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Gurung S, Tong HH, Bryce E, Katz J, Lee ACC, Black RE, Walker N. A systematic review on estimating population attributable fraction for risk factors for small-for-gestational-age births in 81 low- and middle-income countries. J Glob Health 2022; 12:04024. [PMID: 35356650 PMCID: PMC8942297 DOI: 10.7189/jogh.12.04024] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Small for gestational age (SGA) is a public health concern since it is associated with mortality in neonatal and post-neonatal period. Despite the large magnitude of the problem, little is known about the population-attributable risk (PAR) of various risk factors for SGA. This study estimated the relative contribution of risk factors for SGA, as a basis for identifying priority areas for developing and/or implementing interventions to reduce the incidence of SGA births and related mortality and morbidity. Methods We conducted a literature review on 63 potential risk factors for SGA to quantify the risk relationship and estimate the prevalence of risk factors (RFs). We calculated the population-attributable fraction for each of the identified RF for 81 Countdown countries and calculated regional estimates. Twenty-five RFs were included in the final model while extended model included all the 25 RFs from the final model and two additional RFs. Results In the final and extended models, the RFs included in each model have a total PAF equal to 63.97% and 69.66%, respectively of SGA across the 81 LMICs. In the extended model, maternal nutritional status has the greatest PAF (28.15%), followed by environmental and other exposures during pregnancy (15.82%), pregnancy history (11.01%), and general health issues or morbidity (10.34%). The RFs included in the final and extended model for Sub-Saharan African (SSA) region have a total PAF of 63.28% and 65.72% of SGA, respectively. In SSA, the top three RF categories in the extended model are nutrition (25.05%), environment and other exposure (13.01%), and general health issues or morbidity (10.72%), while in South-Asia's it was nutrition (30.56%), environment and other exposure (15.27%) and pregnancy history (11.68%). Conclusions The various types of RFs that play a role in SGA births highlight the importance of a multifaceted approach to tackle SGA. Depending on the types of RFs, intervention should be strategically targeted at either individual or household and/or community or policy level. There is also a need to research the mechanisms by which some of the RFs might hinder fetal growth.
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Affiliation(s)
- Sabi Gurung
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hannah Hanzi Tong
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily Bryce
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joanne Katz
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anne CC Lee
- Department of Pediatric Newborn Medicine, Global Advancement of Infants and Mothers (AIM), Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Neff Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Bortolotti D, Gentili V, Santi E, Taliento C, Vitagliano A, Schiuma G, Beltrami S, Rizzo S, Lanza G, Rizzo R, Gafà R, Greco P. Late-onset intrauterine growth restriction and HHV-6 infection: A pilot study. J Med Virol 2021; 93:6317-6322. [PMID: 34138476 DOI: 10.1002/jmv.27138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022]
Abstract
Late-onset Intrauterine growth restriction (IUGR) refers to impaired growth and development of the fetus, characterized by placental morphological abnormalities that affect the fetus's supply of nutrients. Human leukocyte antigen-G (HLA-G) is physiologically expressed during pregnancy, but decreased in normal placenta during the last weeks of gestation possibly inducing childbirth. Several viruses involved in congenital infection, such as herpesviruses, exploit HLA-G expression as an immune-escape mechanism. To date, despite different congenital herpetic infections having been associated with late IUGR, no direct implication of Human herpesvirus 6 (HHV-6) infection has been reported. We evaluated HLA-G expression and HHV-6 infection in 11 placentas from late-onset IUGR newborns and 11 placentas from uncomplicated pregnancies by histopathological and immunohistochemistry analysis. We found higher levels of HLA-G expression and HHV-6 presence in IUGR placenta samples compared with control placenta samples. We report HHV-6 staining in IUGR placenta samples, characterized by high HLA-G expression. These preliminary data suggest a possible involvement of HHV-6 infection in HLA-G deregulation that might affect vessel remodeling and prevent the correct pregnancy outcome in the IUGR condition.
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Affiliation(s)
- Daria Bortolotti
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Valentina Gentili
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Erica Santi
- Department of Medical Sciences,Obstetric and Gynecological Clinic, University of Ferrara, Ferrara, Italy
| | - Cristina Taliento
- Department of Medical Sciences,Obstetric and Gynecological Clinic, University of Ferrara, Ferrara, Italy
| | - Amerigo Vitagliano
- Department of Medical Sciences,Obstetric and Gynecological Clinic, University of Ferrara, Ferrara, Italy
| | - Giovanna Schiuma
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Silvia Beltrami
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Sabrina Rizzo
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Lanza
- Department of Translational and for Romagna Medicine, University of Ferrara, Ferrara, Italy
| | - Roberta Rizzo
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Roberta Gafà
- Department of Translational and for Romagna Medicine, University of Ferrara, Ferrara, Italy
| | - Pantaleo Greco
- Department of Medical Sciences,Obstetric and Gynecological Clinic, University of Ferrara, Ferrara, Italy
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Chamagne M, Beffara F, Patte C, Vigouroux C, Renevier B. [Management of fetal growth restriction in France: Survey of teaching hospitals and tertiary referral centers]. ACTA ACUST UNITED AC 2021; 49:756-762. [PMID: 33887529 DOI: 10.1016/j.gofs.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES French Guidelines on Fetal Growth Restriction (FGR) were published in December 2013. It seemed interesting to us to carry out an inventory on the management of FGR in teaching hospitals and tertiary referral centers MATERIAL AND METHODS: We carried out a retrospective survey on the academic year 2020/2021. All teaching hospitals and level III maternity in mainland France were contacted (67). The questionnaire focused on the growth curves used, the etiological assessment carried out, the rate and modalities of antenatal surveillance as well as the criteria indicating a birth. RESULTS The response rate was 76%. The CFEF curves are used for screening in 78.4% of centers and in the event of FGR in 39.2% of them. The etiological assessment includes a referent ultrasound in 62.7% of cases and amniocentesis is offered in 74.5% of hospitals in case of severe and early FGR. All centers use umbilical Doppler for FGR. The fetal heart rate is monitored between once a week to three times a day in the event of cerebro-placental redistribution. In case of reverse flow, birth is induced from 28 weeks on for some teams while others continue the pregnancy until 39 weeks. In case of cessation of fetal growth, the expected terms of birth are between 28 and 38 weeks. CONCLUSION There is great heterogeneity in the management of FGR, particularly in terms of antenatal surveillance and the term of birth envisaged.
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Affiliation(s)
- M Chamagne
- Service gynécologie-obstétrique, hôpital André Grégoire, 56, boulevard de la Boissière, 93100 Montreuil, France.
| | - F Beffara
- Service gynécologie-obstétrique, hôpital André Grégoire, 56, boulevard de la Boissière, 93100 Montreuil, France
| | - C Patte
- Service de gynécologie obstétrique, CHU de Nancy, 10, avenue du Dr Heydenreich, 54000 Nancy, France
| | - C Vigouroux
- Service gynécologie-obstétrique, hôpital André Grégoire, 56, boulevard de la Boissière, 93100 Montreuil, France
| | - B Renevier
- Service gynécologie-obstétrique, hôpital André Grégoire, 56, boulevard de la Boissière, 93100 Montreuil, France
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Utility of Neonatal Ophthalmologic Examination for Detection of Infectious Etiologies for Symmetric Intrauterine Growth Restriction. J Pediatr 2020; 226:240-242. [PMID: 32629012 DOI: 10.1016/j.jpeds.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the utility of ophthalmologic examination as part of evaluation for infection in infants with intrauterine growth restriction (IUGR). STUDY DESIGN This is a single-institution retrospective chart review of neonates diagnosed with symmetric IUGR or small for gestational age (SGA) who underwent complete ophthalmologic consultation to assess for intraocular findings suggestive of congenital infection. Data collected included other factors that may cause IUGR, findings of general and ophthalmologic examinations, and results of investigation for intrauterine infection. Cost minimization analysis was also performed. RESULTS One hundred neonates met the study's inclusion criteria (IUGR, n = 24; SGA, n = 45; IUGR and SGA, n = 31). The mean gestational age at birth was 34.6 ± 3.0 weeks, and the mean birth weight was 1691 ± 530 g; 74% had an identifiable risk factor for IUGR and 84 patients underwent investigation for intrauterine infection. Two of the 73 patients who had urine culture for cytomegalovirus (CMV) were positive (1 of whom had systemic signs of severe congenital infection without eye involvement, the other who had no clinical signs of congenital CMV); evaluations for infection were negative otherwise. No patients had any ophthalmologic signs of congenital infection. CONCLUSIONS Current literature suggests that routine evaluation of neonates with isolated IUGR for congenital infection may be low-yield and not cost-effective. Our study found that routine ophthalmologic evaluation in newborns with symmetric IUGR who have no systemic signs of intrauterine infection is of little value.
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Zaidi H, Lamalmi N, Malihi A, Barkat A, Alhamany Z. [Histopathological lesions of the placenta associated with severe intrauterine growth retardation: about a clinical case]. Pan Afr Med J 2019; 34:56. [PMID: 31762922 PMCID: PMC6859036 DOI: 10.11604/pamj.2019.34.56.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/28/2019] [Indexed: 11/21/2022] Open
Abstract
L'examen du placenta est indispensable dans le diagnostic du retard de croissance intra-utérin (RCIU). Son intérêt réside dans la recherche étiologique de cette pathologie, et les conséquences materno-fœtal qui peuvent en découler, ainsi dans la mise en place des stratégies préventive lors des grossesses ultérieures dans le cas des pathologies récidivantes. Nous rapportons les lésions anatomopathologiques possibles retrouvées au niveau du placenta de cette pathologie à travers une observation de RCIU sévère suivi au sein du Service de Néonatologie du CHU Ibn Sina de Rabat.
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Affiliation(s)
- Hanaa Zaidi
- Université Mohammed V, Faculté de Médecine et de Pharmacie, 10170, Rabat, Maroc.,Laboratoire d'Anatomie et de Cytologie Pathologique du Complexe Hôpital d'Enfant Maternité Souissi CHU Ibn Sina, 10170, Rabat, Maroc
| | - Najat Lamalmi
- Université Mohammed V, Faculté de Médecine et de Pharmacie, 10170, Rabat, Maroc.,Laboratoire d'Anatomie et de Cytologie Pathologique du Complexe Hôpital d'Enfant Maternité Souissi CHU Ibn Sina, 10170, Rabat, Maroc
| | - Abderahmane Malihi
- Laboratoire d'Anatomie et de Cytologie Pathologique du Complexe Hôpital d'Enfant Maternité Souissi CHU Ibn Sina, 10170, Rabat, Maroc
| | - Amina Barkat
- Université Mohammed V, Faculté de Médecine et de Pharmacie, 10170, Rabat, Maroc.,Service de Néonatologie P5, Hôpital d'Enfant CHU Ibn Sina, 10170, Rabat, Maroc
| | - Zaytouna Alhamany
- Université Mohammed V, Faculté de Médecine et de Pharmacie, 10170, Rabat, Maroc.,Laboratoire d'Anatomie et de Cytologie Pathologique du Complexe Hôpital d'Enfant Maternité Souissi CHU Ibn Sina, 10170, Rabat, Maroc
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Small for gestational age: Case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data. Vaccine 2018; 35:6518-6528. [PMID: 29150057 PMCID: PMC5710996 DOI: 10.1016/j.vaccine.2017.01.040] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/13/2017] [Indexed: 12/13/2022]
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Is abnormal vaginal microflora a risk factor for intrauterine fetal growth restriction? ASIAN PACIFIC JOURNAL OF REPRODUCTION 2015. [DOI: 10.1016/j.apjr.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Intra-uterine growth retardation (IUGR) is usually defined as impaired growth and development of the fetus and/or its organs during gestation. Infants are defined small for gestational age (SGA), following IUGR, when the birth weight is below the 10th percentile. Pre-natal congenital infections caused by T. gondii, rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), and Treponema are associated with, and account for, approximately 5 to 15% of IUGR. On the other hand, SGA preterm infants are at increased risk of post-natal infection compared to their age-matched appropriately grown controls, in particular nosocomial infection, irrespective of the responsible pathogen. One possible mechanism is the retarded development in the immune system which has been described in association with IUGR. Indeed, SGA infants have a disproportionately small thymus and low leukocyte, lymphocyte and macrophage counts. However, immune therapies, including prophylactic intravenous immunoglobulins and GM-CSF have not proven to be effective in reducing the incidence of sepsis, and further research is required.
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Salomon L, Malan V. Bilan étiologique du retard de croissance intra-utérin (RCIU). ACTA ACUST UNITED AC 2013; 42:929-40. [DOI: 10.1016/j.jgyn.2013.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Benoist G, Leruez-Ville M, Magny JF, Jacquemard F, Salomon LJ, Ville Y. Management of pregnancies with confirmed cytomegalovirus fetal infection. Fetal Diagn Ther 2013; 33:203-14. [PMID: 23571413 DOI: 10.1159/000342752] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/11/2012] [Indexed: 11/19/2022]
Abstract
Systematic screening for cytomegalovirus (CMV) maternal infection is not recommended in most countries. Nevertheless, primary CMV infection will occur in around 1% of women. The vertical transmission rate is estimated to be around 30-50%. Newborns with congenital CMV infection remain asymptomatic in the majority of cases and around 10% will present with a wide range of abnormalities. Fetal infection can be diagnosed by amniocentesis with amplification of the viral genome in the amniotic fluid by polymerase chain reaction. This prenatal diagnosis is mainly performed when ultrasound abnormalities are observed. The purpose of this mini-review is to describe the management options when a fetus is known to be infected.
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Affiliation(s)
- Guillaume Benoist
- Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
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