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Morris RK, Johnstone E, Lees C, Morton V, Smith G. Investigation and Care of a Small-for-Gestational-Age Fetus and a Growth Restricted Fetus (Green-top Guideline No. 31). BJOG 2024; 131:e31-e80. [PMID: 38740546 DOI: 10.1111/1471-0528.17814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Key recommendations
All women should be assessed at booking (by 14 weeks) for risk factors for fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings at the midtrimester anomaly scan should be incorporated into the fetal growth risk assessment and the risk assessment updated throughout pregnancy. [Grade GPP]
Reduce smoking in pregnancy by identifying women who smoke with the assistance of carbon monoxide (CO) testing and ensuring in‐house treatment from a trained tobacco dependence advisor is offered to all pregnant women who smoke, using an opt‐out referral process. [Grade GPP]
Women at risk of pre‐eclampsia and/or placental dysfunction should take aspirin 150 mg once daily at night from 12+0–36+0 weeks of pregnancy to reduce their chance of small‐for‐gestational‐age (SGA) and FGR. [Grade A]
Uterine artery Dopplers should be carried out between 18+0 and 23+6 weeks for women at high risk of fetal growth disorders [Grade B]. In a woman with normal uterine artery Doppler and normal fetal biometry at the midtrimester scan, serial ultrasound scans for fetal biometry can commence at 32 weeks. Women with an abnormal uterine artery Doppler (mean pulsatility index > 95th centile) should commence ultrasound scans at 24+0–28+6 weeks based on individual history. [Grade B]
Women who are at low risk of FGR should have serial measurement of symphysis fundal height (SFH) at each antenatal appointment after 24+0 weeks of pregnancy (no more frequently than every 2 weeks). The first measurement should be carried out by 28+6 weeks. [Grade C]
Women in the moderate risk category are at risk of late onset FGR so require serial ultrasound scan assessment of fetal growth commencing at 32+0 weeks. For the majority of women, a scan interval of four weeks until birth is appropriate. [Grade B]
Maternity providers should ensure that they clearly identify the reference charts to plot SFH, individual biometry and estimated fetal weight (EFW) measurements to calculate centiles. For individual biometry measurements the method used for measurement should be the same as those used in the development of the individual biometry and fetal growth chart [Grade GPP]. For EFW the Hadlock three parameter model should be used. [Grade C]
Maternity providers should ensure that they have guidance that promotes the use of standard planes of acquisition and calliper placement when performing ultrasound scanning for fetal growth assessment. Quality control of images and measurements should be undertaken. [Grade C]
Ultrasound biometry should be carried out every 2 weeks in fetuses identified to be SGA [Grade C]. Umbilical artery Doppler is the primary surveillance tool and should be carried out at the point of diagnosis of SGA and during follow‐up as a minimum every 2 weeks. [Grade B]
In fetuses with an EFW between the 3rd and 10th centile, other features must be present for birth to be recommended prior to 39+0 weeks, either maternal (maternal medical conditions or concerns regarding fetal movements) or fetal compromise (a diagnosis of FGR based on Doppler assessment, fetal growth velocity or a concern on cardiotocography [CTG]) [Grade C]. For fetuses with an EFW or abdominal circumference less than the 10th centile where FGR has been excluded, birth or the initiation of induction of labour should be considered at 39+0 weeks after discussion with the woman and her partner/family/support network. Birth should occur by 39+6 weeks. [Grade B]
Pregnancies with early FGR (prior to 32+0 weeks) should be monitored and managed with input from tertiary level units with the highest level neonatal care. Care should be multidisciplinary by neonatology and obstetricians with fetal medicine expertise, particularly when extremely preterm (before 28 weeks) [Grade GPP]. Fetal biometry in FGR should be repeated every 2 weeks [Grade B]. Assessment of fetal wellbeing can include multiple modalities but must include computerised CTG and/or ductus venous. [Grade B]
In pregnancies with late FGR, birth should be initiated from 37+0 weeks to be completed by 37+6 weeks [Grade A]. Decisions for birth should be based on fetal wellbeing assessments or maternal indication. [Grade GPP]
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Gajić M, Schröder-Heurich B, Mayer-Pickel K. Deciphering the immunological interactions: targeting preeclampsia with Hydroxychloroquine's biological mechanisms. Front Pharmacol 2024; 15:1298928. [PMID: 38375029 PMCID: PMC10875033 DOI: 10.3389/fphar.2024.1298928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
Preeclampsia (PE) is a complex pregnancy-related disorder characterized by hypertension, followed by organ dysfunction and uteroplacental abnormalities. It remains a major cause of maternal and neonatal morbidity and mortality worldwide. Although the pathophysiology of PE has not been fully elucidated, a two-stage model has been proposed. In this model, a poorly perfused placenta releases various factors into the maternal circulation during the first stage, including pro-inflammatory cytokines, anti-angiogenic factors, and damage-associated molecular patterns into the maternal circulation. In the second stage, these factors lead to a systemic vascular dysfunction with consecutive clinical maternal and/or fetal manifestations. Despite advances in feto-maternal management, effective prophylactic and therapeutic options for PE are still lacking. Since termination of pregnancy is the only curative therapy, regardless of gestational age, new treatment/prophylactic options are urgently needed. Hydroxychloroquine (HCQ) is mainly used to treat malaria as well as certain autoimmune conditions such as systemic lupus and rheumatoid arthritis. The exact mechanism of action of HCQ is not fully understood, but several mechanisms of action have been proposed based on its pharmacological properties. Interestingly, many of them might counteract the proposed processes involved in the development of PE. Therefore, based on a literature review, we aimed to investigate the interrelated biological processes of HCQ and PE and to identify potential molecular targets in these processes.
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Affiliation(s)
- Maja Gajić
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Zavala E, Rhodes M, Christian P. Pregnancy Interventions to Improve Birth Outcomes: What Are the Effects on Maternal Outcomes? A Scoping Review. Int J Public Health 2022; 67:1604620. [PMID: 36405527 PMCID: PMC9666362 DOI: 10.3389/ijph.2022.1604620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: Interventions in pregnancy are commonly evaluated for their effects on birth outcomes because maternal infection and poor nutrition are the primary contributors to adverse pregnancy outcomes, especially in low- and middle-income countries (LMICs). However, the extent to which such interventions directly impact maternal health and nutrition has not been succinctly characterized. Methods: We conducted a scoping review of systematic reviews and meta-analyses of 27 pregnancy interventions to summarize the evidence of impact on maternal outcomes. Results: Overall, these were reported incompletely, and we failed to find any evidence for eight interventions. Influenza vaccination, insecticide-treated bed nets, intermittent preventive treatment for malaria, anthelmintic therapy, and treatment of bacterial vaginosis, asymptomatic bacteriuria, and periodontal disease during pregnancy provided direct benefit to women, with reductions in infection risk. Nutritional interventions such as micronutrient supplementation and balanced energy and protein improved outcomes of maternal anemia and gestational weight gain, particularly in deficient populations. Calcium and low dose aspirin significantly reduced the risk of pre-eclampsia. Conclusion: These findings highlight antenatal interventions benefitting maternal health and provide insights into pathways for impacting birth and infant outcomes.
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Gomes F, Ashorn P, Askari S, Belizan JM, Boy E, Cormick G, Dickin KL, Driller‐Colangelo AR, Fawzi W, Hofmeyr GJ, Humphrey J, Khadilkar A, Mandlik R, Neufeld LM, Palacios C, Roth DE, Shlisky J, Sudfeld CR, Weaver C, Bourassa MW. Calcium supplementation for the prevention of hypertensive disorders of pregnancy: current evidence and programmatic considerations. Ann N Y Acad Sci 2022; 1510:52-67. [PMID: 35000200 PMCID: PMC9306576 DOI: 10.1111/nyas.14733] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/27/2021] [Accepted: 11/14/2021] [Indexed: 12/13/2022]
Abstract
Most low‐ and middle‐income countries present suboptimal intakes of calcium during pregnancy and high rates of mortality due to maternal hypertensive disorders. Calcium supplementation during pregnancy is known to reduce the risk of these disorders and associated complications, including preeclampsia, maternal morbidity, and preterm birth, and is, therefore, a recommended intervention for pregnant women in populations with low dietary calcium intake (e.g., where ≥25% of individuals in the population have intakes less than 800 mg calcium/day). However, this intervention is not widely implemented in part due to cost and logistical issues related to the large dose and burdensome dosing schedule (three to four 500‐mg doses/day). WHO recommends 1.5–2 g/day but limited evidence suggests that less than 1 g/day may be sufficient and ongoing trials with low‐dose calcium supplementation (500 mg/day) may point a path toward simplifying supplementation regimens. Calcium carbonate is likely to be the most cost‐effective choice, and it is not necessary to counsel women to take calcium supplements separately from iron‐containing supplements. In populations at highest risk for preeclampsia, a combination of calcium supplementation and food‐based approaches, such as food fortification with calcium, may be required to improve calcium intakes before pregnancy and in early gestation.
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Affiliation(s)
- Filomena Gomes
- Nutrition Science Program New York Academy of Sciences New York City New York
- NOVA Medical School Universidade NOVA de Lisboa Lisboa Portugal
| | - Per Ashorn
- Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
| | | | - Jose M. Belizan
- Institute for Clinical Effectiveness and Health Policy/CONICET Buenos Aires Argentina
| | - Erick Boy
- International Food Policy Research Institute Washington District of Columbia
| | - Gabriela Cormick
- Institute for Clinical Effectiveness and Health Policy/CONICET Buenos Aires Argentina
| | | | | | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health Boston Massachusetts
| | - G. Justus Hofmeyr
- University of Botswana Gaborone Botswana
- University of the Witwatersrand and Walter Sisulu University Mthatha South Africa
| | - Jean Humphrey
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland
| | | | - Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute Pune India
| | | | | | - Daniel E. Roth
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Julie Shlisky
- Nutrition Science Program New York Academy of Sciences New York City New York
| | | | | | - Megan W. Bourassa
- Nutrition Science Program New York Academy of Sciences New York City New York
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5
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Lopez de Romaña D, Greig A, Thompson A, Arabi M. Successful delivery of nutrition programs and the sustainable development goals. Curr Opin Biotechnol 2021; 70:97-107. [PMID: 33812278 DOI: 10.1016/j.copbio.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
Malnutrition affects millions of people globally, especially women, children, and other vulnerable populations. Sustainable Development Goals (SDGs) were set in 2015 to end poverty, protect the planet, and improve the lives and prospects of everyone by 2030. To achieve the SDG goals effective nutrition interventions and programs need to be efficiently delivered to those most in need. Nutrition directly affects 2 SDGs (2 and 3) and indirectly influences five others. In addition, almost all SDGs influence nutrition and thus attaining the SDG goals is also a pre-requisite to achieving the Global Nutrition targets set in 2012. Evidence-based nutrition interventions, for which there is strong evidence of their biological impact, have the potential to directly influence SDGs 2 and 3 if successfully delivered at scale in high-burden countries. Nevertheless, delivery of nutrition programs is a complex process, where policy, government commitment, adequate budget allocation, supplies and delivery systems, training of service providers, informed beneficiaries and program monitoring and evaluation all need to be in place and aligned with each other. Although in the past decade there has been progress in the SDGs that nutrition directly affects, many goals are still off-track, likely due to several pending gaps at policy-level, program-level, and intervention-level. To accelerate the progress toward reaching the SDG goals that are directly influenced by nutrition, countries need to be supported to successfully and sustainably deliver proven interventions and to scale-up and deliver new interventions in new and innovative ways, and the evidence base should be built in promising areas especially integrating (rather than prioritizing over each other) nutrition-specific and sensitive approaches.
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Affiliation(s)
| | - Alison Greig
- Nutrition International, 180 Elgin Street, Suite 1000, Ottawa, Ontario K2P 2K3, Canada
| | - Andrew Thompson
- Nutrition International, 180 Elgin Street, Suite 1000, Ottawa, Ontario K2P 2K3, Canada
| | - Mandana Arabi
- Nutrition International, 180 Elgin Street, Suite 1000, Ottawa, Ontario K2P 2K3, Canada.
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6
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Peng Y, Dewi DPAP, Kyriakopoulou K, van der Goot AJ. Effect of calcium hydroxide and fractionation process on the functional properties of soy protein concentrate. INNOV FOOD SCI EMERG 2020. [DOI: 10.1016/j.ifset.2020.102501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil.,Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil.,Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil.,Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil,Hospital Barão de Lucena, Recife, PE – Brazil,Hospital EMCOR, Recife, PE – Brazil,Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil.,Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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8
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Zhang N, Tan J, Yang H, Khalil RA. Comparative risks and predictors of preeclamptic pregnancy in the Eastern, Western and developing world. Biochem Pharmacol 2020; 182:114247. [PMID: 32986983 DOI: 10.1016/j.bcp.2020.114247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022]
Abstract
Preeclampsia (PE) is a complication of pregnancy characterized by hypertension (HTN-Preg), and often proteinuria. If not managed promptly, PE could lead to eclampsia and seizures. PE could also lead to intrauterine growth restriction (IUGR) and prematurity at birth. Although PE is a major cause of maternal and fetal morbidity and mortality, the underlying mechanisms are unclear. Also, there is a wide variability in the incidence of PE, ranging between 2 and 8% of pregnancies in the Eastern, Western and Developing world, suggesting regional differences in the risk factors and predictors of the pregnancy-related disorder. Several demographic, genetic, dietary and environmental factors, as well as maternal circulating biomarkers have been associated with PE. Demographic factors such as maternal race and ethnicity could play a role in PE. Specific genetic polymorphisms have been identified in PE. Maternal age, parity, education and socioeconomic status could be involved in PE. Dietary fat, protein, calcium and vitamins, body weight, and environmental factors including climate changes and air pollutants could also play a role in PE. Several circulating cytoactive factors including anti-angiogenic factors and cytokines have also been associated with PE. Traditional midwifery care is a common practice in local maternity care units, while advanced perinatal care and new diagnostic tools such as uterine artery Doppler velocimetry have been useful in predicting early PE in major medical centers. These PE risk factors, early predictors and diagnostic tools vary vastly in different regions of the Eastern, Western and Developing world. Further understanding of the differences in the demographic, genetic, dietary and environmental factors among pregnant women in different world regions should help in designing a region-specific cluster of risk factors and predictors of PE, and in turn provide better guidance for region-specific tools for early detection and management of PE.
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Affiliation(s)
- Ning Zhang
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jing Tan
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - HaiFeng Yang
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Raouf A Khalil
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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McKeating DR, Fisher JJ, Zhang P, Bennett WW, Perkins AV. Elemental metabolomics in human cord blood: Method validation and trace element quantification. J Trace Elem Med Biol 2020; 59:126419. [PMID: 31711786 DOI: 10.1016/j.jtemb.2019.126419] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/26/2019] [Accepted: 10/18/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Trace elements are an essential requirement for human health and development and changes in trace element status have been associated with pregnancy complications such as gestational diabetes mellitus (GDM), pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth. Elemental metabolomics, which involves the simultaneous quantification and characterisation of multiple elements, could provide important insights into these gestational disorders. METHODS This study used an Agilent 7900 inductively coupled plasma mass spectrometer (ICP-MS) to simultaneously measure 68 elements, in 166 placental cord blood samples collected from women with various pregnancy complications (control, hypertensive, PE, GDM, FGR, pre-term, and post-term birth). RESULTS There were single element differences across gestational outcomes for elements Mg, P, Cr, Ni, Sr, Mo, I, Au, Pb, and U. Hypertensive and post-term pregnancies were significantly higher in Ni concentrations when compared to controls (control = 2.74 μg/L, hypertensive = 6.72 μg/L, post-term = 7.93 μg/L, p < 0.05), iodine concentration was significantly higher in post-term pregnancies (p < 0.05), and Pb concentrations were the lowest in pre-term pregnancies (pre-term = 2.79 μg/L, control = 4.68 μg/L, PE = 5.32 μg/L, GDM = 8.27 μg/L, p < 0.01). Further analysis was conducted using receiver operating characteristic (ROC) curves for differentiating pregnancy groups. The ratio of Sn/Pb showed the best diagnostic power in discriminating between control and pre-term birth with area under the curve (AUC) 0.86. When comparing control and post-term birth, Mg/Cr (AUC = 0.84), and Cr (AUC = 0.83) had the best diagnostic powers. In pre-term and post-term comparisons Ba was the best single element (81.5%), and P/Cu provided the best ratio (91.7%). CONCLUSIONS This study has shown that analysis of multiple elements can enable differentiation between fetal cord blood samples from control, hypertensive, PE, GDM, FGR, pre and post-term pregnancies. This data highlights the power of elemental metabolomics and provides a basis for future gestational studies.
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Affiliation(s)
- Daniel R McKeating
- School of Medical Science, Griffith University, Gold Coast Campus, Southport, 9726, Queensland, Australia
| | - Joshua J Fisher
- School of Medical Science, Griffith University, Gold Coast Campus, Southport, 9726, Queensland, Australia
| | - Ping Zhang
- School of Medical Science, Griffith University, Gold Coast Campus, Southport, 9726, Queensland, Australia
| | - William W Bennett
- School of Environmental Science, Griffith University, Gold Coast Campus, Southport, 9726, Queensland, Australia
| | - Anthony V Perkins
- School of Medical Science, Griffith University, Gold Coast Campus, Southport, 9726, Queensland, Australia.
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10
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Ajong AB, Kenfack B, Ali IM, Yakum MN, Telefo PB. Prevalence and correlates of low serum calcium in late pregnancy: A cross sectional study in the Nkongsamba Regional Hospital; Littoral Region of Cameroon. PLoS One 2019; 14:e0224855. [PMID: 31697767 PMCID: PMC6837377 DOI: 10.1371/journal.pone.0224855] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Women from low and middle income countries are generally more likely to have sub-optimal calcium intake. The objective of this study was to assess serum calcium disorders and correlates in late pregnancy. METHODS We conducted from December 2018 to April 2019, a cross-sectional hospital-based study targeting pregnant women in late pregnancy in the Nkongsamba Regional Hospital. Data were collected by measurement of parameters (weight, height, blood pressure and foetal birthweight), administration of a semi-structured questionnaire and analysis of blood samples collected from each participant. Absorption spectrophotometry was used to measure serum calcium and albumin concentrations and corrected serum calcium calculated from the Payne's equation. With a statistical significant threshold set at p-value = 0.05, the odds ratio was used as a measure of the strength of association between hypocalcaemia and maternofoetal variables. RESULTS We enrolled a total of 354 consenting participants with a mean age of 27.41±5.84 years. The prevalence of hypocalcaemia in late pregnancy was 58.76 [53.42-63.90]%. The rate of calcium supplementation in pregnancy was 57.63[52.28-62.80]% with a mean duration of supplementation of 3.69±1.47 months. When controlled for marital status, age, level of education, and gestational age at delivery, pregnant women with systolic blood pressures below 130 mmHg were significantly less likely to have hypocalcaemia than their counterparts with higher systolic blood pressures (Adjusted Odds Ratio = 0.41[0.18-0.89], p-value = 0.020). No statistically significant associations were found between diastolic blood pressure, body mass index, foetal birth weight and hypocalcaemia. CONCLUSION Hypocalcaemia in late pregnancy is highly prevalent (59%) among women accessing reproductive services at the Nkongsamba Regional Hospital. There is also a wide gap in calcium supplementation compared to World Health Organization recommendations. Hypocalcaemia is significantly associated to higher systolic blood pressure in pregnancy. Systematic calcium supplementation and consumption of high calcium containing locally available meals should be encouraged.
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Affiliation(s)
- Atem Bethel Ajong
- Kekem District Hospital, Kekem, West Region, Cameroon
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
| | - Bruno Kenfack
- Department of Obstetrics / Gynaecology and Maternal Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, West Region, Cameroon
| | - Innocent Mbulli Ali
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
| | | | - Phelix Bruno Telefo
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
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11
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Gao C, Kho AN, Osmundson S, Malin BA, Chen Y. Obstetric Patients with Repetitious Hospital Location Transfers Have Prolonged Stays. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS 2019; 2019:10.1109/ICHI.2019.8904557. [PMID: 32524087 PMCID: PMC7286595 DOI: 10.1109/ichi.2019.8904557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is a general belief that the workflow of surrounding location transfers between locations documented in electronic health record (EHR) during hospitalization is associated with a patient's length of stay (LOS). However, this belief has had little formal investigation in a data-driven manner. Location transfers in patients' hospitalization are hypothesized to be related to LOS. The objective of this study is to assess this relationship, using data derived from the EHR system of a large hospital system, with a focus on the obstetric setting - a clinical environment that exhibits wide swing in resource utilization. We designed a data-driven framework to infer patterns of location transfers and developed a zero-truncated negative binomial model, adjusting for demographics and billed diagnoses, to learn the association between patterns of location transfers and LOS. Indicative factors found to be of indicative of location transfer patterns were further investigated via their odds ratios, Pearson Correlation Coefficients, and Chi-squared test. We evaluated our approach with two years of data on from 5,774 obstetric inpatient encounters from the EHR system of Northwestern Memorial Hospital. The results indicated that the average LOS for patients with patterns of repetitious location transfers (RLTs) was 4.25 days (95% confidence interval [4.02, 4.47]) longer than patients with no RLT. This difference reduced to 3.62 days (95% confidence interval [3.61, 3.64]) after adjusting for age, race and billed diagnoses. We further discovered 21 indicative factors of RLT (statistically significant with a significance level of 0.05), in the form of billed diagnosis codes, each of which exhibited an odds ratio larger than 4. This study suggests that RLT patterns are associated with a prolonged LOS in the obstetric setting. As such, healthcare organizations may need to pay more attention to patients with RLTs to refine location transfers workflow and to boost efficiency in obstetric care.
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Affiliation(s)
- Cheng Gao
- Department of Biomedical Informatics Vanderbilt University
| | - Abel N Kho
- Institute for Public Health and Medicine Northwestern University
| | - Sarah Osmundson
- Department of Obstetrics and Gynecology Vanderbilt University Medical Center
| | | | - You Chen
- Department of Biomedical Informatics Vanderbilt University
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Haruna M, Matsuzaki M, Ota E, Shiraishi M, Hanada N, Mori R. Guided imagery for treating hypertension in pregnancy. Cochrane Database Syst Rev 2019; 4:CD011337. [PMID: 31032884 PMCID: PMC6487386 DOI: 10.1002/14651858.cd011337.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hypertension (high blood pressure) in pregnancy carries a high risk of maternal morbidity and mortality. Although antihypertensive drugs are commonly used, they have adverse effects on mothers and fetuses. Guided imagery is a non-pharmacological technique that has the potential to lower blood pressure among pregnant women with hypertension. Guided imagery is a mind-body therapy that involves the visualisation of various mental images to facilitate relaxation and reduction in blood pressure. OBJECTIVES To determine the effect of guided imagery as a non-pharmacological treatment of hypertension in pregnancy and its influence on perinatal outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, and two trials registers (October 2018). We also searched relevant conference proceedings and journals, and scanned the reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs). We would have included RCTs using a cluster-randomised design, but none were identified. We excluded quasi-RCTs and cross-over trials.We sought intervention studies of various guided imagery techniques performed during pregnancy in comparison with no intervention or other non-pharmacological treatments for hypertension (e.g. quiet rest, music therapy, aromatherapy, relaxation therapy, acupuncture, acupressure, massage, device-guided slow breathing, hypnosis, physical exercise, and yoga). DATA COLLECTION AND ANALYSIS Three review authors independently assessed the trials for inclusion, extracted data, and assessed risk of bias for the included studies. We checked extracted data for accuracy, and resolved differences in assessments by discussion. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included two small trials (involving a total of 99 pregnant women) that compared guided imagery with quiet rest. The trials were conducted in Canada and the USA. We assessed both trials as at high risk of performance bias, and low risk of attrition bias; one trial was at low risk for selection, detection, and reporting bias, while the other was at unclear risk for the same domains.We could not perform a meta-analysis because the two included studies reported different outcomes, and the frequency of the intervention was slightly different between the two studies. One study performed guided imagery for 15 minutes at least twice daily for four weeks, or until the baby was born (whichever came first). In the other study, the intervention included guided imagery, self-monitoring of blood pressure, and thermal biofeedback-assisted relaxation training for four total hours; the participants were instructed to practice the procedures twice daily and complete at least three relief relaxation breaks each day. The control groups were similar - one was quiet rest, and the other was quiet rest as bed rest.None of our primary outcomes were reported in the included trials: severe hypertension (either systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher); severe pre-eclampsia, or perinatal death (stillbirths plus deaths in the first week of life). Only one of the secondary outcomes was measured.Low-certainty evidence from one trial (69 women) suggests that guided imagery may make little or no difference in the use of antihypertensive drugs (risk ratio 1.27, 95% confidence interval 0.72 to 2.22). AUTHORS' CONCLUSIONS There is insufficient evidence to inform practice about the use of guided imagery for hypertension in pregnancy.The available evidence for this review topic is sparse, and the effect of guided imagery for treating hypertension during pregnancy (compared with quiet rest) remains unclear. There was low-certainty evidence that guided imagery made little or no difference to the use of antihypertensive drugs, downgraded because of imprecision.The two included trials did not report on any of the primary outcomes of this review. We did not identify any trials comparing guided imagery with no intervention, or with another non-pharmacological method for hypertension.Large and well-designed RCTs are needed to identify the effects of guided imagery on hypertension during pregnancy and on other relevant outcomes associated with short-term and long-term maternal and neonatal health. Trials could also consider utilisation and costs of health service.
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Affiliation(s)
- Megumi Haruna
- The University of TokyoDepartment of Midwifery and Women’s Health, Division of Health Sciences & Nursing, Graduate School of Medicine7‐3‐1 HongoTokyoJapan113‐0033
| | - Masayo Matsuzaki
- Osaka University Graduate School of MedicineDepartment of Children and Women's Health1‐7 YamadaokaSuitaOsakaJapan565‐0871
| | - Erika Ota
- St. Luke's International UniversityGlobal Health Nursing, Graduate School of Nursing Sciences10‐1 Akashi‐choChuo‐KuTokyoMSJapan104‐0044
| | - Mie Shiraishi
- Osaka UniversityDepartment of Children and Women's Health1‐7 YamadaokaSuitaOsakaJapan565‐0871
| | - Nobutsugu Hanada
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 OkuraTokyoJapan166‐0014
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 OkuraTokyoJapan166‐0014
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Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension 2019; 72:24-43. [PMID: 29899139 DOI: 10.1161/hypertensionaha.117.10803] [Citation(s) in RCA: 1078] [Impact Index Per Article: 215.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mark A Brown
- From the Departments of Renal Medicine and Medicine, St. George Hospital and University of New South Wales, Sydney, Australia (M.A.B.)
| | - Laura A Magee
- Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M.)
| | - Louise C Kenny
- Faculty of Health and Life Sciences, University of Liverpool, United Kingdom (L.C.K.).,INFANT Centre, Cork University Maternity Hospital, Ireland (L.C.K., F.P.M.)
| | - S Ananth Karumanchi
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (S.A.K.)
| | - Fergus P McCarthy
- INFANT Centre, Cork University Maternity Hospital, Ireland (L.C.K., F.P.M.)
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Japan (S.S.)
| | - David R Hall
- Department Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, South Africa (D.R.H.)
| | - Charlotte E Warren
- Reproductive Health Program, Population Council, Washington, DC (C.E.W.)
| | - Gloria Adoyi
- Reproductive Health Program, Population Council-Nigeria, West Africa (G.A., S.I.)
| | - Salisu Ishaku
- Reproductive Health Program, Population Council-Nigeria, West Africa (G.A., S.I.)
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Rasouli M, Pourheidari M, Hamzeh Gardesh Z. Effect of Self-care Before and During Pregnancy to Prevention and Control Preeclampsia in High-risk Women. Int J Prev Med 2019; 10:21. [PMID: 30820308 PMCID: PMC6390427 DOI: 10.4103/ijpvm.ijpvm_300_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 03/12/2018] [Indexed: 12/16/2022] Open
Abstract
Our aims to examine the factors influencing self-care for the prevention and control of preeclampsia in high-risk women. The current study is a review where the researcher browsed the available databases such as PubMed, Cochrane, Medline, Google Scholar, Medscape, and relevant research published between 1980 and 2016 were studied. To search for articles, relevant Medical Subject Heading keywords were first determined (Self-care, preeclampsia, prevention.) A total of 350 related articles were first selected, and the findings of 70 were used to compile the present article. The results of the study were classified under two general categories, including (1). Counseling and screening strategies and (2) self-care strategies for the prevention and control of preeclampsia in high-risk women. Screening women at risk for preeclampsia include measures such as measuring their blood pressure, checking for signs of depression, testing for thrombosis, taking a history of preeclampsia, providing preconception counseling about the appropriate age, time of pregnancy, and encouraging weight loss in obese women. This review showed a positive relationship between knowledge about self-care for preeclampsia and its control. The factors influencing preeclampsia self-care include making lifestyle changes, having a healthy diet, learning stress management, performing exercise and physical activities, taking antioxidants, dietary supplements, and calcium and adherence to aspirin and heparin regimens. There is a positive relationship between preconception counseling, screening women at risk for preeclampsia, self-care for the prevention, and control of preeclampsia. (1) Tweetable abstract self-care in high-risk women is strongly associated with prevention and control of preeclampsia.
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Affiliation(s)
- Masoumeh Rasouli
- Master of Science in Counselingin Midwifery, Mazandaran Social Security Organization, Beheshahr Clinic, Beheshahr, Mazandaran Province, Iran
| | - Mahboubeh Pourheidari
- Department of Midwifery, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Zeinab Hamzeh Gardesh
- Department of Midwifery, School of Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran
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McKeating DR, Fisher JJ, Perkins AV. Elemental Metabolomics and Pregnancy Outcomes. Nutrients 2019; 11:E73. [PMID: 30609706 PMCID: PMC6356574 DOI: 10.3390/nu11010073] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/26/2018] [Accepted: 01/01/2019] [Indexed: 01/22/2023] Open
Abstract
Trace elements are important for human health and development. The body requires specific micronutrients to function, with aberrant changes associated with a variety of negative health outcomes. Despite this evidence, the status and function of micronutrients during pregnancy are relatively unknown and more information is required to ensure that women receive optimal intakes for foetal development. Changes in trace element status have been associated with pregnancy complications such as gestational diabetes mellitus (GDM), pre-eclampsia (PE), intrauterine growth restriction (IUGR), and preterm birth. Measuring micronutrients with methodologies such as elemental metabolomics, which involves the simultaneous quantification and characterisation of multiple elements, could provide insight into gestational disorders. Identifying unique and subtle micronutrient changes may highlight associated proteins that are affected underpinning the pathophysiology of these complications, leading to new means of disease diagnosis. This review will provide a comprehensive summary of micronutrient status during pregnancy, and their associations with gestational disorders. Furthermore, it will also comment on the potential use of elemental metabolomics as a technique for disease characterisation and prediction.
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Affiliation(s)
- Daniel R McKeating
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Southport 9726, Queensland, Australia.
| | - Joshua J Fisher
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Southport 9726, Queensland, Australia.
| | - Anthony V Perkins
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Southport 9726, Queensland, Australia.
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Khanam F, Hossain B, Mistry SK, Mitra DK, Raza WA, Rifat M, Afsana K, Rahman M. The association between daily 500 mg calcium supplementation and lower pregnancy-induced hypertension risk in Bangladesh. BMC Pregnancy Childbirth 2018; 18:406. [PMID: 30332997 PMCID: PMC6192122 DOI: 10.1186/s12884-018-2046-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/05/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Evidence suggests that daily supplementation of 1500 to 2000 mg of calcium during pregnancy reduces pregnancy-induced hypertension (PIH). However, the evidence on the efficacy of low-dose calcium supplementation on PIH is limited. This paper assesses the longitudinal correlation between low-dose calcium intake (500 mg daily) and change in blood pressure during pregnancy among a homogeneous population in terms of hypertension and pre-eclampsia. METHODS The study followed a retrospective cohort study design, and was carried out among 11,387 pregnant women from 10 rural upazilas (sub-districts) of Bangladesh where maternal nutrition initiative (MNI), implemented by Building Resources Across Communities (BRAC), was ongoing. The modified Poisson regression model was used to estimate the association (risk ratio) between consumption of calcium tablets and PIH. RESULTS The present research found that women who consumed 500 mg/d calcium tablets for more than 6 months during their pregnancy had a 45% lower risk of developing hypertension compared to those who consumed less calcium (RR = 0.55, 95% CI = 0.33-0.93). CONCLUSIONS Daily supplementation of 500 mg oral calcium during pregnancy for at least 180 tablets is associated with a considerably reduced risk of PIH, but this study is unable to confirm whether this association is causal. The causal relationship needs to be confirmed through a large scale randomized controlled trial.
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Affiliation(s)
- Fouzia Khanam
- Research and Evaluation Division, BRAC Center, Dhaka, 1212, Bangladesh
| | - Belal Hossain
- Research and Evaluation Division, BRAC Center, Dhaka, 1212, Bangladesh
| | | | - Dipak K Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Mahfuza Rifat
- Health, Nutrition and Population Program, BRAC Center, Dhaka, Bangladesh
| | - Kaosar Afsana
- Health, Nutrition and Population Program, BRAC Center, Dhaka, Bangladesh
| | - Mahfuzar Rahman
- Research and Evaluation Division, BRAC Center, Dhaka, 1212, Bangladesh.
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Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2018; 10:CD001059. [PMID: 30277579 PMCID: PMC6517256 DOI: 10.1002/14651858.cd001059.pub5] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pre-eclampsia and eclampsia are common causes of serious morbidity and death. Calcium supplementation may reduce the risk of pre-eclampsia, and may help to prevent preterm birth. This is an update of a review last published in 2014. OBJECTIVES To assess the effects of calcium supplementation during pregnancy on hypertensive disorders of pregnancy and related maternal and child outcomes. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (18 September 2017), and reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-randomised trials, comparing high-dose calcium supplementation (at least 1 g daily of calcium) during pregnancy with placebo. For low-dose calcium we included quasi-randomised trials, trials without placebo, trials with cointerventions and dose comparison trials. DATA COLLECTION AND ANALYSIS Two researchers independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two researchers assessed the evidence using the GRADE approach. MAIN RESULTS We included 27 studies (18,064 women). We assessed the included studies as being at low risk of bias, although bias was frequently difficult to assess due to poor reporting and inadequate information on methods.High-dose calcium supplementation (≥ 1 g/day) versus placeboFourteen studies examined this comparison, however one study contributed no data. The 13 studies contributed data from 15,730 women to our meta-analyses. The average risk of high blood pressure (BP) was reduced with calcium supplementation compared with placebo (12 trials, 15,470 women: risk ratio (RR) 0.65, 95% confidence interval (CI) 0.53 to 0.81; I² = 74%). There was also a reduction in the risk of pre-eclampsia associated with calcium supplementation (13 trials, 15,730 women: average RR 0.45, 95% CI 0.31 to 0.65; I² = 70%; low-quality evidence). This effect was clear for women with low calcium diets (eight trials, 10,678 women: average RR 0.36, 95% CI 0.20 to 0.65; I² = 76%) but not those with adequate calcium diets. The effect appeared to be greater for women at higher risk of pre-eclampsia, though this may be due to small-study effects (five trials, 587 women: average RR 0.22, 95% CI 0.12 to 0.42). These data should be interpreted with caution because of the possibility of small-study effects or publication bias. In the largest trial, the reduction in pre-eclampsia was modest (8%) and the CI included the possibility of no effect.The composite outcome maternal death or serious morbidity was reduced with calcium supplementation (four trials, 9732 women; RR 0.80, 95% CI 0.66 to 0.98). Maternal deaths were no different (one trial of 8312 women: one death in the calcium group versus six in the placebo group). There was an anomalous increase in the risk of HELLP syndrome in the calcium group (two trials, 12,901 women: RR 2.67, 95% CI 1.05 to 6.82, high-quality evidence), however, the absolute number of events was low (16 versus six).The average risk of preterm birth was reduced in the calcium supplementation group (11 trials, 15,275 women: RR 0.76, 95% CI 0.60 to 0.97; I² = 60%; low-quality evidence); this reduction was greatest amongst women at higher risk of developing pre-eclampsia (four trials, 568 women: average RR 0.45, 95% CI 0.24 to 0.83; I² = 60%). Again, these data should be interpreted with caution because of the possibility of small-study effects or publication bias. There was no clear effect on admission to neonatal intensive care. There was also no clear effect on the risk of stillbirth or infant death before discharge from hospital (11 trials, 15,665 babies: RR 0.90, 95% CI 0.74 to 1.09).One study showed a reduction in childhood systolic BP greater than 95th percentile among children exposed to calcium supplementation in utero (514 children: RR 0.59, 95% CI 0.39 to 0.91). In a subset of these children, dental caries at 12 years old was also reduced (195 children, RR 0.73, 95% CI 0.62 to 0.87).Low-dose calcium supplementation (< 1 g/day) versus placebo or no treatmentTwelve trials (2334 women) evaluated low-dose (usually 500 mg daily) supplementation with calcium alone (four trials) or in association with vitamin D (five trials), linoleic acid (two trials), or antioxidants (one trial). Most studies recruited women at high risk for pre-eclampsia, and were at high risk of bias, thus the results should be interpreted with caution. Supplementation with low doses of calcium reduced the risk of pre-eclampsia (nine trials, 2234 women: RR 0.38, 95% CI 0.28 to 0.52). There was also a reduction in high BP (five trials, 665 women: RR 0.53, 95% CI 0.38 to 0.74), admission to neonatal intensive care unit (one trial, 422 women, RR 0.44, 95% CI 0.20 to 0.99), but not preterm birth (six trials, 1290 women, average RR 0.83, 95% CI 0.34 to 2.03), or stillbirth or death before discharge (five trials, 1025 babies, RR 0.48, 95% CI 0.14 to 1.67).High-dose (=/> 1 g) versus low-dose (< 1 g) calcium supplementationWe included one trial with 262 women, the results of which should be interpreted with caution due to unclear risk of bias. Risk of pre-eclampsia appeared to be reduced in the high-dose group (RR 0.42, 95% CI 0.18 to 0.96). No other differences were found (preterm birth: RR 0.31, 95% CI 0.09 to 1.08; eclampsia: RR 0.32, 95% CI 0.07 to 1.53; stillbirth: RR 0.48, 95% CI 0.13 to 1.83). AUTHORS' CONCLUSIONS High-dose calcium supplementation (≥ 1 g/day) may reduce the risk of pre-eclampsia and preterm birth, particularly for women with low calcium diets (low-quality evidence). The treatment effect may be overestimated due to small-study effects or publication bias. It reduces the occurrence of the composite outcome 'maternal death or serious morbidity', but not stillbirth or neonatal high care admission. There was an increased risk of HELLP syndrome with calcium supplementation, which was small in absolute numbers.The limited evidence on low-dose calcium supplementation suggests a reduction in pre-eclampsia, hypertension and admission to neonatal high care, but needs to be confirmed by larger, high-quality trials.
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Affiliation(s)
- G Justus Hofmeyr
- Walter Sisulu University, University of Fort Hare, University of the Witwatersrand, Eastern Cape Department of HealthEast LondonSouth Africa
| | - Theresa A Lawrie
- 1st Floor Education Centre, Royal United HospitalCochrane Gynaecological, Neuro‐oncology and Orphan Cancer GroupCombe ParkBathUKBA1 3NG
| | - Álvaro N Atallah
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilR. Borges Lagoa, 564 cj 63Vila ClementinoSão PauloSão PauloBrazil04038‐000
| | - Maria Regina Torloni
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilR. Borges Lagoa, 564 cj 63Vila ClementinoSão PauloSão PauloBrazil04038‐000
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Marangoni F, Pellegrino L, Verduci E, Ghiselli A, Bernabei R, Calvani R, Cetin I, Giampietro M, Perticone F, Piretta L, Giacco R, La Vecchia C, Brandi ML, Ballardini D, Banderali G, Bellentani S, Canzone G, Cricelli C, Faggiano P, Ferrara N, Flachi E, Gonnelli S, Macca C, Magni P, Marelli G, Marrocco W, Miniello VL, Origo C, Pietrantonio F, Silvestri P, Stella R, Strazzullo P, Troiano E, Poli A. Cow's Milk Consumption and Health: A Health Professional's Guide. J Am Coll Nutr 2018; 38:197-208. [PMID: 30247998 DOI: 10.1080/07315724.2018.1491016] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The most recent scientific evidence supports the consumption of cow's milk and dairy products as part of a balanced diet. However, these days, the public and practicing physicans are exposed to a stream of inconsistent (and often misleading) information regarding the relationship between cow's milk intake and health in the lay press and in the media. The purpose of this article, in this context, is to facilitate doctor-patient communication on this topic, providing physicians with a series of structured answers to frequently asked patient questions. The answers range from milk and milk-derived products' nutritional function across the life span, to their relationship with diseases such as osteoporosis and cancer, to lactose intolerance and milk allergy, and have been prepared by a panel of experts from the Italian medical and nutritional scientific community. When consumed according to appropriate national guidelines, milk and its derivatives contribute essential micro- and macronutrients to the diet, especially in infancy and childhood where bone mass growth is in a critical phase. Furthermore, preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes, and cardiovascular disease, while no clear data suggest a significant association between milk intake and cancer. Overall, current scientific literature suggests that an appropriate consumption of milk and its derivatives, according to available nutritional guidelines, may be beneficial across all age groups, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy. Key teaching points: Milk and its derivatives contribute essential micro and macronutrients to the diet, when consumed according to appropriate national guidelines, especially in infancy and childhood where bone mass growth is in a critical phase. Preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes and cardiovascular disease No clear data are available about the association between milk intake and cancer. Current scientific literature suggests that an appropriate consumption of milk and its derivatives may be beneficial at all ages, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy.
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Affiliation(s)
| | - Luisa Pellegrino
- b Department of Food, Environmental and Nutritional Sciences , Università degli Studi di Milano , Milano , Italy
| | - Elvira Verduci
- c Department of Health Sciences, San Paolo Hospital , ASST Santi Paolo e Carlo, Università degli Studi di Milano and SIP-Italian Society of Pediatrics , Milano , Italy
| | - Andrea Ghiselli
- d CREA-Alimenti e Nutrizione, Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria, Roma and SISA-Italian Society of Nutritional Science , Roma , Italy
| | - Roberto Bernabei
- e Institute of Internal Medicine and Geriatrics- Catholic University of the Sacred Heart , Roma , Italy
| | - Riccardo Calvani
- e Institute of Internal Medicine and Geriatrics- Catholic University of the Sacred Heart , Roma , Italy
| | - Irene Cetin
- f Department of Biomedical and Clinical Sciences , Unit of Obstetrics and Gynecology, Hospital Vittore Buzzi , Milano , Italy
| | | | - Francesco Perticone
- h Unit of Obstetrics and Gynecology, Hospital Vittore Buzzi , Università degli Studi "Magna Graecia", Catanzaro and SIMI-Italian Society of Internal Medicine , Catanzaro , Italy
| | - Luca Piretta
- i Alimentary Science and Human Nutrition, Università Campus Biomedico , Roma , Italy
| | - Rosalba Giacco
- j Institute of Food Science, National Research Council, Avellino and SID - Italian Diabetes Society , Avellino , Italy
| | - Carlo La Vecchia
- k Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milano , Italy
| | | | | | - Giuseppe Banderali
- n Department of Health Sciences, San Paolo Hospital , ASST Santi Paolo e Carlo, Università degli Studi di Milano and SINUPE-Italian Society of Pediatric Nutrition , Milano , Italy
| | - Stefano Bellentani
- o SIGE-Italian Society of Gastroenterology and Digestive Endoscopy , Modena , Italy
| | - Giuseppe Canzone
- p Obstetrics and Gynecology Unit , San Cimino Hospital, Termini Imerese and SIGO-Italian Society of Gynecology and Obstetrics , Termini Imerese , Italy
| | | | - Pompilio Faggiano
- r Cardiology Division , Spedali Civili and University of Brescia and GICR-Italian Association for Cardiovascular Prevention and Rehabilitation , Brescia , Italy
| | - Nicola Ferrara
- s Department of Translational Medical Sciences , University of Naples 'Federico II' and SIGG-Italian Society of Gerontology and Geriatrics , Naples , Italy
| | - Evelina Flachi
- t SIPREC-Italian Society for Cardiovascular Prevention , Milan , Italy
| | - Stefano Gonnelli
- u Department of Medicine, Surgery and Neuroscience , University of Siena and SIOMMS-Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases , Siena , Italy
| | - Claudio Macca
- v Dietetics and Clinical Nutrition Unit , Spedali Civili Brescia and ADI - Italian Association of Dietetics , Brescia , Italy
| | - Paolo Magni
- w Department of Pharmacological and Biomolecular Sciences , Università degli Studi di Milano and SISA-Italian Society for the Study of Atherosclerosis , Milano , Italy
| | - Giuseppe Marelli
- x Department of Diabetology Endocrinology and Clinical Nutrition , ASST di Vimercate and AMD - Italian Association of Diabetologists , Vimercate , Italy
| | - Walter Marrocco
- y FIMMG-Italian Federation of General Medicine Doctors and SIMPeSV-Italian Society of Preventive and Lifestyle Medicine , Rome , Italy
| | - Vito Leonardo Miniello
- z Department of Paediatrics , University of Bari and SIPPS-Italian Society of Preventive and Social Pediatrics , Bari , Italy
| | - Carlo Origo
- aa Department of Pediatric Orthoaedics , A.O. SS Antonio e Biagio e Cesare Arrigo, Alessandria and SITOP-Italian Society of Orthopaedics and Traumatology , Alessandria , Italy
| | - Filomena Pietrantonio
- ab Internal Medicine Unit , - H2-Albano Hospital Center, ASL Roma 6, Roma and FADOI-Federation of the Associations of Internist Hospital Managers , Manerbio , Italy
| | - Paolo Silvestri
- ac Interventional Cardiology-CCU Department , G. Rummo Hospital, Benevento and ANMCO-Italian National Association of Hospital Cardiologists , Benevento , Italy
| | - Roberto Stella
- ad SNaMID-National Interdisciplinary Medical Society Primary Care , Milan , Italy
| | - Pasquale Strazzullo
- ae Department of Clinical Medicine and Surgery , ESH Excellence Center of Hypertension, "Federico II" University of Naples and SINU-Italian Society of Human Nutrition , Napoli , Italy
| | | | - Andrea Poli
- a NFI-Nutrition Foundation of Italy , Milano , Italy
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Roth DE, Abrams SA, Aloia J, Bergeron G, Bourassa MW, Brown KH, Calvo MS, Cashman KD, Combs G, De-Regil LM, Jefferds ME, Jones KS, Kapner H, Martineau AR, Neufeld LM, Schleicher RL, Thacher TD, Whiting SJ. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann N Y Acad Sci 2018; 1430:44-79. [PMID: 30225965 DOI: 10.1111/nyas.13968] [Citation(s) in RCA: 281] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 12/15/2022]
Abstract
Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations.
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Affiliation(s)
- Daniel E Roth
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - John Aloia
- NYU Winthrop Hospital, Mineola, New York
| | - Gilles Bergeron
- The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, New York
| | - Megan W Bourassa
- The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, New York
| | | | - Mona S Calvo
- Retired, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, University College Cork, Cork, Ireland
| | | | | | | | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | | | - Adrian R Martineau
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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Non-pharmacological management of hypertension: in the light of current research. Ir J Med Sci 2018; 188:437-452. [DOI: 10.1007/s11845-018-1889-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/16/2018] [Indexed: 02/07/2023]
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21
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Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2018; 13:291-310. [DOI: 10.1016/j.preghy.2018.05.004] [Citation(s) in RCA: 470] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bortolotto MR, Francisco RPV, Zugaib M. Resistant Hypertension in Pregnancy: How to Manage? Curr Hypertens Rep 2018; 20:63. [PMID: 29892919 DOI: 10.1007/s11906-018-0865-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE OF REVIEW The concept of resistant hypertension may be changed during pregnancy by the physiological hemodynamic changes and the particularities of therapy choices in this period. This review discusses the management of pregnant patients with preexisting resistant hypertension and also of those who develop severe hypertension in gestation and puerperium. RECENT FINDINGS The main cause of severe hypertension in pregnancy is preeclampsia, and differential diagnosis must be done with secondary or primary hypertension. Women with preexisting resistant hypertension may need pharmacological therapy adjustment. Several drugs can be used to treat severe hypertension, with exception of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The most used drugs are methyldopa, beta-blockers, and calcium channel antagonists. There is a general agreement that severe hypertension must be treated, but there are still debates over the goals of the treatment. Delivery is indicated in viable pregnancies in which blood pressure control is not achieved with three drugs in full doses. Resistant hypertension may arise in postpartum. The management of resistant hypertension in pregnancy must regard the possible etiology, the fetal well-being, and the mother's risk. Good care is mandatory to reduce maternal mortality risk.
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Affiliation(s)
- Maria Rita Bortolotto
- Divisao de Clinica Obstetrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Zugaib
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
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Abstract
Women with chronic kidney disease (CKD) are at risk for adverse pregnancy-associated outcomes, including progression of their underlying renal dysfunction, a flare of their kidney disease, and adverse pregnancy complications such as preeclampsia and preterm delivery. Earlier-stage CKD, as a rule, is a safer time to have a pregnancy, but even women with end-stage kidney disease have attempted pregnancy in recent years. As such, nephrologists need to be comfortable with pregnancy preparation and management at all stages of CKD. In this article, we review the renal physiologic response to pregnancy and the literature with respect to both expected maternal and fetal outcomes among young women at various stages of CKD, including those who attempt to conceive while on dialysis. The general management of young women with CKD and associated complications, including hypertension and proteinuria are discussed. Finally, the emotional impact these pregnancies may have on young women with a chronic disease and the potential benefits of care in a multidisciplinary environment are highlighted.
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Antwi E, Klipstein-Grobusch K, Browne JL, Schielen PC, Koram KA, Agyepong IA, Grobbee DE. Improved prediction of gestational hypertension by inclusion of placental growth factor and pregnancy associated plasma protein-a in a sample of Ghanaian women. Reprod Health 2018; 15:56. [PMID: 29587776 PMCID: PMC5870183 DOI: 10.1186/s12978-018-0492-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/09/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We assessed whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of a previously developed model for gestational hypertension in a cohort of Ghanaian pregnant women. METHODS This study was nested in a prospective cohort of 1010 pregnant women attending antenatal clinics in two public hospitals in Accra, Ghana. Pregnant women who were normotensive, at a gestational age at recruitment of between 8 and 13 weeks and provided a blood sample for biomarker analysis were eligible for inclusion. From serum, biomarkers PAPP-A and PlGF concentrations were measured by the AutoDELFIA immunoassay method and multiple of the median (MoM) values corrected for gestational age (PAPP-A and PlGF) and maternal weight (PAPP-A) were calculated. To obtain prediction models, these biomarkers were included with clinical predictors maternal weight, height, diastolic blood pressure, a previous history of gestational hypertension, history of hypertension in parents and parity in a logistic regression to obtain prediction models. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to assess the predictive ability of the models. RESULTS Three hundred and seventy three women participated in this study. The area under the curve (AUC) of the model with only maternal clinical characteristics was 0.75 (0.64-0.86) and 0.89(0.73-1.00) for multiparous and primigravid women respectively. The AUCs after inclusion of both PAPP-A and PlGF were 0.82 (0.74-0.89) and 0.95 (0.87-1.00) for multiparous and primigravid women respectively. CONCLUSION Adding the biomarkers PAPP-A and PlGF to maternal characteristics to a prediction model for gestational hypertension in a cohort of Ghanaian pregnant women improved predictive ability. Further research using larger sample sizes in similar settings to validate these findings is recommended.
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Affiliation(s)
- Edward Antwi
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. .,Ghana Health Service, P.M.B, Ministries, Accra, Greater Accra, Ghana.
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter C Schielen
- Center for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Irene A Agyepong
- Ghana Health Service, P.M.B, Ministries, Accra, Greater Accra, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Magee LA, Kenny L, Ananth Karumanchi S, McCarthy F, Saito S, Hall DR, Warren CE, Adoyi G, Mohammed SI. TEMPORARY REMOVAL: The hypertensive disorders of pregnancy: ISSHP classification, diagnosis and management recommendations for international practice 2018. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Khaing W, Vallibhakara SAO, Tantrakul V, Vallibhakara O, Rattanasiri S, McEvoy M, Attia J, Thakkinstian A. Calcium and Vitamin D Supplementation for Prevention of Preeclampsia: A Systematic Review and Network Meta-Analysis. Nutrients 2017; 9:nu9101141. [PMID: 29057843 PMCID: PMC5691757 DOI: 10.3390/nu9101141] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/06/2017] [Accepted: 10/13/2017] [Indexed: 12/18/2022] Open
Abstract
Vitamin D supplementation effects with or without calcium in pregnancy for reducing risk of preeclampsia and gestational or pregnancy induced hypertension are controversial. Literature was systematically searched in Medline, Scopus and Cochrane databases from inception to July 2017. Only randomized controlled trials (RCTs) in English were selected if they had any pair of interventions (calcium, vitamin D, both, or placebo). Systematic review with two-step network-meta-analysis was used to indirectly estimate supplementary effects. Twenty-seven RCTs with 28,000 women were eligible. A direct meta-analysis suggested that calcium, vitamin D, and calcium plus vitamin D could lower risk of preeclampsia when compared to placebo with the pooled risk ratios (RRs) of 0.54 (0.41, 0.70), 0.47 (0.24, 0.89) and 0.50 (0.32, 0.78), respectively. Results of network meta-analysis were similar with the corresponding RRs of 0.49 (0.35, 0.69), 0.43 (0.17, 1.11), and 0.57 (0.30, 1.10), respectively. None of the controls were significant. Efficacy of supplementation, which was ranked by surface under cumulative ranking probabilities, were: vitamin D (47.4%), calcium (31.6%) and calcium plus vitamin D (19.6%), respectively. Calcium supplementation may be used for prevention for preeclampsia. Vitamin D might also worked well but further large scale RCTs are warranted to confirm our findings.
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Affiliation(s)
- Win Khaing
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 RAMA VI Road, Rachathevi, Bangkok 10400, Thailand.
- Department of Preventive and Social Medicine, University of Medicine, Mandalay 100102, Myanmar.
| | - Sakda Arj-Ong Vallibhakara
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 RAMA VI Road, Rachathevi, Bangkok 10400, Thailand.
| | - Visasiri Tantrakul
- Sleep Disorder Center, Division of Pulmonary and Critical Care, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
| | - Orawin Vallibhakara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
| | - Sasivimol Rattanasiri
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 RAMA VI Road, Rachathevi, Bangkok 10400, Thailand.
| | - Mark McEvoy
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - John Attia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 RAMA VI Road, Rachathevi, Bangkok 10400, Thailand.
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Khayat S, Fanaei H, Ghanbarzehi A. Minerals in Pregnancy and Lactation: A Review Article. J Clin Diagn Res 2017; 11:QE01-QE05. [PMID: 29207789 PMCID: PMC5713811 DOI: 10.7860/jcdr/2017/28485.10626] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 07/31/2017] [Indexed: 12/20/2022]
Abstract
Micronutrients (include vitamins and minerals) are essential for normal function, growth and development. Minerals have important effects on the health of the mother and foetus. But biological mechanisms of minerals are not completely understood. Micronutrient deficiency during pregnancy can lead to anaemia, hypertension, obstetric complications and even maternal death and in foetus lead to a fail in growth and development. Mineral deficiency during pregnancy, particularly exist in developing countries. During pregnancy due to the increased demands caused by physiological changes, deficiency is exaggerated and as a result its complications occur. Thus, ensuring to receive enough macronutrients and micronutrients before and during pregnancy, is important. Nevertheless, there are controversies regarding administrating supplements. There are not enough studies about some of the minerals and the challenges remain. Regarding the importance of minerals in pregnancy and lactation, in this review we will analyze the role of them in pregnancy and lactation.
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Affiliation(s)
- Samira Khayat
- Ph.D. Student in Reproductive Health, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Fanaei
- Pregnancy Health Research Center and Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Owusu Darkwa E, Antwi-Boasiako C, Djagbletey R, Owoo C, Obed S, Sottie D. Serum magnesium and calcium in preeclampsia: a comparative study at the Korle-Bu Teaching Hospital, Ghana. Integr Blood Press Control 2017; 10:9-15. [PMID: 28860856 PMCID: PMC5565255 DOI: 10.2147/ibpc.s129106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background A large percentage (16% of maternal mortality in developed countries, compared to 9% in developing countries), is due to hypertensive disorders in pregnancy. The etiology of preeclampsia remains unknown, with poorly understood pathophysiology. Magnesium and calcium play an important role in vascular smooth muscle function and therefore a possible role in the development of preeclampsia. Aim We aimed to compare serum magnesium and total calcium levels of preeclamptic and normal pregnant women at the Korle-Bu Teaching Hospital in Ghana. Patients and methods A comparative cross-sectional study involving 30 normal pregnant and 30 preeclamptic women with >30 weeks gestation and aged 18–35 years, was conducted at the Korle-Bu Teaching Hospital. Magnesium and calcium were determined using a flame atomic absorption spectrometer. Results Mean serum magnesium and total calcium levels in preeclamptic women were 0.70±0.15 and 2.13±0.30 mmol/L, respectively. Mean serum magnesium and total calcium levels in normal pregnant women were 0.76±0.14 and 2.13±0.35 mmol/L, respectively. There was a statistically nonsignificant difference in serum magnesium and total calcium in preeclamptic women compared to normal pregnant women, with p-values of 0.092 and 0.972, respectively. Conclusion Serum magnesium and total calcium, therefore, seem not to differ in preeclamptic women compared to normal pregnant women in Ghana.
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Affiliation(s)
| | - Charles Antwi-Boasiako
- Department of Physiology, University of Ghana School of Biomedical and Allied Health Sciences
| | - Robert Djagbletey
- Department of Anaesthesia, University of Ghana School of Medicine and Dentistry
| | - Christian Owoo
- Department of Anaesthesia, University of Ghana School of Medicine and Dentistry
| | - Samuel Obed
- Department of Obstetrics and Gynaecology, University of Ghana School of Medicine and Dentistry, College of Health Sciences
| | - Daniel Sottie
- Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana
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Purswani JM, Gala P, Dwarkanath P, Larkin HM, Kurpad A, Mehta S. The role of vitamin D in pre-eclampsia: a systematic review. BMC Pregnancy Childbirth 2017; 17:231. [PMID: 28709403 PMCID: PMC5513133 DOI: 10.1186/s12884-017-1408-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 07/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The etiology of pre-eclampsia (PE) is not yet fully understood, though current literature indicates an upregulation of inflammatory mediators produced by the placenta as a potential causal mechanism. Vitamin D is known to have anti-inflammatory properties and there is evidence of an inverse relationship between dietary calcium intake and the incidence of PE. Evidence of the role of vitamin D status and supplementation in the etiology and prevention of PE is reviewed in this article along with identification of research gaps to inform future studies. METHODS We conducted a structured literature search using MEDLINE electronic databases to identify published studies until February 2015. These sources were retrieved, collected, indexed, and assessed for availability of pregnancy-related data on PE and vitamin D. RESULTS Several case-control studies and cross-sectional studies have shown an association between vitamin D status and PE, although evidence has been inconsistent. Clinical trials to date have been unable to show an independent effect of vitamin D supplementation in preventing PE. CONCLUSIONS The included clinical trials do not show an independent effect of vitamin D supplementation in preventing PE; however, issues with dose, timing, and duration of supplementation have not been completely addressed.
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Affiliation(s)
- Juhi M. Purswani
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853 USA
| | - Pooja Gala
- Weill-Cornell Medical College, New York, NY USA
| | | | - Heather M. Larkin
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853 USA
| | - Anura Kurpad
- St. John’s Research Institute, Bangalore, Karnataka India
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853 USA
- St. John’s Research Institute, Bangalore, Karnataka India
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Marangoni F, Cetin I, Verduci E, Canzone G, Giovannini M, Scollo P, Corsello G, Poli A. Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document. Nutrients 2016; 8:E629. [PMID: 27754423 PMCID: PMC5084016 DOI: 10.3390/nu8100629] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/19/2016] [Accepted: 10/08/2016] [Indexed: 12/11/2022] Open
Abstract
The importance of lifestyle and dietary habits during pregnancy and breastfeeding, for health of mothers and their offspring, is widely supported by the most recent scientific literature. The consumption of a varied and balanced diet from the preconceptional period is essential to ensure both maternal well-being and pregnancy outcomes. However, the risk of inadequate intakes of specific micronutrients in pregnancy and lactation is high even in the most industrialized countries. This particularly applies to docosahexaenoic acid (DHA), iron, iodine, calcium, folic acid, and vitamin D, also in the Italian population. Moreover, the risk of not reaching the adequate nutrient supply is increased for selected groups of women of childbearing age: those following exclusion diets, underweight or overweight/obese, smokers, adolescents, mothers who have had multiple or close pregnancies, and those with previous unfavorable pregnancy outcomes.
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Affiliation(s)
| | - Irene Cetin
- Department of Mother and Child Hospital Luigi Sacco, Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences University of Milan-Italian Society of Perinatal Medicine (SIMP), Milano 20157, Italy.
| | - Elvira Verduci
- Department of Pediatrics, Department of Health Sciences, San Paolo Hospital, University of Milan-Italian Society of Pediatrics (SIP), Milano 20142, Italy.
| | - Giuseppe Canzone
- Obstetrics and Gynecology Unit, S. Cimino Hospital-Italian Society of Gynecology and Obstetrics (SIGO), Termini Imerese, Palermo 90018, Italy.
| | - Marcello Giovannini
- Department of Pediatrics, San Paolo Hospital, Department of Health Science, University of Milan-Italian Society of Pediatric Nutrition (SINUPE), Milano 20142, Italy.
| | - Paolo Scollo
- Division of Gynecology and Obstetrics, Maternal and Child Department, Cannizzaro Hospital-Italian Society of Gynecology and Obstetrics (SIGO), Catania 95126, Italy.
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo-Italian Society of Pediatrics (SIP), Palermo 90127, Italy.
| | - Andrea Poli
- NFI-Nutrition Foundation of Italy, Milano 20124, Italy.
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Why non-invasive maternal hemodynamics assessment is clinically relevant in early pregnancy: a literature review. BMC Pregnancy Childbirth 2016; 16:302. [PMID: 27729024 PMCID: PMC5059982 DOI: 10.1186/s12884-016-1091-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 09/27/2016] [Indexed: 01/15/2023] Open
Abstract
Background The maternal cardiovascular system adapts quickly when embryo implantation is recognized by the body. Those adaptations play an important role, as a normal cardiovascular adaptation is a requirement for a normal course of pregnancy. Disturbed adaptations predispose to potential hypertensive disorders further in pregnancy [1–3]. This report aims to briefly inform the obstetricians, general practitioners and midwives, who are the key players in detecting and treating hypertensive disorders during pregnancy. Methods The PubMed database was used as main tool to find studies involving clearly defined first trimester hemodynamic changes in normal pregnancies and hypertensive pregnancies. In addition, the bibliographies of these studies were investigated for further relevant literature. Results A comprehensive overview is given concerning the normal adaptations in the cardiovascular tree in a first trimester pregnancy. Additionally, signs of abnormal cardiovascular changes observed in first trimester are described together with the normal reference range for each non-invasive, easily applicable technique for maternal hemodynamics assessment. Conclusions With a combination of techniques, it is possible to integrate and evaluate the maternal heart, veins and arteries at 12 weeks of pregnancy. Applying those techniques into the daily clinic opens perspectives to prevention and prophylactic treatment, aiming for a reduction of the risk for hypertension during pregnancy.
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Thapa K, Sanghvi H, Rawlins B, Karki YB, Regmi K, Aryal S, Aryal Y, Murakami P, Bhattarai J, Suhowatsky S. Coverage, compliance, acceptability and feasibility of a program to prevent pre-eclampsia and eclampsia through calcium supplementation for pregnant women: an operations research study in one district of Nepal. BMC Pregnancy Childbirth 2016; 16:241. [PMID: 27553004 PMCID: PMC4995763 DOI: 10.1186/s12884-016-1033-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 08/11/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Calcium supplementation during pregnancy has been shown to reduce the incidence of pre-eclampsia/eclampsia among women with low calcium intake. Universal free calcium supplementation through government antenatal care (ANC) services was piloted in the Dailekh district of Nepal. Coverage, compliance, acceptability and feasibility of the intervention were evaluated. METHODS Antenatal care providers were trained to distribute and counsel pregnant women about calcium use, and female community health volunteers (FCHVs) were trained to reinforce calcium-related messages. A post-intervention cluster household survey was conducted among women who had given birth in the last six months. Secondary data analysis was performed using monitoring data from health facilities and FCHVs. RESULTS One Thousand Two hundred-forty postpartum women were interviewed. Most (94.6 %) had attended at least one ANC visit; the median gestational age at first ANC visit was 4 months. All who attended ANC were counseled about calcium and received calcium tablets to take daily until delivery.79.5 % of the women reported consuming the entire quantity of calcium they received. The full course of calcium (300 tablets for 150 days) was provided to 82.3 % of the women. Consumption of the full course of calcium was reported by 67.3 % of all calcium recipients. Significant predictors of completing a full course were gestational age at first ANC visit and number of ANC visits during their most recent pregnancy (p < 0.01). Nearly all (99.2 %) reported taking the calcium as instructed with respect to dose, timing and frequency. Among women who received both calcium and iron (n = 1,157), 98.0 % reported taking them at different times of the day, as instructed. Over 97 % reported willingness to recommend calcium to others, and said they would like to use it during a subsequent pregnancy. There were no stock-outs of calcium. CONCLUSIONS Calcium distribution through ANC was feasible and effective, achieving 94.6 % calcium coverage of pregnant women in the district. Most women (over 80 %) attended ANC early enough in pregnancy to receive the full course of calcium supplements and benefit from the intervention. High coverage, compliance, acceptability among pregnant women and feasibility were reported, suggesting that this intervention can be scaled up in other areas of Nepal.
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Affiliation(s)
- Kusum Thapa
- Jhpiego/Nepal, Oasis Building, Patan Dhoka, Lalitpur, Kathmandu, Nepal.
| | | | - Barbara Rawlins
- Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Avenue, Washington, DC, 20036, USA
| | - Yagya B Karki
- The Population, Health and Development (PHD) Group, Sanepa, Lalitpur, Kathmandu, Nepal
| | - Kiran Regmi
- Ministry of Health and Population, Government of Nepal, Teku, Kathmandu, Nepal
| | - Shilu Aryal
- Ministry of Health and Population, Government of Nepal, Teku, Kathmandu, Nepal
| | - Yeshoda Aryal
- Jhpiego/Nepal, Oasis Building, Patan Dhoka, Lalitpur, Kathmandu, Nepal
| | - Peter Murakami
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Jona Bhattarai
- Jhpiego/Nepal, Oasis Building, Patan Dhoka, Lalitpur, Kathmandu, Nepal
| | - Stephanie Suhowatsky
- Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Avenue, Washington, DC, 20036, USA
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Martin SL, Omotayo MO, Chapleau GM, Stoltzfus RJ, Birhanu Z, Ortolano SE, Pelto GH, Dickin KL. Adherence partners are an acceptable behaviour change strategy to support calcium and iron-folic acid supplementation among pregnant women in Ethiopia and Kenya. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27507135 DOI: 10.1111/mcn.12331] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 01/27/2023]
Abstract
Antenatal calcium and iron-folic acid (IFA) supplementation can reduce maternal mortality and morbidity. Yet, even when pregnant women have a stable supply of supplements, forgetting is often a barrier to adherence. We assessed the acceptability of adherence partners to support calcium and IFA supplementation among pregnant women in Kenya and Ethiopia. Adherence partners are a behaviour change strategy to improve adherence, where pregnant women are counselled to select a partner (e.g. spouse, relative) to remind them to take their supplements. We conducted trials of improved practices, a formative research method that follows participants over time as they try a new behaviour. We provided pregnant women in Ethiopia (n = 50) and Kenya (n = 35) with calcium and IFA supplements and counselling, and suggested selecting an adherence partner. For each participant, we conducted semi-structured interviews about acceptability and adherence during four interviews over six weeks. We analysed interview transcripts thematically and tallied numerical data. In Kenya, 28 of 35 women agreed to try an adherence partner; almost all selected their husbands. In Ethiopia, 42 of 50 women agreed to try an adherence partner; half asked their husbands, others asked children or relatives. Most women who did not select adherence partners reported not needing help or not having anyone to ask. Participants reported adherence partners reminded and encouraged them, brought supplements, provided food and helped address side-effects. Almost all women with adherence partners would recommend this strategy to others. Adherence partners are an acceptable, low-cost strategy with the potential to support antenatal micronutrient supplementation adherence.
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Affiliation(s)
- Stephanie L Martin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Moshood O Omotayo
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Gina M Chapleau
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Rebecca J Stoltzfus
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Stephanie E Ortolano
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Gretel H Pelto
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Hanson MA, Bardsley A, De-Regil LM, Moore SE, Oken E, Poston L, Ma RC, McAuliffe FM, Maleta K, Purandare CN, Yajnik CS, Rushwan H, Morris JL. The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: "Think Nutrition First". Int J Gynaecol Obstet 2016; 131 Suppl 4:S213-53. [PMID: 26433230 DOI: 10.1016/s0020-7292(15)30034-5] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Mark A Hanson
- Institute of Developmental Sciences, University of Southampton; and NIHR Nutrition Biomedical Research Centre, University Hospital Southampton; Southampton, UK
| | - Anne Bardsley
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; and Department of Nutrition, Harvard TH Chan School of Public Health; Boston, MA, USA
| | | | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong; and the Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
| | - Fionnuala M McAuliffe
- UCD School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Ken Maleta
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | | | - Hamid Rushwan
- International Federation of Gynecology and Obstetrics, London, UK
| | - Jessica L Morris
- International Federation of Gynecology and Obstetrics, London, UK.
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García Molina M. Costo efectividad del suplemento de calcio para reducir la mortalidad materna asociada a preeclampsia en Colombia. Rev Salud Publica (Bogota) 2016; 18:300-310. [DOI: 10.15446/rsap.v18n2.48776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
<p>Objetivo. Estimar el costo-efectividad de la administración de calcio (1 200 mg diarios) a partir de la semana 14 de gestación a todas las gestantes, comparada con no administrarlo, para reducir la incidencia de preeclampsia. Métodos. Se construyó un árbol de decisión en TreeAge® con desenlace en años de vida ganados (AVG). Los costos se incluyeron desde la perspectiva del sistema de salud colombiano, en pesos (COP) de 2014. La tasa de descuento fue de 0%. Se realizaron análisis de sensibilidad univariados y probabilísticos para costos y efectividad. Resultados. El suplemento de calcio es una alternativa dominante frente a la no intervención. Si la incidencia de preeclampsia es menor a 51,7 por 1 000 gestantes o el costo por tableta de calcio de 600 mg es mayor a COP$ 507,85, el suplemento de calcio deja de ser una alternativa costo-efectiva en Colombia para un umbral de 3 veces el PIB per cápita de 2013 (COP$ 45 026 379) por AVG. Conclusiones. La administración de calcio a todas las gestantes a partir de la semana 14 de gestación es una alternativa dominante frente a la no intervención, que permite ganar 200 años de vida, al tiempo que disminuye costos del orden de COP$ 5 933 millones por 100 000 gestantes.</p>
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Kane SC. First trimester screening for pre-eclampsia. Obstet Med 2016; 9:106-12. [PMID: 27630745 DOI: 10.1177/1753495x16649074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/18/2016] [Indexed: 11/17/2022] Open
Abstract
The commercial availability of tests in the first trimester of pregnancy that predict the later development of pre-eclampsia has prompted considerable debate regarding their clinical utility and the degree to which they fulfil the longstanding principles of screening. Such tests have been shown to achieve detection rates for early pre-eclampsia (requiring delivery prior to 34 weeks) of over 90%, for a false positive rate of 10%. However, their capacity to predict later onset pre-eclampsia, which accounts for the bulk of the disease burden, is much more limited. The relatively few studies validating the performance of these tests in different populations have demonstrated significant variations in performance. Moreover, prospective research confirming that the administration of aspirin to those screened to be high risk reduces the incidence of pre-eclampsia is yet to be completed, and there may be harms in restricting aspirin therapy to this group, given its broader beneficial effect. In light of these limitations, further development of these tests is recommended prior to their introduction to clinical practice.
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Affiliation(s)
- Stefan C Kane
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Pregnancy Research Centre, Department of Maternal-Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia
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Lassi ZS, Middleton PF, Bhutta ZA, Crowther C. Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review and meta-analysis. Glob Health Action 2016; 9:31408. [PMID: 27171766 PMCID: PMC4864851 DOI: 10.3402/gha.v9.31408] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/10/2016] [Accepted: 04/10/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lack of appropriate health care seeking for ill mothers and neonates contributes to high mortality rates. A major challenge is the appropriate mix of strategies for creating demand as well as provision of services. DESIGN Systematic review and meta-analysis of experimental studies (last search: Jan 2015) to assess the impact of different strategies to improve maternal and neonatal health care seeking in low- and middle-income countries (LMIC). RESULTS Fifty-eight experimental [randomized controlled trials (RCTs), non-RCTs, and before-after studies] with 310,652 participants met the inclusion criteria. Meta-analyses from 29 RCTs with a range of different interventions (e.g. mobilization, home visitation) indicated significant improvement in health care seeking for neonatal illnesses when compared with standard/no care [risk ratio (RR) 1.40; 95 confidence interval (CI): 1.17-1.68, 9 studies, n=30,572], whereas, no impact was seen on health care seeking for maternal illnesses (RR 1.06; 95% CI: 0.92-1.22, 5 studies, n=15,828). These interventions had a significant impact on reducing stillbirths (RR 0.82; 95% CI: 0.73-0.93, 11 studies, n=176,683), perinatal deaths (RR 0.84; 95% CI: 0.77-0.90, 15 studies, n=279,618), and neonatal mortality (RR 0.80; 95% CI: 0.72-0.89, 20 studies, n=248,848). On GRADE approach, evidence was high quality except for the outcome of maternal health care seeking, which was moderate. CONCLUSIONS Community-based interventions integrating strategies such as home visiting and counseling can help to reduce fetal and neonatal mortality in LMIC.
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Affiliation(s)
- Zohra S Lassi
- Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia;
| | - Philippa F Middleton
- Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
- Women's and Children's Health Research Institute, The University of Adelaide, Adelaide, Australia
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Centre of Excellence for Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Caroline Crowther
- Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Jung ME, Stork MJ, Stapleton J, Bourne JE, Martin Ginis KA. A systematic review of behavioural interventions to increase maternal calcium intake. MATERNAL & CHILD NUTRITION 2016; 12:193-204. [PMID: 25536083 PMCID: PMC6860114 DOI: 10.1111/mcn.12158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pregnancy and lactation are a time when adequate calcium consumption is essential for the development of the fetus and to ensure the health of the mother. Over 50% of Canadian women of childbearing and rearing age fail to meet the recommended daily intake of calcium. Identification of effective behavioural intervention strategies for increasing calcium intake is needed within this specific population. This paper brings together all published behavioural interventions designed to increase calcium consumption in pregnant, lactating or post-partum mothers in a systematic review. Relevant studies were obtained through searches of MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library with no date restrictions. Studies were evaluated using previously published criteria for evaluating calcium behaviour change interventions. This systematic literature review identified five behavioural calcium interventions conducted within this population. Three interventions aimed to improve overall dietary behaviours, the fourth aimed to promote breastfeeding (including increasing calcium consumption) and the fifth aimed to increase daily servings of yoghurt. Only one of the five interventions yielded large effect sizes, with a mean change of 954 mg of calcium per day post-intervention. The number of behavioural change techniques did not appear to be related to intervention efficacy. Only one study used a theoretical framework to guide the intervention. This review highlights the lack of research examining behaviour change interventions aimed at increasing calcium consumption in pregnant, lactating and post-partum women and provides practical suggestions for researchers wishing to intervene with this population in the future.
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Affiliation(s)
- Mary E. Jung
- School of Health and Exercise SciencesUniversity of British ColumbiaKelownaBritish ColumbiaCanada
| | - Matthew J. Stork
- Department of KinesiologyMcMaster UniversityHamiltonOntarioCanada
| | | | - Jessica E. Bourne
- School of Health and Exercise SciencesUniversity of British ColumbiaKelownaBritish ColumbiaCanada
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Borghi C, Cicero AFG. Nutraceuticals with a clinically detectable blood pressure-lowering effect: a review of available randomized clinical trials and their meta-analyses. Br J Clin Pharmacol 2016; 83:163-171. [PMID: 26852373 DOI: 10.1111/bcp.12902] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 12/19/2022] Open
Abstract
AIMS The aim of the present study was to review and comment on the available evidence on nutraceuticals with a clinically demonstrable blood pressure (BP)-lowering effect. METHODS We reviewed studies published in the English language from 1990 to 2015 on dietary supplements or nutraceuticals claiming to show an effect on human BP. An initial list of possibly effective agents and studies was obtained from the online reference, the Natural Medicine Comprehensive Database. Using PubMed, we searched agents identified from this list using the MeSH terms 'hypertension', 'blood pressure', 'dietary supplement' and 'nutraceuticals', alone and in combination. We then focused our attention on meta-analyses and randomized clinical trials. RESULTS Beyond the well-known effects on BP of the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, a large number of studies have investigated the possible BP-lowering effect of different dietary supplements and nutraceuticals, most of which are antioxidant agents with a high tolerability and safety profile. In particular, a relatively large body of evidence supports the use of potassium, magnesium, L-arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled-release melatonin and aged garlic extract. The antihypertensive effect of all these nutraceuticals seems to be dose related and the overall tolerability is good. CONCLUSION Some nutraceuticals might have a positive impact on BP in humans. Further clinical research is needed, to identify from the available active nutraceuticals those with the best cost-effectiveness and risk-benefit ratio for widespread and long-term use in the general population with a low-added cardiovascular risk related to uncomplicated hypertension.
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Affiliation(s)
- Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Arrigo F G Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Italy
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40
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Liu FL, Zhang YM, Parés GV, Reidy KC, Zhao WZ, Zhao A, Chen C, Ning CY, Zheng YD, Wang PY. Nutrient Intakes of Pregnant Women and their Associated Factors in Eight Cities of China: A Cross-sectional Study. Chin Med J (Engl) 2016; 128:1778-86. [PMID: 26112720 PMCID: PMC4733713 DOI: 10.4103/0366-6999.159354] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: During the last 3 decades, China has dramatic changes of the dietary pattern among its citizens, particularly in urban cities. This study aimed to determine the nutrient intake status and factors associated with nutrient intakes of urban Chinese pregnant women now-a-day. Methods: The multistage stratified random sampling method was applied in the cross-sectional study. 479 women in three trimesters of pregnancy from eight cities of China were recruited. Nutrient intakes were evaluated with one 24 h dietary recall, and compared with the Chinese Dietary Reference Intakes (DRIs) 2013 for available nutrients. Results: Most pregnant women had imbalanced macronutrient distribution with excessive energy derived from fat. Intakes of Vitamin A, B6, calcium, magnesium, and selenium were below Chinese Recommended Nutrient Intake (RNI) and Estimated Average Requirements (EARs) in all trimesters. Most pregnant women took more folic acid in the first trimester with a significant decrease in the second and third trimester (P < 0.05). Shortfall in iron intake was found in the third trimester whereas some women may be at the risk of excessive iron intake. Intakes of thiamin met RNI in the first trimester but were below EAR in all trimesters. Trimester phasing was positively associated with most nutrients (P < 0.05). Prepregnancy body mass index was inversely associated with energy, fat, Vitamin C, and calcium intake (P < 0.05). Educational level and household income were positively associated with folic acid intake (P < 0.05). Conclusions: Current prenatal dietary choices of urban pregnant women in China are imbalanced in the nutrient intake when compared with national DRIs 2013, particularly in intakes of energy derived from fat and micronutrients. Appropriate dietary advice to pregnant women should promote a balanced diet with emphasis on avoidance of foods of high fat content and incorporation of foods that are good sources of the key micronutrients that are usually lacking in a regular pregnancy diet. Further research is needed to understand the eating habits and food patterns that contribute to this imbalanced diet in order to be able to effectively improve prenatal women's nutrient intake status.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Pei-Yu Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
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Abstract
Pre-eclampsia affects 3-5% of pregnancies and is traditionally diagnosed by the combined presentation of high blood pressure and proteinuria. New definitions also include maternal organ dysfunction, such as renal insufficiency, liver involvement, neurological or haematological complications, uteroplacental dysfunction, or fetal growth restriction. When left untreated, pre-eclampsia can be lethal, and in low-resource settings, this disorder is one of the main causes of maternal and child mortality. In the absence of curative treatment, the management of pre-eclampsia involves stabilisation of the mother and fetus, followed by delivery at an optimal time. Although algorithms to predict pre-eclampsia are promising, they have yet to become validated. Simple preventive measures, such as low-dose aspirin, calcium, and diet and lifestyle interventions, show potential but small benefit. Because pre-eclampsia predisposes mothers to cardiovascular disease later in life, pregnancy is also a window for future health. A collaborative approach to discovery and assessment of the available treatments will hasten our understanding of pre-eclampsia and is an effort much needed by the women and babies affected by its complications.
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Affiliation(s)
- Ben W J Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA, Australia.
| | - Claire T Roberts
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Laura A Magee
- BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | | | - G Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, University of Fort Hare, and Eastern Cape Department of Health, East London, South Africa
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Jamshidi F, Kelishadi R. A systematic review on the effects of maternal calcium supplementation on offspring's blood pressure. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 20:994-9. [PMID: 26929766 PMCID: PMC4746875 DOI: 10.4103/1735-1995.172794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Evidence proposes that maternal calcium (Ca) supplement during pregnancy may be inversely associated with the off spring's blood pressure (BP) level. It is suggested that increased maternal Ca intake during pregnancy may result in lower BP in the off spring. The reduction in the incidence of hypertension in mothers is documented but the effects on the off spring are uncertain. Materials and Methods: We conducted a systematic review of the literature to summarize the evidence supporting an association between maternal dietary Ca intake during pregnancy and the BP in the off spring. In this systematic review, relevant papers were selected in three phases. After quality assessment, a reviewer extracted the data while the other one checked the extracted data. We summarized the information regarding the association of maternal Ca intake either by food or supplements with BP in the off spring. Results: Four randomized trials and three observational studies were included in this review. The results were more consistent among the studies including older children (1-9 years) where a higher maternal Ca intake was associated with a reduction in the off spring's systolic BP. One large randomized trial found a clinically and statistically significant reduction in the incidence of elevated BP in 7-year-old children [relative risk (RR) = 0.59, 95% confidence interval (CI) 0.39-0.90]. Conclusion: Overall, our findings confirm the beneficial effects of maternal Ca intake during pregnancy for the off spring's BP level.
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Affiliation(s)
- Fahimeh Jamshidi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Martin SL, Seim GL, Wawire S, Chapleau GM, Young SL, Dickin KL. Translating formative research findings into a behaviour change strategy to promote antenatal calcium and iron and folic acid supplementation in western Kenya. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 26898417 DOI: 10.1111/mcn.12233] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/07/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
Abstract
The World Health Organization now recommends integrating calcium supplements into antenatal micronutrient supplementation programmes to prevent pre-eclampsia, a leading cause of maternal mortality. As countries consider integrating calcium supplementation into antenatal care (ANC), it is important to identify context-specific barriers and facilitators to delivery and adherence. Such insights can be gained from women's and health workers' experiences with iron and folic acid (IFA) supplements. We conducted in-depth interviews with 22 pregnant and post-partum women and 20 community-based and facility-based health workers in Kenya to inform a calcium and IFA supplementation programme. Interviews assessed awareness of anaemia, pre-eclampsia and eclampsia; ANC attendance; and barriers and facilitators to IFA supplement delivery and adherence. We analyzed interviews inductively using the constant comparative method. Women and health workers identified poor diet quality in pregnancy as a major health concern. Neither women nor health workers identified pre-eclampsia, eclampsia, anaemia or related symptoms as serious health threats. Women and community-based health workers were unfamiliar with pre-eclampsia and eclampsia and considered anaemia symptoms normal. Most women had not received IFA supplements, and those who had received insufficient amounts and little information about supplement benefits. We then developed a multi-level (health facility, community, household and individual) behaviour change strategy to promote antenatal calcium and IFA supplementation. Formative research is an essential first step in guiding implementation of antenatal calcium supplementation programmes to reduce pre-eclampsia. Because evidence on how to implement successful calcium supplementation programmes is limited, experiences with antenatal IFA supplementation can be used to guide programme development.
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Affiliation(s)
- Stephanie L Martin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Gretchen L Seim
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Gina M Chapleau
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Sera L Young
- Department of Population Medicine and Diagnostic Sciences, Program in International Nutrition, Cornell University
| | - Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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8. References. Int J Gynaecol Obstet 2015. [DOI: 10.1016/s0020-7292(15)30032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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DeSousa J, Tong M, Wei J, Chamley L, Stone P, Chen Q. The anti-inflammatory effect of calcium for preventing endothelial cell activation in preeclampsia. J Hum Hypertens 2015; 30:303-8. [PMID: 26155993 DOI: 10.1038/jhh.2015.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/28/2015] [Accepted: 05/01/2015] [Indexed: 12/11/2022]
Abstract
Preeclampsia is a disorder of pregnancy characterized by endothelial activation. It is believed to be a response to a 'toxin(s)' from the placenta including trophoblastic debris and inflammatory cytokines. Calcium is known to reduce the risk of preeclampsia but the mechanism of its protective effect remains unknown. In this study, we investigated the potential mechanism(s) of calcium supplementation for preventing endothelial activation induced by trophoblastic debris. Trophoblastic debris was harvested from preeclamptic placentae and also from first-trimester placentae, which had been treated with preeclamptic sera. Endothelial cells were then cultured with trophoblastic debris in the presence of calcium. Endothelial activation was measured by quantifying endothelial cell-surface intercellular adhesion molecule-1 (ICAM-1) and by U937 monocyte adhesion to endothelial cells. The expression of ICAM-1 and U937 adhesion to endothelial cells were significantly reduced following exposure of endothelial cells to trophoblastic debris from preeclamptic placenta or from first-trimester placentae treated with preeclamptic sera in the presence of calcium compared with treatment without calcium. The expression of ICAM-1 was also significantly reduced following exposure of endothelial cells to trophoblastic debris with the nitric oxide donor or following treatment of endothelial cells with interleukin (IL)-1β in the presence of calcium. Our study demonstrated that calcium supplementation prevented endothelial cell activation induced by trophoblastic debris from preeclamptic placentae. The nitric oxide synthase (NOS) pathway and anti-inflammatory effects are involved in the action of calcium on endothelial cell activation. These findings may suggest, at least in part, the protective mechanism of calcium supplementation on preeclampsia.
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Affiliation(s)
- J DeSousa
- Maternal Fetal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - M Tong
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - J Wei
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - L Chamley
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - P Stone
- Maternal Fetal Medicine, Auckland City Hospital, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Q Chen
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand.,The Hospital of Obstetrics and Gynaecology, Fudan University, Shanghai, China
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An LB, Li WT, Xie TN, Peng X, Li B, Xie SH, Xu J, Zhou XH, Guo SN. Calcium supplementation reducing the risk of hypertensive disorders of pregnancy and related problems: A meta-analysis of multicentre randomized controlled trials. Int J Nurs Pract 2015; 21 Suppl 2:19-31. [DOI: 10.1111/ijn.12171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Li-bin An
- School of Nursing; Jilin University; Changchun China
| | - Wen-tao Li
- School of Nursing; Jilin University; Changchun China
| | - Tie-nan Xie
- Department of Obstetrics and Gynecology; The First Hospital of Jilin University; Changchun China
| | - Xin Peng
- School of Nursing; Jilin University; Changchun China
| | - Bo Li
- School of Public Health; Jilin University; Changchun China
| | - Shu-hong Xie
- School of Nursing; Jilin University; Changchun China
| | - Jing Xu
- School of Nursing; Jilin University; Changchun China
| | - Xiao-hua Zhou
- School of Nursing; Jilin University; Changchun China
| | - Shao-ning Guo
- School of Nursing; Jilin University; Changchun China
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Cicero AFG, Colletti A. Nutraceuticals and Blood Pressure Control: Results from Clinical Trials and Meta-Analyses. High Blood Press Cardiovasc Prev 2015; 22:203-13. [PMID: 25788027 DOI: 10.1007/s40292-015-0081-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/03/2015] [Indexed: 12/16/2022] Open
Abstract
Beyond the well-known effects on blood pressure (BP) of the dietary approaches to stop hypertension (DASH) and the Mediterranean diets, a large number of studies has investigated the possible BP lowering effect of different dietary supplements and nutraceuticals, the most part of them being antioxidant agents with a high tolerability and safety profile. In particular relatively large body of evidence support the use of potassium, L-arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled-release melatonin, and aged garlic extract. However there is a need for data about the long-term safety of a large part of the above discussed products. Moreover further clinical research is advisable to identify between the available active nutraceuticals those with the best cost-effectiveness and risk-benefit ratio for a large use in general population with low-added cardiovascular risk related to uncomplicated hypertension.
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Affiliation(s)
- Arrigo F G Cicero
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy,
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Abstract
Pre-eclampsia remains the second leading direct cause of maternal death, >99 % of which occurs in less developed countries. Over 90 percent of the observed reduction in pre-eclampsia-related maternal deaths in the UK (1952-2008) occurred with antenatal surveillance and timed delivery. In this review, we discuss the pathogenesis, diagnostic criteria, disease prediction models, prevention and management of pre-eclampsia. The Pre-eclampsia Integrated Estimate of RiSk (PIERS) models and markers of angiogenic imbalance identify women at incremental risk for severe pre-eclampsia complications. For women at high risk of developing pre-eclampsia, low doses of aspirin (especially if started <17 weeks) and calcium are evidence-based preventative strategies; heparin is less so. Severe hypertension must be treated and the Control of Hypertension In Pregnancy (CHIPS) Trial (reporting: 2014) will guide non-severe hypertension management. Magnesium sulfate prevents and treats eclampsia; there is insufficient evidence to support alternative regimens. Pre-eclampsia predicts later cardiovascular disease; however, at this time we do not know what to do about it.
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Affiliation(s)
- Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada,
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Dalmar A, Raff H, Chauhan SP, Singh M, Siddiqui DS. Serum 25-hydroxyvitamin D, calcium, and calcium-regulating hormones in preeclamptics and controls during first day postpartum. Endocrine 2015; 48:287-92. [PMID: 24853885 DOI: 10.1007/s12020-014-0296-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/08/2014] [Indexed: 12/30/2022]
Abstract
The evidence for a link between vitamin D and preeclampsia is conflicting. There is a paucity of studies reporting simultaneous 25-hydroxyvitamin D (inactive form) and 1,25-dihydroxyvitamin D (biologically active form). We investigated if levels of serum 25-hydroxyvitamin D, calcium-regulating hormones (1,25-dihydroxyvitamin D, parathyroid hormone), and calcium differ significantly between preeclamptics and controls. On postpartum day one, 98 subjects (44 with preeclampsia, 54 controls) were recruited among women admitted to the postdelivery unit, and their serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, parathyroid hormone, serum calcium, and serum albumin levels were prospectively measured. The majority of participants (70%) had serum 25-hydroxyvitamin D level<20 ng/mL; 53% had <15 ng/mL. Mean serum 25-hydroxyvitamin D level was similar between cases and controls (p=0.50). Mean total serum calcium adjusted for albumin and magnesium was similar between cases and controls (p=0.78). Mean serum 1,25-dihydroxyvitamin D and parathyroid hormone levels were normal, and there were no differences between cases and controls. The only significant differences found between preeclamptic cases and controls were mean body mass index, parity, and season of blood draw. Vitamin D levels did not differ among preeclamptic cases and controls.
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Affiliation(s)
- Ahmed Dalmar
- Aurora Research Institute, Aurora Sinai Medical Center, 960 N. 12th Street, Suite 4120, Milwaukee, Wisconsin, 53233,
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