes and major congenital anomalies associated with the use of these therapies in pregnancy in Australia. METHODS Perinatal data for 1,017,731 deliveries (2004 to 2012) in New South Wales and Western Australia were linked to pharmaceutical dispensing, hospital admission and death records. We identified 97,875 women who smoked during pregnancy; of those, 233, 330 and 1057 were exposed to bupropion, NRT and varenicline in pregnancy, respectively. Propensity scores were used to match exposed women to those who were unexposed to any smoking therapy (1:10 ratio). Propensity scores and gestational age at exposure were used to match varenicline-exposed to NRT-exposed women (1:1 ratio). Time-dependent Cox proportional hazards models estimated hazard ratios (HR) with 95% confidence intervals (95% CI) for any adverse perinatal event (a composite of 10 unfavourable maternal and neonatal outcomes) and any major congenital anomaly. RESULTS The risk of any adverse perinatal event was not significantly different between bupropion-exposed and unexposed women (39.2% versus 39.3%, HR 0.93, 95% CI 0.73-1.19) and between NRT-exposed and unexposed women (44.8% vs 46.3%, HR 1.02, 95% CI 0.84-1.23), but it was significantly lower in women exposed to varenicline (36.9% vs 40.1%, HR 0.86, 95% CI 0.77-0.97). Varenicline-exposed infants were less likely than unexposed infants to be born premature (6.5% vs 8.9%, HR 0.72, 95% CI 0.56-0.92), be small for gestational age (11.4% vs 15.4%, HR 0.68, 95% CI 0.56-0.83) and have severe neonatal complications (6.6% vs 8.2%, HR 0.74, 95% CI 0.57-0.96). Among infants exposed to varenicline in the first trimester, 2.9% had a major congenital anomaly (3.5% in unexposed infants, HR 0.91, 95% CI 0.72-1.15). Varenicline-exposed women were less likely than NRT-exposed women to have an adverse perinatal event (38.7% vs 51.4%, HR 0.58, 95% CI 0.33-1.05). CONCLUSIONS Pregnancy exposure to smoking cessation pharmacotherapies does not appear to be associated with an increased risk of adverse birth outcomes. Lower risk of adverse birth outcomes in varenicline-exposed pregnancies is inconsistent with recommendations that NRT be used in preference to varenicline.
Collapse
Affiliation(s)
- Duong Thuy Tran
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia.
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Kristjana Einarsdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anna Kemp-Casey
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Deborah Randall
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Stephanie K Y Choi
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| |
Collapse
|
58
|
Abstract
Objective: The objective of this study was to find out the maternal risk factors and perinatal complications in small for gestational age (SGA) newborns. Methods: A total of 181 SGA cases and 1299 cases of appropriate for gestational age (AGA) with the same gestational age between January 2015 and December 2016 were enrolled in Linyi People’s Hospital, China. The risk factors were analyzed and the frequencies of perinatal complications were compared between the two groups. Results: The frequencies of maternal risk factors such as pregnancy-induced hypertension, abnormal placenta and twins in the SGA group were significantly higher than that in the AGA group (P<0.05). The incidence of hyperbilirubinemia and hypoglycemia in the perinatal period was also higher in the SGA newborns group (P<0.05), while there were no significant differences in the incidence of pneumonia, apnea, septicemia, intracranial hemorrhage, neonatal asphyxia, congenital malformations, hypoxic-ischemic encephalopathy, respiratory distress syndrome and necrotizing enterocolitis between the two groups. Conclusions: SGA can cause perinatal complications including neonatal hypoglycemia and hyperbilirubinemia. It is necessary to strengthen the perinatal monitoring and antenatal care to reduce SGA and the perinatal complications of SGA.
Collapse
Affiliation(s)
- Qiang Liu
- Dr. Qiang Liu, Department of Newborn, Linyi People's Hospital, Linyi, Shandong, 276003, China
| | - Hui Yang
- Dr. Hui Yang, Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong, 276003, China
| | - Xuemei Sun
- Dr. Xuemei Sun, Department of Newborn, Linyi People's Hospital, Linyi, Shandong, 276003, China
| | - Guimei Li
- Dr. Guimei Li, Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong, 250021, China
| |
Collapse
|
59
|
Diamanti A, Papadakis S, Schoretsaniti S, Rovina N, Vivilaki V, Gratziou C, Katsaounou PA. Smoking cessation in pregnancy: An update for maternity care practitioners. Tob Induc Dis 2019; 17:57. [PMID: 31582946 PMCID: PMC6770622 DOI: 10.18332/tid/109906] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/10/2019] [Accepted: 06/06/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION This paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings. METHODS We conducted a qualitative review of published peer reviewed and grey literature. RESULTS There is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quit-smoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high. CONCLUSIONS There have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes.
Collapse
Affiliation(s)
- Athina Diamanti
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sotiria Schoretsaniti
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Center for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Rovina
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- 1st Department of Respiratory Medicine, ‘Sotiria’ Chest Disease Hospital, Athens, Greece
| | | | - Christina Gratziou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Evgenidio Hospital, Athens, Greece
| | - Paraskevi A. Katsaounou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- First ICU, Evangelismos Hospital, Athens, Greece
| |
Collapse
|
60
|
Flannery C, Dahly D, Byrne M, Khashan A, McHugh S, Kenny LC, McAuliffe F, Kearney PM. Social, biological, behavioural and psychological factors related to physical activity during early pregnancy in the Screening for Pregnancy Endpoints (Cork, Ireland) cohort study. BMJ Open 2019; 9:e025003. [PMID: 31227527 PMCID: PMC6596951 DOI: 10.1136/bmjopen-2018-025003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the social, biological, behavioural and psychological factors related to physical activity (PA) in early pregnancy. DESIGN This is a secondary analysis of data from a prospective cohort study. SETTING The study was conducted in Cork, Ireland. PARTICIPANTS Nulliparous women with singleton pregnancies were recruited and then interviewed at 15±1 weeks' gestation. PRIMARY AND SECONDARY OUTCOMES The biopsychosocial model identified factors including social (age), biological (body mass index), behavioural (diet) and psychological (anxiety) at 15±1 weeks' gestation. PA subgroups were identified based on a latent class analysis of their responses to a set of questions about the amount and intensity of activity they were engaging in during the pregnancy. Associations were estimated with multivariable multinomial logistic regression models. RESULTS From a total of 2579, 1774 (69%) women were recruited; ages ranged from 17 to 45 years. Based on a combination of model fit, theoretical interpretability and classification quality, the latent class analyses identified three PA subgroups: low PA (n=393), moderate PA (n=960) and high PA (n=413). The fully adjusted model suggests non-smokers, and consumers of fruit and vegetables were more likely to be in the high PA subgroup (vs low). Women with more than 12 years of schooling and a higher socioeconomic status were more likely to be in the moderate PA subgroup (vs low). CONCLUSION The findings highlight potential links between PA, a low education level and a low socioeconomic background. These factors should be considered for future interventions to improve low PA levels during pregnancy. TRIAL REGISTRATION NUMBER ACTRN 12607000551493.
Collapse
Affiliation(s)
- Caragh Flannery
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland Galway, Galway, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Darren Dahly
- School of Public Health, University College Cork, Cork, Ireland
- Health Research Board, Clinical Research Facility Cork, University College Cork, Cork, Ireland
| | - Molly Byrne
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland Galway, Galway, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Louise C Kenny
- Department of Women’s and Children’s Health, University of Liverpool School of Life Sciences, Liverpool, UK
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
- National Maternity Hospital, University College Dublin, Dublin, Ireland
| | | |
Collapse
|
61
|
Barriers and facilitators to smoking cessation within pregnant Aboriginal and/or Torres Strait Islander women: An integrative review. Midwifery 2019; 73:49-61. [DOI: 10.1016/j.midw.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/26/2019] [Accepted: 03/06/2019] [Indexed: 12/11/2022]
|
62
|
Kondracki AJ, Hofferth SL. A gestational vulnerability window for smoking exposure and the increased risk of preterm birth: how timing and intensity of maternal smoking matter. Reprod Health 2019; 16:43. [PMID: 30992027 PMCID: PMC6469085 DOI: 10.1186/s12978-019-0705-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing the incidence of preterm birth is a national priority. Maternal cigarette smoking is strongly and consistently associated with preterm birth. The objective of this study was to examine prenatal exposure based on combined measures of timing (by trimester) and intensity level (the number of cigarettes smoked per day) of maternal smoking to identify a pregnancy period with the highest risk of preterm birth. METHODS A sample of 2,485,743 singleton births was drawn from the 2010 National Center of Health Statistics (NCHS) linked birth/infant death file of US residents in 33 states that implemented the revised 2003 birth certificate. Nine mutually exclusive smoking status categories were created to assess prenatal exposure across pregnancy in association with preterm birth. Gestational age was based on the obstetric estimate. Multiple logistic regression analyses were conducted to compare the odds of preterm birth among women who smoked at different intensity levels in the second or third trimester with those who smoked only in the first trimester. RESULTS Overall, 7.95% of women had a preterm birth; 8.90% of low intensity (less than a pack/day) smokers in the first trimester only, 12.99% of low and 15.38% of high intensity (pack a day or more) smokers in the first two trimesters, and 10.56% of low and 11.35% of high intensity smokers in all three trimesters delivered preterm. First and second trimester high (aOR 1.85, 95% CI: 1.66, 2.06) and low intensity smokers (aOR 1.51, 95% CI: 1.41, 1.61) had higher odds of preterm birth compared to those who smoked less than a pack a day only in the first trimester, but the odds did not increase for all three trimester smokers relative to the first and second trimester smokers. In sensitivity analysis, adjustment for exposure misclassification error corrected data and testing for effect modification by maternal race/ethnicity found no significant interaction. CONCLUSIONS This study documented a biologically plausible vulnerability window for smoking exposure and the increased risk of preterm birth. For women who do not modify their smoking behavior preconception, preterm birth risk of smoking remains low until late in the first trimester.
Collapse
Affiliation(s)
- Anthony J. Kondracki
- School of Public Health, Department of Family Science, University of Maryland, 4200 Valley Drive, College Park, MD 20742 USA
| | - Sandra L. Hofferth
- School of Public Health, Department of Family Science, University of Maryland, 4200 Valley Drive, College Park, MD 20742 USA
| |
Collapse
|
63
|
Cabrera-Rodríguez R, Luzardo OP, Almeida-González M, Boada LD, Zumbado M, Acosta-Dacal A, Rial-Berriel C, Henríquez-Hernández LA. Association between prenatal exposure to multiple persistent organic pollutants (POPs) and growth indicators in newborns. ENVIRONMENTAL RESEARCH 2019; 171:285-292. [PMID: 30708232 DOI: 10.1016/j.envres.2018.12.064] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
Despite the fact that many of persistent organic pollutants (POPs) have been banned for decades, they still constitute a group of harmful substances to human health. Prenatal exposure can have adverse effects on one's health as well as on their newborns. The present cross-sectional study, which includes 87% of the births registered in La Palma Island (Canary Islands, Spain) during 2016 (n = 447), aims to evaluate the potential adverse health effects exerted by a wide range of POPs on newborns. We quantified blood cord levels of twenty organochlorine pesticides, eighteen polychlorinated biphenyls (PCBs), eight bromodiphenyl ethers (BDEs), and sixteen polycyclic aromatic hydrocarbons (PAHs) using the method of gas chromatography-mass spectrometry. By groups, p,p'-DDE, PCB-28, BDE-47, and phenanthrene were the most frequently detected compounds (median values = 0.148, 0.107, 0.065, and 0.380 ng/mL, respectively). p,p'-DDE was found to be significantly associated with an increase in neonatal birth weight, with a special emphasis on girls. An inverse association between PCB-28 and PCB-52 with birth weight was observed, and these associations were determined by the gender. A similar trend was obtained for BDE-47 but not for any of the PAHs. When assessing the effect of mixtures, boys exhibiting ≥ 3 OCPs were at lower risk of having higher birth weight (OR = 0.25; 95% CI = 0.07 - 0.89; P = 0.032). The effect of these pollutants on birth weight does not go in the same direction, a fact that is conditioned by several factors, including the chemical nature of the substance or the gender of the newborn. Additional research is needed to understand the role of POPs on fetal development.
Collapse
Affiliation(s)
- Raúl Cabrera-Rodríguez
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Octavio P Luzardo
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Spain.
| | - Maira Almeida-González
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Luis D Boada
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Spain
| | - Manuel Zumbado
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Spain
| | - Andrea Acosta-Dacal
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Cristian Rial-Berriel
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Luis Alberto Henríquez-Hernández
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Spain
| |
Collapse
|
64
|
Grieger JA, Grzeskowiak LE, Smithers LG, Bianco-Miotto T, Leemaqz SY, Andraweera P, Poston L, McCowan LM, Kenny LC, Myers J, Walker JJ, Norman RJ, Dekker GA, Roberts CT. Metabolic syndrome and time to pregnancy: a retrospective study of nulliparous women. BJOG 2019; 126:852-862. [PMID: 30734474 DOI: 10.1111/1471-0528.15647] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 kg/m2 versus BMI ≥ 30 kg/m2 ). DESIGN Retrospective cohort study. SETTING Multiple centres (in Australia, Ireland, New Zealand, and the UK). POPULATION Five thousand five hundred and nineteen low-risk nulliparous pregnant women. METHODS Data on retrospectively reported TTP (number of months to conceive) and a blood sample to assess metabolic health were collected between 14 and 16 weeks of gestation. MetS was defined according to the International Diabetes Federation criteria. Accelerated failure time models with log-normal distribution were conducted to estimate time ratios (TRs) and 95% CIs. Differences in MetS on infertility (TTP > 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs; 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors. MAIN OUTCOME MEASURES Time to pregnancy and infertility. RESULTS Of the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30; 95% CI 1.15-1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0-3.3 months) versus 4.1 months (3.6-4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62; 95% CI 1.15-2.29) or not (adjusted RR 1.73; 95% CI 1.33-2.23). Reduced high-density lipoprotein cholesterol (HDL-C) and raised triglycerides (TGs) were the main individual components associated with risk for infertility. CONCLUSION Metabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether individual components are amenable to modification. TWEETABLE ABSTRACT Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity.
Collapse
Affiliation(s)
- J A Grieger
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - L E Grzeskowiak
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - L G Smithers
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - T Bianco-Miotto
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Waite Research Institute, School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - S Y Leemaqz
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - P Andraweera
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - L Poston
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge, London, UK
| | - L M McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - L C Kenny
- Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - J Myers
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - J J Walker
- Obstetrics and Gynaecology Section, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - R J Norman
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Fertility SA, Adelaide, South Australia, Australia
| | - G A Dekker
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Women and Children's Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - C T Roberts
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
65
|
Wang XM, Tian FY, Fan LJ, Xie CB, Niu ZZ, Chen WQ. Comparison of DNA methylation profiles associated with spontaneous preterm birth in placenta and cord blood. BMC Med Genomics 2019; 12:1. [PMID: 30606219 PMCID: PMC6318854 DOI: 10.1186/s12920-018-0466-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background The etiology and mechanism of spontaneous preterm birth (sPTB) are still unclear. Accumulating evidence has documented that various environmental exposure scenarios may cause maternal and fetal epigenetic changes, which initiates the focus on whether epigenetics can contribute to the occurrence of sPTB. Therefore, we conducted the current study to examine and compare the DNA methylation changes associated with sPTB in placenta and cord blood. Methods This hospital-based case-control study was carried out at three Women and Children’s hospitals in South China, where 32 spontaneous preterm births and 16 term births were recruited. Genome-wide DNA methylation profiles of the placenta and cord blood from these subjects were measured using the Illumina HumanMethylation EPIC BeadChip, and sPTB-associated differential methylated CpG sites were identified using limma regression model, after controlling for major maternal and infant confounders. Further Gene Ontology analysis was performed with PANTHER in order to assess different functional enrichment of the sPTB-associated genes in placenta and cord blood. Results After controlling for potential confounding factors, one differentially methylated position (DMP) in placenta and 31 DMPs in cord blood were found significantly associated with sPTB (Bonferroni corrected p < 0.05). The sPTB-associated CpG sites in placenta were mapped to genes that showed higher enrichment on biological processes including biological regulation, multicellular organismal process, and especially response to stimulus, while those in cord blood were mapped to genes that had higher enrichment on biological processes concerning cellular process, localization, and particularly metabolic process. Conclusion Findings of this study indicated that DNA methylation alteration in both placenta and cord blood are associated with sPTB, yet the DNA methylation modification patterns may appear differently in placenta and cord blood. Electronic supplementary material The online version of this article (10.1186/s12920-018-0466-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Xi-Meng Wang
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health. School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fu-Ying Tian
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health. School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.,Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Li-Jun Fan
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health. School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chuan-Bo Xie
- Department of Cancer Prevention Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No 21 Qingcaigang, Jianshe Road 6, Guangzhou, 510600, Guangdong, China
| | - Zhong-Zheng Niu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, 265 Farber Hall, Buffalo, NY, 14214, USA
| | - Wei-Qing Chen
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health. School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China. .,Department of Information Management, Xinhua College, Sun Yat-sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
66
|
Reducing fetal origins of childhood obesity through maternal smoking cessation during pregnancy: an intervention study. Int J Obes (Lond) 2018; 43:1435-1439. [PMID: 30518822 PMCID: PMC7328766 DOI: 10.1038/s41366-018-0267-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/09/2018] [Accepted: 10/28/2018] [Indexed: 11/24/2022]
Abstract
Rapid infant weight gain predicts childhood obesity. We aimed to estimate effect size and identify critical timing for intervention-assisted smoking cessation during pregnancy to impact infant weight gain. We followed 25 mother-infant dyads in the UB Pregnancy and Smoking Cessation Study (Buffalo, NY, USA). Maternal smoking status was biochemically verified and monitored through pregnancy. Birth weight and length were extracted from birth records. Research staff measured infant weight and length at 2 weeks and monthly from 1–12 months of age. Mixed models were used to fit infant BMI-for-age z-score (ZBMI) trajectories. We found infants of quitters had lower ZBMI gain from birth to 12 months (mean ± SD, 1.13 ± 1.16) than infants of persistent smokers (2.34 ± 1.40; p=0.035), with Cohen’s d effect size being large (0.96). The infant ZBMI gain from birth to 12 months was low (<0.47) if smoking cessation was initiated between 15 and 27 weeks of pregnancy, but started to increase if quitting at 28 weeks (0.65) and accelerated with time (e.g., 3.16 if quitting at 36 weeks). We concluded maternal smoking cessation during pregnancy may reduce fetal origins of obesity through reducing infant weight gain, especially if quitting smoking by 27 weeks of pregnancy.
Collapse
|
67
|
Papadakis S, Vyzikidou VK, Vivilaki VG, Vardavas CI, Loukopoulou AN, Peleki T, Evangelopoulou V, Behrakis P. A pilot study of the Tobacco Treatment Guidelines for High-Risk Groups (TOB-G) for pregnant and postpartum women. Eur J Midwifery 2018; 2:16. [PMID: 33537577 PMCID: PMC7839106 DOI: 10.18332/ejm/99543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Maternal smoking constitutes a significant risk to the fetus and is associated with multiple adverse pregnancy outcomes. Despite this, an estimated 6-19% of women in Europe smoke during pregnancy. We conducted a pilot study to examine the feasibility and effectiveness of the clinical practice recommendations of the 2017 Tobacco Cessation Guidelines for High-Risk Groups (TOB-G) for pregnant and postpartum women in an outpatient obstetrics setting. METHODS The guideline recommendations were tested on a sample of 67 pregnant women recruited from obstetrics outpatient visits. Pregnant women who smoked received three behavioural counselling sessions through a combination of face-toface and telephone consultations by a midwife trained in the TOBG tobacco treatment recommendations. Smoking status was assessed at 1 month and at 6 months follow-up via self-report. RESULTS Seventy-one per cent of pregnant smokers screened agreed to participate in the counselling intervention. Pregnant women participants (mean age, M=31.73 years, SD±6.09) smoked for an average of 12.2 (SD±6.55) years. Women reported smoking an average of 4.82 (SD±4.14) cigarettes per day with 51% reporting smoking within 30 minutes of waking, an indicator of higher levels of nicotine addiction. Rates of smoking abstinence among pregnant women undergoing the counselling intervention were 43.9% and 45.6% at the 1 month and at 6 months follow-up, respectively. Replacing those participants with missing data as smokers, the quit rates were 26.9% and 38.8% at the 1 month and 6 months follow-up, respectively. CONCLUSIONS The counselling intervention delivered to pregnant women who smoke was feasible to implement in a manner that was consistent with the TOB-G guideline recommendations in an outpatient obstetrics setting. Future work should focus on increasing uptake of evidence-based tobacco treatment recommendations in outpatient obstetrics settings.
Collapse
Affiliation(s)
- Sophia Papadakis
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Institute of Public Health, American College of Greece, Athens, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | - Constantine I. Vardavas
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Institute of Public Health, American College of Greece, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | | | - Theodosia Peleki
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Institute of Public Health, American College of Greece, Athens, Greece
| | - Vaso Evangelopoulou
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - Panagiotis Behrakis
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Institute of Public Health, American College of Greece, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
- Biomedical Research Foundation of the Athens Academy, Athens, Greece
- Academy of Medicine, University of Athens, Athens, Greece
| |
Collapse
|
68
|
Hajdu T, Hajdu G. Smoking ban and health at birth: Evidence from Hungary. ECONOMICS AND HUMAN BIOLOGY 2018; 30:37-47. [PMID: 29908431 DOI: 10.1016/j.ehb.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/20/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
In 2012, smoking restrictions were extended to hospitality venues in Hungary. Women working in bars and restaurants were primarily affected by the intervention. In this research, we analyze the effect of this smoking ban on the outcomes of their pregnancies. Using individual live birth, fetal loss, and infant mortality registry data, we examine the probability of live birth, indicators of health at birth, and the probability of death in the first year of life. We apply a difference-in-differences framework and show that the smoking ban has improved health at birth. We observed birth weight to increase by 56 g (95% CI: 4.2 to 106.8) and gestation length by 0.19 weeks (95% CI: 0.02 to 0.36). Due to the ban, the probability of being born with very low and low birth weight has decreased by 1.2 and 2.2 percentage points, respectively (95% CI: -0.2 to -2.2 and 0.06 to -4.4), and we see a 0.9 percentage points reduction in the chance of being born very preterm (95% CI: -0.03 to -1.9). We also observe a decrease in the probability of being born with a low Ponderal index (decrease of 4.1 percentage points, 95% CI: -0.7 to -7.5). Performing a series of robustness and placebo tests, we provide evidence that supports the causal interpretation of our results. We also show that the ban was more beneficial for newborns of parents with low educational attainment and at the bottom of the fetal health endowment distribution.
Collapse
Affiliation(s)
- Tamás Hajdu
- Institute of Economics, Centre for Economic and Regional Studies, Hungarian Academy of Sciences, Tóth Kálmán u. 4., 1097 Budapest, Hungary.
| | - Gábor Hajdu
- Institute for Sociology, Centre for Social Sciences, Hungarian Academy of Sciences, Tóth Kálmán u. 4., 1097 Budapest, Hungary; MTA-ELTE Peripato Comparative Social Dynamics Research Group, Pázmány Péter sétány 1/A, 1117 Budapest, Hungary.
| |
Collapse
|
69
|
Ogawa Y, Takeshima N, Furukawa TA. Maternal exposure to benzodiazepine and risk of preterm birth and low birth weight: A case-control study using a claims database in Japan. Asia Pac Psychiatry 2018; 10:e12309. [PMID: 29314716 DOI: 10.1111/appy.12309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To examine (1) if the use of benzodiazepines and antidepressants during pregnancy may increase the risk of preterm birth and/or low birth weight (LBW), and, if yes, (2) which types of benzodiazepines or antidepressants have stronger influences. METHODS A case-control study was performed using a large claims database in Japan. Cases were mothers who had given birth to preterm and/or LBW infants between 2005 and 2014 (737 with preterm births and 1615 with LBW). Controls were mothers who had neither experienced preterm birth nor given birth to an LBW infant. RESULTS Overall, 42 058 births were included. The maternal use of benzodiazepines was significantly associated with an increased risk of preterm birth (adjusted odds ratio [OR], 2.03; 95% confidence interval [CI], 1.11-3.69, P < .05), while the maternal use of benzodiazepines was not significantly associated with LBW (adjusted OR, 1.55; 0.96-2.50). The use of antidepressants was not significantly associated with both preterm deliveries (adjusted OR, 0.57; 0.08-4.16) and LBW (adjusted OR, 0.56; 0.14-2.29). CONCLUSIONS Benzodiazepine use was associated with increased risk of preterm birth but not with LBW. Antidepressant use was not associated with both preterm deliveries and LBW.
Collapse
Affiliation(s)
- Yusuke Ogawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| |
Collapse
|
70
|
Core Outcome Set for GROwth restriction: deVeloping Endpoints (COSGROVE). Trials 2018; 19:451. [PMID: 30134949 PMCID: PMC6106886 DOI: 10.1186/s13063-018-2819-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/24/2018] [Indexed: 11/15/2022] Open
Abstract
Background Foetal growth restriction (FGR) refers to a foetus that does not reach its genetically predetermined growth potential. It is well recognised that growth-restricted foetuses are at increased risk of stillbirth, foetal compromise, early neonatal death and neonatal morbidity. Later in life, they are prone to health problems, including increased risk of cardiovascular diseases and neurodevelopmental disorders. Interventions for preventing and treating FGR have been studied in many trials, but evidence is often difficult to synthesise and compare because of differences in the selection and definition of outcomes. To enable future trials to measure similar, meaningful outcomes, we are developing two core outcome sets (COS) – one for prevention and the other for treatment of FGR. Methods We will review the literature to identify previously reported outcomes. An international panel of relevant stakeholders who have experience of FGR (parent or carer of a baby that was growth restricted, health professional involved in the care of mothers and babies affected by FGR, a person with expertise in FGR research) will rate the importance of each of those outcomes in a series of three sequential online rounds of a Delphi study. Participants will be able to add items to the proposed list in round 1. A final face-to-face consensus meeting will be held with representatives of each stakeholder group at which a final list of outcomes for inclusion in the COS will be agreed. Discussion The development of COSs in FGR will ensure the collection and reporting of a minimum dataset agreed by stakeholder consensus and will reduce inconsistencies in the reporting of outcomes across relevant trials. Such standardisation in the reporting of outcomes will improve synthesis of evidence and generalisability of knowledge in the future by reducing heterogeneity in outcomes between trials and thus improve the results of systematic reviews and meta-analyses. Ultimately, we hope that the COSs will lead to an improvement in the quality of evidence-based clinical practice, enhance patient care, and improve the quality and consistency of research. Trial registration Not applicable. This study is registered in the Core Outcome Measures for Effectiveness (COMET) database.
Collapse
|
71
|
Scherman A, Tolosa JE, McEvoy C. Smoking cessation in pregnancy: a continuing challenge in the United States. Ther Adv Drug Saf 2018; 9:457-474. [PMID: 30364850 PMCID: PMC6199686 DOI: 10.1177/2042098618775366] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/29/2018] [Indexed: 12/21/2022] Open
Abstract
Despite significant population level declines, smoking during pregnancy remains a major public health issue in the United States (US). Approximately 360,000-500,000 smoke-exposed infants are born yearly, and prenatal smoking remains a leading modifiable cause of poor birth outcomes (e.g. birth < 37 gestational weeks, low birth weight, perinatal mortality). Women who smoke during pregnancy are more likely to be younger and from disadvantaged socioeconomic and racial and ethnic groups, with some US geographic regions reporting increased prenatal smoking rates since 2000. Such disparities in maternal prenatal smoking suggests some pregnant women face unique barriers to cessation. This paper reviews the current state and future direction of smoking cessation in pregnancy in the US. We briefly discuss the etiology of smoking addiction among women, the pathophysiology and effects of tobacco smoke exposure on pregnant women and their offspring, and the emerging issue of electronic nicotine delivery systems. Current population-based and individual smoking cessation interventions are reviewed in the context of pregnancy and barriers to cessation among US women. Finally, we consider interventions that are on the horizon and areas in need of further investigation.
Collapse
Affiliation(s)
- Ashley Scherman
- Oregon Health & Science University, 3181 SW
Sam Jackson Park Rd, Portland, OR 97239, USA
| | | | - Cindy McEvoy
- Oregon Health & Science University,
Portland, OR, USA
| |
Collapse
|
72
|
Li R, Lodge J, Flatley C, Kumar S. The burden of adverse obstetric and perinatal outcomes from maternal smoking in an Australian cohort. Aust N Z J Obstet Gynaecol 2018; 59:356-361. [PMID: 30014485 DOI: 10.1111/ajo.12849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/05/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Maternal smoking is associated with a number of adverse outcomes with a dose-dependent increase in risk. The aim of this study was to evaluate the obstetric and perinatal outcomes in women who smoked during pregnancy. METHODS This was a retrospective cohort study of women who smoked during pregnancy and birthed at a major perinatal centre in Australia between January 2000 and April 2017. The study cohort was compared to a cohort of women who did not smoke in pregnancy. Smoking status was ascertained on history and included all types of smoking. Demographic characteristics and obstetric, intrapartum and perinatal outcomes were compared between the two groups. RESULTS The study cohort included 20 477 (14.6%) women who smoked during pregnancy and 119 396 controls. Women who smoked tended to be younger, of higher body mass index (BMI), Caucasian and Indigenous ethnicity. Smokers were less likely to be nulliparous, but more likely to be hypertensive and have a lower socioeconomic status compared to non-smokers. Women who smoked were more likely to have a caesarean section for non-reassuring fetal status (adjusted odds ratio (aOR) 1.16, 95%CI 1.07-1.26, P < 0.001). The infants of women who smoked were more likely to be born preterm, have a lower median birth weight and birth weights <10th (aOR 1.76, 95%CI 1.66-1.86, P < 0.001) and <5th centile (aOR 2.00, 95%CI 1.86-2.16, P < 0.001). Neonatal outcomes in the smoking cohort were worse with an increase in neonatal intensive care unit admission (aOR 1.34, 95%CI 1.27-1.43, P < 0.001), severe acidosis (aOR 1.41, 95%CI 1.27-1.43, P < 0.001) and a composite of severe neonatal outcomes (18.0% vs 12.0%, aOR 1.35, 95%CI 1.28-1.43, P < 0.001). CONCLUSION Women who smoke in pregnancy have worse obstetric and perinatal outcomes compared to controls and should be managed as high risk.
Collapse
Affiliation(s)
- Raymond Li
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jade Lodge
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
73
|
Cabrera-Rodríguez R, Luzardo OP, González-Antuña A, Boada LD, Almeida-González M, Camacho M, Zumbado M, Acosta-Dacal AC, Rial-Berriel C, Henríquez-Hernández LA. Occurrence of 44 elements in human cord blood and their association with growth indicators in newborns. ENVIRONMENT INTERNATIONAL 2018; 116:43-51. [PMID: 29649776 DOI: 10.1016/j.envint.2018.03.048] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/30/2018] [Accepted: 03/30/2018] [Indexed: 05/20/2023]
Abstract
There is growing concern about environmental pollution produced by elements, including "emerging" contaminants, such as rare earth elements (REE) and other trace elements (TE), which are extensively and increasingly employed in the manufacture of consumer electronics. Previous research has shown that prenatal exposure to some elements (mainly heavy metals) may be associated with decreased fetal growth and other adverse birth outcomes. Recent studies have also shown that environmental exposure to REE and TE may be related to adverse effects on human health. This cross-sectional study, which included nearly 92% of the births in 2016 in La Palma (Canary Islands, Spain; n = 471), aimed to evaluate the potential adverse health effects exerted by a wide range of elements on newborns. We quantified the levels of 44 elements (including 26 REE and TE) in their umbilical cord blood. Our results showed low or very low levels of most elements. We found an inverse association between antimony (Sb) and birth weight (Spearman's r = -0.106, p = 0.021). A similar trend was observed between nickel (Ni) and birth weight and between chromium (Cr) and birth length, although in this case the significance was borderline. Bismuth appeared as a risk factor for having a birth weight below the tenth percentile in the univariate (OR = 3.30; 95% CI = 1.25-8.78; p = 0.017) and multivariate analyses (OR = 5.20; 95% CI = 1.29-20.91; p = 0.020). When assessing the effect of element mixtures, the sum of Cr, Ni, and Sb appeared as a risk factor for having a birth weight below the tenth percentile in the univariate (OR = 2.41; 95% CI = 1.08-5.35; p = 0.031) and multivariate analyses (OR = 3.84; 95% CI = 1.42-10.39; p = 0.008). Our findings suggest that some inorganic elements-isolated or in mixture-are associated to a lower fetal growth. Additional research is needed to understand the role of inorganic pollutants on fetal development.
Collapse
Affiliation(s)
- Raúl Cabrera-Rodríguez
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Octavio P Luzardo
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Spain.
| | - Ana González-Antuña
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Luis D Boada
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain; Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Spain
| | - Maira Almeida-González
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - María Camacho
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Manuel Zumbado
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Andrea Carolina Acosta-Dacal
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Cristian Rial-Berriel
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - Luis Alberto Henríquez-Hernández
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera s/n, 35016 Las Palmas de Gran Canaria, Spain
| |
Collapse
|
74
|
Wilson RL, Leviton AJ, Leemaqz SY, Anderson PH, Grieger JA, Grzeskowiak LE, Verburg PE, McCowan L, Dekker GA, Bianco-Miotto T, Roberts CT. Vitamin D levels in an Australian and New Zealand cohort and the association with pregnancy outcome. BMC Pregnancy Childbirth 2018; 18:251. [PMID: 29925344 PMCID: PMC6011374 DOI: 10.1186/s12884-018-1887-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 06/07/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Pregnant women are at increased susceptibility to vitamin D deficiency. Hence, there is continuing interest in determining how vitamin D influences pregnancy health. We aimed to compare vitamin D status in two distinct populations of pregnant women in Australia and New Zealand and to investigate the relationship between vitamin D status and pregnancy outcome. This included evaluating possible effect measure modifications according to fetal sex. METHODS Serum 25-hydroxy vitamin D (25(OH)D) was measured at 15 ± 1 weeks' gestation in 2800 women from Adelaide and Auckland who participated in the multi-centre, prospective cohort SCreening fOr Pregnancy Endpoints (SCOPE) study. RESULTS Mean serum 25(OH)D in all women was 68.1 ± 27.1 nmol/L and 28% (n = 772) were considered vitamin D deficient (< 50 nmol/L). Serum 25(OH)D was lower in the women recruited in Adelaide when compared to the women recruited in Auckland and remained lower after adjusting for covariates including maternal body mass index and socioeconomic index (Adelaide: 58.4 ± 50.3 vs. Auckland: 70.2 ± 54.5 nmol/L, P < 0.001). A 53% decreased risk for gestational diabetes mellitus (GDM) was observed with high (> 81 nmol/L) "standardised" vitamin D status when compared to moderate-high (63-81 nmol/L, aRR, 0.47; 95% CI: 0.23, 0.96). Marginal sex-specific differences occurred between vitamin D status and GDM: women carrying a female fetus had a 56% decreased risk for GDM in those with low-moderate levels of standardised vitamin D (44-63 nmol/L) compared to moderate-high levels (aRR: 0.44; 95% CI: 0.20, 0.97), whilst in women carrying a male fetus, a 55% decreased risk of GDM was found with high standardised vitamin D when compared to moderately-high vitamin D, but this was not statistically significant (aRR: 0.45; 95% CI: 0.15, 1.38). CONCLUSIONS High serum 25(OH)D at 15 ± 1 weeks' gestation was shown to be protective against the development of GDM. A possible association between fetal sex, vitamin D status and GDM provides further questions and encourages continual research and discussion into the role of vitamin D in pregnancy, particularly in vitamin D replete populations.
Collapse
Affiliation(s)
- Rebecca L Wilson
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Alison J Leviton
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Shalem Y Leemaqz
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul H Anderson
- School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jessica A Grieger
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Luke E Grzeskowiak
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Petra E Verburg
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lesley McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Gustaaf A Dekker
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Women's and Children's Division, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Tina Bianco-Miotto
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Waite Research Institute & School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Claire T Roberts
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia. .,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
| |
Collapse
|
75
|
Pre-pregnancy fast food and fruit intake is associated with time to pregnancy. Hum Reprod 2018; 33:1063-1070. [DOI: 10.1093/humrep/dey079] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Indexed: 11/14/2022] Open
|
76
|
Abstract
Fetal growth restriction (FGR) continues to be a leading cause of preventable stillbirth and poor neurodevelopmental outcomes in offspring, and furthermore is strongly associated with the obstetrical complications of iatrogenic preterm birth and pre-eclampsia. The terms small for gestational age (SGA) and FGR have, for too long, been considered equivalent and therefore used interchangeably. However, the delivery of improved clinical outcomes requires that clinicians effectively distinguish fetuses that are pathologically growth-restricted from those that are constitutively small. A greater understanding of the multifactorial pathogenesis of both early- and late-onset FGR, especially the role of underlying placental pathologies, may offer insight into targeted treatment strategies that preserve placental function. The new maternal blood biomarker placenta growth factor offers much potential in this context. This review highlights new approaches to effective screening for FGR based on a comprehensive review of: etiology, diagnosis, antenatal surveillance and management. Recent advances in novel imaging methods provide the basis for stepwise multi-parametric testing that may deliver cost-effective screening within existing antenatal care systems.
Collapse
|
77
|
Wilson RL, Bianco-Miotto T, Leemaqz SY, Grzeskowiak LE, Dekker GA, Roberts CT. Early pregnancy maternal trace mineral status and the association with adverse pregnancy outcome in a cohort of Australian women. J Trace Elem Med Biol 2018; 46:103-109. [PMID: 29413099 DOI: 10.1016/j.jtemb.2017.11.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 01/26/2023]
Abstract
Maternal micronutrient deficiencies in pregnancy can have profound effects on fetal development and pregnancy outcome. Plasma trace minerals including copper, zinc, selenium and iron have been shown to be extremely important in supporting reproduction. We sought to determine whether there is an association between maternal trace mineral status in early pregnancy and pregnancy complications using a prospective cohort study of 1065 pregnant Australian women who were recruited as part of the Screening for Pregnancy Endpoints (SCOPE) study in Adelaide. Copper, zinc, selenium and iron present in the plasma were measured using mass spectrometry in samples collected at 15±1 weeks' gestation. After adjusting for covariates, women with lower plasma copper (<27.9μmol/L and 27.9-32.5μmol/L) had decreased risk for any pregnancy complication when compared with women with high plasma copper (>32.5μmol/L) (aRR=0.87; 95% CI=0.76, 0.99 and aRR=0.88; 95% CI=0.78, 1.00, respectively). This was also observed when adjusting for plasma zinc and selenium status (<27.9μmol/L: aRR=0.81; 95% CI=0.69, 0.96 and 27.9-32.5μmol/L: aRR=0.84; 95% CI=0.72, 0.98). Combined low copper and zinc status was also associated with a reduced risk of any pregnancy complication as compared with high copper and zinc status (aRR=0.80; 95% CI=0.70, 0.93). These results provide justification for further work into elucidating the mechanistic role of trace elements in early pregnancy, as well as their interactions in supporting successful pregnancy outcomes.
Collapse
Affiliation(s)
- Rebecca L Wilson
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Tina Bianco-Miotto
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Waite Research Institute & School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia
| | - Shalem Y Leemaqz
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Luke E Grzeskowiak
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Gustaaf A Dekker
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Women's and Children's Division, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Claire T Roberts
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| |
Collapse
|
78
|
Grzeskowiak LE, Smithers LG, Grieger JA, Bianco-Miotto T, Leemaqz SY, Clifton VL, Poston L, McCowan LM, Kenny LC, Myers J, Walker JJ, Norman RJ, Dekker GA, Roberts CT. Asthma treatment impacts time to pregnancy: evidence from the international SCOPE study. Eur Respir J 2018; 51:51/2/1702035. [PMID: 29444917 DOI: 10.1183/13993003.02035-2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/06/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Luke E Grzeskowiak
- Robinson Research Institute, University of Adelaide, Adelaide, Australia .,Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Lisa G Smithers
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,School of Public Health, University of Adelaide, Adelaide, Australia
| | - Jessica A Grieger
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Tina Bianco-Miotto
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Waite Research Institute, School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia
| | - Shalem Y Leemaqz
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Vicki L Clifton
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Lucilla Poston
- Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Lesley M McCowan
- Dept of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Dept of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Jenny Myers
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
| | - James J Walker
- Obstetrics and Gynaecology Section, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Fertility SA, Adelaide, Australia
| | - Gus A Dekker
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Women and Children's Division, Lyell McEwin Hospital, Adelaide, Australia
| | - Claire T Roberts
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia
| |
Collapse
|
79
|
Berry SD, Walker CG, Ly K, Snell RG, Atatoa Carr PE, Bandara D, Mohal J, Castro TG, Marks E, Morton SMB, Grant CC. Re: "Widespread prevalence of a CREBRF variant amongst Māori and Pacific children is associated with weight and height in early childhood". Int J Obes (Lond) 2018; 42:1392-1393. [PMID: 29463920 DOI: 10.1038/s41366-018-0026-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/29/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Sarah D Berry
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, Auckland, New Zealand.
| | - Caroline G Walker
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, Auckland, New Zealand
| | - Kien Ly
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, Auckland, New Zealand
| | - Russell G Snell
- School of Biological Sciences, Centre for Brain Research University of Auckland, Auckland, New Zealand
| | - Polly E Atatoa Carr
- National Institute of Demographic and Economic Analysis, University of Waikato, Hamilton, New Zealand
| | - Dinusha Bandara
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, Auckland, New Zealand
| | - Jatender Mohal
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, Auckland, New Zealand
| | - Teresa G Castro
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, Auckland, New Zealand
| | - Emma Marks
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
80
|
Kingdom JC, Audette MC, Hobson SR, Windrim RC, Morgen E. A placenta clinic approach to the diagnosis and management of fetal growth restriction. Am J Obstet Gynecol 2018; 218:S803-S817. [PMID: 29254754 DOI: 10.1016/j.ajog.2017.11.575] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 12/13/2022]
Abstract
Effective detection and management of fetal growth restriction is relevant to all obstetric care providers. Models of best practice to care for these patients and their families continue to evolve. Since much of the disease burden in fetal growth restriction originates in the placenta, the concept of a multidisciplinary placenta clinic program, managed primarily within a maternal-fetal medicine division, has gained popularity. In this context, fetal growth restriction is merely one of many placenta-related disorders that can benefit from an interdisciplinary approach, incorporating expertise from specialist perinatal ultrasound and magnetic resonance imaging, reproductive genetics, neonatal pediatrics, internal medicine subspecialties, perinatal pathology, and nursing. The accurate diagnosis and prognosis for women with fetal growth restriction is established by comprehensive clinical review and detailed sonographic evaluation of the fetus, combined with uterine artery Doppler and morphologic assessment of the placenta. Diagnostic accuracy for placenta-mediated fetal growth restriction may be enhanced by quantification of maternal serum biomarkers including placenta growth factor alone or combined with soluble fms-like tyrosine kinase-1. Uterine artery Doppler is typically abnormal in most instances of early-onset fetal growth restriction and is associated with coexistent preeclampsia and underlying maternal vascular malperfusion pathology of the placenta. By contrast, rare but potentially more serious underlying placental diagnoses, such as massive perivillous fibrinoid deposition, chronic histiocytic intervillositis, or fetal thrombotic vasculopathy, may be associated with normal uterine artery Doppler waveforms. Despite minor variations in placental size, shape, and cord insertion, placental function remains, largely normal in the general population. Consequently, morphologic assessment of the placenta is not currently incorporated into current screening programs for placental complications. However, placental ultrasound can be diagnostic in the context of fetal growth restriction, for example in Breus' mole and triploidy, which in turn may enhance diagnosis and management. Several examples are illustrated in our figures and supplementary videos. Recent advances in the ability of multiparameter screening and intervention programs to reduce the risk of severe preeclampsia will likely increase efforts to deliver similar improvements for women at risk of fetal growth restriction. Placental pathology is important because the underlying pathologies associated with fetal growth restriction have a wide range of recurrence risks. Rare conditions such as massive perivillous fibrinoid deposition or chronic histolytic intervillositis may recur in >50% of subsequent pregnancies. Postpartum care in a placenta-focused program can provide effective counseling for modifiable maternal risk factors, and can assist in planning future pregnancy care based on the pathologic basis of fetal growth restriction.
Collapse
|
81
|
Voidazan S, Tarcea M, Abram Z, Georgescu M, Marginean C, Grama O, Buicu F, Ruţa F. Associations between lifestyle factors and smoking status during pregnancy in a group of Romanian women. Birth Defects Res 2018; 110:519-526. [PMID: 29318743 DOI: 10.1002/bdr2.1190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/26/2017] [Accepted: 12/04/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is an estimated birth rate of 9.27 births/1,000 population in Romania each year, with approximately 8.4% born with low birth weight (LBW). Our purpose was to evaluate the relationships between maternal smoking and LBW and preterm birth in Mureș County, Romania. METHODS We conducted a cross-sectional survey of 1,278 mothers who had given birth in Mureș County obstetrical wards in 2015, based on a lifestyle questionnaire of 109 items and personal and laboratory data from hospitals records. RESULTS The variables associated with smoking during pregnancy taken into account were: Rroma ethnicity, education <8 grades, income lower than 140 dollars (minimum wages in our country), and lack of facilities in their households. In a multivariable model, smoking during pregnancy was correlated with a low level of education (p = .02), coffee and alcohol use (p = .0001), and lack of interest in potential environmental and behavioral risks during pregnancy (including smoking and diet). The newborn baby's weight was associated with smoker status of the mother (OR 1.71, 95%CI 1.09-2.66, p = .01), by the lack of ownership of a household (OR 3.52, 95%CI 2.27-5.47, p = .0001), and by the pregnant woman not receiving proper information regarding a healthy behavior and diet during pregnancy (OR 1.91, 95%CI 1.33-2.74, p = .0005). CONCLUSION Our study aimed to emphasize the high rates of maternal smoking during pregnancy and its importance in LBW outcomes in Romanian pregnant women. Moreover, the study highlights disparities in smoking status observed in ethnic minorities and those living in poverty.
Collapse
Affiliation(s)
- S Voidazan
- Department of Epidemiology, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - M Tarcea
- Department of Community Nutrition and Food safety, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - Z Abram
- Department of Hygiene, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - M Georgescu
- Ward No. Gynecology 1, Regional Emergency Hospital of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - C Marginean
- Department of Gynecology II, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - O Grama
- Department of Gynecology II, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - F Buicu
- Department of Public Health, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - F Ruţa
- Department of Community Nutrition and Food safety, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| |
Collapse
|
82
|
Blaga OM, Brînzaniuc A, Rus IA, Cherecheș RM, Wallis AB. Smoking and Smoking Cessation During Pregnancy. An Analysis of a Hospital Based Cohort of Women in Romania. J Community Health 2018; 42:333-343. [PMID: 27651165 DOI: 10.1007/s10900-016-0259-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Perinatal smoking is associated with a wide range of negative reproductive and pregnancy outcomes. The aim of the current study was to examine the prevalence and characteristics of women who report smoking prenatally and quit during pregnancy in a large sample of Romanian women. Understanding which women are more likely to quit will contribute to public health knowledge that will help more women stop smoking prior to or during pregnancy and prevent relapse postpartum. This cross-sectional analysis was conducted based on cross-sectional data collected between May 2012 and April 2015 as part of a cohort study of pregnancy implemented in six clinical settings in central Romania (N = 2370). Approximately 28 % of the sample reported smoking in the 6 months prior to learning they were pregnant. Half of the women who reported smoking 6 months before learning of their pregnancy, also reported that they stopped smoking by the time of the interview. Overall, tobacco consumption decreased from a sample mode of 10 cigarettes/day (range: 1-30) before pregnancy, to a sample mode of 5 cigarettes/day (range: 1-25) at the time of the interview. Women who quit had a higher socioeconomic position, were more likely to live in urban areas, partnered, primigravid, nulliparous, and reported lower anxiety and more social support. The combination of a socioeconomic gradient, less anxiety, and more social support suggests that efforts should be increased to target lower income, less educated, multigravid, and multiparous women and to develop programs that heighten social support and alleviate anxiety.
Collapse
Affiliation(s)
- Oana M Blaga
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor St, 400376, Cluj-Napoca, Cluj County, Romania
| | - Alexandra Brînzaniuc
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor St, 400376, Cluj-Napoca, Cluj County, Romania
| | - Ioana A Rus
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor St, 400376, Cluj-Napoca, Cluj County, Romania
| | - Răzvan M Cherecheș
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor St, 400376, Cluj-Napoca, Cluj County, Romania.
| | - Anne Baber Wallis
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor St, 400376, Cluj-Napoca, Cluj County, Romania.,Department of Epidemiology & Population Health, University of Louisville, School of Public Health & Information Sciences, 485 E Gray Street, Louisville, KY, USA
| |
Collapse
|
83
|
Hanson-Manful P, Whitcombe AL, Young PG, Atatoa Carr PE, Bell A, Didsbury A, Mitchell EA, Dunbar PR, Proft T, Moreland NJ. The novel Group A Streptococcus antigen SpnA combined with bead-based immunoassay technology improves streptococcal serology for the diagnosis of acute rheumatic fever. J Infect 2017; 76:361-368. [PMID: 29269013 DOI: 10.1016/j.jinf.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/27/2017] [Accepted: 12/12/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Streptococcal serology provides evidence of prior Group A Streptococcus (GAS) exposure, crucial to the diagnosis of acute rheumatic fever (ARF) and post-streptococcal glomerulonephritis. However, current tests, which measure anti-streptolysin-O and anti-DNaseB antibodies, are limited by false positives in GAS endemic settings, and incompatible methodology requiring the two tests to be run in parallel. The objective was to improve streptococcal serology by combining the novel GAS antigen, SpnA, with streptolysin-O and DNaseB in a contemporary, bead-based immunoassay. METHODS Recombinant streptolysin-O, DNAseB and SpnA were conjugated to polystyrene beads with unique fluorescence positions so antibody binding to all three antigens could be detected simultaneously by cytometric bead array. Multiplex assays were run on sera collected in three groups: ARF; ethnically matched healthy children; and healthy adults. RESULTS The ability of the antigens to detect a previous GAS exposure in ARF was assessed using the 80th centile of the healthy children group as cut-off (upper limit of normal). SpnA had the highest sensitivity at 88%, compared with 75% for streptolysin-O and 56% for DNaseB. CONCLUSIONS SpnA has favorable immunokinetics for streptococcal serology, and can be combined with anti-streptolysin-O and anti-DNaseB in a multiplex format to improve efficiency and accuracy.
Collapse
Affiliation(s)
- Paulina Hanson-Manful
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand
| | - Alana L Whitcombe
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Paul G Young
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Polly E Atatoa Carr
- Waikato District Health Board, Hamilton, New Zealand; National Institute of Demographic and Economic Analysis, University of Waikato, Waikato, New Zealand
| | - Anita Bell
- Waikato District Health Board, Hamilton, New Zealand
| | - Alicia Didsbury
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Edwin A Mitchell
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - P Rod Dunbar
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Thomas Proft
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand.
| | - Nicole J Moreland
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
84
|
Norris T, McCarthy FP, Khashan AS, Murray DM, Kiely M, Hourihane JO, Baker PN, Kenny LC. Do changing levels of maternal exercise during pregnancy affect neonatal adiposity? Secondary analysis of the babies after SCOPE: evaluating the longitudinal impact using neurological and nutritional endpoints (BASELINE) birth cohort (Cork, Ireland). BMJ Open 2017; 7:e017987. [PMID: 29196482 PMCID: PMC5719326 DOI: 10.1136/bmjopen-2017-017987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate whether changing levels of exercise during pregnancy are related to altered neonatal adiposity. DESIGN Secondary analysis of data from a prospective cohort study. SETTING Cork, Ireland. PARTICIPANTS 1200 mother - infant pairs recruited as part of a prospective birth cohort, Babies After SCOPE: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints (BASELINE). MAIN OUTCOME MEASURES Neonatal adiposity was assessed within several days of birth using air displacement plethysmography (PEAPOD). Per cent body fat (BF%) as a continuous outcome and a pair of dichotomous variables; high or low adiposity, representing BF% >90th or <10th centile, respectively. Multivariable linear and logistic regression models were used to investigate the relationship between exercise and the respective outcomes. RESULTS Crude analysis revealed no association between a changing level of exercise (since becoming pregnant) at 15 weeks' gestation and any of the outcomes (BF%, low adiposity and high adiposity). At 20 weeks' gestation, analyses revealed that relative to women who do not change their exercise level up to 20 weeks, those women who decreased their exercise level were more likely to give birth to a neonate with adiposity above the 90th centile (OR 1.62, 95% CI 1.07 to 2.46). This association was maintained after adjustment for putative confounders (OR 1.62, 95% CI 1.06 to 2.47). CONCLUSIONS We observed a possible critical period for the association between changing exercise levels and neonatal adiposity, with no association observed with exercise recall for the first 15 weeks of gestation, but an association with a decreasing level of exercise between 15 and 20 weeks. These results should be interpreted in line with the limitations of the study and further studies utilising objectively measured estimates of exercise are required in order to replicate these findings. TRIAL REGISTRATION NUMBER NCT01498965.
Collapse
Affiliation(s)
- Tom Norris
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - Fergus P McCarthy
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Division of Women's Health KCL, Women's Health Academic Centre KHP, St Thomas's Hospital, London, UK
| | - Ali S Khashan
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Deidre M Murray
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Mairead Kiely
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Jonathan O'B Hourihane
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Philip N Baker
- College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Louise C Kenny
- Department of Obstetrics and Gynecology, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
| |
Collapse
|
85
|
Zulyniak MA, de Souza RJ, Shaikh M, Desai D, Lefebvre DL, Gupta M, Wilson J, Wahi G, Subbarao P, Becker AB, Mandhane P, Turvey SE, Beyene J, Atkinson S, Morrison KM, McDonald S, Teo KK, Sears MR, Anand SS. Does the impact of a plant-based diet during pregnancy on birth weight differ by ethnicity? A dietary pattern analysis from a prospective Canadian birth cohort alliance. BMJ Open 2017; 7:e017753. [PMID: 29138203 PMCID: PMC5695448 DOI: 10.1136/bmjopen-2017-017753] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Birth weight is an indicator of newborn health and a strong predictor of health outcomes in later life. Significant variation in diet during pregnancy between ethnic groups in high-income countries provides an ideal opportunity to investigate the influence of maternal diet on birth weight. SETTING Four multiethnic birth cohorts based in Canada (the NutriGen Alliance). PARTICIPANTS 3997 full-term mother-infant pairs of diverse ethnic groups who had principal component analysis-derived diet pattern scores-plant-based, Western and health-conscious-and birth weight data. RESULTS No associations were identified between the Western and health-conscious diet patterns and birth weight; however, the plant-based dietary pattern was inversely associated with birth weight (β=-67.6 g per 1-unit increase; P<0.001), and an interaction with non-white ethnicity and birth weight was observed. Ethnically stratified analyses demonstrated that among white Europeans, maternal consumption of a plant-based diet associated with lower birth weight (β=-65.9 g per 1-unit increase; P<0.001), increased risk of small-for-gestational age (SGA; OR=1.46; 95% CI 1.08 to 1.54;P=0.005) and reduced risk of large-for-gestational age (LGA; OR=0.71; 95% CI 0.53 to 0.95;P=0.02). Among South Asians, maternal consumption of a plant-based diet associated with a higher birth weight (β=+40.5 g per 1-unit increase; P=0.01), partially explained by cooked vegetable consumption. CONCLUSIONS Maternal consumption of a plant-based diet during pregnancy is associated with birth weight. Among white Europeans, a plant-based diet is associated with lower birth weight, reduced odds of an infant born LGA and increased odds of SGA, whereas among South Asians living in Canada, a plant-based diet is associated with increased birth weight.
Collapse
Affiliation(s)
- Michael A Zulyniak
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mateen Shaikh
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Cardiovascular Research Network, Brampton, Ontario, Canada
| | - Julie Wilson
- Six Nations Health Services, Ohsweken, Ontario, Canada
| | - Gita Wahi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Padmaja Subbarao
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Allan B Becker
- Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush Mandhane
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stuart E Turvey
- Department of Paediatrics, Faculty of Medicine, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Atkinson
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Sarah McDonald
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Koon K Teo
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
86
|
Kehl S, Dötsch J, Hecher K, Schlembach D, Schmitz D, Stepan H, Gembruch U. Intrauterine Growth Restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry No. 015/080, October 2016). Geburtshilfe Frauenheilkd 2017; 77:1157-1173. [PMID: 29375144 PMCID: PMC5784232 DOI: 10.1055/s-0043-118908] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 08/19/2017] [Accepted: 08/25/2017] [Indexed: 12/12/2022] Open
Abstract
AIMS The aim of this official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG) was to provide consensus-based recommendations obtained by evaluating the relevant literature for the diagnostic treatment and management of women with fetal growth restriction. METHODS This S2k guideline represents the structured consensus of a representative panel of experts with a range of different professional backgrounds commissioned by the Guideline Committee of the DGGG. RECOMMENDATIONS Recommendations for diagnostic treatment, management, counselling, prophylaxis and screening are presented.
Collapse
Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg Dötsch
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Köln, Köln, Germany
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Dagmar Schmitz
- Institut für Geschichte, Theorie und Ethik der Medizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Holger Stepan
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Gembruch
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Germany
| |
Collapse
|
87
|
Freund JD, Linberg A, Weinert S. Einfluss eines schwierigen frühkindlichen Temperaments auf die Qualität der Mutter-Kind-Interaktion unter psychosozialen Risikolagen. ZEITSCHRIFT FUR ENTWICKLUNGSPSYCHOLOGIE UND PADAGOGISCHE PSYCHOLOGIE 2017. [DOI: 10.1026/0049-8637/a000181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Die Qualität frühkindlicher häuslicher Lernumwelt, insbesondere mütterlichen Interaktionsverhaltens, ist ein bedeutsamer Prädiktor kindlicher Entwicklung. Die Frage, ob diese Interaktionsqualität durch ein schwieriges Temperament des Kindes reduziert ist, wenn kumulierte Belastungsfaktoren ihre Bewältigungskapazitäten einschränken, wurde an 2190 Fällen der Startkohorte 1 des Nationalen Bildungspanels (NEPS) untersucht. Im häuslichen Kontext wurde die Interaktionsqualität über Videoaufnahmen halb-strukturierter Spielsituationen, die übrigen Variablen über computerunterstützte Elterninterviews erhoben, als die Kinder 6 – 8 Monate alt waren. Während in der Nichtrisikogruppe kein Einfluss auf die Interaktionsqualität festzustellen war, zeigte sich in der Risikogruppe (Kumulation von mindestens drei Belastungsfaktoren) ein deutlicher negativer Zusammenhang mit der Neigung des Kindes zu negativen Affektäußerungen, nicht jedoch mit dessen Regulierbarkeit. Negative Affektivität stellt daher besonders in ohnehin gefährdeten Gruppen ein Entwicklungsrisiko dar.
Collapse
Affiliation(s)
- Jan-David Freund
- Lehrstuhl Psychologie I – Entwicklungspsychologie, Otto-Friedrich-Universität Bamberg
| | - Anja Linberg
- Leibniz-Institut für Bildungsverläufe e.V. - Bamberg
| | - Sabine Weinert
- Lehrstuhl Psychologie I – Entwicklungspsychologie, Otto-Friedrich-Universität Bamberg
| |
Collapse
|
88
|
Teixeira MPC, Queiroga TPR, Mesquita MDA. Frequency and risk factors for the birth of small-for-gestational-age newborns in a public maternity hospital. EINSTEIN-SAO PAULO 2017; 14:317-323. [PMID: 27759818 PMCID: PMC5234741 DOI: 10.1590/s1679-45082016ao3684] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 05/15/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: To determine the frequency and risk factors of small-for-gestational-age newborns in a high-risk maternity. Methods: This is an observational, cross-sectional, and case-control study, conducted in a public tertiary care maternity hospital. Data from 998 newborns and their mothers were collected through interviews and review of medical records and prenatal care cards. Some placentas underwent histopathological analysis. The variables of small-for-gestational-age and non-small-for-gestational-age newborns and of their mothers were statistically compared by means of Student's t test, Fisher's exact test, and odds ratio. The significance level used was 0.050. Results: There was a 17.9% frequency of small-for-gestational-age newborns. The statistically significant factors associated with the birth of these babies were female sex (p=0.012); positive history of another small-for-gestational-age child (p=0.006); inadequate prenatal care (p=0.019); smoking (p=0.003); hypertensive disorders of pregnancy (p=0.007); placental bleeding (p=0.009) and infarction (p=0.001). Conclusion: In the population studied, the frequency of small-for-gestational-age newborns was high and associated with sex, inappropriate prenatal care, presence of maternal diseases and addictions, and placental abnormalities. Objetivo: Determinar a frequência e os fatores de risco de recém-nascidos pequenos para idade gestacional em uma maternidade de alto risco. Métodos: Trata-se de um estudo observacional, transversal e caso-controle, realizado em maternidade pública de nível terciário. Foram levantados dados de 998 recém-nascidos e de suas respectivas mães por meio de entrevista e análise de prontuários e de cartões do pré-natal. Algumas placentas foram submetidas à análise anatomopatológica. As variáveis dos recém-nascidos pequenos e não pequenos para idade gestacional e de suas respectivas mães foram comparadas estatisticamente pelo teste paramétrico t de Student, pelo teste exato de Fisher e por odds ratio. O nível de significância adotado foi de 0,050. Resultados: A frequência de recém-nascidos pequenos para idade gestacional foi de 17,9%. Os fatores com significado estatístico associados ao nascimento desses bebês foram sexo feminino (p=0,012); história positiva para filho anterior pequeno para idade gestacional (p=0,006); realização de pré-natal inadequado (p=0,019); tabagismo (p=0,003); doença hipertensiva específica da gestação (p=0,007); hemorragia (p=0,009) e infarto (p=0,001) placentários. Conclusão: Na população estudada, a frequência de recém-nascidos pequenos para idade gestacional foi elevada e relacionada ao sexo, à inadequação do pré-natal, à presença de doenças e vícios maternos e às alterações placentárias.
Collapse
Affiliation(s)
- Marina Parca Cavelagna Teixeira
- Hospital Municipal Maternidade Escola de Vila Nova Cachoeirinha "Dr. Mario de Moraes Altenfelder Silva", São Paulo, SP, Brazil
| | - Tatiana Peloso Reis Queiroga
- Hospital Municipal Maternidade Escola de Vila Nova Cachoeirinha "Dr. Mario de Moraes Altenfelder Silva", São Paulo, SP, Brazil
| | - Maria Dos Anjos Mesquita
- Hospital Municipal Maternidade Escola de Vila Nova Cachoeirinha "Dr. Mario de Moraes Altenfelder Silva", São Paulo, SP, Brazil
| |
Collapse
|
89
|
Harpham ME, Algert CS, Roberts CL, Ford JB, Shand AW. Cervical cerclage placed before 14 weeks gestation in women with one previous midtrimester loss: A population‐based cohort study. Aust N Z J Obstet Gynaecol 2017; 57:593-598. [DOI: 10.1111/ajo.12635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Margaret E. Harpham
- Clinical and Population Perinatal Health Research, Kolling Institute Northern Sydney Local Health District Sydney New South Wales Australia
- Sydney Medical School Northern University of Sydney Sydney New South Wales Australia
- Department of Maternal Fetal Medicine National Women's Hospital Auckland New Zealand
- Department of Maternal Fetal Medicine Royal Hospital for Women Sydney New South Wales Australia
| | - Charles S. Algert
- Clinical and Population Perinatal Health Research, Kolling Institute Northern Sydney Local Health District Sydney New South Wales Australia
- Sydney Medical School Northern University of Sydney Sydney New South Wales Australia
| | - Christine L. Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute Northern Sydney Local Health District Sydney New South Wales Australia
- Sydney Medical School Northern University of Sydney Sydney New South Wales Australia
| | - Jane B. Ford
- Clinical and Population Perinatal Health Research, Kolling Institute Northern Sydney Local Health District Sydney New South Wales Australia
- Sydney Medical School Northern University of Sydney Sydney New South Wales Australia
| | - Antonia W. Shand
- Clinical and Population Perinatal Health Research, Kolling Institute Northern Sydney Local Health District Sydney New South Wales Australia
- Sydney Medical School Northern University of Sydney Sydney New South Wales Australia
- Department of Maternal Fetal Medicine Royal Hospital for Women Sydney New South Wales Australia
| |
Collapse
|
90
|
Berlin I, Golmard JL, Jacob N, Tanguy ML, Heishman SJ. Cigarette Smoking During Pregnancy: Do Complete Abstinence and Low Level Cigarette Smoking Have Similar Impact on Birth Weight? Nicotine Tob Res 2017; 19:518-524. [PMID: 28403475 PMCID: PMC6092690 DOI: 10.1093/ntr/ntx033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/26/2017] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Despite awareness of negative health outcomes associated with smoking, pregnant smokers might reduce their tobacco consumption thinking that a low smoking rate reduces smoking-related negative birth outcomes. We aimed to assess in a clinical sample whether there is a smoking rate that would not impact on birth weight (BW). METHODS Pregnant smokers ≥18 years, gestational age of 9-20 weeks of amenorrhea, motivated to quit smoking, smoking ≥5 cigarettes/day (cpd) and their newborns (381 singleton, live births) were included in this secondary analysis of a French smoking cessation trial. RESULTS The mean BW when the mother quit smoking was 3417 g (95 % CI: 3098-3738 g); when smoking >0<5 cpd, 3081g (3003-3159 g); when smoking 5-9 cpd, 3043 g (2930-3157 g); and when smoking ≥10 cpd, 2831 g (2596-3157 g) (p = .006). The corresponding effect sizes ranged from medium to large (Cohen's d for BW: 0.54, 0.57 and 0.85) compared to BW when the mother quit. In the multivariable analysis, adjusted for all significant confounders, when the mother smoked on average >0<5 cpd, the loss in BW was 228 g; when smoking 5-9 cpd, 251 g; and when smoking ≥10 cpd, 262 g (all p ≤ .02) compared to newborns' BW of mothers who stopped smoking since quit date. CONCLUSIONS Even low cigarette consumption during pregnancy is associated with BW loss. All efforts should be made to help pregnant smokers quit completely during their pregnancy. IMPLICATIONS As an alternative to quitting smoking, pregnant smokers reduce their smoking rate thinking that this diminishes smoking-related negative health outcomes. No study has established whether low smoking rate (more than 0 but less than 5 cpd) during pregnancy impacts BW compared to abstinence from smoking. Among treatment-seeking pregnant smokers BW of newborns of mothers who smoked even less than 5 cpd was significantly lower than of those whose mothers quit; effect sizes of different consumption levels on BW ranged from moderate (>0<5 cpd) to large (≥10 cpd). Even low smoking rate is associated with reduced BW compared to complete maternal smoking abstinence.
Collapse
Affiliation(s)
- Ivan Berlin
- Département de Pharmacologie, Université P. and M. Curie, Faculté de médecine-Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Jean-Louis Golmard
- Département de Biostatistique, Université P. and M. Curie, Faculté de médecine-Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Nelly Jacob
- Département de Pharmacologie, Université P. and M. Curie, Faculté de médecine-Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Marie-Laure Tanguy
- Unité de Recherche Clinique, Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Stephen J Heishman
- NIH, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD
| |
Collapse
|
91
|
Oh S, Reingle Gonzalez JM, Salas-Wright CP, Vaughn MG, DiNitto DM. Prevalence and correlates of alcohol and tobacco use among pregnant women in the United States: Evidence from the NSDUH 2005-2014. Prev Med 2017; 97:93-99. [PMID: 28111096 DOI: 10.1016/j.ypmed.2017.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/04/2016] [Accepted: 01/17/2017] [Indexed: 11/18/2022]
Abstract
Alcohol and tobacco use during pregnancy are among the strongest and most preventable risk factors for adverse neonatal health outcomes, but few developmentally sensitive, population-based studies of this phenomenon have been conducted. To address this gap, the present study examined the prevalence and correlates of alcohol and tobacco use among pregnant adolescents (aged 12-17) and adults (aged 18-44) in the United States. Data were derived from the population-based National Survey of Drug Use and Health (80,498 adolescent and 152,043 adult women) between 2005 and 2014. Findings show disconcerting levels of past-month use among pregnant women with 11.5% of adolescent and 8.7% of adult women using alcohol, and 23.0% of adolescent and 14.9% of adult women using tobacco. Compared to their non-pregnant counterparts, pregnant adolescents were less likely to report past 30-day alcohol use (AOR=0.52, 95% CI=0.36-0.76), but more likely to report past 30-day tobacco use (AOR=2.20, 95% CI=1.53-3.18). Compared to their non-pregnant adult counterparts, pregnant adults were less likely to report using alcohol (AOR=0.06, 95% CI=0.05-0.07) and tobacco (AOR=0.47, 95% CI=0.43-0.52). Compared to pregnant abstainers, pregnant women reporting alcohol/tobacco use were more likely to have had a major depressive episode in the past 12months, report criminal justice system involvement, and endorse comorbid alcohol/tobacco use. Given alcohol and tobacco's deleterious consequences during pregnancy, increased attention to reducing use is critical. Findings suggest that tobacco use is especially problematic for both adolescents and adults and is strongly linked with depression and criminal justice involvement, especially among adults.
Collapse
Affiliation(s)
- Sehun Oh
- School of Social Work, The University of Texas at Austin, United States.
| | - Jennifer M Reingle Gonzalez
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, United States
| | | | - Michael G Vaughn
- College for Public Health and Social Justice, Saint Louis University, United States
| | - Diana M DiNitto
- School of Social Work, The University of Texas at Austin, United States
| |
Collapse
|
92
|
Nur N. Association of risk factors with smoking during pregnancy among women of childbearing age: an epidemiological field study in Turkey. SAO PAULO MED J 2017; 135:100-106. [PMID: 28380202 PMCID: PMC9977337 DOI: 10.1590/1516-3180.2016.021921102016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/21/2016] [Indexed: 12/12/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Smoking during pregnancy is an important risk factor for maternal and infant health that is preventable. This study aimed to investigate the risk factors associated with smoking behavior during pregnancy. DESIGN AND SETTING: A household-based probability sample survey of 1,510 women was conducted in the center of the city of Sivas, Turkey, between September 2013 and May 2014. METHODS: The prevalence of smoking during pregnancy was estimated according to independent variables by means of regression analysis. RESULTS: The prevalence of smoking during pregnancy was 16.5%. Logistic regression showed that being at a relatively young age (odds ratio, OR = 1.92, P = 0.025 for 15-24 age group; and OR = 2.45, P = 0.001 for 25-34 age group), having a low educational level (OR = 1.76, P = 0.032), being unmarried (OR = 1.48, P = 0.002) and living in an extended family (OR = 1.98, P = 0.009) were the factors associated with the risk of smoking during pregnancy. CONCLUSIONS: Systematic attention should be paid to socioeconomic inequalities, to support women towards quitting smoking before or at an early stage of their pregnancies. Younger women and particularly those in lower socioeconomic groups should be targeted. This will lead to better pregnancy status, especially among young women.
Collapse
Affiliation(s)
- Naim Nur
- MD. Professor, Department of Public Health, School of Medicine, Cumhuriyet University, Sivas, Turkey.
| |
Collapse
|
93
|
Wagijo MA, Sheikh A, Duijts L, Been JV. Reducing tobacco smoking and smoke exposure to prevent preterm birth and its complications. Paediatr Respir Rev 2017; 22:3-10. [PMID: 26482273 DOI: 10.1016/j.prrv.2015.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
Tobacco smoking and smoke exposure during pregnancy are associated with a range of adverse health outcomes, including preterm birth. Also, children born preterm have a higher risk of complications including bronchopulmonary dysplasia and asthma when their mothers smoked during pregnancy. Smoking cessation in early pregnancy can help reduce the adverse impact on offspring health. Counselling interventions are effective in promoting smoking cessation and reducing the incidence of preterm birth. Peer support and incentive-based approaches are likely to be of additional benefit, whereas the effectiveness of pharmacological interventions, including nicotine replacement therapy, has not definitely been established. Smoke-free legislation can help reduce smoke exposure as well as maternal smoking rates at a population level, and is associated with a reduction in preterm birth. Helping future mothers to stop smoking and protect their children from second hand smoke exposure must be a key priority for health care workers and policy makers alike.
Collapse
Affiliation(s)
- Mary-Ann Wagijo
- Division of Neonatology, Erasmus University Medical Centre - Sophia Children's Hospital, PO Box 2060, 3000CB, Rotterdam, The Netherlands.
| | - Aziz Sheikh
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK; School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands.
| | - Liesbeth Duijts
- Division of Neonatology, Erasmus University Medical Centre - Sophia Children's Hospital, PO Box 2060, 3000CB, Rotterdam, The Netherlands; Department of Paediatrics, division of Respiratory Medicine, Erasmus University Medical Centre - Sophia Children's Hospital, PO Box 2060, 3000CB Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Centre, PO Box 2060, 3000CB, Rotterdam, The Netherlands.
| | - Jasper V Been
- Division of Neonatology, Erasmus University Medical Centre - Sophia Children's Hospital, PO Box 2060, 3000CB, Rotterdam, The Netherlands; Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK; School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands.
| |
Collapse
|
94
|
Bell R, Glinianaia SV, Waal ZVD, Close A, Moloney E, Jones S, Araújo-Soares V, Hamilton S, Milne EM, Shucksmith J, Vale L, Willmore M, White M, Rushton S. Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: interrupted time series analysis with economic evaluation. Tob Control 2017; 27:90-98. [PMID: 28202783 PMCID: PMC5801649 DOI: 10.1136/tobaccocontrol-2016-053476] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/14/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022]
Abstract
Objectives To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking. Design Interrupted time series analysis of routine data before and after introducing the intervention, within-study economic evaluation. Setting Eight acute NHS hospital trusts and 12 local authority areas in North East England. Participants 37 726 records of singleton delivery including 10 594 to mothers classified as smoking during pregnancy. Interventions A package of measures implemented in trusts and smoking cessation services, aimed at increasing the proportion of pregnant smokers quitting during pregnancy, comprising skills training for healthcare and smoking cessation staff; universal carbon monoxide monitoring with routine opt-out referral for smoking cessation support; provision of carbon monoxide monitors and supporting materials; and an explicit referral pathway and follow-up protocol. Main outcome measures Referrals to smoking cessation services; probability of quitting smoking during pregnancy; additional costs to health services; incremental cost per additional woman quitting. Results After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter. Conclusions The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.
Collapse
Affiliation(s)
- Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Andrew Close
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | - Eoin Moloney
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Jones
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Vera Araújo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sharon Hamilton
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | | | - Janet Shucksmith
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Martin White
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Steven Rushton
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
95
|
Dall’Asta A, Brunelli V, Prefumo F, Frusca T, Lees CC. Early onset fetal growth restriction. Matern Health Neonatol Perinatol 2017; 3:2. [PMID: 28116113 PMCID: PMC5241928 DOI: 10.1186/s40748-016-0041-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/27/2016] [Indexed: 01/01/2023] Open
Abstract
Fetal growth restriction (FGR) diagnosed before 32 weeks is identified by fetal smallness associated with Doppler abnormalities and is associated with significant perinatal morbidity and mortality and maternal complications. Recent studies have provided new insights into pathophysiology, management options and postnatal outcomes of FGR. In this paper we review the available evidence regarding diagnosis, management and prognosis of fetuses diagnosed with FGR before 32 weeks of gestation.
Collapse
Affiliation(s)
- Andrea Dall’Asta
- Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS United Kingdom
- Department of Obstetrics & Gynecology, University of Parma, Parma, Italy
| | - Valentina Brunelli
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - Tiziana Frusca
- Department of Obstetrics & Gynecology, University of Parma, Parma, Italy
| | - Christoph C Lees
- Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Development and Regeneration, KU Leuven, Belgium
| |
Collapse
|
96
|
Lausman A, Kingdom J. Retard de croissance intra-utérin : Dépistage, diagnostic et prise en charge. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S277-S286. [PMID: 28063541 DOI: 10.1016/j.jogc.2016.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
97
|
Smoke-free legislation and child health. NPJ Prim Care Respir Med 2016; 26:16067. [PMID: 27853176 PMCID: PMC5113157 DOI: 10.1038/npjpcrm.2016.67] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/25/2016] [Accepted: 08/02/2016] [Indexed: 11/08/2022] Open
Abstract
In this paper, we aim to present an overview of the scientific literature on the link between smoke-free legislation and early-life health outcomes. Exposure to second-hand smoke is responsible for an estimated 166 ,000 child deaths each year worldwide. To protect people from tobacco smoke, the World Health Organization recommends the implementation of comprehensive smoke-free legislation that prohibits smoking in all public indoor spaces, including workplaces, bars and restaurants. The implementation of such legislation has been found to reduce tobacco smoke exposure, encourage people to quit smoking and improve adult health outcomes. There is an increasing body of evidence that shows that children also experience health benefits after implementation of smoke-free legislation. In addition to protecting children from tobacco smoke in public, the link between smoke-free legislation and improved child health is likely to be mediated via a decline in smoking during pregnancy and reduced exposure in the home environment. Recent studies have found that the implementation of smoke-free legislation is associated with a substantial decrease in the number of perinatal deaths, preterm births and hospital attendance for respiratory tract infections and asthma in children, although such benefits are not found in each study. With over 80% of the world’s population currently unprotected by comprehensive smoke-free laws, protecting (unborn) children from the adverse impact of tobacco smoking and SHS exposure holds great potential to benefit public health and should therefore be a key priority for policymakers and health workers alike.
Collapse
|
98
|
van Zijl MD, Koullali B, Mol BW, Pajkrt E, Oudijk MA. Prevention of preterm delivery: current challenges and future prospects. Int J Womens Health 2016; 8:633-645. [PMID: 27843353 PMCID: PMC5098751 DOI: 10.2147/ijwh.s89317] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Preterm birth (PTB), defined as delivery at <37 weeks of gestation, is the most important cause of neonatal morbidity and mortality. Therefore, preventing PTB is one of the main goals in obstetric care. In this review, we provide an overview of the current available literature on screening for risk factors for PTB and a summary of preventive strategies in both low-risk and high-risk women with singleton or multiple gestations. Furthermore, current challenges and future prospects on PTB are discussed. For an optimal prevention of PTB, risk stratification should be based on a combination of (maternal) risk factors, obstetric history, and screening tools. Cervical length measurements can help identify women at risk. Thereafter, preventive strategies such as progesterone, pessaries, and cerclage may help prevent PTB. Effective screening and prevention of PTB vary between the different pregnancy populations. In singleton or multiple pregnancies with a short cervix, without previous PTB, a pessary or progesterone might prevent PTB. In women with a (recurrent) PTB in the past, progesterone and a cerclage may prevent recurrence. The effect of a pessary in these high-risk women is currently being studied. A strong collaboration between doctors, patients' organizations, pharmaceutical companies, and (international) governments is needed to reduce the morbidity and mortality as a result of spontaneous PTB.
Collapse
Affiliation(s)
- Maud D van Zijl
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bouchra Koullali
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Ben Wj Mol
- The Robinson Research Institute, School for Reproductive Health and Pediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
99
|
Hayes C, Kearney M, O'Carroll H, Zgaga L, Geary M, Kelleher C. Patterns of Smoking Behaviour in Low-Income Pregnant Women: A Cohort Study of Differential Effects on Infant Birth Weight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1060. [PMID: 27801861 PMCID: PMC5129270 DOI: 10.3390/ijerph13111060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
Abstract
Maternal smoking accounts for 20%-30% of low birth weight (BW). Second-Hand Smoke (SHS) also negatively affects BW. This cohort study explored the differential effect of smoking patterns during pregnancy on infant BW. Smoking status for 652 self-reported smokers attending public ante-natal clinics was assessed at baseline (V1 first ante-natal visit), 28-32 weeks (V2) and one week after birth (V3). Multivariable generalised linear regression models tested smoking patterns (continuing to smoke, sustained quitting, partial quitting) on BW adjusting for household smoking and other co-variates. Total quitting showed a median increase of 288 g in BW (95% CI (confidence intervals): 153.1-423 g, p < 0.001), compared to partial quitting (147 g, (95% CI: 50-244 g), p < 0.003). In partial quitters, increased BW was observed only in females 218 g, (95% CI: 81-355 g), p = 0.002). Household SHS showed a specific negative influence on pre-term but not term BW. This study suggests that, for low-income women, quitting or partial quitting during pregnancy both have a positive influence on infant BW. Whether others in the household smoke is also important.
Collapse
Affiliation(s)
- Catherine Hayes
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin 2, Ireland.
| | - Morgan Kearney
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin 1, Ireland.
| | - Helen O'Carroll
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin 1, Ireland.
| | - Lina Zgaga
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin 2, Ireland.
| | - Michael Geary
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin 1, Ireland.
| | - Cecily Kelleher
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland.
| |
Collapse
|
100
|
Ahumada-Barrios ME, Alvarado GF. Risk Factors for premature birth in a hospital. Rev Lat Am Enfermagem 2016; 24:e2750. [PMID: 27463110 PMCID: PMC4982444 DOI: 10.1590/1518-8345.0775.2750] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 11/13/2015] [Indexed: 11/24/2022] Open
Abstract
Objective: to determine the risk factors for premature birth. Methods: retrospective case-control study of 600 pregnant women assisted in a hospital,
with 298 pregnant women in the case group (who gave birth prematurely <37
weeks) and 302 pregnant women who gave birth to a full-term newborn in the control
group. Stata software version 12.2 was used. The Chi-square test was used in
bivariate analysis and logistic regression was used in multivariate analysis, from
which Odds Ratios (OR) and Confidence Intervals (CI) of 95% were derived. Results: risk factors associated with premature birth were current twin pregnancy
(adjusted OR= 2.4; p= 0.02), inadequate prenatal care (< 6 controls) (adjusted
OR= 3.2; p <0.001), absent prenatal care (adjusted OR= 3.0; p <0.001),
history of premature birth (adjusted OR= 3.7; p <0.001) and preeclampsia
(adjusted OR= 1.9; p= 0.005). Conclusion: history of premature birth, preeclampsia, not receiving prenatal care and
receiving inadequate prenatal care were risk factors for premature birth.
Collapse
Affiliation(s)
| | - German F Alvarado
- Facultad de Ciencias de la Salud, Universidad Católica Sedes Sapientiae, Lima, Peru
| |
Collapse
|