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Ali A, Islam J, Paul R, Parvin S, Mohammed Mohiuddin Chowdhury AT, Islam R, Siddique S, Rahman A, Tasnim ST, Hasna S. Geographic inequalities and determinants of anaemia among preeclamptic women: a cross-sectional sample-based study in Bangladesh. BMC Public Health 2024; 24:1650. [PMID: 38902634 PMCID: PMC11191240 DOI: 10.1186/s12889-024-18176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/21/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Anaemia among preeclamptic (PE) women is a major undefined health issue in Bangladesh. This study explored the risk factors associated with anaemia and mapped the regional influences to understand the geographical inequalities. METHODS Data from 180 respondents were prospectively collected from the Preeclampsia ward of Dhaka Medical College Hospital (DMCH), Bangladesh. Anaemia was defined as a blood haemoglobin level less than 11.0 g/dl. Preeclampsia was defined as systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) ≥ 90 mmHg with proteinuria. Factors associated with anaemia were explored using the chi-square test. Logistic regression (LR) was done to determine the level of association with the risk factors. RESULTS Among the participants, 28.9% were identified as having early onset and 71.1% reported late onset of PE. 38.9% of the subjects were non-anaemic, whereas mild, moderate, and severe anaemia was found among 38.3%, 17.8%, and 5% of patients respectively. The following factors were identified; including age range 25-34 (OR: 0.169, p < 0.05), a lower education level (OR: 3.106, p < 0.05), service-holder mothers (OR: 0.604, p < 0.05), pregnancy interval of less than 24 months (OR: 4.646, p < 0.05), and gestational diabetes mellitus (OR: 2.702, p < 0.05). Dhaka district (IR: 1.46), Narayanganj district (IR: 1.11), and Munshiganj district (IR: 0.96) had the highest incidence rates. CONCLUSION Determinants of anaemia must be considered with importance. In the future, periodic follow-ups of anaemia should be scheduled with a health care program and prevent maternal fatality and fetus morbidity in patients with PE.
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Affiliation(s)
- Ahasan Ali
- Department of Physiology and Pathophysiology, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Jahirul Islam
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia
| | - Ratna Paul
- Department of Gynecology and Obstetrics, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh
| | - Shahinur Parvin
- Department of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | | | - Rafiqul Islam
- Daffodil International University Dhaka, Dhaka, Bangladesh
| | - Sharmina Siddique
- Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Atiqur Rahman
- Plastic, Aesthetic and Maxillofacial surgery, Xian Jiaotong University, Xi'an, Shaanxi, P.R. China
| | | | - Suraiya Hasna
- Ad-din Women Medical College Hospital Dhaka, Dhaka, Bangladesh
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Deady C, McCarthy FP, Barron A, McCarthy CM, O’Keeffe GW, O’Mahony SM. An altered gut microbiome in pre-eclampsia: cause or consequence. Front Cell Infect Microbiol 2024; 14:1352267. [PMID: 38774629 PMCID: PMC11106424 DOI: 10.3389/fcimb.2024.1352267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Hypertensive disorders of pregnancy, including pre-eclampsia, are a leading cause of serious and debilitating complications that affect both the mother and the fetus. Despite the occurrence and the health implications of these disorders there is still relatively limited evidence on the molecular underpinnings of the pathophysiology. An area that has come to the fore with regard to its influence on health and disease is the microbiome. While there are several microbiome niches on and within the body, the distal end of the gut harbors the largest of these impacting on many different systems of the body including the central nervous system, the immune system, and the reproductive system. While the role of the microbiome in hypertensive disorders, including pre-eclampsia, has not been fully elucidated some studies have indicated that several of the symptoms of these disorders are linked to an altered gut microbiome. In this review, we examine both pre-eclampsia and microbiome literature to summarize the current knowledge on whether the microbiome drives the symptoms of pre-eclampsia or if the aberrant microbiome is a consequence of this condition. Despite the paucity of studies, obvious gut microbiome changes have been noted in women with pre-eclampsia and the individual symptoms associated with the condition. Yet further research is required to fully elucidate the role of the microbiome and the significance it plays in the development of the symptoms. Regardless of this, the literature highlights the potential for a microbiome targeted intervention such as dietary changes or prebiotic and probiotics to reduce the impact of some aspects of these disorders.
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Affiliation(s)
- Clara Deady
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Fergus P. McCarthy
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
- The Infant Research Centre, University College Cork, Cork, Ireland
| | - Aaron Barron
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Cathal M. McCarthy
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Gerard W. O’Keeffe
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Cork Neuroscience Centre, University College Cork, Cork, Ireland
| | - Siobhain M. O’Mahony
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
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Hahka TM, Slotkowski RA, Akbar A, VanOrmer MC, Sembajwe LF, Ssekandi AM, Namaganda A, Muwonge H, Kasolo JN, Nakimuli A, Mwesigwa N, Ishimwe JA, Kalyesubula R, Kirabo A, Anderson Berry AL, Patel KP. Hypertension Related Co-Morbidities and Complications in Women of Sub-Saharan Africa: A Brief Review. Circ Res 2024; 134:459-473. [PMID: 38359096 PMCID: PMC10885774 DOI: 10.1161/circresaha.123.324077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Hypertension is the leading cause of cardiovascular disease in women, and sub-Saharan African (SSA) countries have some of the highest rates of hypertension in the world. Expanding knowledge of causes, management, and awareness of hypertension and its co-morbidities worldwide is an effective strategy to mitigate its harms, decrease morbidities and mortality, and improve individual quality of life. Hypertensive disorders of pregnancy (HDPs) are a particularly important subset of hypertension, as pregnancy is a major stress test of the cardiovascular system and can be the first instance in which cardiovascular disease is clinically apparent. In SSA, women experience a higher incidence of HDP compared with other African regions. However, the region has yet to adopt treatment and preventative strategies for HDP. This delay stems from insufficient awareness, lack of clinical screening for hypertension, and lack of prevention programs. In this brief literature review, we will address the long-term consequences of hypertension and HDP in women. We evaluate the effects of uncontrolled hypertension in SSA by including research on heart disease, stroke, kidney disease, peripheral arterial disease, and HDP. Limitations exist in the number of studies from SSA; therefore, we will use data from countries across the globe, comparing and contrasting approaches in similar and dissimilar populations. Our review highlights an urgent need to prioritize public health, clinical, and bench research to discover cost-effective preventative and treatment strategies that will improve the lives of women living with hypertension in SSA.
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Affiliation(s)
- Taija M Hahka
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Rebecca A Slotkowski
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Anum Akbar
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Matt C VanOrmer
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Lawrence Fred Sembajwe
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdul M Ssekandi
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Namaganda
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Muwonge
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Josephine N Kasolo
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology (A. Nakimuli), Makerere University College of Health Sciences, Kampala, Uganda
| | - Naome Mwesigwa
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Jeanne A Ishimwe
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Robert Kalyesubula
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annet Kirabo
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Ann L Anderson Berry
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Kaushik P Patel
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
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Arafa A, Teramoto M, Kawachi H, Matsumoto C, Nosaka S, Matsuo M, Yasui Y, Kato Y, Kokubo Y. The association between antenatal coffee consumption and preeclampsia: a systematic review and meta-analysis. Environ Health Prev Med 2024; 29:49. [PMID: 39313394 DOI: 10.1265/ehpm.24-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND A growing body of evidence has documented unfavorable maternal outcomes attributed to excessive antenatal coffee consumption. Preeclampsia is one of the most common hypertensive disorders of pregnancy with several adverse maternal and neonatal outcomes. However, the association between antenatal coffee consumption and preeclampsia remains debatable. Herein, we performed a systematic review and meta-analysis of available evidence to investigate this association. METHODS After systematically reviewing PubMed and Scopus for eligible studies published until October 2023, we pooled the odds ratios (ORs) and their 95% confidence intervals (CIs) of preeclampsia for women who reported the highest versus the lowest frequencies of antenatal coffee consumption. We used the I2 statistic to measure heterogeneity across studies and the funnel plot asymmetry to assess publication bias. RESULTS This meta-analysis included seven retrospective studies (six case-control studies and one cross-sectional study) investigating 904 women with preeclampsia and 6,257 women without it. Combined, the highest frequencies of antenatal coffee consumption were associated with higher odds of preeclampsia: (pooled OR = 1.39, 95% CI: 1.03, 1.86), with a moderate heterogeneity across studies (I2 = 40.34% and p-value for heterogeneity = 0.122) and no publication bias (z = 0.610 and p-value for publication bias = 0.542). However, excluding the cross-sectional study, which contributed to 24.3% of the meta-analysis weight, left the association statistically non-significant: (pooled OR = 1.33, 95% CI: 0.91, 1.95; I2 = 44.59%). The association became even weaker after limiting the analysis to studies that excluded women with chronic hypertension: (pooled OR = 1.21, 95% CI: 0.77, 1.89; I2 = 41.64%) or after excluding studies with low quality: (pooled OR = 1.24, 95% CI: 0.70, 2.19; I2 = 65.79%). CONCLUSION The association between antenatal coffee consumption and preeclampsia remains inconclusive. Future prospective cohort studies are needed to better investigate this association.
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Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
- Department of Public Health, Faculty of Medicine, Beni-Suef University
| | - Masayuki Teramoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Haruna Kawachi
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
- Department of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University
| | - Chisa Matsumoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
- Department of Cardiology, Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital
| | - Saya Nosaka
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Miki Matsuo
- Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center
| | - Yuka Yasui
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
- Graduate School of Human Life and Science, Doshisha Women's College of Liberal Arts
| | - Yuka Kato
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
- School of Cardiovascular & Metabolic Health, University of Glasgow
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Esquivel MK. Nutritional Status and Nutrients Related to Pre-Eclampsia Risk. Am J Lifestyle Med 2023; 17:41-45. [PMID: 36636396 PMCID: PMC9830236 DOI: 10.1177/15598276221129841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Elevated blood pressure during pregnancy, pre-eclampsia, is in part a result of inflammatory processes related to pregnancy. Reducing risk for pre-eclampsia is important to improve birth outcomes and reduce morbidity and mortality. Nutritional status and dietary intake of key foods and nutrients can aid in the reduction of pre-eclampsia risk. Excessive gestational weight gain is associated with pre-eclampsia risk, however, fluid retention, may be the driver of this relationship. While diets rich in fruits, vegetables, and dietary fiber can reduce pre-eclampsia risk and adherence to a western diet pattern can increase risk. Other nutrients, which may improve hypertension, such as sodium or salt, have little to no effect on pre-eclampsia risk. Key nutrients impacting pre-eclampsia risk are described in this article.
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Affiliation(s)
- Monica Kazlausky Esquivel
- Department of Human Nutrition, Food and Animal Sciences,
College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, USA
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6
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Jikamo B, Adefris M, Azale T, Alemu K. The effect of preeclampsia on adverse maternal outcomes in Sidama region, Ethiopia: a prospective open cohort study. Sci Rep 2022; 12:19300. [PMID: 36369533 PMCID: PMC9652349 DOI: 10.1038/s41598-022-24034-7] [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: 06/23/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Ethiopia has made improvements in the reduction of maternal mortality; the high burden of preeclampsia remains a concern in the Sidama region. This study aimed to measure the effect of preeclampsia on adverse maternal outcomes and identify risk factors among women with preeclampsia in Sidama region. A prospective open cohort study was conducted from August 8, 2019, to October 1, 2020. We enrolled a total of 1015 the pregnant women who had preeclampsia and normotensive women at ≥ 20 weeks of gestation and followed them until 42 days after delivery. A log-binomial logistic regression model was used to estimate the incidence of adverse maternal outcomes and its risk factors. There were 276 adverse maternal outcomes observed in the preeclampsia group compared to 154 adverse maternal outcomes in the normotensive group (P < 0.001). Women with severe features of preeclampsia had a 43% (aRR = 1.43, 95% CI 1.3-1.58) higher risk for adverse maternal outcomes compared to women without severe features of preeclampsia. Women without severe features of preeclampsia had a 39% (aRR = 1.39, 95% CI 1.2-1.76) higher risk for adverse maternal outcomes compared to women in the normotensive group. More adverse maternal outcomes occurred among women with preeclampsia after controlling for confounders.
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Affiliation(s)
- Birhanu Jikamo
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia ,grid.192268.60000 0000 8953 2273Hawassa University College of Medicine and Health Sciences, Hawassa, Southern Nations Ethiopia
| | - Mulat Adefris
- grid.59547.3a0000 0000 8539 4635Department of Gynecology and Obstetrics Gondar University Hospital, School of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- grid.59547.3a0000 0000 8539 4635Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Chen B, Zhang M, He Y, Si Y, Shi Y, Jiang K, Shen J, Hong J, Ni S. The association between caffeine exposure during pregnancy and risk of gestational hypertension/preeclampsia: A meta-analysis and systematical review. J Obstet Gynaecol Res 2022; 48:3045-3055. [PMID: 36156331 PMCID: PMC10087308 DOI: 10.1111/jog.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/26/2022] [Accepted: 09/14/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The potential effect of caffeine exposure during pregnancy on gestational hypertension (GH)/preeclampsia has attracted attention but remains unclear. METHODS A systematic literature search of PubMed, Embase, and Cochrane Library databases was performed until March 2022. Observational studies assessing the association between caffeine exposure during pregnancy and the risk of GH/preeclampsia were included. The study protocol was registered in PROSPERO: CRD42022322387. RESULTS Ten studies involving 114 984 pregnant women (2548 diagnosed with GH and 2473 diagnosed with preeclampsia) were included. Comparing caffeine exposure with noncaffeine exposure, no significant association was found between caffeine exposure during pregnancy and the risk of GH (odds ratio [OR] = 0.99, 95% confidence interval [CI]: 0.90-1.08, p = 0.800) and preeclampsia (OR = 1.13, 95% CI: 0.97-1.31, p = 0.114). Subgroup analyses comparing low to moderate doses with no/lowest doses showed that caffeine exposure during pregnancy was not significant associated with GH (OR = 1.00, p = 0.987) or preeclampsia (OR = 1.03, p = 0.648). Besides, subgroup analyses comparing high doses with no/lowest doses showed that caffeine exposure during pregnancy was not significant associated with GH (OR = 1.06, p = 0.623) or preeclampsia (OR = 1.18, p = 0.192). CONCLUSION This study found that caffeine exposure during pregnancy was not significantly associated with the risk of GH/preeclampsia.
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Affiliation(s)
- Bangsheng Chen
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Mengting Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yuexiu Si
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yetan Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ke Jiang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jingyi Shen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiaze Hong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Saisai Ni
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
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Perry A, Stephanou A, Rayman MP. Dietary factors that affect the risk of pre-eclampsia. BMJ Nutr Prev Health 2022; 5:118-133. [PMID: 35814725 PMCID: PMC9237898 DOI: 10.1136/bmjnph-2021-000399] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/03/2022] [Indexed: 12/18/2022] Open
Abstract
Pre-eclampsia affects 3%-5% of pregnant women worldwide and is associated with a range of adverse maternal and fetal outcomes, including maternal and/or fetal death. It particularly affects those with chronic hypertension, pregestational diabetes mellitus or a family history of pre-eclampsia. Other than early delivery of the fetus, there is no cure for pre-eclampsia. Since diet or dietary supplements may affect the risk, we have carried out an up-to-date, narrative literature review to assess the relationship between nutrition and pre-eclampsia. Several nutrients and dietary factors previously believed to be implicated in the risk of pre-eclampsia have now been shown to have no effect on risk; these include vitamins C and E, magnesium, salt, ω-3 long-chain polyunsaturated fatty acids (fish oils) and zinc. Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain. The association between the risk and progression of the pathophysiology of pre-eclampsia may explain the apparent benefit of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25-30 g/day) may attenuate dyslipidaemia and reduce blood pressure and inflammation. Other key nutrients that may mitigate the risk include increased calcium intake, a daily multivitamin/mineral supplement and an adequate vitamin D status. For those with a low selenium intake (such as those living in Europe), fish/seafood intake could be increased to improve selenium intake or selenium could be supplemented in the recommended multivitamin/mineral supplement. Milk-based probiotics have also been found to be beneficial in pregnant women at risk. Our recommendations are summarised in a table of guidance for women at particular risk of developing pre-eclampsia.
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Affiliation(s)
- Abigail Perry
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Anna Stephanou
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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9
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The Prevalence of Alcohol Consumption Among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis. Matern Child Health J 2022; 26:1800-1810. [PMID: 34978020 DOI: 10.1007/s10995-021-03286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Evidence indicates that a significant proportion of women drink alcohol during pregnancy. Studies have also suggested that prenatal alcohol consumption was associated with a wide range of adverse outcomes. To the best of our knowledge, this is the first systematic review and meta-analysis aimed to systematically summarize the available evidence on the epidemiology of alcohol consumption among pregnant women in Ethiopia and suggest evidence based recommendations for future clinical practice. METHODS This systematic review and meta-analysis was followed the PRISMA guidelines. PubMed, SCOPUS and EMBASE databases were searched to identify relevant articles that assessed alcohol consumption among pregnant women in Ethiopia. The Comprehensive Meta-Analysis software version 3.0 was used to conduct a meta-analysis using the random-effect model. Cochran's Q- and I2-tests were used to assess the heterogeneity of the included studies. RESULTS A total of 6361 pregnant women from fifteen primary studies were included in the final analysis. The pooled prevalence estimate of alcohol consumption among pregnant women in Ethiopia was found to be 14.1%. The pooled prevalence of alcohol consumption among pregnant women in Ethiopia was reported to be lower in the studies that used the standardized alcohol consumption assessment tools (9.4%) when compared to the studies that did not use standardized tools (17%). The pooled prevalence of alcohol consumption among pregnant women ranged between 12.8% and 15.5% in leave-one-out sensitivity analysis. CONCLUSION A considerable number of women in Ethiopia consume alcohol during pregnancy. Therefore, early identification and intervention strategies are highly recommended.
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Kinshella MLW, Omar S, Scherbinsky K, Vidler M, Magee LA, von Dadelszen P, Moore SE, Elango R. Maternal Dietary Patterns and Pregnancy Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. Adv Nutr 2021; 12:2387-2400. [PMID: 34019634 PMCID: PMC8634459 DOI: 10.1093/advances/nmab057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Healthy maternal diets can lower the odds of developing pre-eclampsia, a direct and second leading cause of maternal death, globally. However, there is a research gap in low- and middle-income countries (LMIC), which bear a disproportionate burden of these deaths. The objectives of this systematic review were to: 1) evaluate the association between dietary patterns in pregnancy and hypertensive disorders, including pre-eclampsia for pregnant and postpartum women in LMIC, and 2) compile barriers and facilitators to an adequate maternal diet. A systematic search was performed on MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health, Web of Science, Cochrane Central Register of Controlled Trials, African Journals Online, the WHO Regional Databases, 2 trial registries, Google Scholar, and reference lists. Included in the analysis were primary research studies of dietary patterns during pregnancy, with pregnancy hypertension outcome(s), and conducted in LMIC. Included studies were assessed using ROBINS-I risk of bias. Thirteen studies were included, of which 5 studies were included in a meta-analysis (Review Manager 5). Lower odds of pre-eclampsia were associated with adequate (compared with no or low) consumption of vegetables (OR: 0.38; 95% CI: 0.18, 0.80; I2 = 85%; P = 0.01) and adequate (compared with no or low) consumption of fruit (OR: 0.42; 95% CI: 0.24, 0.71; I2 = 79%; P = 0.008). No firm conclusions could be drawn about the impact on pre-eclampsia odds of any of the following during pregnancy: high consumption of meat or grains; a "Western" diet; or alcohol consumption. More LMIC-based research is needed to explore whether the apparent beneficial effects of fruits and vegetables on pre-eclampsia incidence might be enhanced when maternal malnutrition is prevalent, and/or whether other sociodemographic factors might contribute.
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Affiliation(s)
- Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Shazmeen Omar
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerri Scherbinsky
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Department of Women & Children's Health, King's College London, London, United Kingdom
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Department of Women & Children's Health, King's College London, London, United Kingdom
| | - Sophie E Moore
- Department of Women & Children's Health, King's College London, London, United Kingdom
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Rajavel Elango
- Department of Pediatrics, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Model for Early Prediction of Preeclampsia: A Nested Case Controlled Study in Indian Women. J Obstet Gynaecol India 2021; 72:299-306. [PMID: 35923506 PMCID: PMC9339447 DOI: 10.1007/s13224-021-01511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/01/2021] [Indexed: 10/21/2022] Open
Abstract
Purpose Preeclampsia (PE) affects 5-7% of the pregnancies worldwide, and is one of the most dreaded disorders of pregnancy contributing to maternal and neonatal mortality. PE is mostly presented in the third trimester of pregnancy. Here, we used serum placental growth factor (PIGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) to develop a model for predicting PE in Indian women in early second trimester. Methods In this case-control study, a total 1452 healthy pregnant women were recruited. Blood samples were collected at the following gestational weeks (GWs), 12-20 (GW1), 21-28 (GW2) and 29-term (GW3), and post-delivery. Body mass index (BMI) was calculated by anthropometric measurements. Serum sFlt-1, PIGF and VEGF were analyzed by ELISA. A predictive model for PE was developed using multivariable logistic regression analysis. Results In PE cases, serum PlGF and VEGF levels were significantly lower at each GW, while serum sFlt-1 was lower only at GW1, relative to age-matched controls, (n = 132/group). Age-matched comparison between PE cases and controls indicated that sFlt-1 was associated with decreased PE outcome (Odds ratio. OR = 0.988, CI = 0.982-0.993), whereas sFlt-1/PlGF ratio (OR = 1.577, CI = 1.344-1.920) and BMI (OR = 1.334, CI = 1.187-1.520) were associated with increased PE outcome. Logistic regression was used to develop a predictive model for PE at GW1. Using testing dataset, model was externally validated which resulted in 88% accuracy in predicting PE cases at 0.5 probability cutoff. Conclusion Prediction model using sFlt-1, sFlt-1/PlGF ratio and BMI may be useful to predict PE as early as 12-20 weeks in women with optimal sensitivity and specificity.
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Stitterich N, Shepherd J, Koroma MM, Theuring S. Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study. BMC Pregnancy Childbirth 2021; 21:413. [PMID: 34078312 PMCID: PMC8173903 DOI: 10.1186/s12884-021-03874-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the African region, 5.6% of pregnancies are estimated to be complicated by preeclampsia and 2.9% by eclampsia, with almost one in ten maternal deaths being associated with hypertensive disorders. In Sierra Leone, representing one of the countries with the highest maternal mortality rates in the world, 16% of maternal deaths were caused by pregnancy-induced hypertension in 2016. In the light of the high burden of preeclampsia and eclampsia (PrE/E) in Sierra Leone, we aimed at assessing population-based risk factors for PrE/E to offer improved management for women at risk. METHODS A facility-based, unmatched observational case-control study was conducted in Princess Christian Maternity Hospital (PCMH). PCMH is situated in Freetown and is the only health care facility providing 'Comprehensive Emergency Obstetric and Neonatal Care services' throughout the entire country. Cases were defined as pregnant or postpartum women diagnosed with PrE/E, and controls as normotensive postpartum women. Data collection was performed with a questionnaire assessing a wide spectrum of factors influencing pregnant women's health. Statistical analysis was performed by estimating a binary logistic regression model. RESULTS We analyzed data of 672 women, 214 cases and 458 controls. The analysis yielded several independent predictors for PrE/E, including family predisposition for PrE/E (AOR = 2.72, 95% CI: 1.46-5.07), preexisting hypertension (AOR = 3.64, 95% CI: 1.32-10.06), a high mid-upper arm circumflex (AOR = 3.09, 95% CI: 1.83-5.22), presence of urinary tract infection during pregnancy (AOR = 2.02, 95% CI: 1.28-3.19), presence of prolonged diarrhoea during pregnancy (AOR = 2.81, 95% CI: 1.63-4.86), low maternal assets (AOR = 2.56, 95% CI: 1.63-4.02), inadequate fruit intake (AOR = 2.58, 95% CI: 1.64-4.06), well or borehole water as the main source of drinking water (AOR = 2.05, 95% CI: 1.31-3.23) and living close to a waste deposit (AOR = 1.94, 95% CI: 1.15-3.25). CONCLUSION Our findings suggest that systematic assessment of identified PrE/E risk factors, including a family predisposition for PrE/E, preexisting hypertension, or obesity, should be performed early on in ANC, followed by continued close monitoring of first signs and symptoms of PrE/E. Additionally, counseling on nutrition, exercise, and water safety is needed throughout pregnancy as well as education on improved hygiene behavior. Further research on sources of environmental pollution in Freetown is urgently required.
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Affiliation(s)
- N Stitterich
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - J Shepherd
- National School of Midwifery, Freetown, Sierra Leone
| | - M M Koroma
- Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - S Theuring
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
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Determinants of Preeclampsia among Women Attending Delivery Services in Public Hospitals of Central Tigray, Northern Ethiopia: A Case-Control Study. J Pregnancy 2021; 2021:4654828. [PMID: 34123429 PMCID: PMC8189820 DOI: 10.1155/2021/4654828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Preeclampsia occurs in up to 5% of all pregnancies, in 10% of first pregnancies, and 20-25% of women with a history of chronic hypertension. Objective This study aims to assess the determinants of preeclampsia among women attending delivery services in public hospitals of central Tigray, Ethiopia. Methods Hospital-based unmatched case-control study design was conducted. Women diagnosed with preeclampsia were cases, and women who had no preeclampsia were controls admitted to the same hospitals. A systematic sampling technique was used to select study participants for both cases and controls. The data were entered in EPI data 3.1 statistical software and, then, exported to SPSS Version 22 for cleaning and analysis. Results Family history of hypertension (AOR: 2.60; 95% CI: 1.15, 5.92), family history of preeclampsia (AOR: 5.24; 95% CI: 1.85, 14.80), history of diabetes mellitus (AOR: 4.31; 95% CI: 1.66, 11.21), anemia (AOR: 3.23; 95% CI: 1.18, 8.86), history of preeclampsia on prior pregnancy (AOR: 5.55; 95% CI: 1.80, 17.10), primigravida (AOR: 5.41; 95% CI: 2.85, 10.29), drinking alcohol during pregnancy (AOR: 4.06; 95% CI: 2.20, 7.52), and vegetable intake during pregnancy (AOR: 0.39; 95% CI: 0.21, 0.74) were significantly associated with preeclampsia. Conclusion This study concludes that a family history of hypertension and preeclampsia; a history of diabetes mellitus and anemia; and a history of preeclampsia on prior pregnancy, primigravida, and drinking alcohol were found to be risk factors for preeclampsia. However, vegetable intake was found to be a protective factor for the development of preeclampsia.
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Ngwenya S, Jones B, Mwembe D, Nare H, Heazell AE. Development and validation of risk prediction models for adverse maternal and neonatal outcomes in severe preeclampsia in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe. Pregnancy Hypertens 2021; 23:18-26. [DOI: 10.1016/j.preghy.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
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Tesfa E, Nibret E, Gizaw ST, Zenebe Y, Mekonnen Z, Assefa S, Melese M, Fentahun N, Munshea A. Prevalence and determinants of hypertensive disorders of pregnancy in Ethiopia: A systematic review and meta-analysis. PLoS One 2020; 15:e0239048. [PMID: 32936834 PMCID: PMC7494091 DOI: 10.1371/journal.pone.0239048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/30/2020] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Hypertensive disorder of pregnancy is the second commonest causes of maternal death globally. Different public health studies were conducted on hypertensive disorder of pregnancy which presented inconsistent result. Therefore, this systematic review and meta-analysis was commenced to summarize the findings conducted in several parts of the country and to generate the nationwide representative data on the prevalence and risk factors of hypertensive disorder of pregnancy in Ethiopia. METHODS AND MATERIALS Electronic databases such as PubMed, Scopus, Google Scholar, Hinari, and African Journals Online were searched for studies published in English up to March, 2020. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and Newcastle-Ottawa Scale were used for data extraction and quality assessment of the included studies. The meta- regression analysis was computed at 95% CI to present the pooled prevalence and risk factors of hypertensive disorder of pregnancy. RESULTS Thirty four studies were included in this systematic review and meta-analysis. The pooled prevalence of hypertensive disorder of pregnancy and preeclampsia in Ethiopia were 6.82% (95% CI (5.90, 7.74)) and 4.74% (95% CI (3.99, 5.49)) respectively. Maternal age ≥35 years (Adjusted Odds Ratio (AOR): 2.91 (95% CI: 1.60, 5.26)), twin pregnancy (AOR: 3.04 (95% CI: 1.89, 4.87)), previous history of preeclampsia (AOR: 5.36 (95% CI: 3.37, 8.53)), family history of hypertension (AOR: 4.01 (95% CI: 2.65, 6.07)), family history of diabetes mellitus (AOR: 3.07 (95% CI: 1.66, 7.70)), body mass index ≥25 (AOR: 3.92 (95% CI: 1.82, 8.42)), alcohol consumption (AOR: 1.77 (95% CI: 1.11, 2.83)), urinary tract infection (AOR: 4.57 (95% CI: 3.47, 6.02)), lack of nutritional counseling during antenatal period (AOR: 4.87 (95% CI: 3.36, 7.06)), lack of fruits (AOR: 3.49 (95% CI: 2.29, 5.30)), and vegetables consumption (AOR: 2.94 (95% CI: 2.01, 4.31)) were the risk factors of hypertensive disorder of pregnancy in Ethiopia. CONCLUSIONS The pooled prevalence of hypertensive disorder of pregnancy is relatively higher compared with the previous reports. Maternal age ≥35 years, twin pregnancy, previous history of preeclampsia, family history of hypertension, family history of diabetes mellitus, body mass index ≥25, alcohol consumption, urinary tract infection, lack of fruits and vegetables during pregnancy were risk factors of hypertensive disorder of pregnancy. The governments and stakeholders should work to strengthen the antenatal care practice to include the possible risk factors of hypertensive disorders of pregnancy.
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Affiliation(s)
- Endalamaw Tesfa
- Department of Biochemistry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalkachew Nibret
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Solomon Tebeje Gizaw
- Department of Biochemistry, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Zenebe
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zewdie Mekonnen
- Department of Biochemistry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Biochemistry, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sefealem Assefa
- Department of Biochemistry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulatu Melese
- Amhara Public Health Institute (APHI), Bahir Dar, Ethiopia
| | - Netsanet Fentahun
- Department of Nutrition and Dietetics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abaineh Munshea
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
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Systematic and meta-analysis of factors associated with preeclampsia and eclampsia in sub-Saharan Africa. PLoS One 2020; 15:e0237600. [PMID: 32813750 PMCID: PMC7437916 DOI: 10.1371/journal.pone.0237600] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/29/2020] [Indexed: 01/24/2023] Open
Abstract
Background Preeclampsia and eclampsia are common complications of pregnancy globally, including sub-Saharan African (SSA) countries. Although it has a high burden on maternal and neonatal mortality and morbidity, evidence on the risk of the problem is limited. Therefore, the aim of this review was to examine the factors associated with preeclampsia and eclampsia among mothers in SSA countries. Methods We searched article from SSA countries using electronic database MEDLINE, EMBASE, PubMed, CINAHL published in English from January 2000 to May 2020. Two reviewers independently screened, extracted and assessed the quality of the articles. Both random and fixed effect model were used for analysis. Heterogeneity of the studies and publication bias were checked. STATA 16 used for analysis. Results Fifty-one studies met the inclusion criteria and included in this review. The following factors were identified through meta-analysis: being primiparous (OR: 2.52; 95% CI:1.19, 3.86), previous history of maternal preeclampsia/eclampsia (OR:5.6; 95% CI:1.82, 9.28), family history of preeclampsia/eclampsia (OR:1.68; 95% CI:1.26, 2.11), high maternal body mass index (OR: 1.69; 95% CI:1.17, 2.21), chronic hypertension (OR: 2.52; 95% CI:1.29, 3.74), anaemia during pregnancy (OR: 3.22; 95% CI:2.70, 3.75) and lack of antenatal care visits (OR: 2.71; 95% CI:1.45, 3.96). There was inconclusive evidence for a relationship with a number of other factors, such as nutrition and related factors, antenatal care visits, birth spacing, and other factors due to few studies found in our review. Conclusions The risk of preeclampsia and eclampsia is worse among women who have a history of preeclampsia/eclampsia (either themselves or family members), primiparous, obesity and overweight, living with chronic disease, having anaemia during pregnancy and absence from ANC visits. Therefore, investment must be made in women’s health needs to reduce the problem and health service providers need to give due attention to high-risk women.
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Wang P, Yamabe N, Hong CJ, Bai HW, Zhu BT. Caffeic acid phenethyl ester, a coffee polyphenol, inhibits DNA methylation in vitro and in vivo. Eur J Pharmacol 2020; 887:173464. [PMID: 32781171 DOI: 10.1016/j.ejphar.2020.173464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022]
Abstract
DNA methylation represents an important epigenetic regulation of the genome. Earlier studies have suggested that dietary phenolic compounds including those contained in coffee, tea and soy products may modulate the level of DNA methylation. In this study, we first characterize the effect of caffeic acid phenethyl ester (CAPE) and other dietary phenolic compounds on DNA methylation in vitro. The IC50 values of CAPE, daidzein, isorhamnetin and genistein are 7.6, 6.9, 6.2, and 4.3 μM, respectively, in an in-vitro enzymatic assay system. Computational analysis indicates that CAPE, daidzein, isorhamnetin and genistein can bind inside the DNA substrate-binding site in human DNMT1 with a favorable binding energy. In an animal study, we find that maternal CAPE treatment shifts the coat color distribution of the 21-day-old Avy/a offspring towards the yellow phenotype, indicating that CAPE inhibits the methylation of the agouti gene promoter sequence in vivo. The results from this study may shed light on the potential epigenetic effect in the offspring resulting from maternal intake of certain coffee phenolics during pregnancy.
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Affiliation(s)
- Pan Wang
- Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Life and Health Sciences, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, China.
| | - Noriko Yamabe
- College of Korean Medicine, Gachon University, Seongnam, 13120, Republic of Korea
| | - Can-Jian Hong
- Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Life and Health Sciences, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, China
| | - Hyoung-Woo Bai
- Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup-si, Jeollabuk-do, 580-185, Republic of Korea
| | - Bao Ting Zhu
- Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Life and Health Sciences, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, China; Department of Pharmacology, Toxicology and Therapeutics, School of Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
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Prasetya PAC, Winardi B, Nuswantoro D. Anemia in the first trimester is associated with anemia during pregnancy in Sidotopo Wetan Community Health Center, Surabaya. MAJALAH OBSTETRI & GINEKOLOGI 2020. [DOI: 10.20473/mog.v28i12020.16-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To analyze association between anemia in the first trimester and preeclampsia during pregnancy in Sidotopo Wetan Community Health Center Surabaya.Materials and Methods: This study was a analytic case control study. The samples were 49 women with preeclampsia as case group and 49 women non-preeclampsia as control group. The data were secondary data collected from medical record of pregnancy women on Sidotopo Wetan Community Health Center Surabaya from January 2016 – Desember 2017. The analysis was done by Chi Square Statistics.Results: 79,6% women in preeclampsia group and 93.9% women in non-preeclampsia group was not anemia in the first trimester. There is association between anemia in the first trimester and preeclampsia during pregnancy in Sidotopo Wetan Community Health Center Surabaya (p = 0.037; OR = 3.932 (CI 95% = 1.010 – 15.303)).Conclusion: There is association between anemia in the first trimester and preeclampsia during preg-nancy in Sidotopo Wetan Community Health Center Surabaya.
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Addila AE, Bisetegn TA, Gete YK, Mengistu MY, Beyene GM. Alcohol consumption and its associated factors among pregnant women in Sub-Saharan Africa: a systematic review and meta-analysis' as given in the submission system. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:29. [PMID: 32293479 PMCID: PMC7158038 DOI: 10.1186/s13011-020-00269-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/23/2020] [Indexed: 12/14/2022]
Abstract
Background Alcohol consumption during pregnancy represents a significant public health concern. It has several adverse health effects for both the mother and the developing fetus. This study aimed to estimate the pooled prevalence and the effect size of associated factors of alcohol consumption during pregnancy in Sub-Saharan Africa countries. Methods The results of the review were reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA) guideline and, it was registered in the Prospero database, number CRD42019127103. The available primary studies were collated from different databases: PubMed, CINAHL, Cochrane Library, PsycINFO, Google Scholar, African Journals Online and Centre for Addiction and Mental Health Library. The main search terms were [((alcohol consumption) OR (alcohol drinking) OR (alcohol use) OR (ethanol use) OR (alcohol exposure)) AND ((pregnant women) OR (pregnant mother) OR (during pregnancy)) AND (Sub-Saharan Africa)]. We used the Joanna Briggs Institute (JBI) for critical appraisal of studies. The random-effects model was computed to estimate the pooled prevalence. Heterogeneity between studies was checked using the I2 statistic and the Cochrane Q test. Results The review resulted in 963 original studies after searching various databases, and finally 37 studies in qualitative synthesis and 30 articles in the systematic review and meta-analysis were included. The overall summary estimate of the prevalence of alcohol consumption during pregnancy was found to be 20.83% (95% CI: 18.21, 23.46). The pooled estimate of meta-analysis showed that depression (OR: 1.572; 95% CI: 1.34, 1.845), partners’ alcohol use (OR: 1.32, 95% CI: 1.11, 1.57), knowledge on harmful effect of alcohol consumption (OR: 0.36, 95% CI: 0.29, 0.45) and, unplanned pregnancy (OR: 2.33, 95% CI: 1.17, 4.63) were statistically significant factors with alcohol consumption during pregnancy. Conclusions The result showed that there was high alcohol consumption during pregnancy in Sub- Saharan Africa. Alcohol consumption during pregnancy was associated with depression, partners’ alcohol use, unplanned pregnancy and knowledge of the harmful effects of alcohol consumption. Therefore, this will be a basis for public policy and resource allocation for prevention initiatives.
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Affiliation(s)
- Alemu Earsido Addila
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia. .,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Telake Azale Bisetegn
- Department of Health Promotion and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal Mengistu
- Department of Health Systems and Policy, Institute of Public Health, College of medicine and health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getnet Mihretie Beyene
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Department of Psychiatry, College of Medicine and Health sciences, Debre Tabor University, Debra Tabor, Ethiopia
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Mekie M, Mekonnen W, Assegid M. Cohabitation duration, obstetric, behavioral and nutritional factors predict preeclampsia among nulliparous women in West Amhara Zones of Ethiopia: Age matched case control study. PLoS One 2020; 15:e0228127. [PMID: 31986179 PMCID: PMC6984729 DOI: 10.1371/journal.pone.0228127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Preeclampsia is a major cause of maternal and perinatal mortality in developing countries. Identifying its risk factors is essential for early diagnosis and management. However, there has been a paucity of information on predictors of preeclampsia among nulliparous women in a resource limited setting. This study bridges the gap in this regard by examining the association of cohabitation duration, obstetric, behavioral and nutrition factors with preeclampsia among nulliparous women in West Amhara Zones of Ethiopia. METHODS Age matched case-control study design was employed among 110 preeclamptic and 220 non-preeclamptic women who came for delivery services at Felege Hiwot, Addis Alem, and Debre Tabor hospitals. Double population proportion formula with an assumption of 95% confidence interval, 80% power and a 2:1 control to case ratio was used to calculate sample size. Epi data 3.1 and SPSS 20 were used for data entry and analysis, respectively. Magnitudes of cohabitation duration, obstetric, behavioral and nutritional factors among nulliparous women with preeclampsia and their controls were calculated and the differences were tested with a Chi-square test. Conditional bivariable and multivariable logistic regression analysis were fitted to identify predictors of preeclampsia. Odds ratio along with their 95% confidence interval were used to identify the strength, direction and significance of association. Ethical clearance was secured from the research ethics committee of the School of Public Health in Addis Ababa University. RESULTS A total of 107 cases and 214 controls completed the interview giving a response rate of 97.27% for both cases and controls. Short cohabitation duration (AOR = 2.13, 95% CI (1.10, 4.1)), unplanned pregnancy (AOR = 2.35, 95% CI (1.01, 5.52)), and high body weight (AOR = 2.00, 95% CI (1.10, 3.63)) were found to be significant risk factors for preeclampsia. Whereas, antenatal advice about nutrition (AOR = 0.52, 95% CI (0.29, 0.96)), vegetable intake (AOR = 0.42, 95% CI (0.22, 0.82)) and fruit intake during pregnancy (AOR = 0.45, 95% CI (0.24, 0.87)) were protective factors for preeclampsia. CONCLUSION Special attention should be given to nulliparous women with short cohabitation duration, unplanned pregnancy, and high body weight to minimize the effect of preeclampsia. Nutritional counseling shall be stressed during antenatal care follow ups.
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Affiliation(s)
- Maru Mekie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubegzier Mekonnen
- School of Public health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meselech Assegid
- School of Public health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Vegetable dietary pattern associated with low risk of preeclampsia possibly through reducing proteinuria. Pregnancy Hypertens 2019; 16:131-138. [PMID: 31056148 DOI: 10.1016/j.preghy.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/17/2019] [Accepted: 04/06/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence on the potential roles that dietary patterns play in the risk of preeclampsia remains limited. OBJECTIVE To examine the associations between dietary patterns during pregnancy and the risk of preeclampsia. STUDY DESIGN We analyzed data from a cluster randomized controlled trial among 987 healthy pregnant women in three rural counties in northwestern China. Maternal diet during the whole pregnancy was assessed using a 107-item food frequency questionnaire with proportion size administered before delivery. Principal component factor analysis with varimax rotation was used to identify common dietary patterns. Preeclampsia was diagnosed by trained clinicians and recorded in delivery records. RESULTS Nineteen participants (1.9%) were diagnosed with preeclampsia. Gestational hypertension and proteinuria were only weakly correlated with each other (Kappa = 0.06): 10.7% participants with gestational hypertension only, 8.8% with proteinuria only, 1.9% with both, and 78.6% with neither. Five common dietary patterns were identified: vegetable, meat, fruit, snack, and wheat staple patterns. After adjusting for calories, other dietary pattern scores and baseline blood pressure, a higher vegetable pattern scores was associated with lower risk of preeclampsia (P for trend = 0.041; the highest vs lowest quartile, adjusted relative risk = 0.20 [95% confidence interval, 0.04-0.98]). A similar association was also observed for the risk of proteinuria (P for trend = 0.015): the highest vs lowest quartiles of the vegetable pattern score, adjusted relative risk = 0.44 (95% confidence interval, 0.24-0.80). The other four pattern scores were not associated with preeclampsia. CONCLUSIONS Adherence to vegetable dietary pattern may be associated with the lower risk of preeclampsia, possibly through reducing development of proteinuria. The original full study was registered at clinicaltrials.gov as NCT02537392.
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Ikem E, Halldorsson TI, Birgisdóttir BE, Rasmussen MA, Olsen SF, Maslova E. Dietary patterns and the risk of pregnancy-associated hypertension in the Danish National Birth Cohort: a prospective longitudinal study. BJOG 2019; 126:663-673. [PMID: 30675768 DOI: 10.1111/1471-0528.15593] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the association between mid-pregnancy dietary patterns and pregnancy-associated hypertension (PAH). DESIGN A prospective longitudinal cohort study. SETTING Denmark. POPULATION About 55 139 Danish women with single enrolments and recorded food frequency questionnaire dates with complete information on dietary intake. METHODS Women were eligible if they could speak Danish and were planning to carry to term. Diet was assessed using a validated semi-quantitative 360-item food frequency questionnaire and dietary patterns were derived using factor analysis. MAIN OUTCOME MEASURES Gestational hypertension (GH) and pre-eclampsia (PE). RESULTS Disease prevalence was 14% for GH (5491/39 362); 2% for PE (1168/54 778), and 0.4% for severe PE (234/55 086). Seven dietary patterns were characterised in the population, of which two were associated with PAH. The Seafood diet characterised by high consumption of fish and vegetables was inversely associated with the odds of developing GH [odds ratio (OR) 0.86; 95% CI 0.77-0.95)] and PE (OR 0.79; 95% CI 0.65-0.97). The Western diet characterised by high consumption of potatoes (including French fries), mixed meat, margarine and white bread increased the odds of developing GH (OR 1.18; 95% CI 1.05-1.33) and PE (OR 1.40; 95% CI 1.11-1.76). No association was seen with severe PE. CONCLUSIONS We found protective associations of Seafood diet and harmful associations of Western diet with PAH. Dietary interventions encouraging the reduction of Western diet may contribute to a decrease of PAH. TWEETABLE ABSTRACT Western diet increases (Seafood diet decreases) the likelihood of developing pre-eclampsia among Danish pregnant women.
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Affiliation(s)
- E Ikem
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK.,Department of Primary Care and Public Health, Imperial College, London, UK
| | - T I Halldorsson
- Department of Epidemiology Research, Centre for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark.,Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - B E Birgisdóttir
- Department of Epidemiology Research, Centre for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark
| | - M A Rasmussen
- Department of Epidemiology Research, Centre for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark.,Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Paediatric Asthma Centre, Gentofte Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - S F Olsen
- Department of Epidemiology Research, Centre for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark.,Department of Nutrition, Harvard Chan School of Public Health, Boston, MA, USA
| | - E Maslova
- Department of Primary Care and Public Health, Imperial College, London, UK.,Department of Epidemiology Research, Centre for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark.,Danish Diabetes Academy, Odense, Denmark
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Abdillahi HA, Hassan KA, Kiruja J, Osman F, Egal JA, Klingberg-Allvin M, Erlandsson K. A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland. Int J Gynaecol Obstet 2017; 138:119-124. [PMID: 28391614 DOI: 10.1002/ijgo.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/04/2017] [Accepted: 04/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent. METHODS A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015). RESULTS Of the 138 maternal near misses and deaths recorded, 50 (36%) were associated with emergency cesarean delivery. The most frequent maternal complication was severe pre-eclampsia (n=17; 34%), and the most frequent underlying causes were hypertensive disorders (n=31; 62%) and obstetric hemorrhage (n=15; 30%). Healthcare providers were often prevented from performing emergency cesarean delivery until the required consent had been received from the woman's extended family. CONCLUSION Maternity care in Somaliland must be improved, and the issue of legal authority for consent examined, to ensure both safe and timely provision of emergency cesarean delivery.
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Affiliation(s)
- Hamda A Abdillahi
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Hargeisa, Somaliland
| | - Khadra A Hassan
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Hargeisa, Somaliland
| | - Jonah Kiruja
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Hargeisa, Somaliland
| | - Fatumo Osman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Jama A Egal
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Hargeisa, Somaliland
| | | | - Kerstin Erlandsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Endeshaw M, Abebe F, Worku S, Menber L, Assress M, Assefa M. Obesity in young age is a risk factor for preeclampsia: a facility based case-control study, northwest Ethiopia. BMC Pregnancy Childbirth 2016; 16:237. [PMID: 27543276 PMCID: PMC4992278 DOI: 10.1186/s12884-016-1029-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 08/15/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Preeclampsia is one of the most commonly encountered hypertensive disorders of pregnancy. For many years, obesity has been suggested to play a role in preeclampsia. However, the hypotheses have been diverse and often revealed inconsistent results. This study has aimed to estimate the effect of obesity and dietary habits on preeclampsia in Bahir Dar City, north-western Ethiopia. METHODS A facility-based unmatched case-control study was conducted on 453 (151 cases and 302 controls) pregnant women, attending antenatal care or skilled delivery at Bahir Dar City. Data were collected through face to face interviews and measurements of mid-upper-arm circumference (MUAC) at the time of the interviews. Data were cleaned and entered into IBM SPSS version 20 and later analyzed using STATA version 12. Univariate and multivariate logistic regression analyses were employed to estimate the effect of independent variables on preeclampsia. Stratified analysis was conducted to check for presence of confounding and/or effect modification between covariates. RESULT The odds of preeclampsia were higher among obese (MUAC ≥25 cm) women than their leaner counterparts (AOR = 3.33, 95 % CI: 1.87, 5.79). Obesity was also found to have a similar magnitude of risk for late onset preeclampsia (AOR = 3.63, 95 % CI: 1.89, 6.97). When stratified by age, the effect of obesity on overall and late onset preeclampsia was significant among young (age < 35 years) women (COR = 1.81, 95 % CI: 1.11, 2.99) and (COR = 2.09, 95 % CI: 1.16, 3.86), respectively. As the age groups became more homogenous through adjusted stratification, obesity showed a particularly significant effect in women age ≤24 and 25-29 years; (AOR = 2.31, 95 % CI: 1.06, 5.12) and (AOR = 3.66, 95 % CI: 1.37, 10.87) respectively. Similarly, the effect of obesity on late onset preeclampsia was evident among younger women age ≤24 and 25-29 years; (AOR = 3.16, 95 % CI: 1.21, 8.24) and (AOR = 1.98, 95 % CI: 1.16, 3.40) respectively. However, obesity has no significant effect on early onset of preeclampsia (AOR = 1.98, 95 % CI: 0.79, 4.94). On the other hand, compliance to folate supplementation during pregnancy and fruit consumption were associated with reduced risk of preeclampsia. CONCLUSION Obesity in young age was found to be a risk factor for preeclampsia while compliance to folate supplement and adequate fruit consumption were found to be protective against preeclampsia. Promoting healthy life style, including body weight control, consumption of fruits and vegetables, and folate supplementation should be promoted to reduce the risk of preeclampsia.
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Affiliation(s)
| | - Fantu Abebe
- Pre-service Education of Health Professionals, International Non-Governmental Organization, P.O. Box, 1566, Bahir Dar, Ethiopia.
| | - Solomon Worku
- Medical Education & In-service Training of Health professionals, ICAP, Addis Ababa, Ethiopia
| | - Lalem Menber
- Pre-service Education of Health Professionals, Non- Governmental Organization, Bahir Dar, Ethiopia
| | - Muluken Assress
- Consortium of Christian Relief & Development Associations (CCRDA), Addis Ababa, Ethiopia
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Hromi-Fiedler A, Chapman D, Segura-Pérez S, Damio G, Clark P, Martinez J, Pérez-Escamilla R. Barriers and Facilitators to Improve Fruit and Vegetable Intake Among WIC-Eligible Pregnant Latinas: An Application of the Health Action Process Approach Framework. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:468-477.e1. [PMID: 27373861 PMCID: PMC4934128 DOI: 10.1016/j.jneb.2016.04.398] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 04/04/2016] [Accepted: 04/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Identify barriers and facilitators to improve prenatal fruit and vegetable (F&V) intake among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible Latinas using the Health Action Process Approach framework. DESIGN Qualitative data were collected via audiotaped in-depth interviews as part of a larger study to design an intervention to increase prenatal F&V intake. SETTING Hartford, Connecticut. PARTICIPANTS Forty-five WIC-eligible Latinas completed the study. Included women were: ≥ 18 years old; in 2nd or 3rd trimester; having a singleton pregnancy; overweight or obese (ie, pregravid body mass index ≥ 25); not on a restricted diet; nonsmokers. PHENOMENON OF INTEREST Prenatal factors that promote and hinder F&V intake. ANALYSIS Transcripts were independently read and coded, and a consensus was reached about emerging themes. RESULTS Ten factors influenced prenatal F&V intake: social support, family structure, F&V access, F&V preferences, F&V knowledge, F&V health outcome expectations, self-efficacy, intentions, F&V action/coping planning strategies, and maternal health status. CONCLUSIONS AND IMPLICATIONS Social support from family/friends emerged as the primary distal factor driving prenatal F&V intake. Interventions designed to empower pregnant Latinas to gain the access, confidence, knowledge, and strategies necessary to consume more F&Vs must consider strengthening support to achieve the desired outcome.
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Affiliation(s)
- Amber Hromi-Fiedler
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT.
| | - Donna Chapman
- Exercise Science and Sports Studies Department, Springfield College, Springfield, MA
| | | | | | - Pamela Clark
- Women's Ambulatory Health Services, Hartford Hospital, Hartford, CT
| | - Josefa Martinez
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT
| | - Rafael Pérez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT
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Buzyan LO. Mild anemia as a protective factor against pregnancy loss. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2016; 27 Suppl 1:S7-8. [PMID: 26639719 DOI: 10.3233/jrs-150668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Iron deficiency anemia is traditionally considered to be a pathological condition during pregnancy. According to the standards, prescription of iron supplements to pregnant women is required at hemoglobin levels of 110 g/l and lower. Numerous studies at different periods showed the relationship of anemia and premature birth [5], preeclampsia [1], low birth-weight [2]. Meanwhile, physiological hemodilution carries in pregnancy an important adaptive function. It is well known, that in the second half of pregnancy physiological hypercoagulability develops (increased activity of the plasma clotting factors, platelet aggregation, decreased activity and blood concentrations of physiological anticoagulants) aimed at implementing adequate hemostasis in labor. Under these conditions, moderate hemodilution is an effective mechanism for preventing the development of severe disseminated intravascular coagulation (DIC) in labor, during surgery, in various forms of obstetric pathology. OBJECTIVE To study the effect of anemia of varying severity on the pregnancy course and outcomes. METHODS We conducted a "case-control" study based on cohort. The study included 421 pregnant women who received outpatient care under the monitoring of pregnancy in the antenatal clinic of the South Ural State Medical University and the antenatal clinic of Chelyabinsk Clinical Hospital №6. The inclusion period was from January to March 2014. Inclusion criteria were: confirmed pregnancy, informed consent to participate in the study. Exclusion criteria were multiple pregnancy, induced pregnancy, late first appearance in the antenatal clinic (after 25 weeks' gestation), change of residence and medical supervision during pregnancy, the presence of severe mental disorders, severe somatic diseases in decompensation stage, HIV infection, cancer, active tuberculosis. Study design complies with the legislation of the Russian Federation, international ethical standards and was approved by the Ethics Committee of the South Ural State Medical University. Prospective observation was conducted. All pregnancy complications were registered, in particular, preeclampsia, placental insufficiency (violation of utero-placental blood flow), the presence and severity of anemia during pregnancy, as well as outcomes: the duration and mode of delivery, fetal weight at birth. The criteria for the diagnosis of anemia during pregnancy were: decrease of hemoglobin levels below 110 g/l. All pregnant women with confirmed anemia were treated with iron supplements. After the completion of follow-up the odds ratios analysis of presenting anemia was performed in subgroups: 1) a patient gave birth to a live child, and patient with the loss of the fetus at various stages of gestation; 2) patients who have given birth in time, and patients with premature birth; 3) patients with placental insufficiency (violation of utero-placental blood flow) during pregnancy and patients without placental insufficiency; 4) patients with preeclampsia and patients without pre-eclampsia; 5) patients who have delivered live births weighing less than 2,500 grams and birth weight over 2500. In each case, odds ratios (ORs) and confidence intervals (95% CI) were calculated. Statistical calculations were performed using the software package SPSS 22.0. RESULTS Among all patients (n = 421) anemia of varying severity has been diagnosed in 190 (45.13%), including mild anemia in 161 (38.24%), moderate or severe anemia - in 29 patients (6.88%). In 16 (3.8%) cases, the pregnancy resulted in miscarriage or fetal death. Premature birth of live fetus before 34 weeks of gestation was recorded in 13 cases (3.2%; n = 405). Preeclampsia was diagnosed in 15 women (3.56%). Live births with weights less than 2,500 g were registered in 23 cases (5.67%; n = 405).An analysis of odds ratios was performed to compare the groups of women with anemia of any severity and without anemia, with mild anemia compared with women without anemia, and moderate/severe anemia compared to women with mild anemia or without anemia.According to our results, there was a statistically significant reduction in the chance of having anemia of any severity in patients whose pregnancy was completed by fetal loss. For mild anemia odds ratio in these subgroups was even lower. Thus, the odds of having mild anemia in the group of women who completed a pregnancy to a live birth, was 90.3%, which may indicate a protective role of mild anemia against the loss of the fetus.In all other cases, statistically significant results were not received. Thus, we didn't receive significant positive association between anemia and development of preeclampsia, placental insufficiency during pregnancy, low birth weight and premature birth. There are other publications that show a protective role of anemia in pregnancy. Case control study [3] showed a protective role of anemia against the development of pre-eclampsia (n = 636, p = 0,01). In [4] anemia was a protective factor against stillbirth. There is evidence [6] of the higher risk of stillbirth in women with high hemoglobin level (146 g/l and above), while the link of the risk of stillbirth with anemia has not been confirmed (n = 1404). CONCLUSIONS Our data suggest a protective role of mild anemia during pregnancy in relation to pregnancy loss.
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