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von Dadelszen P, Vidler M, Tsigas E, Magee LA. Management of Preeclampsia in Low- and Middle-Income Countries: Lessons to Date, and Questions Arising, from the PRE-EMPT and Related Initiatives. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Tipping the scale: the role of a national nutritional supplementation programme for pregnant mothers in reducing low birth weight and neonatal mortality in India. Br J Nutr 2021; 127:289-297. [PMID: 33745458 PMCID: PMC8756072 DOI: 10.1017/s0007114521000982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With over 1·3 million Anganwadi centres (AWC) (meaning ‘courtyard shelter’), the Indian government runs a nationwide intervention providing nutrition supplement to pregnant mothers to improve the health of their children. Using two successive rounds of the nationally representative cross-sectional National Family Health Survey data (collected during 2005–2006 and 2015–2016) of India, we assessed whether nutrition supplements given to pregnant mothers through AWC were associated with select child health indicators – extremely low birth weight (ELBW), very low birth weight (VLBW), low birth weight (LBW) and neonatal mortality (death during day 0–27) stratified by death during day 0–1, day 2–6 and day 7–27. A total of 148 019 children and 205 593 children were eligible for analysing birth weight and neonatal mortality, respectively. OR with 95% CI, estimated from multivariate logistic regression models, suggest that receipt of nutrition supplements was associated with decreased risk of VLBW (OR: 0·73, 95% CI 0·63, 0·83, P < 0·001), LBW (OR: 0·92, 95% CI 0·88, 0·96, P < 0·001), but not ELBW (OR: 0·80, 95% CI 0·56, 1·15, P = 0·226). Women who always received nutrition supplements during their pregnancy saw lower risk of death of their neonates (OR: 0·67, 95% CI 0·61, 0·73, P < 0·001), including death on day 0–1 (OR: 0·66, 95% CI 0·58, 0·74, P < 0·001), day 2–6 (OR: 0·69, 95% CI 0·58, 0·82, P < 0·001) and day 7–27 (OR: 0·68, 95% CI 0·53, 0·87, P = 0·002). Therefore, nutritional supplementation to pregnant mothers appears to be helpful in deterring various stages of neonatal mortality, VLBW and LBW, though it might not be effective in mitigating ELBW. Findings were discussed considering possible limitations of the study.
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The association between pre-conception intuitive eating and gestational weight gain. Eat Weight Disord 2021; 26:467-474. [PMID: 32125687 DOI: 10.1007/s40519-020-00878-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To determine if pre-conception intuitive eating, an adaptive eating behavior, was related to gestational weight gain (GWG) and the likelihood of exceeding GWG recommendations. METHODS This prospective survey study took place in an outpatient obstetric clinic. Participants completed the pre-conception Intuitive Eating Scale for Pregnancy during a prenatal check-up appointment and total GWG was collected from the medical record. The pre-conception Intuitive Eating Scale for Pregnancy assesses unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on hunger and satiety to inform what, when, and how much to eat. Hierarchical linear multiple regression and logistic multiple regression analyses determined associations between pre-conception intuitive eating and GWG on the total sample and stratified by weight status (normal/underweight, overweight, and obese). RESULTS The majority of the sample (n = 253) was white, married, employed, had annual household income > $50,000, and had a college degree. No aspects of pre-conception intuitive eating predicted the likelihood of excess GWG. However, in the total sample, unconditional permission to eat (subscale) was inversely related to total GWG (B = -0.16, p < 0.05). Among women with obesity (n = 36), eating for physical rather than emotional reasons (subscale) was inversely related to total GWG (B = -0.47, p < 0.05). DISCUSSION Some aspects of intuitive eating during the pre-conception period were related to total GWG, particularly for women with obesity. However, intuitive eating scores did not increase or decrease the likelihood of excess GWG. More research is needed to understand the mechanisms for this association before clinical recommendations can be made. LEVEL OF EVIDENCE Level III (Evidence obtained from well-designed cohort or case-control analytic studies).
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Dennis CL, Marini F, Dick JA, Atkinson S, Barrett J, Bell R, Berard A, Berger H, Brown HK, Constantin E, Da Costa D, Feller A, Guttmann A, Janus M, Joseph KS, Jüni P, Kimmins S, Letourneau N, Li P, Lye S, Maguire JL, Matthews SG, Millar D, Misita D, Murphy K, Nuyt AM, O'Connor DL, Parekh RS, Paterson A, Puts M, Ray J, Roumeliotis P, Scherer S, Sellen D, Semenic S, Shah PS, Smith GN, Stremler R, Szatmari P, Telnner D, Thorpe K, Tremblay MS, Vigod S, Walker M, Birken C. Protocol for a randomised trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). BMJ Open 2021; 11:e046311. [PMID: 33568380 PMCID: PMC7878148 DOI: 10.1136/bmjopen-2020-046311] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The 'Developmental Origins of Health and Disease' hypothesis suggests that a healthy trajectory of growth and development in pregnancy and early childhood is necessary for optimal health, development and lifetime well-being. The purpose of this paper is to present the protocol for a randomised controlled trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). The primary objective of HeLTI Canada is to determine whether a 4-phase 'preconception to early childhood' lifecourse intervention can reduce the rate of child overweight and obesity. Secondary objectives include improved child: (1) growth trajectories; (2) cardiometabolic risk factors; (3) health behaviours, including nutrition, physical activity, sedentary behaviour and sleep; and (4) development and school readiness at age 5 years. METHOD AND ANALYSIS A randomised controlled multicentre trial will be conducted in two of Canada's highly populous provinces-Alberta and Ontario-with 786 nulliparous (15%) and 4444 primiparous (85%) women, their partners and, when possible, the first 'sibling child.' The intervention is telephone-based collaborative care delivered by experienced public health nurses trained in healthy conversation skills that includes detailed risk assessments, individualised structured management plans, scheduled follow-up calls, and access to a web-based app with individualised, evidence-based resources. An 'index child' conceived after randomisation will be followed until age 5 years and assessed for the primary and secondary outcomes. Pregnancy, infancy (age 2 years) and parental outcomes across time will also be assessed. ETHICS AND DISSEMINATION The study has received approval from Clinical Trials Ontario (CTO 1776). The findings will be published in peer-reviewed journals and disseminated to policymakers at local, national and international agencies. Findings will also be shared with study participants and their communities. TRIAL REGISTRATION NUMBER ISRCTN13308752; Pre-results.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Jennifer Abbass Dick
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Stephanie Atkinson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rhonda Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Anick Berard
- Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
- Saint Justine Hospital, Montreal, Québec, Canada
| | - Howard Berger
- St Michael's Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Hillary K Brown
- Department of Health & Society (Scarborough Campus), University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Evelyn Constantin
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
- McGill University Health Centre, Montreal, Ontario, Canada
| | - Deborah Da Costa
- McGill University Health Centre, Montreal, Ontario, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
| | - Andrea Feller
- Niagara Region Public Health, Thorold, Ontario, Canada
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Magdalena Janus
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - K S Joseph
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Jüni
- St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Kimmins
- Department of Animal Science, McGill University, Montreal, Québec, Canada
| | | | - Patricia Li
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Stephen Lye
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- St Michael's Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Stephen G Matthews
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - David Millar
- Monarch Maternal and Newborn Health Centre, Ottawa, Ontario, Canada
| | - Dragana Misita
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Kellie Murphy
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anne Monique Nuyt
- Saint Justine Hospital, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Deborah L O'Connor
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Rulan Savita Parekh
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Paterson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Joel Ray
- St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Stephen Scherer
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Sellen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Semenic
- McGill University Health Centre, Montreal, Ontario, Canada
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Robyn Stremler
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Szatmari
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Deanna Telnner
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Simone Vigod
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Mark Walker
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Catherine Birken
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Hamdanieh M, Ftouni L, Al Jardali B, Ftouni R, Rawas C, Ghotmi M, El Zein MH, Ghazi S, Malas S. Assessment of sexual and reproductive health knowledge and awareness among single unmarried women living in Lebanon: a cross-sectional study. Reprod Health 2021; 18:24. [PMID: 33509225 PMCID: PMC7842035 DOI: 10.1186/s12978-021-01079-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/13/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sexual and reproductive health (SRH), a globally recognized fundamental health concern and a basic human right is poorly addressed and seldom researched in the Arab world. Disregarding this aspect of health creates various obstacles to accessing SRH related services and education. This threatens the health of a female, namely through increasing the probability of unplanned pregnancies and unsafe abortions, augmenting the risk of acquiring sexually transmitted infections, and most importantly, increasing the hazard of maternal and neonatal death. Thus, this study aimed to assess the level of SRH related knowledge and awareness among single unmarried women living in Lebanon. METHODS A descriptive cross-sectional study design was conducted using a self-administered questionnaire in both English and Arabic languages. The questionnaire included 9 sections; socio-demographic characteristics section, sexually transmitted infections (STIs) section, premarital tests section, vaccines section, menstruation and its abnormalities section, pregnancy symptoms and identification section, methods of contraception section, vitamins section, and honeymoon events section. The questionnaire was distributed among all Lebanese governorates to 491 single unmarried women living in Lebanon aged between 17 and 55 years. Student t-test and Chi-Square test were used to analyze results. RESULTS It was found that only 8.8% of all the participants had adequate knowledge. The highest level of SRH related knowledge was about pregnancy (88.0%), and the least was about contraception (13.5%). Most of the knowledgeable participants lived in Beirut governorate (13.6%, n = 8) and had reached universities (10.3%, n = 41), but this was not statistically significant (p-value > 0.05). The effect of a prior visit to a gynecologist was statistically non-significant on the overall level of knowledge (p-value = 0.269). CONCLUSION Due to the inadequate level of knowledge, SRH education campaigns empowered by the Ministry of Public Health in collaboration with primary care physicians and gynecologists, are recommended in both the societal and academic sectors to enhance the awareness level and make SRH knowledge readily available among unmarried women aged between 17 and 55. Knowing the massive role of social media nowadays, the messages they present should contribute to enhancing the level of SRH knowledge and redirect attitudes and behaviors of unmarried females in Lebanon.
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Affiliation(s)
- Maya Hamdanieh
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Louna Ftouni
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | | | - Racha Ftouni
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Chaymaa Rawas
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Marina Ghotmi
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | | | - Sara Ghazi
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Salah Malas
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
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Bo Y, Zhu Y, Tao Y, Li X, Zhai D, Bu Y, Wan Z, Wang L, Wang Y, Yu Z. Association Between Folate and Health Outcomes: An Umbrella Review of Meta-Analyses. Front Public Health 2020; 8:550753. [PMID: 33384976 PMCID: PMC7770110 DOI: 10.3389/fpubh.2020.550753] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background: There is no study that has systematically investigated the breadth and validity of the associations of folate and multiple health outcomes. We aimed to evaluate the quantity, validity, and credibility of evidence regarding associations between folate and multiple health outcomes by using umbrella review of meta-analysis. Methods: We searched the MEDLINE, EMBASE, and Cochrane Library databases from inception to May 20, 2018, to identify potential meta-analyses that examined the association of folate with any health outcome. For each included meta-analysis, we estimated the summary effect size and their 95% confidence interval using the DerSimonian and Laird random-effects model. We used the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) to assess methodological quality and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation working group classification) to assess the quality of evidence for each outcome included in the umbrella review. Results: Overall, 108 articles reporting 133 meta-analyses of observational studies and 154 meta-analyses of randomized controlled trials (RCTs) were included in the study. Among them, 108 unique exposure-outcome-population triplets (referred to as unique meta-analyses hereafter) of RCTs and 87 unique meta-analyses of observational studies were reanalyzed. Beneficial effects of folate were observed in the all-cause mortality rate and in a number of chronic diseases, including several birth/pregnancy outcomes, several cancers, cardiovascular disease and metabolic-related outcomes, neurological conditions, and several other diseases. However, adverse effects of folate were observed for prostate cancer, colorectal adenomatous lesions, asthma or wheezing, and wheezing as an isolated symptom and depression. Conclusions: Current evidence allows for the conclusion that folate is associated with decreased risk of all-cause mortality and a wide range of chronic diseases. However, folate may be associated with an increased risk of prostate cancer. Further research is warranted to improve the certainty of the estimates.
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Affiliation(s)
- Yacong Bo
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Yongjian Zhu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuchang Tao
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xue Li
- School of Public Health, Xinxiang Medical University, Xinxiang, China.,Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Desheng Zhai
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Yongjun Bu
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Zhongxiao Wan
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ling Wang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuming Wang
- Department of Administration, Henan University People's Hospital, Zhengzhou, China
| | - Zengli Yu
- School of Public Health, Xinxiang Medical University, Xinxiang, China
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Pillarisetti A, Roy S, Diamond-Smith N, Ghorpade M, Dhongade A, Balakrishnan K, Sambandam S, Patil R, Levine DI, Juvekar S, Smith KR. Marriage-based pilot clean household fuel intervention in India for improved pregnancy outcomes. BMJ Open 2020; 10:e044127. [PMID: 33020110 PMCID: PMC7537452 DOI: 10.1136/bmjopen-2020-044127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Health interventions often target pregnant women and their unborn children. Interventions in rural India targeting pregnant women, however, often do not cover the critical early windows of susceptibility during the first trimester and parts of the second trimester. This pilot seeks to determine if targeting newlyweds could protect entire pregnancies with a clean stove and fuel intervention. METHODS We recruited 50 newlywed couples who use biomass as a cooking fuel into a clean cooking intervention that included a liquefied petroleum gas (LPG) stove, two gas cylinders, a table to place the stove on and health education. We first evaluated whether community health workers in this region could identify and recruit couples at marriage. We quantified how many additional days of pregnancy could be covered by an intervention if we recruited at marriage versus recruiting after detection of pregnancy. RESULTS On average, we identified and visited newlywed couples within 40 (SD 21) days of marriage. Of the 50 couples recruited, 25 pregnancies and 18 deliveries were identified during this 1-year study. Due to challenges securing fuel from the LPG supply system, not all couples received their intervention prior to pregnancy. Regardless, couples recruited in the marriage arm had substantially more days with the intervention than couples recruited into a similar arm recruited at pregnancy (211 SD 46 vs 120 SD 45). At scale, a stove intervention targeting new marriages would cover about twice as many weeks of first pregnancies as an intervention recruiting after detection of pregnancy. CONCLUSIONS We were able to recruit in early marriage using existing community health workers. Households recruited early in marriage had more days with clean fuel coverage than those recruited at pregnancy. Our findings indicate that recruitment at marriage is feasible and warrants further exploration for stove and other interventions targeting pregnancy-related outcomes.
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Affiliation(s)
- Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Sudipto Roy
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | | | - Makarand Ghorpade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Arun Dhongade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Kalpana Balakrishnan
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sankar Sambandam
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rutuja Patil
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - David I Levine
- Haas School of Business, University of California, Berkeley, California, USA
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
- Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Kirk R Smith
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
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Nourizadeh R, Azami S, Farshbaf-Khalili A, Mehrabi E. The Effect of Motivational Interviewing on Women with Overweight and Obesity Before Conception. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:859-866. [PMID: 32591267 DOI: 10.1016/j.jneb.2020.04.219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the efficacy of motivational interviewing (MI) to elicit change in eating and physical activity behaviors in women with overweight and obesity before conception. DESIGN A randomized controlled trial was conducted. The participants were randomly divided into intervention and comparison groups. Data were gathered using the Three-Factor Eating Questionnaire Revised 18-item version (TFEQ-R18), International Physical Activity Questionnaire (IPAQ), and Stages of Change checklist. SETTING Primary health centers of Tabriz, Iran. PARTICIPANTS The participants were 70 women with overweight or obesity, aged 18-35 years, who were referred for preconception care. INTERVENTION(S) The intervention group received 6 MI sessions, and the comparison group received routine preconception care. MAIN OUTCOME MEASURE(S) Variables of primary outcomes were eating behavior measures and physical activity levels 8 weeks after intervention. ANALYSIS Independent t test, ANCOVA, Fisher exact test, Mann-Whitney U test, and Wilcoxon test were used. RESULTS The MI had a positive effect on physical activity in the moderate and vigorous levels in the intervention group (P = .01, P = .02, respectively). After the intervention, the mean score of cognitive restraint in the intervention group was higher than in the comparison group (adjusted mean difference, 16.9; 95% CI, 10.8 to 23.0; P < .001), whereas there were no significant differences between the 2 groups in terms of emotional and uncontrolled eating (P = .33 and P = .25, respectively). CONCLUSIONS AND IMPLICATIONS The MI had a positive effect on physical activity and eating behavior change, except for uncontrolled and emotional eating. Future studies to examine differences between overweight and women with obesity and within other populations is warranted.
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Affiliation(s)
- Roghaiyeh Nourizadeh
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samar Azami
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azizeh Farshbaf-Khalili
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmat Mehrabi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Massari M, Novielli C, Mandò C, Di Francesco S, Della Porta M, Cazzola R, Panteghini M, Savasi V, Maggini S, Schaefer E, Cetin I. Multiple Micronutrients and Docosahexaenoic Acid Supplementation during Pregnancy: A Randomized Controlled Study. Nutrients 2020; 12:E2432. [PMID: 32823606 PMCID: PMC7468952 DOI: 10.3390/nu12082432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
Maternal dietary intake during pregnancy needs to meet increased nutritional demands to maintain metabolism and to support fetal development. Docosahexaenoic acid (DHA) is essential for fetal neuro-/visual development and in immunomodulation, accumulating rapidly within the developing brain and central nervous system. Levels available to the fetus are governed by the maternal diet. In this multicenter, parallel, randomized controlled trial, we evaluated once-daily supplementation with multiple micronutrients and DHA (i.e., multiple micronutrient supplementation, MMS) on maternal biomarkers and infant anthropometric parameters during the second and third trimesters of pregnancy compared with no supplementation. Primary efficacy endpoint: change in maternal red blood cell (RBC) DHA (wt% total fatty acids) during the study. Secondary variables: other biomarkers of fatty acid and oxidative status, vitamin D, and infant anthropometric parameters at delivery. Supplementation significantly increased RBC DHA levels, the omega-3 index, and vitamin D levels. Subscapular skinfold thickness was significantly greater with MMS in infants. Safety outcomes were comparable between groups. This first randomized controlled trial of supplementation with multiple micronutrients and DHA in pregnant women indicated that MMS significantly improved maternal DHA and vitamin D status in an industrialized setting-an important finding considering the essential roles of DHA and vitamin D.
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Affiliation(s)
- Maddalena Massari
- Department of Woman, Mother and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy; (M.M.); (S.D.F.); (I.C.)
- Department of Woman, Mother and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy;
- “Luigi Sacco” Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (C.N.); (C.M.); (M.D.P.); (R.C.); (M.P.)
| | - Chiara Novielli
- “Luigi Sacco” Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (C.N.); (C.M.); (M.D.P.); (R.C.); (M.P.)
| | - Chiara Mandò
- “Luigi Sacco” Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (C.N.); (C.M.); (M.D.P.); (R.C.); (M.P.)
| | - Stefania Di Francesco
- Department of Woman, Mother and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy; (M.M.); (S.D.F.); (I.C.)
| | - Matteo Della Porta
- “Luigi Sacco” Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (C.N.); (C.M.); (M.D.P.); (R.C.); (M.P.)
| | - Roberta Cazzola
- “Luigi Sacco” Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (C.N.); (C.M.); (M.D.P.); (R.C.); (M.P.)
| | - Mauro Panteghini
- “Luigi Sacco” Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (C.N.); (C.M.); (M.D.P.); (R.C.); (M.P.)
| | - Valeria Savasi
- Department of Woman, Mother and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy;
- “Luigi Sacco” Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (C.N.); (C.M.); (M.D.P.); (R.C.); (M.P.)
| | | | | | - Irene Cetin
- Department of Woman, Mother and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy; (M.M.); (S.D.F.); (I.C.)
- Department of Woman, Mother and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy;
- “Luigi Sacco” Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (C.N.); (C.M.); (M.D.P.); (R.C.); (M.P.)
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Yuan X, Liu Z, Zhu J, Yu P, Deng Y, Chen X, Li N, Li S, Yang S, Li J, Liu H, Li X. Association between prepregnancy body mass index and risk of congenital heart defects in offspring: an ambispective observational study in China. BMC Pregnancy Childbirth 2020; 20:444. [PMID: 32753039 PMCID: PMC7405421 DOI: 10.1186/s12884-020-03100-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Congenital heart defects (CHDs) are the most common birth defect around the world. Maternal prepregnancy obesity has been proposed as a risk factor of CHDs, but the relationship of CHD risk with over- and underweight is controversial, especially because body mass index (BMI) distribution differs between Asia and the West. The study aimed to examine the potential associations of maternal over- and underweight on risk of offspring CHDs. METHODS An ambispective observational study involving 1206 fetuses with CHDs and 1112 fetuses without defects at seven hospitals in China was conducted. Standardized questionnaires were used to collect information on maternal prepregnancy weight and height, social demographic characteristics, living and occupational environments, and lifestyle behaviors. Univariate, multivariate and multilevel logistic regression as well as unrestricted cubic spline analysis were used to examine potential associations of prepregnancy BMI and offspring CHDs. RESULTS Prepregnancy maternal underweight (BMI<18.5) or low average BMI (18.5 ≤ BMI<21.25) was associated with significantly higher risk of CHD in offspring than high average BMI (21.25 ≤ BMI<24.0): multilevel logistic regression indicated adjusted odds ratios of 1.53 (95%CI 1.13, 2.08) for underweight, 1.44 (95%CI 1.10, 1.89) for low average BMI and 1.29 (95%CI 0.84, 1.97) for overweight or obesity (BMI ≥ 24.0). Mothers with prepregnancy BMI < 21.25 were at greater risk of offspring with septal defects, while mothers with low average BMI were at greater risk of offspring with conotruncal defects and septal defects. CONCLUSIONS Our findings suggest that underweight or low average BMI may be associated with higher risk of CHDs in offspring. Health professionals may wish to advise women planning to be pregnant to maintain or even gain weight to ensure adequate, balanced nutrition and thereby reduce the risk of CHDs in their offspring.
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Affiliation(s)
- Xuelian Yuan
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ying Deng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xinlin Chen
- Department of Ultrasound, Hubei Maternal and Child Healthcare Hospital, Wuhan, Hubei, China
| | - Nana Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Shengli Li
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Shuihua Yang
- Department of Ultrasound, Guangxi Maternal and Child Healthcare Hospital, Nanning, Guangxi, China
| | - Jun Li
- Department of Ultrasonic Diagnosis, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hanmin Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, People's Republic of China.
| | - Xiaohong Li
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, People's Republic of China.
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Soheilirad Z. Folic acid intake in prevention of congenital heart defects: A mini evidence review. Clin Nutr ESPEN 2020; 38:277-279. [PMID: 32690169 DOI: 10.1016/j.clnesp.2020.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/18/2020] [Accepted: 05/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Congenital heart defects (CHDs) have been known as the most frequent kind of congenital disorders among all human congenital abnormalities all over the world. There has been a potential connection between the use of folic acid by mothers and an amelioration in the rate of offsprings being born with CHDs in future. In this article, we aimed to assess the strength of evidence related to folic acid intake in prevention of CHDs. METHODS PubMed, Web of science, Scopus, ScienceDirect, and the Cochrane Library were searched up to October 2019 for publications involving the association between using folic acid and rate of CHDs. RESULTS The search strategy yielded 1223 potentially relevant articles. Reading the titles and abstracts was fulfilled after finishing the search of databases to identify appropriate articles for review of full texts of the publications. A total of 20 articles were finalized for full text analysis. No more publications were added to current study after the reference review of the included studies. CONCLUSION Based on the conducted studies, the effectiveness of folic acid alone on CHDs is still not fully clear and more comprehensive studies, well-designed trials with respect to well-defined CHDs, appropriate doses of folic acid, early onset of its prescription in a homogeneous population of nulliparous women without any history of abortions or stillbirths are needed to develop medical primary preventive measures for CHDs in future.
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Affiliation(s)
- Zahra Soheilirad
- Department of Pediatrics, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
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Chowdhury R, Taneja S, Dhabhai N, Mazumder S, Upadhyay RP, Sharma S, Tupaki-Sreepurna A, Dewan R, Mittal P, Chellani H, Bahl R, Bhan MK, Bhandari N. Burden of preconception morbidity in women of reproductive age from an urban setting in North India. PLoS One 2020; 15:e0234768. [PMID: 32555694 PMCID: PMC7302496 DOI: 10.1371/journal.pone.0234768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/01/2020] [Indexed: 12/26/2022] Open
Abstract
Background There is a growing interest in the life course approach for the prevention, early detection and subsequent management of morbidity in women of reproductive age to ensure optimal health and nutrition when they enter pregnancy. Reliable estimates of such morbidities are lacking. We report the prevalence of health or nutrition-related morbidities, specifically, anemia, undernutrition, overweight and obesity, sexually transmitted infections (STIs) or reproductive tract infections (RTIs), diabetes or prediabetes, hypothyroidism, hypertension, and depressive symptoms, during the preconception period among women aged 18 to 30 years. Methods A cross-sectional study was conducted among 2000 nonpregnant married women aged 18 to 30 years with no or one child who wished to have more children in two low- to middle-income urban neighborhoods in Delhi, India, in the context of a randomized controlled trial. STIs and RTIs were measured by symptoms and signs, blood pressure by a digital device, height by stadiometer and weight by a digital weighing scale. A blood specimen was taken to screen for anemia, diabetes, thyroid disorders and syphilis. Maternal depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression analysis was performed to identify sociodemographic factors associated with individual morbidity. Results Overall, 58.7% of women were anemic; 16.5%, undernourished; 26%, overweight or obese; 13.2%, hypothyroid; and 10.5% with both symptoms and signs of STIs/RTIs. There was an increased risk of RTI/STI symptoms and signs in undernourished women and an increased risk of diabetes or prediabetes in overweight or obese women. An increased risk of undernutrition was also observed in women from lower categories of wealth quintiles. A decreased risk of moderate to severe anemia was seen in overweight women and those who completed at least secondary education. Conclusions Our findings show a high burden of undernutrition, anemia, RTIs, hypothyroidism and prediabetes among women in the study. This information will aid policymakers in planning special programs for women of reproductive age.
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Affiliation(s)
- Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Neeta Dhabhai
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ravi Prakash Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sitanshi Sharma
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Rupali Dewan
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pratima Mittal
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Harish Chellani
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Maharaj Kishan Bhan
- Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC), Department of Biotechnology, Government of India, New Delhi, India
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
- * E-mail:
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Roppel R, D'Amico F, Cui K, Srinivasan S. Predictors of Insufficient Preconception Multivitamin Use: An IMPLICIT Network Study. PRIMER (LEAWOOD, KAN.) 2020; 4:9. [PMID: 32537609 PMCID: PMC7279114 DOI: 10.22454/primer.2020.832898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Adequate maternal nutrition before pregnancy is important to reduce the risk of poor birth outcomes. However, patients report suboptimal intake of multivitamins with folic acid (MVIs). METHODS We conducted a quality improvement study to identify predictors of insufficient multivitamin use in women of childbearing age at five University of Pittsburgh Medical Center (UPMC) family health centers that implemented the IMPLICIT interconception care (ICC) model of maternal health screenings during well-child visits (WCVs). We derived this analysis from a retrospective chart review of patient-reported demographic information and physician documented maternal behaviors of 758 women who accompanied their children to 2,706 total well-child visits. Insufficient multivitamin use was defined as having one or more visits where the mother reported that she was not taking multivitamins. RESULTS Insufficient multivitamin use at these health centers was associated with younger age (OR 0.96, 95% CI 0.92, 0.98), less than high school education (OR 3.3, 95% CI 1.56-6.80), public insurance (OR 1.56, 95% CI 1.05-2.34), and increased number of well-child visits attended (OR 1.46, 95% CI 1.31-1.61). CONCLUSION Among women who received screening, younger, low-income, and less educated women are likely to benefit from targeted interventions to improve multivitamin use during the interconception period. Findings also suggest that WCVs are a viable access point to assess and address multivitamin use and other desired maternal health behaviors.
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Affiliation(s)
- Ramey Roppel
- St. Margaret Family Medicine Residency, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Frank D'Amico
- St. Margaret Family Medicine Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Sukanya Srinivasan
- McKeesport Family Medicine Residency | University of Pittsburgh Medical Center, Pittsburgh, PA
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Djossinou DRA, Savy M, Fanou‐Fogny N, Landais E, Accrombessi M, Briand V, Yovo E, Hounhouigan DJ, Gartner A, Martin‐Prevel Y. Changes in women's dietary diversity before and during pregnancy in Southern Benin. MATERNAL & CHILD NUTRITION 2020; 16:e12906. [PMID: 31833230 PMCID: PMC7083447 DOI: 10.1111/mcn.12906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/12/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
Dietary diversity before and during pregnancy is crucial to ensure optimal foetal health and development. We carried out a cohort study of women of reproductive age living in the Sô-Ava and Abomey-Calavi districts (Southern Benin) to investigate women's changes in dietary diversity and identify their determinants both before and during pregnancy. Nonpregnant women were enrolled (n = 1214) and followed up monthly until they became pregnant (n = 316), then every 3 months during pregnancy. One 24-hr dietary recall was administered before conception and during each trimester of pregnancy. Women's dietary diversity scores (WDDS) were computed, defined as the number of food groups out of a list of 10 consumed by the women during the past 24 hr. The analysis included 234 women who had complete data. Mixed-effects linear regression models were used to examine changes in the WDDS over the entire follow-up, while controlling for the season, subdistrict, socio-demographic, and economic factors. At preconception, the mean WDDS was low (4.3 ± 1.1 food groups), and the diet was mainly composed of cereals, oils, vegetables, and fish. The mean WDDS did not change during pregnancy and was equally low at all trimesters. Parity and household wealth index were positively associated with the WDDS before and during pregnancy in the multivariate analysis. Additional research is needed to better understand perceptions of food consumption among populations, and more importantly, efforts must be made to encourage women and communities in Benin to improve the diversity of their diets before and during pregnancy.
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Affiliation(s)
- Diane R. A. Djossinou
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
| | - Mathilde Savy
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Nadia Fanou‐Fogny
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
| | - Edwige Landais
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Manfred Accrombessi
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
- UMR 216‐MERIT, Institut de Recherche pour le Développement (IRD)Université Paris DescartesParisFrance
| | - Valérie Briand
- UMR 216‐MERIT, Institut de Recherche pour le Développement (IRD)Université Paris DescartesParisFrance
| | - Emmanuel Yovo
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
| | - D. Joseph Hounhouigan
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Agnès Gartner
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Yves Martin‐Prevel
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
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Lassi ZS, Kedzior SGE, Tariq W, Jadoon Y, Das JK, Bhutta ZA. Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review. Nutrients 2020; 12:E606. [PMID: 32110886 PMCID: PMC7146400 DOI: 10.3390/nu12030606] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Pregnancy in adolescence and malnutrition are common challenges in low- and middle-income countries (LMICs), and are associated with many complications and comorbidities. The preconception period is an ideal period for intervention as a preventative tactic for teenage pregnancy, and to increase micronutrient supplementation prior to conception. Over twenty databases and websites were searched and 45 randomized controlled trials (RCTs) or quasi-experimental interventions with intent to delay the age at first pregnancy (n = 26), to optimize inter-pregnancy intervals (n = 4), and supplementation of folic acid (n = 5) or a combination of iron and folic acid (n = 10) during the periconception period were included. The review found that educational interventions to delay the age at first pregnancy and optimizing inter-pregnancy intervals significantly improved the uptake of contraception use (RR = 1.71, 95% CI = 1.42-2.05; two studies, n = 911; I2 = 0%) and (RR = 2.25, 95% CI = 1.29-3.93; one study, n = 338), respectively. For periconceptional folic acid supplementation, the incidence of neural tube defects were reduced (RR = 0.53; 95% CI = 0.41-0.77; two studies, n = 248,056; I2 = 0%), and iron-folic acid supplementation improved the rates of anemia (RR = 0.66, 95% CI = 0.53-0.81; six studies; n = 3430, I2 = 88%), particularly when supplemented weekly and in a school setting. Notwithstanding the findings, more robust RCTs are required from LMICs to further support the evidence.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research Institute, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide 5005, Australia;
| | - Sophie G. E. Kedzior
- Robinson Research Institute, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide 5005, Australia;
| | - Wajeeha Tariq
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
| | - Yamna Jadoon
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
| | - Jai K. Das
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
| | - Zulfiqar A. Bhutta
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
- Centre for Global Child Health, the SickKids Hospital, Toronto, ON M5G 0A4, Canada
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Oh C, Keats EC, Bhutta ZA. Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:E491. [PMID: 32075071 PMCID: PMC7071347 DOI: 10.3390/nu12020491] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Almost two billion people are deficient in key vitamins and minerals, mostly women and children in low- and middle-income countries (LMICs). Deficiencies worsen during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child, but could be mitigated by interventions like micronutrient supplementation. To our knowledge, this is the first systematic review that aimed to compile evidence from both efficacy and effectiveness trials, evaluating different supplementation interventions on maternal, birth, child health, and developmental outcomes. We evaluated randomized controlled trials and quasi-experimental studies published since 1995 in peer-reviewed and grey literature that assessed the effects of calcium, vitamin A, iron, vitamin D, and zinc supplementation compared to placebo/no treatment; iron-folic (IFA) supplementation compared to folic acid only; multiple micronutrient (MMN) supplementation compared to IFA; and lipid-based nutrient supplementation (LNS) compared to MMN supplementation. Seventy-two studies, which collectively involved 314 papers (451,723 women), were included. Meta-analyses showed improvement in several key birth outcomes, such as preterm birth, small-for-gestational age (SGA) and low birthweight with MMN supplementation, compared to IFA. MMN also improved child outcomes, including diarrhea incidence and retinol concentration, which are findings not previously reported. Across all comparisons, micronutrient supplementation had little to no effect on mortality (maternal, neonatal, perinatal, and infant) outcomes, which is consistent with other systematic reviews. IFA supplementation showed notable improvement in maternal anemia and the reduction in low birthweight, whereas LNS supplementation had no apparent effect on outcomes; further research that compares LNS and MMN supplementation could help understand differences with these commodities. For single micronutrient supplementation, improvements were noted in only a few outcomes, mainly pre-eclampsia/eclampsia (calcium), maternal anemia (iron), preterm births (vitamin D), and maternal serum zinc concentration (zinc). These findings highlight that micronutrient-specific supplementation should be tailored to specific groups or needs for maximum benefit. In addition, they further contribute to the ongoing discourse of choosing antenatal MMN over IFA as the standard of care in LMICs.
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Affiliation(s)
- Christina Oh
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (C.O.); (E.C.K.)
| | - Emily C. Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (C.O.); (E.C.K.)
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (C.O.); (E.C.K.)
- Centre of Excellence in Women and Child’s Health, Aga Khan University, Karachi 74800, Pakistan
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Dhaded SM, Hambidge KM, Ali SA, Somannavar M, Saleem S, Pasha O, Khan U, Herekar V, Vernekar S, Kumar S. Y, Westcott JE, Thorsten VR, Sridhar A, Das A, McClure E, Derman RJ, Goldenberg RL, Koso-Thomas M, Goudar SS, Krebs NF. Preconception nutrition intervention improved birth length and reduced stunting and wasting in newborns in South Asia: The Women First Randomized Controlled Trial. PLoS One 2020; 15:e0218960. [PMID: 31995570 PMCID: PMC6988936 DOI: 10.1371/journal.pone.0218960] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/24/2019] [Indexed: 11/22/2022] Open
Abstract
South Asia has >50% of the global burden of low birth weight (LBW). The objective was to determine the extent to which maternal nutrition interventions commenced before conception or in the 1st trimester improved fetal growth in this region. This was a secondary analysis of combined newborn anthropometric data for the South Asian sites (India and Pakistan) in the Women First Preconception Maternal Nutrition Trial. Participants were 972 newborn of mothers who were poor, rural, unselected on basis of nutritional status, and had been randomized to receive a daily lipid-based micronutrient supplement commencing ≥3 months prior to conception (Arm 1), in the 1st trimester (Arm 2), or not at all (Arm 3). An additional protein-energy supplement was provided if BMI <20 kg/m2 or gestational weight gain was less than guidelines. Gestational age was established in the 1st trimester and newborn anthropometry obtained <48-hours post-delivery. Mean differences at birth between Arm 1 vs. 3 were length +5.3mm and weight +89g. Effect sizes (ES) and relative risks (RR) with 95% CI for Arm 1 vs. 3 were: length-for-age Z-score (LAZ) +0.29 (0.11-0.46, p = 0.0011); weight-for-age Z-score (WAZ) +0.22 (0.07-0.37, p = 0.0043); weight-to-length-ratio-for-age Z-score (WLRAZ) +0.27 (0.06-0.48, p = 0.0133); LAZ<-2, 0.56 (0.38-0.82, p = 0.0032); WAZ <-2, 0.68 (0.53-0.88, p = 0.0028); WLRAZ <-2, 0.76 (0.64-0.89, p = 0.0011); small-for-gestational-age (SGA), 0.74 (0.66-0.83, p<0.0001); low birth weight 0.81 (0.66-1.00, p = 0.0461). For Arm 2 vs. 3, LAZ, 0.21 (0.04-0.38); WAZ <-2, 0.70 (0.53-0.92); and SGA, 0.88 (0.79-0.97) were only marginally different. ES or RR did not differ for preterm birth for either Arm 1 vs. 3 or 2 vs. 3. In conclusion, point estimates for both continuous and binary anthropometric outcomes were consistently more favorable when maternal nutrition supplements were commenced ≥3 months prior to conception indicating benefits to fetal growth of improving women's nutrition in this population.
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Affiliation(s)
- Sangappa M. Dhaded
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - K. Michael Hambidge
- Pediatric Nutrition, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | | | - Manjunath Somannavar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | | | | | | | - Veena Herekar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Sunil Vernekar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Yogesh Kumar S.
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Jamie E. Westcott
- Pediatric Nutrition, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | | | - Amaanti Sridhar
- RTI International, Durham, North Carolina, United States of America
| | - Abhik Das
- RTI International, Durham, North Carolina, United States of America
| | | | - Richard J. Derman
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Robert L. Goldenberg
- Department of Obstetrics/Gynecology, Columbia University Medical Center, New York, New York, United States of America
| | | | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Nancy F. Krebs
- Pediatric Nutrition, University of Colorado School of Medicine, Aurora, Colorado, United States of America
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Ratcliffe SD, Rosener SE, Frayne DJ. Preconception Care. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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69
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Berhane Y, Canavan CR, Darling AM, Sudfeld CR, Vuai S, Adanu R, Bärnighausen T, Dessie Y, Bukenya JN, Guwatudde D, Killewo J, Sando MM, Sie A, Oduola AMJ, Fawzi WW. The age of opportunity: prevalence of key risk factors among adolescents 10-19 years of age in nine communities in sub-Saharan Africa. Trop Med Int Health 2019; 25:15-32. [PMID: 31698531 DOI: 10.1111/tmi.13339] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To measure health-related behaviours and risk factors among sub-Saharan African adolescents. METHODS Cross-sectional study in nine communities in Burkina Faso, Ethiopia, Eswatini, Ghana, Nigeria, Tanzania and Uganda between 2015 and 2017. Community-representative samples of males and females 10-19 years of age were selected. All communities used a uniform questionnaire that was adapted from the WHO Global School-based Student Health Survey. Weighted prevalence estimates and 95% confidence intervals were calculated for each indicator and stratified by age and sex using SAS version 9.4. All prevalence estimates were pooled across communities through random-effects meta-analyses in Stata version 14. RESULTS A total of 8075 adolescents participated in the study. We observed a high prevalence of inadequate fruit consumption (57-63%) and low physical activity (82-90%); a moderate prevalence of inadequate vegetable consumption (21-31%), unprotected last sex (38-45%), age at first sex <15 years (21-28%) and bullying and physical fighting (12-35%); and a low prevalence of mental health risk factors (1-11%) and alcohol and substance use risk factors (0-6%). We observed a moderate to high prevalence of daily soft drink consumption (21-31%) for all adolescents. Among sexually active adolescents 15-19 years, 37% of females reported ever being pregnant and 8% of males reported to have ever made someone pregnant. Bullying (23%) and physical fighting (35%) were more common among younger male adolescents . The prevalence of low mood was generally higher among older (15-19 years) than younger adolescents (10-14 years). The proportion of adolescents reporting alcohol, drug or cigarette use was very small, with the exception of khat use in Ethiopia. CONCLUSION Overall, diet and physical activity, violence, sexual and reproductive health, and depression are important risk factors for these sub-Saharan African communities. These findings suggest that more evidence is needed including novel efforts for the collection of sensitive information, as well as a need to move towards community-tailored interventions to reach adolescent populations with varying needs.
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Affiliation(s)
- Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Chelsey R Canavan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Justine Nnakate Bukenya
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary M Sando
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Ayoade M J Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Sethi V, Dinachandra K, Murira Z, Gausman J, Bhanot A, de Wagt A, Unisa S, Bhatia S, Baswal D, Subramanian SV. Nutrition status of nulliparous married Indian women 15-24 years: Decadal trends, predictors and program implications. PLoS One 2019; 14:e0221125. [PMID: 31454363 PMCID: PMC6711595 DOI: 10.1371/journal.pone.0221125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/12/2019] [Indexed: 01/15/2023] Open
Abstract
In India, 66% of 8 million married adolescents (~5.3 million) are nulliparous and likely to conceive soon. Among married young women aged 20–24 years about 9.1 million are nulliparous. This group remains relatively less reached in maternal nutrition programs. Current estimates of their nutritional status and predictors of body mass index (BMI) are unavailable. Thinness (BMI <18.5 kg/m2), severe thinness (BMI <16 kg/m2), overweight or obesity (BMI ≥ 23kg/m2) prevalence estimates are presented based on a sample of 11,265 married nulliparous adolescents (15–19 years, married, no parity) and 15,358 young women (20–24 years, married, no parity) drawn from the National Family Health Surveys 2005–06 and 2015–16. Trends by age, time and state were analysed. Predictors of BMI were investigated using linear regression. Using BMI for age z score (BAZ) as standard reference, BMI cut-off was calculated for thinness (-2SD) and overweight or obesity (+1SD) among married nulliparous adolescents as recommended for population under 19 years. 35% sampled adolescents and 26% young women were thin; 4%-5% severely thin. Overweight or obesity was higher among married nulliparous young women than married nulliparous adolescents (21% versus 11%). Eight in 1000 were short, thin and young and six in 1000 were short, thin, anemic and young. At 15 years of age, prevalence of thinness based on BMI was 46.5% while based on BAZ, 7.6%. At 24 years of age thinness was 22.5%. Decadal reduction in thinness was half among married nulliparous adolescents (4% points) compared with married nulliparous young women (8% points). Decadal increase in overweight/ obesity ranged from 4% to 5% in both age groups. Western states had high prevalence of thinness; Tamil Nadu had highest prevalence of overweight or obesity. Incremental increase in age and wealth increased BMI among young women more than adolescents. BMI was lower among adolescents and young women wanting a child later than soon [β -0.28 (CI -0.49- -0.07), β -0.33(CI -0.56- -0.093), respectively]. BMI cut-off 16.49 kg/m2 and 24.12 kg/m2 had a high sensitivity (100%, 99.7%) and specificity (98.9%, 98.5%) to screen thin and overweight or obese adolescents, respectively. Owing to the high prevalence of both thinness and overweight/obesity among nulliparous married adolescents and women, nutritional anthropometry based screening should be initiated for this target group, along with a treatment package in states with high and persistent malnutrition. Family planning services should be integrated in nutrition programs for this target group to achieve normal nutritional status before conception.
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Affiliation(s)
- Vani Sethi
- Nutrition Section, UNICEF India, Country Office, New Delhi, India
- * E-mail:
| | | | - Zivai Murira
- Regional Office for South Asia, UNICEF, Kathmandu, Nepal
| | - Jewel Gausman
- Women & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | | | - Arjan de Wagt
- Nutrition Section, UNICEF India, Country Office, New Delhi, India
| | - Sayeed Unisa
- International Institute for Population Sciences, Mumbai, India
| | - Salima Bhatia
- Ministry of Health and Family Welfare, Government of India, Guwahati, Assam, India
| | - Dinesh Baswal
- Ministry of Health and Family Welfare, Government of India, Guwahati, Assam, India
| | - S. V. Subramanian
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Lassi ZS, Kedzior SG, Das JK, Bhutta ZA. PROTOCOL: Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low‐ and middle‐income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1007. [PMCID: PMC6988117 DOI: 10.1002/cl2.1007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Zohra S. Lassi
- Robinson Research Institute, Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Sophie G.E. Kedzior
- Robinson Research Institute, Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Jai K. Das
- Department of PediatricsAga Khan UniversityKarachiSindhPakistan
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72
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Canavan CR, Fawzi WW. Addressing Knowledge Gaps in Adolescent Nutrition: Toward Advancing Public Health and Sustainable Development. Curr Dev Nutr 2019; 3:nzz062. [PMID: 31218273 PMCID: PMC6571436 DOI: 10.1093/cdn/nzz062] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
Adolescence marks a critical period of growth in the life course. Malnutrition among adolescents includes suboptimal dietary intake of macronutrients and micronutrients as well as overweight and obesity linked to poor dietary quality. We discuss adolescent nutrition and outline 3 knowledge gaps toward advancing adolescent health. First, micronutrient and macronutrient supplements have significant potential to improve nutritional status, but information on the most effective implementation strategies is lacking. Second, food system interventions offer a promising avenue to improve access to healthy foods, and school settings may be an important entry point for improving diets. Third, nutrition programs should be combined with delayed pregnancy interventions for greatest impact given the adverse effects of early pregnancy on maternal and infant health and nutrition outcomes. Evidence-based solutions for adolescent nutritional supplementation, food system and dietary intake interventions, and integration with sexual and reproductive health strategies present crucial opportunities for improving adolescent health and well-being.
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Affiliation(s)
- Chelsey R Canavan
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Preconception Health Attitudes and Behaviours of Women: A Qualitative Investigation. Nutrients 2019; 11:nu11071490. [PMID: 31261954 PMCID: PMC6682867 DOI: 10.3390/nu11071490] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
Abstract
The preconception period is a critical window in which maternal health can profoundly affect both individual and intergenerational health. Despite its importance, little information about women’s preconception health attitudes, behaviours and information preferences exists, yet these details are vital to inform targeted health communication. Semi-structured interviews were conducted to explore women’s attitudes to preconception health (areas of importance, support sources, enablers and barriers), behaviours (information seeking and health actions taken) and information preferences. Interviews were transcribed, coded and thematically analysed. Fifteen women participated (n = 7 preconception, n = 7 pregnant and n = 1 postpartum). Women perceived optimising lifestyle behaviours including a healthy diet, regular physical activity, reducing alcohol intake and pre-pregnancy vitamin supplementation as important preconception health actions to adopt. Few women acknowledged the importance of formal preconception health checks and screening with health professionals. Barriers to achieving health behaviour change included anxiety, stress and challenges obtaining reputable information. Participants reported a lack of preconception information about supplementation requirements, safe foods and exercise recommendations. Information preferences included the internet or their general practitioner. Whilst women predominantly prioritised optimising diet and physical activity prior to pregnancy, there appeared to be limited awareness of preconception health checks and screening, highlighting a need for broader awareness of overall preconception health and wellbeing.
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74
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Young MF, Oaks BM, Tandon S, Martorell R, Dewey KG, Wendt AS. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci 2019; 1450:47-68. [PMID: 30994929 PMCID: PMC6767572 DOI: 10.1111/nyas.14093] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/05/2019] [Accepted: 03/19/2019] [Indexed: 12/14/2022]
Abstract
Maternal anemia is a well‐recognized global health problem; however, there remain questions on specific hemoglobin (Hb) thresholds that predict health risk or protection for mother and child. We conducted a systematic review and meta‐analysis to examine the associations of maternal Hb concentrations with a range of maternal and infant health outcomes, accounting for the timing of measurement (preconception, and first, second, and third trimesters), etiology of anemia, and cutoff category. The systematic review included 272 studies and the meta‐analysis included 95 studies. Low maternal Hb (<110 g/L) was associated with poor birth outcomes (low birth weight, preterm birth, small‐for‐gestational‐age (SGA), stillbirth, and perinatal and neonatal mortality) and adverse maternal outcomes (postpartum hemorrhage, preeclampsia, and blood transfusion). High maternal Hb (>130 g/L) was associated with increased odds of SGA, stillbirth, preeclampsia, and gestational diabetes. Relationships varied by the timing of measurement and cutoff category (stronger associations with lower cutoffs); limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long‐term child health outcomes. Current data are insufficient for determining if revisions to current Hb cutoffs are required. Pooled high‐quality individual‐level data analyses, as well as prospective cohort studies, would be valuable to inform the reevaluation of Hb cutoffs.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island
| | - Sonia Tandon
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | | | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, California
| | - Amanda S Wendt
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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King DM, Donley T, Mbizo J, Higgins M, Langaigne A, Middleton EJ, Stokes-Williams C. The Use of a Community-Based Preconception Peer Health Educator Training Intervention to Improve Preconception Health Knowledge. J Racial Ethn Health Disparities 2019; 6:686-700. [PMID: 30838558 DOI: 10.1007/s40615-019-00567-y] [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: 04/25/2018] [Revised: 01/03/2019] [Accepted: 01/25/2019] [Indexed: 12/22/2022]
Abstract
This paper highlights the use of an adapted Office of Minority Health (OMH) Preconception Health Peer Educator program to address persistent infant mortality health disparities. The community-based Attack Infant Mortality (AIM Escambia) initiative was established to increase preconception health knowledge among African American women at risk for adverse birth outcomes. Participants (N = 122) attended a 6-h AIM peer educator training, completed pretest and posttest questionnaires about their health knowledge, health attitudes, and planned engagement in health behaviors. Study results support the use of preconception health education training to inform health knowledge, health attitudes, and planned health sharing behaviors. Multidisciplinary collaborations and targeted interventions should be considered when seeking to improve community health conditions and increase health knowledge and health literacy for minority populations.
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Affiliation(s)
- Dione Moultrie King
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Tiffany Donley
- Department of Population Health, NYU Langone Health, New York, NY, 10016, USA
| | - Justice Mbizo
- Usha Kundu, MD College of Health, Department of Public Health, University of West Florida, Pensacola, FL, 32514, USA
| | - Melody Higgins
- School of Social Work, University of Alabama, Tuscaloosa, AL, 35487, USA
| | - Anika Langaigne
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, 33199, USA
| | - Erica Jordan Middleton
- Department of Psychological Health & Learning Sciences, University of Houston, Houston, TX, 77004, USA
| | - Charu Stokes-Williams
- Family Medicine Residency Clinic, 55th Medical Group, United States Air Force, 2501 Capehart Rd, Bellevue, NE, 68113, USA
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76
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Bhutta ZA. Balancing the benefits of maternal nutritional interventions; time to put women first! Am J Clin Nutr 2019; 109:249-250. [PMID: 30721972 DOI: 10.1093/ajcn/nqy336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/16/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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77
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Hambidge KM, Westcott JE, Garcés A, Figueroa L, Goudar SS, Dhaded SM, Pasha O, Ali SA, Tshefu A, Lokangaka A, Derman RJ, Goldenberg RL, Bose CL, Bauserman M, Koso-Thomas M, Thorsten VR, Sridhar A, Stolka K, Das A, McClure EM, Krebs NF. A multicountry randomized controlled trial of comprehensive maternal nutrition supplementation initiated before conception: the Women First trial. Am J Clin Nutr 2019; 109:457-469. [PMID: 30721941 PMCID: PMC6367966 DOI: 10.1093/ajcn/nqy228] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022] Open
Abstract
Background Reported benefits of maternal nutrition supplements commenced during pregnancy in low-resource populations have typically been quite limited. Objectives This study tested the effects on newborn size, especially length, of commencing nutrition supplements for women in low-resource populations ≥3 mo before conception (Arm 1), compared with the same supplement commenced late in the first trimester of pregnancy (Arm 2) or not at all (control Arm 3). Methods Women First was a 3-arm individualized randomized controlled trial (RCT). The intervention was a lipid-based micronutrient supplement; a protein-energy supplement was also provided if maternal body mass index (kg/m2) was <20 or gestational weight gain was less than recommendations. Study sites were in rural locations of the Democratic Republic of the Congo (DRC), Guatemala, India, and Pakistan. The primary outcome was length-for-age z score (LAZ), with all anthropometry obtained <48 h post delivery. Because gestational ages were unavailable in DRC, outcomes were determined for all 4 sites from WHO newborn standards (non-gestational-age-adjusted, NGAA) as well as INTERGROWTH-21st fetal standards (3 sites, gestational age-adjusted, GAA). Results A total of 7387 nonpregnant women were randomly assigned, yielding 2451 births with NGAA primary outcomes and 1465 with GAA outcomes. Mean LAZ and other outcomes did not differ between Arm 1 and Arm 2 using either NGAA or GAA. Mean LAZ (NGAA) for Arm 1 was greater than for Arm 3 (effect size: +0.19; 95% CI: 0.08, 0.30, P = 0.0008). For GAA outcomes, rates of stunting and small-for-gestational-age were lower in Arm 1 than in Arm 3 (RR: 0.69; 95% CI: 0.49, 0.98, P = 0.0361 and RR: 0.78; 95% CI: 0.70, 0.88, P < 0.001, respectively). Rates of preterm birth did not differ among arms. Conclusions In low-resource populations, benefits on fetal growth-related birth outcomes were derived from nutrition supplements commenced before conception or late in the first trimester. This trial was registered at clinicaltrials.gov as NCT01883193.
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Affiliation(s)
- K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jamie E Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ana Garcés
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City, Guatemala
| | - Lester Figueroa
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City, Guatemala
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | - Omrana Pasha
- Aga Khan University, Karachi, Pakistan,Johns Hopkins University, Baltimore, MD
| | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Carl L Bose
- University of North Carolina, Chapel Hill, NC
| | | | - Marion Koso-Thomas
- National Institute of Child Health and Human Development/NIH, Bethesda, MD
| | | | | | | | | | | | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO,Address correspondence to NFK (e-mail: )
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Hemalatha R, Radhakrishna K, Kumar BN. Undernutrition in children & critical windows of opportunity in Indian context. Indian J Med Res 2018; 148:612-620. [PMID: 30666986 PMCID: PMC6366257 DOI: 10.4103/ijmr.ijmr_1963_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Indexed: 12/24/2022] Open
Abstract
It is intriguing to note that majority of the wasting among the under 5 yr in India is present at birth. The National Family Health Survey 4 (NFHS-4) data analysis shows 31.9 per cent wasting at birth, which is decreasing to 17.7 per cent in the under five children; clearly suggesting that any reduction in wasting should come from improvement in foetal growth. In addition, children with both severe wasting and severe stunting, in whom the risk of mortality increases many folds, are <1 per cent in almost all the States; and these are the children in whom special care is required under the community-based management of severe acute malnutrition. This article presents an overview of nutrition status in children, their antecedents, and the critical phases; especially, nutrition status before pregnancy that plays a crucial role in all the nutrition status indicators of children. More attention on the critical phases is crucial to maximize the benefits from national programmes.
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Affiliation(s)
- R. Hemalatha
- ICMR-National Institute of Nutrition, Hyderabad, India
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Young MF, Nguyen PH, Gonzalez Casanova I, Addo OY, Tran LM, Nguyen S, Martorell R, Ramakrishnan U. Role of maternal preconception nutrition on offspring growth and risk of stunting across the first 1000 days in Vietnam: A prospective cohort study. PLoS One 2018; 13:e0203201. [PMID: 30161206 PMCID: PMC6117029 DOI: 10.1371/journal.pone.0203201] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/10/2018] [Indexed: 12/20/2022] Open
Abstract
Growing evidence supports the role of preconception maternal nutritional status (PMNS) on birth outcomes; however, evidence of relationships with child growth are limited. We examined associations between PMNS (height, weight and body mass index- BMI) and offspring growth during the first 1000 days. We used prospective cohort data from a randomized-controlled trial of preconception micronutrient supplementation in Vietnam, PRECONCEPT (n = 1409). Poisson regression models were used to examine associations between PMNS and risk of offspring stunting (<-2 HAZ) at 2 years. We used path analytic models to examine associations with PMNS on fetal growth (ultrasound measurements) and offspring HAZ at birth and 2 years. All models were adjusted for child age, sex, gestational weight gain, education, socioeconomic status and treatment group. A third of women had a preconception height < 150cm or weight < 43 kg. Women with preconception height < 150 cm or a weight < 43 kg were at increased risk of having a stunted child at 2 years (incident risk ratio IRR: 1.85, 95% CI 1.51–2.28; IRR 1.35, 95% CI 1.10–1.65, respectively). While the traditional low BMI cut-off (< 18.5 kg/m2) was not significant, lower BMI cut-offs (< 17.5 kg/m2 or < 18.0 kg/m2) were significantly associated with 1.3 times increased risk of child stunting. In path models, PMNS were positively associated with fetal growth (ultrasound measurements) and offspring HAZ at birth and 2 years. For each 1 standard deviation (SD) increase in maternal height and weight, offspring HAZ at 2 years increased by 0.30 SD and 0.23 SD, respectively. In conclusion, PMNS influences both offspring linear growth and risk of stunting across the first 1000 days. These findings underscore the importance of expanding the scope of current policies and strategies to include the preconception period in order to reduce child stunting.
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Affiliation(s)
- Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Phuong Hong Nguyen
- International Food Policy Research Institute, Washington, District of Columbia, United States of America
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Ines Gonzalez Casanova
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - O. Yaw Addo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Lan Mai Tran
- International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Son Nguyen
- International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Li J, Wang Z, Wei D, Liu H, Zhang J, Wang J, Shi Y, Chen ZJ. Effect of preconceptional orlistat treatment on in-vitro fertilization outcome in overweight/obese women: study protocol for a randomized controlled trial. Trials 2018; 19:391. [PMID: 30021634 PMCID: PMC6052605 DOI: 10.1186/s13063-018-2780-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 07/02/2018] [Indexed: 11/29/2022] Open
Abstract
Background Obese women have fewer oocytes retrieved, an increased cancelation rate, a higher miscarriage rate, and a lower live birth rate after assisted reproductive technology (ART) treatment compared with women with normal weight. Weight loss before ART treatment can significantly improve pregnancy rates and/or live births. An orlistat plus diet intervention could promote weight loss, but there is no evidence from randomized clinical trials evaluating the effect of orlistat preconceptional treatment on pregnancy outcome in overweight and obese women. Methods/design We are conducting a multicenter, randomized placebo-controlled, double-blind clinical trial in overweight and obese women aged 20–40 years undergoing in-vitro fertilization and embryo transfer (IVF-ET) with or without intracytoplasmic sperm injection, to evaluate whether orlistat treatment for 1–3 months before IVF-ET can improve the live birth rate. The primary outcome is live birth. Discussion The results of this study will provide evidence for the effect of preconceptional orlistat treatment on IVF outcome in overweight/obese women. Trial registration Chinese Clinical Trial Registry, ChiCTR-IPR-17011629. Registered on 11 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2780-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jing Li
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Ze Wang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Daimin Wei
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Hong Liu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Jiangtao Zhang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Jianfeng Wang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Yuhua Shi
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China.
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China.,Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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Cormick G, Betrán AP, Harbron J, Dannemann Purnat T, Parker C, Hall D, Seuc AH, Roberts JM, Belizán JM, Hofmeyr GJ. Are women with history of pre-eclampsia starting a new pregnancy in good nutritional status in South Africa and Zimbabwe? BMC Pregnancy Childbirth 2018; 18:236. [PMID: 29907146 PMCID: PMC6003186 DOI: 10.1186/s12884-018-1885-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 06/05/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Maternal nutritional status before and during pregnancy is an important contributor to pregnancy outcomes and early child health. The aim of this study was to describe the preconceptional nutritional status and dietary intake during pregnancy in high-risk women from South Africa and Zimbabwe. METHODS This is a prospective observational study, nested to the CAP trial. Anthropometric measurements before and during pregnancy and dietary intake using 24-h recall during pregnancy were assessed. The Intake Distribution Estimation software (PC-SIDE) was used to evaluate nutrient intake adequacy taking the Estimated Average Requirement (EAR) as a cut-off point. RESULTS Three hundred twelve women who had pre-eclampsia in their last pregnancy and delivered in hospitals from South Africa and Zimbabwe were assessed. 73.7 and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) whereas the prevalence of underweight was virtually non-existent. The majority of women had inadequate intakes of micronutrients. Considering food and beverage intake only, none of the micronutrients measured achieved the estimated average requirement. Around 60% of pregnant women reported taking folic acid or iron supplements in South Africa, but almost none did so in Zimbabwe. CONCLUSION We found a high prevalence of overweight and obesity and high micronutrient intake inadequacy in pregnant women who had the previous pregnancy complicated with pre-eclampsia. The obesity figures and micronutrient inadequacy are issues of concern that need to be addressed. Pregnant women have regular contacts with the health system; these opportunities could be used to improve diet and nutrition. TRIAL REGISTRATION PACTR201105000267371 . Registered 06 December 2010.
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Affiliation(s)
- Gabriela Cormick
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Emilio Ravignani, 2024 Buenos Aires, Argentina
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ana Pilar Betrán
- HRP – UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Janetta Harbron
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Catherine Parker
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Effective Care Research Unit, Eastern Cape Department of Health Walter Sisulu University, Mthatha, South Africa
- Effective Care Research Unit, University of Fort Hare, East London, South Africa
| | - David Hall
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Armando H. Seuc
- Epidemiología y Microbiología La Habana, Instituto Nacional de Higiene, Havana, Cuba
| | - James M. Roberts
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, USA
| | - José M. Belizán
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Emilio Ravignani, 2024 Buenos Aires, Argentina
| | - G. Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Effective Care Research Unit, Eastern Cape Department of Health Walter Sisulu University, Mthatha, South Africa
- Effective Care Research Unit, University of Fort Hare, East London, South Africa
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Green BN, Johnson CD, Haldeman S, Griffith E, Clay MB, Kane EJ, Castellote JM, Rajasekaran S, Smuck M, Hurwitz EL, Randhawa K, Yu H, Nordin M. A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders. PLoS One 2018; 13:e0197987. [PMID: 29856783 PMCID: PMC5983449 DOI: 10.1371/journal.pone.0197987] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/11/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders. METHODS A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities. RESULTS Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers' compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders. CONCLUSION Many associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal disorders is needed to address this gap in the literature.
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Affiliation(s)
- Bart N. Green
- Qualcomm Health Center, Stanford Health Care, San Diego, California, United States of America
- Publications Department, National University of Health Sciences, Lombard, Illinois, United States of America
| | - Claire D. Johnson
- Publications Department, National University of Health Sciences, Lombard, Illinois, United States of America
| | - Scott Haldeman
- Department of Neurology, University of California, Irvine, California, United States of America
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, California, United States of America
- World Spine Care, Santa Ana, California, United States of America
| | - Erin Griffith
- Emergency Medicine, Carlsbad, California, United States of America
| | - Michael B. Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, United States of America
| | - Edward J. Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, California, United States of America
| | - Juan M. Castellote
- National School of Occupational Medicine, Carlos III Institute of Health, Complutense University of Madrid, Madrid, Spain
| | | | - Matthew Smuck
- Section of Physical Medicine and Rehabilitation and Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
| | - Eric L. Hurwitz
- Office of Public Health Studies, University of Hawai`i, Mānoa, Honolulu, Hawaii, United States of America
| | - Kristi Randhawa
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Toronto, Ontario, Canada
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Hainan Yu
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Toronto, Ontario, Canada
| | - Margareta Nordin
- World Spine Care, Santa Ana, California, United States of America
- Department of Orthopedic Surgery, New York University, New York, New York, United States of America
- Department of Environmental Medicine, New York University, New York, New York, United States of America
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Baxter JAB, Wasan Y, Soofi SB, Suhag Z, Bhutta ZA. Effect of life skills building education and micronutrient supplements provided from preconception versus the standard of care on low birth weight births among adolescent and young Pakistani women (15-24 years): a prospective, population-based cluster-randomized trial. Reprod Health 2018; 15:104. [PMID: 29855317 PMCID: PMC5984313 DOI: 10.1186/s12978-018-0545-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk factors known to impact maternal and newborn nutrition and health can exist from adolescence. If an undernourished adolescent girl becomes pregnant, her own health and pregnancy are at an increased risk for adverse outcomes. Offering preconception care from adolescence could provide an opportunity for health and nutrition promotion to improve one's own well-being, as well as future pregnancy outcomes and the health of the next generation. METHODS The Matiari emPowerment and Preconception Supplementation (MaPPS) Trial is a population-based two-arm, cluster-randomized, controlled trial of life skills building education and multiple micronutrient supplementation provided in a programmatic context to evaluate the impact on pre-identified nutrition and health outcomes among adolescent and young women (15-24 years) in Matiari district Pakistan, and the infants born to them within the context of the trial. The primary aim is to assess the effect of the intervention on the prevalence of low birth weight births (< 2500 g). The intervention includes bi-monthly life skills building education provided from preconception, and supplementation with multiple micronutrients during preconception (twice-weekly), pregnancy (daily), and post-partum (daily to 6 months). The standard of care includes non-regulated community-based health sessions and daily iron and folic acid supplementation during pregnancy. Additional outcome information will also be collected at set time periods. Among participants, these relate to nutrition (anthropometry, nutritional status), morbidity, and mortality. Among infants, these include birth outcomes (stillbirth, preterm birth, length of gestation, small for gestational age, birth defects), anthropometry, morbidity, and mortality. DISCUSSION Preconception care from adolescence that includes interventions targeting life skills development and nutrition is suggested to be important to improving the health and nutrition of adolescent and young women and their future offspring. This study is expected to offer insight into providing such an intervention both within a programmatic context and with an extended exposure period prior to conception. TRIAL REGISTRATION The MaPPS Trial was registered retrospectively on clinicaltrials.gov (Identifier: NCT03287882 ) on September 19, 2017.
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Affiliation(s)
- Jo-Anna B Baxter
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Zamir Suhag
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan.
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Baxter JAB, Wasan Y, Soofi SB, Suhag Z, Bhutta ZA. Feasibility and effect of life skills building education and multiple micronutrient supplements versus the standard of care on anemia among non-pregnant adolescent and young Pakistani women (15-24 years): a prospective, population-based cluster-randomized trial. Reprod Health 2018; 15:103. [PMID: 29848335 PMCID: PMC5977744 DOI: 10.1186/s12978-018-0547-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/24/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adolescence is a critical period for physical and psychological growth and development, and vitamin and mineral requirements are correspondingly increased. Health and health behaviours correspond strongly from adolescence to adulthood. Developing a preconception care package for adolescent and young women in resource-limited settings could serve to empower them to make informed decisions about their nutrition, health, and well-being, as well as function as a platform for the delivery of basic nutrition-related interventions to address undernutrition. METHODS In this population-based two-arm, cluster-randomized, controlled trial of life skills building education (provided bi-monthly) and multiple micronutrient supplementation (provided twice-weekly; UNIMMAP composition), we aim to evaluate the effectiveness of the intervention on the prevention of anemia (hemoglobin concentration < 12 g/dL) among adolescent and young women (15-24 years) in Matiari district, Pakistan compared to the standard of care. Several secondary objectives related to nutrition (anthropometry [height, weight, middle upper arm circumference (MUAC)], nutritional status [iron, vitamin A, vitamin D]); general health (morbidity, mortality); and empowerment (age at marriage, completion of the 10th grade, use of personal hygienic materials during menstruation) will also be assessed. Participants will be enrolled in the study for a maximum of 2 years. DISCUSSION Empowering adolescent and young women with the appropriate knowledge to make informed and healthy decisions will be key to sustained behavioural change throughout the life-course. Although multiple micronutrient deficiencies are known to exist among adolescent and young women in low-resource settings, recommendations on preconception multiple micronutrient supplementation do not exist at this time. This study is expected to offer insight into providing an intervention that includes both education and supplements to non-pregnant adolescent and young women for a prolonged duration of time within the existing public health programmatic context. TRIAL REGISTRATION This study is part of the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial. The MaPPS Trial was registered retrospectively on clinicaltrials.gov (Identifier: NCT03287882 ) on September 19, 2017.
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Affiliation(s)
- Jo-Anna B Baxter
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, M6S 1S6, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Zamir Suhag
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, M6S 1S6, Canada.
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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Bhide P, Kar A. A national estimate of the birth prevalence of congenital anomalies in India: systematic review and meta-analysis. BMC Pediatr 2018; 18:175. [PMID: 29801440 PMCID: PMC5970488 DOI: 10.1186/s12887-018-1149-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background A quarter of all global neonatal deaths occur in India. Congenital anomalies constitute the fifth largest cause of neonatal mortality in the country, but national estimates of the prevalence of these conditions are lacking. The objective of the study was to derive an estimate of the birth prevalence of congenital anomalies in India. Methods The search was carried out in PubMed and pooled prevalence was estimated using the inverse variance method. A random effects model was used due to high heterogeneity between the studies. Forest plots were generated using the Review Manager software. Results The PubMed search identified 878 articles from which 52 hospital based and three community based studies were included in the meta-analysis. The pooled prevalence of congenital anomaly affected births was 184.48 per 10,000 births (95% CI 164.74–204.21) among 802,658 births. Anomalies of the musculoskeletal system were highest among live births while the prevalence of central nervous system defects was highest when stillbirths were included in the analysis. Anencephaly and talipes were the most commonly reported anomalies. Conclusions Data from this meta-analysis suggests that there may be as many as 472,177 (421,652 to 522,676) congenital anomaly affected births in India each year. Population based studies using standard definitions are needed to validate these estimates. The two most frequently reported anomalies were anencephaly that is potentially preventable through preconception folate supplementation, and talipes which can be corrected using relatively low cost interventions. Studies are needed to determine the impact of congenital anomalies on neonatal mortality in India.
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Affiliation(s)
- Prajkta Bhide
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, 411007, India
| | - Anita Kar
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, 411007, India.
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Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet 2018; 391:1830-1841. [PMID: 29673873 PMCID: PMC6075697 DOI: 10.1016/s0140-6736(18)30311-8] [Citation(s) in RCA: 651] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/03/2017] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
Abstract
A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.
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Affiliation(s)
- Judith Stephenson
- Institute for Women's Health, University College London, London, UK.
| | - Nicola Heslehurst
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Hall
- Institute for Women's Health, University College London, London, UK
| | | | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, UK
| | | | - Sarah R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Kalyanaraman Kumaran
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Chittaranjan S Yajnik
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, Maharashtra, India
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Gita D Mishra
- School of Public Health, University of Queensland, Herston, QLD, Australia
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Carducci B, Bhutta ZA. Care of the growth-restricted newborn. Best Pract Res Clin Obstet Gynaecol 2018; 49:103-116. [PMID: 29571821 DOI: 10.1016/j.bpobgyn.2018.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/15/2018] [Indexed: 12/23/2022]
Abstract
With the first 1,000 days of life proving to be a critical window of opportunity for physical and cognitive growth and development, an optimal intrauterine environment is vital. If fetus needs are compromised prenatally, there is an increased risk of intrauterine growth restriction (IUGR), and infants being born premature, low birth weight (LBW), or small-for-gestational age (SGA). Specialized care of these high-risk infants is necessary in terms of preconception interventions, resuscitation, thermoregulation, nutritional support and kangaroo mother care. Significant evidence supports exclusive breastfeeding as the standard of care for feeding SGA, preterm, LBW and very low birth weight infants. Expressed milk or donor milk may also require fortification, to meet higher nutrient needs of these newborns. Future research should address the gap in the literature on specific care of term and preterm IUGR and or SGA infants, and strengthening evidence for human milk bank models and emollient care.
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Affiliation(s)
- Bianca Carducci
- Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada.
| | - Zulfiqar A Bhutta
- Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada.
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Lassi ZS, Salam RA, Bhutta ZA. Recommendations on Arresting Global Health Challenges Facing Adolescents and Young Adults. Ann Glob Health 2017; 83:704-712. [PMID: 29248085 DOI: 10.1016/j.aogh.2017.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The health challenges faced by young people are more complex than adults and can compromise their full growth and development. Attention must be paid to the health of this age group, yet adolescents and youth remain largely invisible and often disappear from the major global datasets. OBJECTIVE The aim of this paper is to discuss the global health challenges faced by adolescents and youth, global legislations and guidelines pertaining to this particular age group, recommendations to arrest these challenges, and research priorities. RESULTS Major direct and indirect global health risks faced by adolescents include early pregnancy and childbirth, femicide, honor killing, female genital mutilation, nutritional habits and choices, social media, and peer pressure. There are no standard legal age cut-offs for adulthood; rather, the age varies for different activities, such as age of consent or the minimum age that young people can legally work, leave school, drive, buy alcohol, marry, be held accountable for criminal action, and make medical decisions. This reflects the fact that the existing systems and structures are focused on either children or adults, with very few investments and interventions directed specifically to young people. Existing legislation and guidelines need transformation to bring about a specific focus on adolescents in the domains of substance use and sexual behaviors, and the capacity for adolescent learning should be exploited through graduated legal and policy frameworks. CONCLUSION Sustainable development goals provide an opportunity to target this neglected and vulnerable age group. A multisectoral approach is needed to bring about healthy change and address the challenges faced by adolescents and youth, from modifications at a broader legislative and policy level to ground-level (community-level) implementations.
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Affiliation(s)
- Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Australia
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan; South Australian Health and Medical Research Institute and University of Adelaide, Australia
| | - Zulfiqar A Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
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Maffoni S, De Giuseppe R, Stanford FC, Cena H. Folate status in women of childbearing age with obesity: a review. Nutr Res Rev 2017; 30:265-271. [PMID: 28587698 PMCID: PMC6232191 DOI: 10.1017/s0954422417000142] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Several studies have described a positive association between elevated BMI and birth defects risk. Data on plasma concentration of folate in pregnant women with obesity have shown values far below those recommended, regardless of diet, while folate levels should increase before pregnancy to reduce neural tube defects. We report a descriptive review of the most recent studies (from 2005 to 2015) to evaluate folate status through a population of women of childbearing age affected by obesity. The literature contains few studies, which present conflicting results regarding folate status in non-pregnant women of childbearing age affected by obesity, and it appears that there is a modification in folate metabolism, with a reduction in plasma folate levels and an increase in erythrocyte folate uptake. In conclusion, the folate status in women of childbearing age should be assessed by both plasma and erythrocyte levels to start a personalised and more adequate supplementation before conception. Further studies need to be conducted in a larger population, which take into account variables that can affect folate metabolism, such as dietary intake, lifestyle and genetic factors, oral contraceptives or other drug use, previous weight-loss programmes, or a history of bariatric surgery.
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Affiliation(s)
- Silvia Maffoni
- University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, Pavia, Italy
| | - Rachele De Giuseppe
- University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, Pavia, Italy
| | - Fatima Cody Stanford
- Department of Medicine and Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hellas Cena
- University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, Pavia, Italy
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90
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Lawrie TA, Betrán AP, Singata-Madliki M, Ciganda A, Hofmeyr GJ, Belizán JM, Purnat TD, Manyame S, Parker C, Cormick G. Participant recruitment and retention in longitudinal preconception randomized trials: lessons learnt from the Calcium And Pre-eclampsia (CAP) trial. Trials 2017; 18:500. [PMID: 29073916 PMCID: PMC5658921 DOI: 10.1186/s13063-017-2220-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/02/2017] [Indexed: 11/26/2022] Open
Abstract
Background The preconception period has the potential to influence pregnancy outcomes and randomized controlled trials (RCTs) are needed to evaluate a variety of potentially beneficial preconception interventions. However, RCTs commencing before pregnancy have significant participant recruitment and retention challenges. The Calcium And Pre-eclampsia trial (CAP trial) is a World Health Organization multi-country RCT of calcium supplementation commenced before pregnancy to prevent recurrent pre-eclampsia in which non-pregnant participants are recruited and followed up until childbirth. This sub-study explores recruitment methods and preconception retention of participants of the CAP trial to inform future trials. Methods Recruiters at the study sites in Argentina, South Africa and Zimbabwe completed post-recruitment phase questionnaires on recruitment methods used. Qualitative data from these questionnaires and quantitative data on pre-pregnancy trial visit attendance and pregnancy rates up to September 2016 are reported in this paper. RStudio (Version 0.99.903 https://www.rstudio.org) statistical software was used for summary statistics. Results Between July 2011 and 8 September 2016, 1354 women with previous pre-eclampsia were recruited. Recruitment took 2 years longer than expected and was facilitated mainly through medical record/register and maternity ward/clinic-based strategies. Recruiters highlighted difficulties associated with inadequate medical records, redundant patient contact details, and follow-up of temporarily ineligible women as some of the challenges faced. Whilst the attendance rates at pre-pregnancy visits were high (78% or more), visits often occurred later than scheduled. Forty-five percent of participants became pregnant (614/1354), 33.5% (454/1354) within 1 year of randomization. Conclusions In preconception trials, both retrospective and prospective methods are useful for recruiting eligible women with certain conditions. However, these are time-consuming in low-resource settings with suboptimal medical records and other challenges. Trial planners should ensure that trial budgets cover sufficient on-site researchers with pre-trial training, and should consider using mobile phone and web-based electronic tools to optimize recruitment and retention. This should lead to greater efficiency and shorter trial durations. Trial registration Pan-African Clinical Trials Registry, Registration Number: PACTR201105000267371. The trial was registered on 6 December 2016.
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Affiliation(s)
- Theresa A Lawrie
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, East London, South Africa. .,HRP - UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Ana Pilar Betrán
- HRP - UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, East London, South Africa
| | - Alvaro Ciganda
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024, Buenos Aires, Argentina
| | - G Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, East London, South Africa
| | - José M Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Tina Dannemann Purnat
- Division of Information, Evidence, Research and Innovation, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Sarah Manyame
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Catherine Parker
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, East London, South Africa
| | - Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024, Buenos Aires, Argentina
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91
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Shadab P, Nekuei N, Yadegarfar G. The prevalence of preconception care, its relation with recipients' individuality, fertility, and the causes of lack of checkup in women who gave birth in Isfahan hospitals in 2016. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2017; 6:88. [PMID: 29114556 PMCID: PMC5651651 DOI: 10.4103/jehp.jehp_99_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 05/23/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Preconception care is a set of interventions that aim to identify and repair the factors that can affect the outcome of pregnancy. The aim of this study was to determine the prevalence of receiving preconception care, its relation with recipients' individuality, fertility, and determining the reason for lack of checkup. MATERIALS AND METHODS This was a descriptive cross-sectional study that was conducted based on simple stratified random quota sampling on 702 women who gave birth in hospitals of Isfahan (Iran) from April to June in 2016. The tool of collecting data was researcher-made questionnaire. The data were analyzed by the SPSS software version 18 using the mean, standard deviation, relativity, and independent Chi-square tests. RESULTS The results showed that 47.7% of participants had received preconception care. There was a significant relationship between educational levels, income, wanted pregnancy, number of pregnancies, and previous individual delivery with preconception care (P < 0/05). The main reason for the lack of preconception care was unplanned pregnancy. CONCLUSIONS Results of this study indicated that the quantity of preconception care is not desirable. Therefore, notifying and sensitizing women of childbearing age is essential to refer to service centers and receiving preconception care and planning to present it to all eligible women before pregnancy care. The main causes of the lack of preconception care can be adjusted through health programs.
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Affiliation(s)
- Parisa Shadab
- Students Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafisehsadat Nekuei
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghasem Yadegarfar
- Department of Epidemiology and Biostatistics, Heart Failure Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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92
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Maternal Nutritional Deficiencies and Small-for-Gestational-Age Neonates at Birth of Women Who Have Undergone Bariatric Surgery. J Pregnancy 2017; 2017:4168541. [PMID: 29082043 PMCID: PMC5610850 DOI: 10.1155/2017/4168541] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 07/08/2017] [Accepted: 07/20/2017] [Indexed: 01/14/2023] Open
Abstract
The aim is to compare the prevalence of maternal deficiencies in micronutrients, the obstetrical and neonatal complications after bariatric surgery according to surgical techniques, the time between surgery and conception, and BMI at the onset of pregnancy. A retrospective cohort study concerned 57 singleton pregnancies between 2011 and 2016 of 48 adult women who have undergone bariatric surgery. Small-for-gestational-age neonates were identified in 36.0% of pregnancies. With supplements intake (periconceptional period: 56.8%, trimester 1 (T1): 77.8%, T2: 96.3%, and T3: 100.0%), nutritional deficiencies involved vitamins A (T1: 36.4%, T2: 21.1%, and T3: 40.0%), D (T1: 33.3%, T2: 26.3%, and T3: 8.3%), C (T1: 66.7%, T2: 41.2%, and T3: 83.3%), B1 (T1: 45.5%, T2: 15.4%, and T3: 20.0%), and B9 (T1: 14.3%, T2: 0%, and T3: 9.1%) and selenium (T1: 77.8%, T2: 22.2%, and T3: 50.0%). There was no significant difference in the prevalence of nutritional deficiencies and complications according to surgery procedures and in the prevalence of pregnancy issues according to BMI at the beginning of the pregnancy and time between surgery and pregnancy. Prevalence of micronutritional deficiencies and small-for-gestational-age neonates is high in pregnant women following bariatric surgery. Specific nutritional programmes should be recommended for these women.
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93
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Vaivada T, Gaffey MF, Bhutta ZA. Promoting Early Child Development With Interventions in Health and Nutrition: A Systematic Review. Pediatrics 2017; 140:peds.2016-4308. [PMID: 28771408 DOI: 10.1542/peds.2016-4308] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Although effective health and nutrition interventions for reducing child mortality and morbidity exist, direct evidence of effects on cognitive, motor, and psychosocial development is lacking. OBJECTIVE To review existing evidence for health and nutrition interventions affecting direct measures of (and pathways to) early child development. DATA SOURCES Reviews and recent overviews of interventions across the continuum of care and component studies. STUDY SELECTION We selected systematic reviews detailing the effectiveness of health or nutrition interventions that have plausible links to child development and/or contain direct measures of cognitive, motor, and psychosocial development. DATA EXTRACTION A team of reviewers independently extracted data and assessed their quality. RESULTS Sixty systematic reviews contained the outcomes of interest. Various interventions reduced morbidity and improved child growth, but few had direct measures of child development. Of particular benefit were food and micronutrient supplementation for mothers to reduce the risk of small for gestational age and iodine deficiency, strategies to reduce iron deficiency anemia in infancy, and early neonatal care (appropriate resuscitation, delayed cord clamping, and Kangaroo Mother Care). Neuroprotective interventions for imminent preterm birth showed the largest effect sizes (antenatal corticosteroids for developmental delay: risk ratio 0.49, 95% confidence interval 0.24 to 1.00; magnesium sulfate for gross motor dysfunction: risk ratio 0.61, 95% confidence interval 0.44 to 0.85). LIMITATIONS Given the focus on high-quality studies captured in leading systematic reviews, only effects reported within studies included in systematic reviews were captured. CONCLUSIONS These findings should guide the prioritization and scale-up of interventions within critical periods of early infancy and childhood, and encourage research into their implementation at scale.
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Affiliation(s)
- Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; and .,Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
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94
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Ma YY, Huang TJ, Lin MS, Chen PH, Chen MY. Early detection of oral health status and cardiometabolic risk factors among reproductive-aged women in rural areas: A cross-sectional study. Eur J Cardiovasc Nurs 2017; 16:484-491. [DOI: 10.1177/1474515116688386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yen-Ying Ma
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taiwan
| | - Tung-Jung Huang
- Division of Internal Medicine, Chang Gung Memorial Hospital, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Taiwan
| | - Ming-Shyan Lin
- Division of Internal Medicine, Chang Gung Memorial Hospital, Taiwan
| | - Po-Han Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Mei-Yen Chen
- College of Nursing, Chang Gung University of Science and Technology, Taiwan
- Research Fellow, Department of Cardiology, Chang Gung Memorial Hospital, Taiwan
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95
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Koutelidakis AE, Alexatou O, Kousaiti S, Gkretsi E, Vasios G, Sampani A, Tolia M, Kiortsis DN, Giaginis C. Higher adherence to Mediterranean diet prior to pregnancy is associated with decreased risk for deviation from the maternal recommended gestational weight gain. Int J Food Sci Nutr 2017; 69:84-92. [PMID: 28614986 DOI: 10.1080/09637486.2017.1330403] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The present retrospective study was conducted on 1482 women in order to evaluate whether their pre-pregnancy adherence to the Mediterranean diet may affect maternal gestational weight gain (GWG). For this purpose, the study population was classified according to the Institute of Medicine (IOM) recommendations concerning GWG. Pre-pregnancy adherence to the Mediterranean diet was assessed with 11 food patterns groups based on their contribution in the Mediterranean diet pyramid. Women with high adherence to the Mediterranean diet were more frequently characterised by GWG inside the IOM recommendations. In multivariate analysis, women with low Mediterranean diet adherence were almost twice at risk in presenting deflection from recommended GWG regardless of various confounding factors. These findings suggested that high pre-pregnancy adherence to the Mediterranean diet may be associated with reduced risk for GWG outside the IOM recommendations. However, larger prospective studies are strongly recommended in order for more precise conclusions to be drawn.
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Affiliation(s)
- Antonios E Koutelidakis
- a Department of Food Science and Nutrition , University of the Aegean , Myrina, Lemnos , Greece
| | - Olga Alexatou
- a Department of Food Science and Nutrition , University of the Aegean , Myrina, Lemnos , Greece
| | - Savvina Kousaiti
- a Department of Food Science and Nutrition , University of the Aegean , Myrina, Lemnos , Greece
| | - Elisavet Gkretsi
- a Department of Food Science and Nutrition , University of the Aegean , Myrina, Lemnos , Greece
| | - George Vasios
- a Department of Food Science and Nutrition , University of the Aegean , Myrina, Lemnos , Greece
| | | | - Maria Tolia
- c School of Health Sciences, Faculty of Medicine , University of Thessaly , Larissa , Greece
| | - Dimitrios N Kiortsis
- d Laboratory of Physiology, Medical School , University of Ioannina , Ioannina , Greece
| | - Constantinos Giaginis
- a Department of Food Science and Nutrition , University of the Aegean , Myrina, Lemnos , Greece
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96
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Bogaerts A, Ameye L, Bijlholt M, Amuli K, Heynickx D, Devlieger R. INTER-ACT: prevention of pregnancy complications through an e-health driven interpregnancy lifestyle intervention - study protocol of a multicentre randomised controlled trial. BMC Pregnancy Childbirth 2017; 17:154. [PMID: 28549455 PMCID: PMC5446743 DOI: 10.1186/s12884-017-1336-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/19/2017] [Indexed: 01/24/2023] Open
Abstract
Background Excessive maternal pre-pregnancy and gestational weight gain are related to pregnancy- and birth outcomes. The interpregnancy time window offers a unique opportunity to intervene in order to acquire a healthy lifestyle before the start of a new pregnancy. Methods INTER-ACT is an e-health driven multicentre randomised controlled intervention trial targeting women at high risk of pregnancy- and birth related complications. Eligible women are recruited for the study at day 2 or 3 postpartum. At week 6 postpartum, participants are randomised into the intervention or control arm of the study. The intervention focuses on weight, diet, physical activity and mental well-being, and comprises face-to-face coaching, in which behavioural change techniques are central, and use of a mobile application, which is Bluetooth-connected to a weighing scale and activity tracker. The intervention is rolled out postpartum (4 coaching sessions between week 6 and month 6) and in a new pregnancy (3 coaching sessions, one in each trimester of pregnancy); the mobile app is used throughout the two intervention phases. Data collection includes data from the medical record of the participants (pregnancy outcomes and medical history), anthropometric data (height, weight, waist- and hip circumferences, skinfold thickness and body composition by bio-electrical impedance analysis), data from the mobile app (physical activity and weight; intervention group only) and questionnaires (socio-demographics, breastfeeding, food intake, physical activity, lifestyle, psychosocial factors and process evaluation). Medical record data are collected at inclusion and at delivery of the subsequent pregnancy. All other data are collected at week 6 and month 6 postpartum and every subsequent 6 months until a new pregnancy, and in every trimester in the new pregnancy. Primary outcome is the composite endpoint score of pregnancy-induced hypertension, gestational diabetes mellitus, caesarean section, and large-for-gestational-age infant in the subsequent pregnancy. Discussion INTER-ACT is a unique randomised controlled lifestyle intervention trial in its implementation between pregnancies and during the subsequent pregnancy, with an e-health driven approach. Trial registration ClinicalTrials.gov Identifier: NCT02989142. Registered August 2016.
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Affiliation(s)
- Annick Bogaerts
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Research Unit Healthy Living, Faculty of Health and Social Work, University College Limburg-Leuven, Wetenschapspark 21, 3590, Diepenbeek, Belgium. .,Department of Nursing and Midwifery, CRIC Centre for Research & Innovation in Care, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Lieveke Ameye
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Margriet Bijlholt
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Nursing and Midwifery, CRIC Centre for Research & Innovation in Care, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Kelly Amuli
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Nursing and Midwifery, CRIC Centre for Research & Innovation in Care, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Dorine Heynickx
- Research Unit Healthy Living, Faculty of Health and Social Work, University College Limburg-Leuven, Wetenschapspark 21, 3590, Diepenbeek, Belgium
| | - Roland Devlieger
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Oosterveldlaan 24, 2610, Wilrijk, Belgium. .,Department of Obstetrics and Gynecology, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
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97
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Piccoli GB, Cabiddu G, Castellino S, Gernone G, Santoro D, Moroni G, Spotti D, Giacchino F, Attini R, Limardo M, Maxia S, Fois A, Gammaro L, Todros T. A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy. J Nephrol 2017; 30:307-317. [PMID: 28434090 DOI: 10.1007/s40620-017-0390-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/09/2017] [Indexed: 02/07/2023]
Abstract
Preeclampsia (PE) is a protean syndrome causing a transitory kidney disease, characterised by hypertension and proteinuria, ultimately reversible after delivery. Its prevalence is variously estimated, from 3 to 5% to 10% if all the related disorders, including also pregnancy-induced hypertension (PIH) and HELLP syndrome (haemolysis, increase in liver enzyme, low platelets) are included. Both nephrologists and obstetricians are involved in the management of the disease, according to different protocols, and the clinical management, as well as the role for each specialty, differs worldwide. The increased awareness of the role of chronic kidney disease in pregnancy, complicating up to 3% of pregnancies, and the knowledge that PE is associated with an increased risk for development of CKD later in life have recently increased the interest and redesigned the role of the nephrologists in this context. However, while the heterogeneous definitions of PE, its recent reclassification, an emerging role for biochemical biomarkers, the growing body of epidemiological data and the new potential therapeutic interventions lead to counsel long-term follow-up, the lack of resources for chronic patients and the increasing costs of care limit the potential for preventive actions, and suggest tailoring specific interventional strategies. The aim of the present position statement of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology is to review the literature and to try to identify theoretical and pragmatic bases for an agreed management of PE in the nephrological setting, with particular attention to the prevention of the syndrome (recurrent PE, presence of baseline CKD) and to the organization of the postpartum follow-up.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy. .,Nephrologie, Centre Hospitalier Le Mans, Avenue Roubillard, 72000, Le Mans, France.
| | | | | | | | | | - Gabriella Moroni
- Nephrology, Fondazione Ca' Granda Ospedale Maggiore, Milan, Italy
| | - Donatella Spotti
- Nephrology and Dialysis, IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, Turin, Italy
| | - Monica Limardo
- Nephrology, Azienda Ospedaliera della Provincia di Lecco, Lecco, Italy
| | | | - Antioco Fois
- Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Linda Gammaro
- Nephrology Ospedale Fracastoro San Bonifacio, San Bonifacio, Italy
| | - Tullia Todros
- Obstetrics, Department of Surgery, University of Torino, Turin, Italy
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98
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Abstract
Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future. The recommendations for action of the consensus workshop are the results of combined clinical experience, shared research expertise, and a review of the literature. They highlight the need to act early to prevent CKD and other related noncommunicable diseases later in life by reducing low birth weight, small for gestational age, prematurity, and low nephron numbers at birth through coordinated interventions. Meeting the current unmet needs would help to define the most cost-effective strategies and to optimize interventions to limit or interrupt the developmental programming cycle of CKD later in life, especially in the poorest part of the world.
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99
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Fieldwick D, Smith A, Paterson H. General practitioners and preconception weight management in New Zealand. Aust N Z J Obstet Gynaecol 2017; 57:420-425. [DOI: 10.1111/ajo.12609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/15/2016] [Indexed: 12/29/2022]
Affiliation(s)
| | - Alesha Smith
- School of Pharmacy; University of Otago; Dunedin New Zealand
| | - Helen Paterson
- Department of Women's and Children's Health; University of Otago; Dunedin New Zealand
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100
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von Dadelszen P, Magee LA. Strategies to reduce the global burden of direct maternal deaths. Obstet Med 2017; 10:5-9. [PMID: 28491124 DOI: 10.1177/1753495x16686287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 12/14/2022] Open
Abstract
The leading direct causes of the estimated 196 maternal deaths per 100,000 live births globally are postpartum haemorrhage, the hypertensive disorders of pregnancy, obstructed labour, unsafe abortion and obstetric sepsis. Of the Sustainable Development Goals, one (Sustainable Development Goal 3.1) specifically addresses maternal mortality; by 2030, the goal is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Eleven other Sustainable Development Goals provide opportunities to intervene. Unapologetically, this review focusses the reader's attention on health advocacy and its central role in altering the risks that many of the world's women face from direct obstetric causes of mortality. Hard work to alter social determinants of health and health outcomes remains. That work needs to start today to improve the health and social equality of today's girls who will be the women delivering their babies in 2030.
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Affiliation(s)
- Peter von Dadelszen
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
| | - Laura A Magee
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
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