The burden of severe hypertensive disorders of pregnancy on perinatal outcomes: a nationwide case-control study in Suriname

Association between Liver and Kidney Function and Birth Outcomes in Pregnant Surinamese Women Exposed to Mercury and Lead in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) Environmental Epidemiologic Cohort Study

Exposure to mercury (Hg) and lead (Pb), in combination with liver and kidney impairment, may result in adverse birth outcomes. From 408 women in the age range of 16 to 46 years, living in rural and urban areas in the interior of Suriname, we looked at the association between adverse birth outcomes and exposure to Hg and Pb in combination with liver and kidney function. This group of women represented a subcohort of pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)-Meki Tamara study. Liver function was assessed by measuring aspartate amino transferase (AST), alanine amino transferase (ALT), and gamma-glutamyl transferase (GGT). Kidney function was assessed by measuring creatinine, urea, and cystatin C. We defined preterm births as birth before 37 weeks of gestation, low birthweight as birthweight < 2500 g, and low Apgar score as a score < 7 at 5 min, and these were used as indicators for adverse birth outcomes. Small size for gestational age was defined as gestational age < -2SD weight for GA. We found significant statistical associations between biomarkers for liver and kidney functions and adverse birth outcomes Apgar score and gestational age. No significant association was found between heavy metals Hg and lead and adverse birth outcomes.

Factors Associated with Perinatal Mortality in Adult Pregnant Women with Hypertensive Disorders: A Case-Control Study

Background

Hypertension complicates 5-10% of pregnancies and is a common cause of perinatal death. The perinatal mortality is estimated to be 3 to 5 times higher in hypertensive women compared to those without hypertension.

Methods

A hypertensive mother either with a stillbirth or if baby died within 7 days of life was included as a case. Once a case was recognized, the next two consecutive hypertensive mothers who delivered a live baby, who survived up to 7 days of life, were taken as controls. Fetuses with congenital malformations incompatible with life and multiple pregnancies were excluded from the study. One hundred and twelve women in cases and 224 women in controls were studied.

Results

Among 112 cases of perinatal death, 70% had died in utero before labor. Among the 33 fetuses alive, 50% were born still after labor and 50% died within 7 days of birth. We found that early onset hypertension (< 34 weeks) (p-< 0.001 (Chi2-23.819)), gestational age at termination of 28-32 weeks (OR 2.76), value of serum creatinine > 1.1 mg/dl (OR 10.1), abruption (OR 6.2) and birth weight < 1.5 kg was significantly associated with perinatal mortality (p-0.007, OR 5.7). Abnormal Doppler findings was a predictor of perinatal deaths.

Conclusion

Severely growth retarded fetuses in association with early onset severe preeclampsia are likely to die in utero and need vigilant monitoring antenatally. Abnormal umbilical artery Dopplers predict perinatal mortality. Caesarean section at the gestational age of ≥ 32 weeks and an estimated fetal weight of ≥ 1.2 kg in our hospital resulted in favorable outcome.

Determinants of neonatal near-miss among neonates delivered in public hospitals of Ilu Abba Bor Zone, Southwest Ethiopia: An unmatched case-control study during the COVID-19 pandemic

Background

The neonatal period is the time with the highest risk of neonatal and infant mortality. The COVID-19 pandemic diverted resources from routine maternal health services, which raises the possibility of neonatal near misses (NNMs). To implement prompt treatments that could improve the standard of infant care and lower neonatal mortality, it has been theorized that pinpointing the determinants of NNM during this outbreak is crucial. In light of this, the current study identified the determinants of NNM in neonates delivered in public hospitals of Ilu Abba Bor Zone, South West Ethiopia.

Methods

An institution-based unmatched case-control study was conducted among randomly selected 303 (101 cases and 202 controls) neonates admitted to Mettu Karl Comprehensive Specialized Hospital (MKCSH) and Darimu Primary Hospital (DPH) from 1 November to 28 December 2020. Data were collected using interviewer-administered structured questionnaire and checklist. The collected data were coded and entered into Epi-Data version 4.6 and then exported to SPSS version 20 for analysis. Adjusted odds ratios (AOR) along with a 95% confidence interval was used to assess the strength of the association, and a p-value < 0.05 was considered to declare the statistical significance in the multivariable logistic regression analysis.

Result

A total of 303 (101 cases and 202 controls) neonates admitted to MKCSH and DPH were included in the study making a 97.4% response rate. In the multivariable logistic regression analysis, no formal maternal education [AOR = 3.534, 95% CI: (1.194-10.455)], Breech presentation during birth [AOR = 3.088, 95% CI: (1.029-9.268)], < 4 antenatal care (ANC) visits [AOR = 1.920, 95% CI: (1.065-3.461], cesarean section delivery [AOR = 4.347, 95% CI: (1.718-10.996)], antepartum hemorrhage (APH) [AOR = 3.37, 95% CI: (1.23-9.24)], and hypertensive disorders of pregnancy (HDP) [AOR = 4.05, 95% CI: (2.36-11.05)] were independent determinants of NNM.

Conclusion

The study's result revealed that factors such as education level, birth presentation, ANC visit, mode of delivery, APH, and HDP continued to be important determinants of the NNM in Ethiopia during this pandemic. Therefore, much work is needed to improve neonatal health by providing adequate ANC services and other identified potential determinant factors that predispose the newborn to life-threatening (near-miss) conditions especially during this pandemic.

Prenatal Exposure to Mercury, Manganese, and Lead and Adverse Birth Outcomes in Suriname: A Population-Based Birth Cohort Study

Globally, adverse birth outcomes are increasingly linked to prenatal exposure to environmental contaminants, such as mercury, manganese, and lead. This study aims to assess an association between prenatal exposure to mercury, manganese, and lead and the occurrence of adverse birth outcomes in 380 pregnant women in Suriname. The numbers of stillbirths, preterm births, low birth weights, and low Apgar scores were determined, as well as blood levels of mercury, manganese, lead, and relevant covariates. Descriptive statistics were calculated using frequency distributions. The associations between mercury, manganese, and lead blood levels, on the one hand, and adverse birth outcomes, on the other hand, were explored using contingency tables, tested with the χ2-test (Fisher's exact test), and expressed with a p value. Multivariate logistic regression models were computed to explore independent associations and expressed as (adjusted) odds ratios (aOR) with 95% confidence intervals (CI). The findings of this study indicate no statistically significant relationship between blood mercury, manganese, or lead levels and stillbirth, preterm birth, low birth weight, and low Apgar score. However, the covariate diabetes mellitus (aOR 5.58, 95% CI (1.38-22.53)) was independently associated with preterm birth and the covariate hypertension (aOR 2.72, 95% CI (1.081-6.86)) with low birth weight. Nevertheless, the observed high proportions of pregnant women with blood levels of mercury, manganese, and lead above the reference levels values of public health concern warrants environmental health research on risk factors for adverse birth outcomes to develop public health policy interventions to protect pregnant Surinamese women and their newborns from potential long-term effects.