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Tian Y, Liu M, Sun JY, Wang Y, Chen L, Sun W, Zhou L. Diagnosis of preeclampsia using metabolomic biomarkers. Hypertens Pregnancy 2024; 43:2379386. [PMID: 39039822 DOI: 10.1080/10641955.2024.2379386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/30/2024] [Indexed: 07/24/2024]
Abstract
The diagnostic criteria for preeclampsia do not accurately reflect the pathophysiological characteristics of patients with preeclampsia. Conventional biomarkers and diagnostic approaches have proven insufficient to fully comprehend the intricacies of preeclampsia. This study aimed to screen differentially abundant metabolites as candidate biomarkers for preeclampsia. A propensity score matching method was used to perform a 1:1 match between preeclampsia patients (n = 70) and healthy control individuals (n = 70). Based on univariate and multivariate statistical analysis methods, the different characteristic metabolites were screened and identified. Least absolute shrinkage and selection operator (LASSO) regression analysis was subsequently used to further screen for differentially abundant metabolites. A receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of the metabolites. A total of 1,630 metabolites were identified and quantified in maternal serum samples. Fifty-three metabolites were significantly increased, and two were significantly decreased in preeclampsia patients. The area under the curve (AUC) of the model composed of isobutyryl-L-carnitine and acetyl-leucine was 0.878, and the sensitivity and specificity in detecting preeclampsia were 81.4% and 87.1%, respectively. There are significant differences in metabolism between preeclampsia patients and healthy pregnant women, and a range of novel biomarkers have been identified. These findings lay the foundation for the use of metabolomic biomarkers for the diagnosis of preeclampsia.
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Affiliation(s)
- Yunfan Tian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingwei Liu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Yu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yifeng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lianmin Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ling Zhou
- Department of Obstetrics and Gynecology, Liyang People's Hospital, Liyang, Jiangsu, China
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Rolnik DL, Syngelaki A, O'Gorman N, Wright D, Nicolaides KH, Poon LC. Aspirin for evidence-based preeclampsia prevention trial: effects of aspirin on maternal serum pregnancy-associated plasma protein A and placental growth factor trajectories in pregnancy. Am J Obstet Gynecol 2024; 231:342.e1-342.e9. [PMID: 38151219 DOI: 10.1016/j.ajog.2023.12.031] [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: 10/14/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND The exact mechanism by which aspirin prevents preeclampsia remains unclear. Its effects on serum placental biomarkers throughout pregnancy are also unknown. OBJECTIVE To investigate the effects of aspirin on serum pregnancy-associated plasma protein A and placental growth factor trajectories using repeated measures from women at increased risk of preterm preeclampsia. STUDY DESIGN This was a longitudinal secondary analysis of the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-based Preeclampsia Prevention trial using repeated measures of pregnancy-associated plasma protein A and placental growth factor. In the trial, 1620 women at increased risk of preterm preeclampsia were identified using the Fetal Medicine Foundation algorithm at 11 to 13+6 weeks of gestation, of whom 798 were randomly assigned to receive aspirin 150 mg and 822 to receive placebo daily from before 14 weeks to 36 weeks of gestation. Serum biomarkers were measured at baseline and follow-up visits at 19 to 24, 32 to 34, and 36 weeks of gestation. Generalized additive mixed models with treatment by gestational age interaction terms were used to investigate the effect of aspirin on biomarker trajectories over time. RESULTS Overall, there were 5507 pregnancy-associated plasma protein A and 5523 placental growth factor measurements. Raw pregnancy-associated plasma protein A values increased over time, and raw placental growth factor increased until 32 weeks of gestation followed by a decline. The multiple of the median mean values of the same biomarkers were consistently below 1.0 multiple of the median, reflecting the high-risk profile of the study population. Trajectories of mean pregnancy-associated plasma protein A and placental growth factor multiple of the median values did not differ significantly between the aspirin and placebo groups (aspirin treatment by gestational age interaction P values: .259 and .335, respectively). CONCLUSION In women at increased risk of preterm preeclampsia, aspirin 150 mg daily had no significant effects on pregnancy-associated plasma protein A or placental growth factor trajectories when compared to placebo.
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Affiliation(s)
- Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
| | - Argyro Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Neil O'Gorman
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - David Wright
- Institute of Health Research, University of Exeter, Exeter, United Kingdom
| | - Kypros H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Liona C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong SAR
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Stephansson O, Sandström A. Can short- and long-term maternal and infant risks linked to hypertension and diabetes during pregnancy be reduced by therapy? J Intern Med 2024; 296:216-233. [PMID: 39045893 DOI: 10.1111/joim.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Hypertensive disorders of pregnancy (HDP), especially preeclampsia, and diabetes during pregnancy pose significant risks for both maternal and infant health, extending to long-term outcomes such as early-onset cardiovascular disease and metabolic disorders. Current strategies for managing HDP focus on screening, prevention, surveillance, and timely intervention. No disease-modifying therapies exist so far for established preeclampsia; delivery remains the definitive resolution. Preventive measures-including early pregnancy screening, exercise, and low-dose aspirin-show promise. Antihypertensive treatments reduce severe hypertension risks, whereas magnesium sulfate remains the standard for preventing eclampsia. Planned delivery from gestational week 37 can balance maternal benefits and neonatal risks in women with established preeclampsia. Delivery between 34 and 37 weeks gestation in women with preeclampsia has to balance risks for mother and infant. Lifestyle interventions-particularly diet and physical activity-are pivotal in managing gestational diabetes mellitus and type 2 diabetes. The oral antidiabetic metformin has shown benefits in glycaemic control and reducing maternal weight gain, although its long-term effects on offspring remain uncertain. The safety of other peroral antidiabetics in pregnancy is less studied. Advancements in glucose monitoring and insulin administration present encouraging prospects for enhancing outcomes in women with diabetes types 1 and 2. Both HDP and diabetes during pregnancy necessitate vigilant management through a combination of lifestyle modifications, pharmacological interventions, and timely obstetric care. Although certain treatments such as low-dose aspirin and metformin show efficacy in risk reduction, further research is ongoing to ensure safety for both mothers and their offspring to reduce short- and long-term adverse effects.
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Affiliation(s)
- Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandström
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
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Lee S, Nantale R, Wani S, Kasibante S, Marvin Kanyike A. Influence of women's decision-making autonomy and partner support on adherence to the 8 antenatal care contact model in Eastern Uganda: A multicenter cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2024; 300:175-181. [PMID: 39018658 DOI: 10.1016/j.ejogrb.2024.07.028] [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: 03/04/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Maternal and child health outcomes remain a challenge in Uganda. Antenatal care (ANC) is effective in mitigating pregnancy and childbirth risks. Women's decision-making autonomy and partner support are crucial for adherence to ANC contacts and better pregnancy outcomes. We assessed the impact of women's decision-making autonomy and partner support on adherence to the 8 + ANC contact schedule among post-partum mothers in Eastern Uganda. METHODS A multicenter cross-sectional study was conducted in four tertiary health facilities in Eastern Uganda, utilizing quantitative techniques to collect data from 1077 postnatal mothers. Eligible participants were those who had given birth within the previous 48 h and had documentation of ANC contacts from their pregnancy. Data was collected using structured questionnaires and analyzed using multivariable logistic regression to assess factors associated with adherence to the WHO-recommended 8 + ANC contacts. RESULTS Most women were aged 20-34 years (792; 73.5 %). Only 253 (23.5 %) women adhered to the 8 + ANC contacts. A significant proportion lacked decision-making autonomy (839; 77.9 %), and over half reported partner support (550; 51.2 %). Decision-making autonomy and partner support were significantly associated with adherence to the 8 + ANC contacts (aOR: 1.6, 95 % CI: 1.2 - 2.2, p = 0.005) and (aOR: 1.9, 95 % CI: 1.4 - 2.7, p < 0.001), respectively. Women with at least five children had lower adherence to the 8 + ANC contacts (aOR=0.4, 95 % CI: 0.2 - 0.7, p = 0.002). CONCLUSION Empowering women and engaging their partners can improve maternal health service utilization and increase ANC contact adherence, leading to better maternal and neonatal health outcomes.
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Affiliation(s)
- Seungwon Lee
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, USA; Communities for Childbirth International, Jinja, Uganda
| | - Ritah Nantale
- Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Solomon Wani
- Department of Research and Innovation, Sanyu Africa Research Institute, Mbale, Uganda
| | - Samuel Kasibante
- Department of Community Health, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Andrew Marvin Kanyike
- Communities for Childbirth International, Jinja, Uganda; Department of Internal Medicine, Mengo Hospital, Kampala, Uganda; HIV, Infectious Disease and Global Health Implementation Research Institute, Washington University in St Louis, USA.
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Borgonove KCA, Lansky S, Soares VMN, Matozinhos FP, Martins EF, Silva RAR, Souza KVD. Time series analysis: trend in late maternal mortality in Brazil, 2010-2019. CAD SAUDE PUBLICA 2024; 40:e00168223. [PMID: 39194090 DOI: 10.1590/0102-311xen168223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 06/15/2024] [Indexed: 08/29/2024] Open
Abstract
To analyze the temporal trend of the late maternal mortality ratio (LMMR) in Brazil and its geographic regions in the period from 2010 to 2019, an ecological time series study was conducted. Data related to late maternal mortality from information systems of the Brazilian Ministry of Health were used. Statistical analysis used Prais-Winsten autoregressive models. A total of 1,470 late maternal deaths were reported in Brazil, resulting in an LMMR of 5 deaths per 100,000 live births. The late maternal mortality records revealed regional disparities, with the lowest index in the North (3.5/100,000 live births) and the highest in the South (8.3/100,000 live births). The LMMR showed an increasing trend in the country, with a general increase in the LMMR in the period and a mean annual percentage variation of 9.79% (95%CI: 4.32; 15.54). The Central-West region led this increase, with a mean annual percentage change of 26.06% (95%CI: 16.36; 36.56), followed by the North and Northeast regions, with 23.5% (95%CI: 13.93; 33.88). About 83% of the reported late maternal deaths were investigated, and 65.6% were corrected by the Maternal Mortality Committees. These findings highlight the relevance of late maternal mortality as an important indicator for maternal health, which is often invisible. The increase in the LMMR result from the improvement in the quality of the registration of these deaths in recent years in Brazil, and especially from the work of investigating deaths. The fragility of reporting with regional disparities points to the need for a more comprehensive approach that promotes equity and prevention of avoidable late maternal mortality.
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Affiliation(s)
| | - Sônia Lansky
- Secretaria Municipal de Saúde Belo Horizonte, Belo Horizonte, Brasil
| | | | | | | | - Roberto Allan Ribeiro Silva
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Janaúba, Brasil
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Irfan A, Haider SH, Sheikh SM, Larik MO, Abbas M, Hashmi MR. Evaluation of antihypertensives for post partum management of hypertensive disorders of pregnancy: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102584. [PMID: 38679150 DOI: 10.1016/j.cpcardiol.2024.102584] [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: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND There is a lack of evidence that directly shows the best antihypertensive treatment options for post partum management of the hypertensive disorders of pregnancy. Our objective was to analyze the safest and most effective antihypertensive drugs post partum for patients with hypertensive disorders of pregnancy. METHODS PubMed, Cochrane, and MEDLINE were searched to find relevant articles published from inception to Feb 2024. We included randomized control trials, in English, featuring a population of postnatal women with hypertensive disorders of pregnancy or postpartum women with de novo hypertension with a follow-up of up to 6 months in which any antihypertensive medication was compared with Placebo or a comparison between different doses of antihypertensives was done. The statistical analyses were conducted using Review Manager with a random-effects model. RESULTS Our analysis revealed that almost all antihypertensives are effective in treating postpartum hypertension. However, some medications had alternating roles in controlling specific outcomes. Using calcium channel blockers resulted in a faster time to sustain BP control than the control (SMD: -0.37; 95% CI: -0.73 to -0.01; P = 0.04). In contrast, using ACE inhibitors or ARBs demanded the use of other antihypertensives in contrast to all other drugs assessed (RR: 2.09; 95% CI: 1.07 to 4.07; P = 0.03). CONCLUSION Timely management of the hypertensive disorders of pregnancy postpartum is life-saving. All the traditional antihypertensives we assessed effectively manage hypertension postpartum, thus allowing the physician to tailor the particular drug regimen according to the patient's needs and comorbidities without any hindrance.
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Affiliation(s)
- Areeka Irfan
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200 Karachi, Pakistan.
| | - Syed Hamza Haider
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200 Karachi, Pakistan
| | - Samir Mustafa Sheikh
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200 Karachi, Pakistan
| | - Muhammad Omar Larik
- Department of Internal Medicine, Dow International Medical College, Dow University of Health Sciences, W4WR+G6W, Gulzar-e-Hijri Gulshan-e-Iqbal, Karachi, Karachi City, Sindh, Pakistan
| | - Mudassir Abbas
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200 Karachi, Pakistan
| | - Mahnoor Rehan Hashmi
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200 Karachi, Pakistan
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Rueda Camino JA, Azcoaga-Lorenzo A, Meseguer RN, Seijo DJ, García MA, Trujillo D, Miranda C, Barba-Martín R. Incidence of pregnancy related pulmonary embolism in Spain 2016-2021: an observational population-based retrospective study. Rev Clin Esp 2024:S2254-8874(24)00103-6. [PMID: 39094786 DOI: 10.1016/j.rceng.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
OBJECTIVE This study aimed to estimate the overall and annual age-standardized incidence of pregnancy-related pulmonary embolism (PE) in Spain from 2016 to 2021, explore the distribution of PE events during pregnancy and the postpartum period, identify potential risk factors, and estimate mortality rates during hospital admission. METHODS In a retrospective, observational, population-based study, data from the Spanish National Hospital Discharge Database were analyzed to identify women with hospital episodes of pregnancy-related-PE. The primary outcome was the overall and annual age-standardized incidence of pregnancy-related-PE, with secondary aims including the distribution of events during pregnancy and postpartum and the calculation of age-standardized mortality rates during admission. RESULTS Among 2,178,805 births from 2016 to 2021, 522 women were diagnosed with pregnancy-related PE, yielding an overall age-standardized incidence of 2.83 cases per 10,000 births. A non-significant increasing trend was observed from 2.43 to 4.18 cases per 10,000 births (p = 0.06). Comorbidities were low, with a notable association between PE and SARS-CoV-2 infection during the last two years. The mortality rate among women with pregnancy-related PE was 2.8%, with a higher incidence of PE reported during the postpartum period. CONCLUSION The incidence of pregnancy-related-PE in Spain exhibits a non-significant increasing trend, with a significant risk of mortality. The association with SARS-CoV-2 infection underscores the importance of vigilant monitoring and management of pregnant women, particularly during pandemics. This study contributes specific data on the incidence and characteristics of pregnancy-related-PE in Spain, emphasizing the need to consider PE in the differential diagnosis and management strategies for pregnant and postpartum women.
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Affiliation(s)
- J A Rueda Camino
- Internal Medicine Department, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain; Hospital Universitario Rey Juan Carlos, Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain; Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - A Azcoaga-Lorenzo
- Hospital Universitario Rey Juan Carlos, Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain; Research Network On Chronicity, Primary Care and Prevention and Health Promotion, (ISCIII), Madrid, Spain; Department of Gynecology and Obstetrics, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - R N Meseguer
- Hospital Universitario Rey Juan Carlos, Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain; Department of Gynecology and Obstetrics, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - D J Seijo
- Internal Medicine Department, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain; Hospital Universitario Rey Juan Carlos, Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain; Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - M A García
- Internal Medicine Department, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - D Trujillo
- Internal Medicine Department, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - C Miranda
- Internal Medicine Department, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - R Barba-Martín
- Internal Medicine Department, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain; Hospital Universitario Rey Juan Carlos, Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain; Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK.
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Syairaji M, Nurdiati DS, Wiratama BS, Prüst ZD, Bloemenkamp KWM, Verschueren KJC. Trends and causes of maternal mortality in Indonesia: a systematic review. BMC Pregnancy Childbirth 2024; 24:515. [PMID: 39080562 PMCID: PMC11290122 DOI: 10.1186/s12884-024-06687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The maternal mortality ratio (MMR) in Indonesia is among the highest in Southeast Asia. We aim to describe trends in the MMR and causes of maternal deaths in Indonesia over the past decades, regionally and nationally. METHODS We performed a systematic review and conducted a search using PubMed, Embase, Global Health, CINAHL, Cochrane, Portal Garuda, and Google Scholar from the inception of the database to April 2023. We included all studies on the incidence and/or the causes of maternal deaths in Indonesia. The MMR was defined as the number of maternal deaths per 100,000 live births. Maternal death causes were assessed and reclassified according to the WHO International Classification of Disease Maternal Mortality (ICD-MM). RESULTS We included 63 studies that reported the MMR (54 studies) and/or the causes of maternal deaths (44 studies) in Indonesia from 1970 to 2022, with a total of 254,796 maternal deaths. The national MMR declined from 450 to 249 (45%) between 1990 and 2020. Great differences in MMR exist across the country, with the lowest in Java-Bali and the highest (more than twice the national MMR) in Sulawesi and Eastern Indonesia. Between 1990 and 2022, the proportion of deaths due to hemorrhage and sepsis decreased, respectively from 48 to 18% and 15-5%, while the share of deaths due to hypertensive disorders and non-obstetric causes increased, respectively from 8 to 19% and 10-49%. CONCLUSION Despite the steady decline of maternal deaths in Indonesia, it remains one of the highest in Southeast Asia, with enormous disparities within the country. Hypertensive disorders and non-communicable diseases make up a growing share of maternal deaths, making maternal death reduction strategies increasingly challenging. National Maternal Death Surveillance and Response needs to be prioritized to eliminate preventable maternal deaths in Indonesia. REGISTRATION OF SYSTEMATIC REVIEWS PROSPERO, CRD42022320213.
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Affiliation(s)
- M Syairaji
- Department of Health Information and Services, Vocational College, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Detty Siti Nurdiati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Bayu Satria Wiratama
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Zita D Prüst
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Kim J C Verschueren
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
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Wilson EB, Niehaus L, Jiwani SS, Hazel EA, Maïga A, Amouzou A. Delivery and postnatal care among women in 71 low- and middle-income countries: analyzing coverage gaps using household surveys. BMC Pregnancy Childbirth 2024; 24:505. [PMID: 39060978 PMCID: PMC11282627 DOI: 10.1186/s12884-024-06681-y] [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: 03/06/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND High levels of maternal morbidity and mortality persist in low- and middle-income countries, despite increases in coverage of facility delivery and skilled assistance at delivery. We compared levels of facility birth to a summary delivery care measure and quantified gaps. METHODS We approximated a delivery care score from type of delivery (home, lower-level facility, or hospital), skilled attendant at delivery, a stay of 24-or-more-hours after delivery, and a health check within 48-h after delivery. Data were obtained from 333,316 women aged 15-49 who had a live birth in the previous 2 years, and from 71 countries with nationally representative surveys between 2013 and 2020. We computed facility delivery and delivery care coverage estimates to assess the gap. We stratified the analysis by country characteristics, including the national maternal mortality ratio (MMR), to assess the size of coverage gaps, and we assessed missed opportunities through coverage cascades. We looked at the association between MMR and delivery care coverage. RESULTS Delivery care coverage varied by country, ranging from 24% in Sudan to 100% in Cuba. Median coverage was 70% with an interquartile range of 30 percentage points (55% and 85%). The cascade showed that while 76% of women delivered in a facility, only 41% received all four interventions. Coverage gaps exist across all MMR levels. Gaps between highest and lowest wealth quintiles were greatest in countries with MMR levels of 100 or higher, and the gap narrowed in countries with MMR levels below 100. The delivery care indicator had a negative association with MMR. CONCLUSIONS In addition to providing high-quality evidenced-based care to women during birth and the postpartum period, there is also a need to address gaps in delivery care, which occur within and between countries, wealth quintiles, and MMR phases.
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Affiliation(s)
- Emily B Wilson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lori Niehaus
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Safia S Jiwani
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Hazel
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abdoulaye Maïga
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Agbessi Amouzou
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Parker J, Hofstee P, Brennecke S. Prevention of Pregnancy Complications Using a Multimodal Lifestyle, Screening, and Medical Model. J Clin Med 2024; 13:4344. [PMID: 39124610 PMCID: PMC11313446 DOI: 10.3390/jcm13154344] [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: 06/19/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
Prevention of pregnancy complications related to the "great obstetrical syndromes" (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. The resulting adverse pregnancy outcomes are associated with increased maternal and perinatal morbidity and mortality and increased post-partum risk of cardiometabolic disease. Maternal nutritional and environmental factors are known to play a significant role in altering bidirectional communication between fetal-derived trophoblast cells and maternal decidual cells and contribute to abnormal placentation. As a result, lifestyle-based interventions have increasingly been recommended before, during, and after pregnancy, in order to reduce maternal and perinatal morbidity and mortality and decrease long-term risk. Antenatal screening strategies have been developed following extensive studies in diverse populations. Multivariate preeclampsia screening using a combination of maternal, biophysical, and serum biochemical markers is recommended at 11-14 weeks' gestation and can be performed at the same time as the first-trimester ultrasound and blood tests. Women identified as high-risk can be offered prophylactic low dose aspirin and monitored with angiogenic factor assessment from 22 weeks' gestation, in combination with clinical assessment, serum biochemistry, and ultrasound. Lifestyle factors can be reassessed during counseling related to antenatal screening interventions. The integration of lifestyle interventions, pregnancy screening, and medical management represents a conceptual advance in pregnancy care that has the potential to significantly reduce pregnancy complications and associated later life cardiometabolic adverse outcomes.
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Affiliation(s)
- Jim Parker
- School of Medicine, University of Wollongong, Wollongong 2522, Australia;
| | - Pierre Hofstee
- School of Medicine, University of Wollongong, Wollongong 2522, Australia;
- Tweed Hospital, Northern New South Wales Local Health District, Tweed Heads 2485, Australia
| | - Shaun Brennecke
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, The Royal Women’s Hospital, Melbourne 3052, Australia;
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne 3052, Australia
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Harsono AAH, Bond CL, Enah C, Ngong MG, Kyeng RM, Wallace E, Turan JM, Szychowski JM, Carlo WA, Ambe LN, Halle-Ekane G, Muffih PT, Tita ATN, Budhwani H. Structural barriers to maternity care in Cameroon: a qualitative study. Reprod Health 2024; 21:108. [PMID: 39030544 PMCID: PMC11264682 DOI: 10.1186/s12978-024-01834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 06/21/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The maternal mortality and perinatal mortality rate in Cameroon are among the highest worldwide. To improve these outcomes, we conducted a formative qualitative assessment to inform the adaptation of a mobile provider-to-provider intervention in Cameroon. We explored the complex interplay of structural barriers on maternity care in this low-resourced nation. The study aimed to identify structural barriers to maternal care during the early adaptation of the mobile Medical Information Service via Telephone (mMIST) program in Cameroon. METHODS We conducted in-depth interviews and focus groups with 56 key stakeholders including previously and currently pregnant women, primary healthcare providers, administrators, and representatives of the Ministry of Health, recruited by purposive sampling. Thematic coding and analysis via modified grounded theory approach were conducted using NVivo12 software. RESULTS Three main structural barriers emerged: (1) civil unrest (conflict between Ambazonian militant groups and the Cameroonian government in the Northwest), (2) limitations of the healthcare system, (3) inadequate physical infrastructure. Civil unrest impacted personal security, transportation safety, and disrupted medical transport system. Limitations of healthcare system involved critical shortages of skilled personnel and medical equipment, low commitment to evidence-based care, poor reputation, ineffective health system communication, incentives affecting care, and inadequate data collection. Inadequate physical infrastructure included frequent power outages and geographic distribution of healthcare facilities leading to logistical challenges. CONCLUSION Dynamic inter-relations among structural level factors create barriers to maternity care in Cameroon. Implementation of policies and intervention programs addressing structural barriers are necessary to facilitate timely access and utilization of high-quality maternity care.
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Affiliation(s)
- Alfonsus Adrian Hadikusumo Harsono
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA.
| | - Christyenne Lily Bond
- Intervention Research and Implementation Science (IRIS) Lab, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Comfort Enah
- School of Nursing, College of Health Sciences, University of Massachusetts Lowell, Massachusetts, USA
| | - Mary Glory Ngong
- Cameroon Baptist Convention Heath Services, Bamenda, Northwest Region, Cameroon
| | - Rahel Mbah Kyeng
- Cameroon Baptist Convention Heath Services, Bamenda, Northwest Region, Cameroon
| | - Eric Wallace
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffery M Szychowski
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lionel Neba Ambe
- Regional Delegation of Public Health, Bamenda, Northwest Region, Cameroon
| | | | - Pius Tih Muffih
- Cameroon Baptist Convention Heath Services, Bamenda, Northwest Region, Cameroon
| | - Alan Thevenet N Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Henna Budhwani
- Intervention Research and Implementation Science (IRIS) Lab, College of Nursing, Florida State University, Tallahassee, FL, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Amster E, Jessani G, Gupta G, Hlyva O, Rae C. Mapping maternal and infant health in Morocco: A global scoping review of themes, gaps, and the "unseen" in the published health research literature, 2000-2022. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003488. [PMID: 39024351 PMCID: PMC11257357 DOI: 10.1371/journal.pgph.0003488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/21/2024] [Indexed: 07/20/2024]
Abstract
Global efforts to reduce Maternal Mortality Rates (MMR) have been significant, but researchers are exploring new approaches to address stalled progress and enduring health inequities. This scoping review offers an analytic synthesis of maternal and infant health (MIH) research in the low-middle income North African Islamic country of Morocco over 22 years, a mapping of the themes, research gaps, geographies, and methodologies, 2000-2022. Morocco is an official MIH success story with excellent health indicators, yet indicators do not address local contexts, gender issues, or health disparities. To understand how medical research has reflected social reality over the past 22 years, we explored not just what is known, but how it is known, where it is known, what remained unseen, and why. Four databases were searched: OVID: MEDLINE, Embase, APA PsycINFO, and EBSCO: CINAHL. 4590 abstracts were identified, 3131 abstracts screened, and 402 full MIH articles and 128 sub-group articles identified and subject to data extraction. The 402 full MIH articles were subject to qualitative thematic analysis, classified by 34 primary research themes and explored especially for gender, health equity, and methodology. Findings included significant geographic research disparities; four regions were the location of 75% of research and many regions remained virtually "unseen" by research. The best-equipped urban public hospitals in higher-income regions produced the most research, creating an urban, hospital-based research perspective. Maternal health articles predominated, often >50% more than articles published about infant health. Infants studied were mostly neonates. Socially marginalized women were often invisible to research, as were private healthcare, NGO care (non-governmental civic organizations), and healthcare in community. In articles, researchers recommended new policies, new laws, health system reform, and government actions to advocate for patients. Three solutions emerged to broaden the research perspective: increase geographic breadth, address missing topics and populations, and embrace interdisciplinary methods.
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Affiliation(s)
- Ellen Amster
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ghazal Jessani
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gauri Gupta
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Oksana Hlyva
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Charlene Rae
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Mohamed MA, Venkatesh K, Abdelatif D, Nandakumar V, Hoffman H. Healthcare system variability and inpatient maternal mortality in the United States. J Neonatal Perinatal Med 2024:NPM240025. [PMID: 39031391 DOI: 10.3233/npm-240025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
OBJECTIVE To examine the association of inpatient maternal mortality with variability in healthcare services delivery such as hospital size, urban/rural designation, teaching/non-teaching status, regional location, and insurance coverage. METHODS This is a pooled, cross-sectional analysis of the National Inpatient Sample (2012-2014). Information on maternal demographics, clinical conditions, and birth outcomes were identified using respective ICD9-CM codes. Bivariate and multivariate analysis using logistic regression models were used to describe maternal characteristics and to calculate the risk of mortality with each independent variable. RESULTS The weighted sample included 12,409,939 hospital records (82.6% are 18-34-year-old and 49.5% are Caucasians). Maternal death during hospitalization occurred in 1310 cases (12/100,000 live birth). Women with cardiovascular disorders, hemorrhage or sepsis were 33.6, 4.7, and 5.4 times more likely to suffer inpatient maternal mortality. Compared to small-sized hospitals, delivery at medium or large size hospitals is associated with higher mortality, adjusted odds ratios (aOR) 1.8 (1.4-2.3), and 2.2 (1.8-2.8), respectively. Adjusted OR for inpatient maternal mortality in urban non-teaching or urban teaching compared to rural hospitals were 2.2 (1.7-3.0) and 2.9 (2.2-3.9), respectively. Women in the South have higher maternal mortality compared to Northeast, aOR 1.7 (1.5-2.1). Women coved with public insurance experience higher inpatient maternal mortality compared to those with private insurance, aOR: 2.6 (2.1-3.2) and 1.9 (1.6-2.1), respectively. CONCLUSION Factors related to variability in healthcare delivery may play a role in inpatient maternal mortality. Some could be explained by the case mix and the clinical conditions affecting birthing outcomes. A qualitative analysis is needed to explore how these factors relate to increased maternal mortality in certain hospital settings.
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Affiliation(s)
- M A Mohamed
- Division of Neonatology, Cleveland Clinic Children's, Cleveland, USA
| | - K Venkatesh
- Department of Biostatistics and Bioinformatics, The George Washington University - Milken Institute School of Public Health, Washington, USA
| | - D Abdelatif
- Department of Obstetrics and Gynecology, The George Washington University/Medical Faculty Associates, Washington, USA
| | - V Nandakumar
- Division of Neonatology, Cleveland Clinic Children's, Cleveland, USA
| | - H Hoffman
- Department of Biostatistics and Bioinformatics, The George Washington University - Milken Institute School of Public Health, Washington, USA
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Firouzbakht M, Nikbakht H, Omidvar S. Risk factors for postpartum readmission: a prediction model in Iranian pregnant women. BMC Pregnancy Childbirth 2024; 24:466. [PMID: 38971754 PMCID: PMC11227716 DOI: 10.1186/s12884-024-06663-0] [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: 03/30/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Postpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran. METHODS This retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019-2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05. RESULTS Among 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery. CONCLUSION The method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth.
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Affiliation(s)
- Mojgan Firouzbakht
- Department of Nursing- Midwifery, Comprehensive Health Research Center, Isalamic Azad University, Babol Branch, Iran.
| | - HossinAli Nikbakht
- Population, Family and Spiritual Health Research Center, Department of Biostatistics and Epidemiology, School of Public Health, Health Research Institute &, Babol University of Medical Sciences, Babol, Iran
| | - Shabnam Omidvar
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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15
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Weeks AD. Reducing maternal deaths from haemorrhage: Seeking the low-hanging fruit. BJOG 2024; 131:1025-1028. [PMID: 38177088 DOI: 10.1111/1471-0528.17753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Andrew D Weeks
- Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK
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Shamim MA, Kumar J, Patil AN, Tiwari K, Sharma S, Anil A, Saravanan A, Sandeep M, Varthya SB, Singh S, Ahmed MI, Najmi A, Shamim MA, Gandhi A, Satapathy P, Sah R, Rustagi S, Gaidhane AM, Zahiruddin QS, Khatib MN, Padhi BK, Singh K, Dwivedi P. PeRinatal, neOnatal, and Maternal OuTcomEs with azithromycin prophylaxis in pregnancy and labour (PROMOTE-PROPHYLAXIS): systematic review and meta-analysis. EClinicalMedicine 2024; 73:102691. [PMID: 39022799 PMCID: PMC11253273 DOI: 10.1016/j.eclinm.2024.102691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
Background Initial randomised controlled trials (RCTs) showed that prophylactic azithromycin in pregnant women improved maternal and neonatal outcomes; however, the recent evidence did not show any benefit to neonatal survival. There is conflicting evidence over the role of azithromycin prophylaxis in antenatal and intrapartum periods. We explored whether azithromycin prophylaxis in pregnant women improves maternal and neonatal outcomes. Methods For this systematic review and meta-analysis registered on PROSPERO [CRD42023411093], we searched seven databases (PubMed, Scopus, Embase, Cochrane Library, EBSCOHost, ProQuest, and Web of Science) and clinical trial registries until 04/23/2024, for RCTs evaluating antenatal/intrapartum azithromycin prophylaxis against placebo/routine care in pregnant women. The primary outcome was neonatal mortality. Intrapartum and antenatal administration were assessed separately. We used random-effects meta-analysis. The risk of bias was assessed using the Cochrane RoB 2 tool. The GRADE approach was used to evaluate the certainty of the evidence. Findings Screening 2161 records retrieved 20 RCTs (56,381 participants). Intrapartum azithromycin may make little or no difference to neonatal mortality [5 RCTs, 44,436 participants; Risk Ratio (RR): 1.02, 95% CI 0.86-1.20, I 2 = 0%, very low certainty], and maternal mortality [3 RCTs, 44,131 participants, RR: 1.26, 0.65-2.42, I 2 = 0%, low certainty]. Similarly, antenatal azithromycin may have little or no effect on neonatal mortality [3 RCTs; 5304 participants; RR: 0.74, 0.35-1.56, I 2 = 43%, very-low certainty] and maternal mortality [3 RCTs; 8167 participants RR: 1.62, 0.67-3.91, I 2 = 0%, low certainty]. There is no data on long-term adverse outcomes and antimicrobial resistance. Interpretation Low to very low certainty evidence suggests that intrapartum or antenatal azithromycin prophylaxis in pregnant women might not reduce maternal or neonatal mortality. Funding None.
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Affiliation(s)
- Muhammad Aaqib Shamim
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jogender Kumar
- Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Amol N. Patil
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Krishna Tiwari
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sakshi Sharma
- Department of Pediatrics, Government District Hospital, Pratapgarh, Rajasthan, India
| | - Abhishek Anil
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Aswini Saravanan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Shoban Babu Varthya
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Molla Imaduddin Ahmed
- Pediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, Leicestershire, LE1 5WW, United Kingdom
| | - Ahmad Najmi
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Muhammad Aasim Shamim
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aravind Gandhi
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Prakisini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Chennai, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, Iraq
| | - Ranjit Sah
- Department of Clinical Microbiology, D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
- Department of Public Health Dentistry, D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Abhay M. Gaidhane
- Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuldeep Singh
- Centre of Excellence for Tribal Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Dwivedi
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- Centre of Excellence for Tribal Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Thomopoulos C, Hitij JB, De Backer T, Gkaliagkousi E, Kreutz R, Lopez-Sublet M, Marketou M, Mihailidou AS, Olszanecka A, Pechère-Bertschi A, Pérez MP, Persu A, Piani F, Socrates T, Stolarz-Skrzypek K, Cífková R. Management of hypertensive disorders in pregnancy: a Position Statement of the European Society of Hypertension Working Group 'Hypertension in Women'. J Hypertens 2024; 42:1109-1132. [PMID: 38690949 DOI: 10.1097/hjh.0000000000003739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Hypertensive disorders in pregnancy (HDP), remain the leading cause of adverse maternal, fetal, and neonatal outcomes. Epidemiological factors, comorbidities, assisted reproduction techniques, placental disorders, and genetic predisposition determine the burden of the disease. The pathophysiological substrate and the clinical presentation of HDP are multifarious. The latter and the lack of well designed clinical trials in the field explain the absence of consensus on disease management among relevant international societies. Thus, the usual clinical management of HDP is largely empirical. The current position statement of the Working Group 'Hypertension in Women' of the European Society of Hypertension (ESH) aims to employ the current evidence for the management of HDP, discuss the recommendations made in the 2023 ESH guidelines for the management of hypertension, and shed light on controversial issues in the field to stimulate future research.
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Affiliation(s)
- Costas Thomopoulos
- Department of Cardiology, General Hospital of Athens 'Laiko', Athens, Greece
| | - Jana Brguljan Hitij
- Department of Hypertension, University Medical Centre Ljubljana, Medical University Ljubljana, Slovenia
| | - Tine De Backer
- Cardiovascular Center & Clinical Pharmacology, University Hospital Gent, Belgium
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Reinhold Kreutz
- Charite-Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Marilucy Lopez-Sublet
- AP-HP, Hopital Avicenne, Centre d'Excellence Europeen en Hypertension Arterielle, Service de Medecine Interne, INSERM UMR 942 MASCOT, Paris 13-Universite Paris Nord, Bobigny, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
| | - Maria Marketou
- School of Medicine, University of Crete, Heraklion, Greece
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology, and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | | | - Mariana Paula Pérez
- Department of Hypertension. Hospital de Agudos J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Federica Piani
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Thenral Socrates
- Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence University Hospital Basel, Basel, Switzerland
| | - Katarzyna Stolarz-Skrzypek
- 1st Department of Cardiology, Interventional Electrocardiology, and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
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Park SK, Kim H, Kim Y, Jang YE, Kim JT. Effect of epidural anesthesia on the optic nerve sheath diameter in patients with pre-eclampsia: a prospective observational study. Reg Anesth Pain Med 2024:rapm-2024-105444. [PMID: 38950931 DOI: 10.1136/rapm-2024-105444] [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: 03/04/2024] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Optic nerve sheath diameter (ONSD) reflects intracranial pressure and is increased in pre-eclampsia. Administrating a significant volume of epidural solution into the epidural space can potentially increase ONSD. We investigated the impact of epidural local anesthetic injection on ONSD in patients with pre-eclampsia. METHODS Patients with pre-eclampsia (n=11) and normotensive pregnant women (n=11) received de novo epidural anesthesia for cesarean delivery. We administered 21 mL of an epidural solution containing 2% lidocaine and 50 μg fentanyl into the lumbar epidural space in incremental doses. ONSD was measured at baseline, 3, 10, and 20 min after completing the epidural injection, after delivery, and at the end of surgery. Primary outcome was the change in ONSD from baseline to 3 min after epidural injection in patients with pre-eclampsia and normotensive pregnant women. Serial changes in the ONSD were analyzed using a linear mixed model. RESULTS At baseline and 3 min after epidural drug injection, ONSD was significantly larger in patients with pre-eclampsia than in normotensive mothers (5.7 vs 4.1 mm, p=0.001 and 5.4 vs 4.1 mm, p<0.001, respectively). However, there were no significant changes in ONSD at 3 min after injection from baseline in either group (p>0.999). Linear mixed model demonstrated that ONSD did not change after epidural anesthesia in either group (p=0.279 and p=0.347, respectively). CONCLUSIONS Despite a higher baseline ONSD in pre-eclampsia, epidural anesthesia did not further increase ONSD. Our findings indicate that epidural anesthesia can be safely administered in patients with pre-eclampsia at risk of increased intracranial pressure, without other intracranial pathology. TRIAL REGISTRATION NUMBER NCT04095832.
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Affiliation(s)
- Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hansol Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngwon Kim
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Koi-Larbi K, Obiri D, Browne JL, Fondjo LA, Katsande S, Garti I. Advancing hypertensive disorders of pregnancy management: insights from the 5th preeclampsia scientific symposium in Ghana. BMC Proc 2024; 18:12. [PMID: 38867245 PMCID: PMC11170767 DOI: 10.1186/s12919-024-00295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
The 5th Preeclampsia Scientific Symposium (PSS2023) organized by Action on Preeclampsia (APEC) Ghana was themed: 'Realign, Refocus: Improving outcomes of Hypertensive Disorders of Pregnancy through Shared Decision Making, Research & Quality of Care'. It took place on the 18th and 19th of May 2023 at the Ghana College of Physicians and Surgeons (GCPS), Accra Ghana. This transdisciplinary symposium brought together a national representation of experts, policy makers, scientists, and healthcare professionals to discuss key priorities, opportunities, approaches, and strategies to improve the maternal and perinatal outcomes of hypertensive disorders of pregnancy (HDP) in Ghana and the sub-region. The symposium centered around three key themes: realigning/refocusing patient-doctor decision making processes to improve outcomes of HDP; realigning/refocusing clinical care to improve outcomes of HDP; and leveraging on research to predict, recognize and manage high-risk women.This report summarizes insights from the diverse presentations and discussions held at the #PSS2023. This will form a roadmap for future research, policy, and interventions to improve outcomes of HDP in Ghana and the sub-region. The symposium provided a wealth of evidence and knowledge from various experts, highlighting the need for women-centered care, equitable re-allocation of resources, multi-sectoral and innovative approaches, capacity strengthening. Other highlights include knowledge base development and increased stakeholder and community engagement with an overall aim of improving outcomes of HDP. The symposium also fostered inclusivity, welcoming survivors of HDP and their families at a scientific platform. They provided invaluable insights into the challenges faced and the lived experiences of those affected by the disease. Trainees and students also benefited from the symposium as it provided networking opportunities with fellow researchers, and a front row to gaining insights into cutting-edge research in Ghana.
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Affiliation(s)
- Koiwah Koi-Larbi
- Action On Preeclampsia Ghana (APEC-GH), Accra, Ghana.
- Severe Pre-Eclampsia Adverse Outcome Triage (SPOT) Study, Accra, Ghana.
| | - Dorotheah Obiri
- Action On Preeclampsia Ghana (APEC-GH), Accra, Ghana
- Severe Pre-Eclampsia Adverse Outcome Triage (SPOT) Study, Accra, Ghana
- Department of Immunology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joyce L Browne
- Severe Pre-Eclampsia Adverse Outcome Triage (SPOT) Study, Accra, Ghana
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda Ahenkorah Fondjo
- Action On Preeclampsia Ghana (APEC-GH), Accra, Ghana
- Severe Pre-Eclampsia Adverse Outcome Triage (SPOT) Study, Accra, Ghana
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Isabella Garti
- Action On Preeclampsia Ghana (APEC-GH), Accra, Ghana
- Faculty of Health, Charles Darwin University, Darwin, Australia
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Sáenz R, Nigenda G, Gómez-Duarte I, Rojas K, Castro A, Serván-Mori E. Persistent inequities in maternal mortality in Latin America and the Caribbean, 1990-2019. Int J Equity Health 2024; 23:96. [PMID: 38730305 PMCID: PMC11088099 DOI: 10.1186/s12939-024-02100-y] [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: 06/01/2023] [Accepted: 01/09/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10-54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reproductive, maternal, and neonatal health services. METHODS Using 1990-2019 data from the Global Burden of Disease project, we carried out a two-stepwise analysis to (a) identify the differences in the MMR temporal patterns and (b) assess its relationship with selected indicators: government health expenditure (GHE), the GHE as percentage of gross domestic product (GDP), the availability of human resources for health (HRH), the coverage of effective interventions to reduce maternal mortality, and the level of economic development of each country. FINDINGS In the descriptive analysis, we observed a heterogeneous overall reduction of MMR in the region between 1990 and 2019 and heterogeneous overall increases in the GHE, GHE/GDP, and HRH availability. The correlation analysis showed a close, negative, and dependent association of the economic development level between the MMR and GHE per capita, the percentage of GHE to GDP, the availability of HRH, and the coverage of SBA. We observed the lowest MMRs when GHE as a percentage of GDP was close to 3% or about US$400 GHE per capita, HRH availability of 6 doctors, nurses, and midwives per 1,000 inhabitants, and skilled birth attendance levels above 90%. CONCLUSIONS Within the framework of the Sustainable Development Goals (SDGs) agenda, health policies aimed at the effective reduction of maternal mortality should consider allocating more resources as a necessary but not sufficient condition to achieve the goals and should prioritize the implementation of new forms of care with a gender and rights approach, as well as strengthening actions focused on vulnerable groups.
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Affiliation(s)
- Rocío Sáenz
- Center for Research in Nursing and Health Care (CICES), University of Costa Rica, San Pedro Montes de Oca, San Jose, Costa Rica
| | - Gustavo Nigenda
- Faculty of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ingrid Gómez-Duarte
- Center for Research in Nursing and Health Care (CICES), University of Costa Rica, San Pedro Montes de Oca, San Jose, Costa Rica
| | - Karol Rojas
- Center for Research in Nursing and Health Care (CICES), University of Costa Rica, San Pedro Montes de Oca, San Jose, Costa Rica
| | - Arachu Castro
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, State of Louisiana, USA
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health of Mexico, Universidad Av. 655, Cuernavaca, Morelos, Mexico.
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21
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Reitsma SE, Barsoum JR, Hansen KC, Sassin AM, Dzieciatkowska M, James AH, Aagaard KM, Ahmadzia HK, Wolberg AS. Agnostic identification of plasma biomarkers for postpartum hemorrhage risk. Am J Obstet Gynecol 2024:S0002-9378(24)00576-3. [PMID: 38710264 DOI: 10.1016/j.ajog.2024.04.050] [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] [Received: 10/30/2023] [Revised: 04/20/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Postpartum hemorrhage is difficult to predict, is associated with significant maternal morbidity, and is the leading cause of maternal mortality worldwide. The identification of maternal biomarkers that can predict increased postpartum hemorrhage risk would enhance clinical care and may uncover mechanisms that lead to postpartum hemorrhage. OBJECTIVE This retrospective case-control study employed agnostic proteomic profiling of maternal plasma samples to identify differentially abundant proteins in controls and postpartum hemorrhage cases. STUDY DESIGN Maternal plasma samples were procured from a cohort of >60,000 participants in a single institution's perinatal repository. Postpartum hemorrhage was defined as a decrease in hematocrit of ≥10% or receipt of transfusion within 24 hours after delivery. Postpartum hemorrhage cases (n=30) were matched by maternal age and delivery mode (vaginal or cesarean) with controls (n=56). Mass spectrometry was used to identify differentially abundant proteins using integrated peptide peak areas. Statistically significant differences between groups were defined as P<.05 after controlling for multiple comparisons. RESULTS By study design, cases and controls did not differ in race, ethnicity, gestational age at delivery, blood type, or predelivery platelet count. Cases had slightly but significantly lower predelivery and postdelivery hematocrit and hemoglobin. Mass spectrometry detected 1140 proteins, including 77 proteins for which relative abundance differed significantly between cases and controls (fold change >1.15, P<.05). Of these differentially abundant plasma proteins, most had likely liver or placental origins. Gene ontology term analysis mapped to protein clusters involved in responses to wound healing, stress response, and host immune defense. Significantly differentially abundant proteins with the highest fold change (prostaglandin D2 synthase, periostin, and several serine protease inhibitors) did not correlate with predelivery hematocrit or hemoglobin but identified postpartum hemorrhage cases with logistic regression modeling revealing good-to-excellent area under the operator receiver characteristic curves (0.802-0.874). Incorporating predelivery hemoglobin with these candidate proteins further improved the identification of postpartum hemorrhage cases. CONCLUSION Agnostic analysis of maternal plasma samples identified differentially abundant proteins in controls and postpartum hemorrhage cases. Several of these proteins are known to participate in biologically plausible pathways for postpartum hemorrhage risk and have potential value for predicting postpartum hemorrhage. These findings identify candidate protein biomarkers for future validation and mechanistic studies.
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Affiliation(s)
- Stéphanie E Reitsma
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Julia R Barsoum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Science, Washington DC
| | - Kirk C Hansen
- Biochemistry and Molecular Genetics, The University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Alexa M Sassin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Monika Dzieciatkowska
- Biochemistry and Molecular Genetics, The University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Andra H James
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology Duke University School of Medicine, Durham, NC; Department of Medicine under Hematology, Duke University School of Medicine, Durham, NC
| | - Kjersti M Aagaard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Homa K Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Science, Washington DC.
| | - Alisa S Wolberg
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina School of Medicine, Chapel Hill, NC.
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Uhawenimana TC, Gakwerere M, Ngabonzima A, Yamuragiye A, Harindimana F, Ndayisenga JP. Utilization of technology to provide on-the-job trainings on Emergency Obstetric and Neonatal Care: Perspectives of nurses and midwives working in Rwanda's remote health facilities. PLoS One 2024; 19:e0291219. [PMID: 38669298 PMCID: PMC11051650 DOI: 10.1371/journal.pone.0291219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/25/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION One of the targets for the third sustainable development goals is to reduce worldwide maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030. To address issues affecting women and the newborns during childbirth and postnatal period, concerted efforts from governments and their stakeholders are crucial to maximize the use of technology to enhance frontline health professionals' skills to provide the emergency obstetric and newborn care (EmONC). However, no study has garnered nurses' and midwives' perspectives regarding the application of technology-enhanced learning approach to provide on-the-job Continuous Professional Development (CPD) and factors that may influence the application of this training approach in the Rwandan context. METHODS The study collected data from nurses and midwives from forty (40) public health facilities in remote areas nationwide. The study applied a qualitative descriptive design to explore and describe nurses' and midwives' perspectives on the feasibility and acceptability of technology enhanced learning approaches such as e-learning, phone-based remote training, and other online methods to provide trainings in EmONC. Two focus group discussions with EmONC mentors, two with nurses and midwives were conducted. Twelve key informant interviews were conducted. Participants were selected purposively. In total, 54 individuals were included in this study. A thematic approach was used to analyse data. RESULTS Nurses and midwives highlighted the need to provide refresher trainings about the management of pre-eclampsia. Most of the EmONC trainings are still provided face-to-face and the use of technology enhanced learning approaches have not yet been embraced in delivering EmONC CPDs for nurses and midwives in remote areas. Nurses and midwives found the first developed prototype of smartphone app training of the EmONC acceptable as it met the midwives' expectations in terms of the knowledge and skills' gap in EmONC. CONCLUSION Although the newly developed application was found acceptable, further research involving practical sessions by nurses and midwives using the developed application is needed to garner views about the ease of use of the application, relevance of the EmONC uploaded content on the app, and needed improvements on the app to address their needs in EmONC.
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Affiliation(s)
| | - Mathias Gakwerere
- United Nations Populations Fund East and Southern Africa Region, Johannesburg, South Africa
| | - Anaclet Ngabonzima
- JSI Research and Training Institute Inc, Denver, Colorado, United States of America
| | - Assumpta Yamuragiye
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Jean Pierre Ndayisenga
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Nivatpumin P, Nithi-Uthai J, Lertbunnaphong T, Sukcharoen N, Soponsiripakdee T, Yonphan P. Perioperative outcomes and causes of postpartum hemorrhage in patients undergoing cesarean delivery in Thailand: A comprehensive retrospective study. PLoS One 2024; 19:e0300620. [PMID: 38626161 PMCID: PMC11020384 DOI: 10.1371/journal.pone.0300620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/03/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND This study aimed to identify the characteristics, causes, perioperative anesthetic, and obstetric outcomes of patients experiencing postpartum hemorrhage (PPH) after cesarean delivery. METHODS We retrospectively analyzed patients who underwent cesarean delivery at the largest university hospital in Bangkok, Thailand, during a 5-year period (January 1, 2016-December 31, 2020). PPH was defined as an estimated blood loss (EBL) of ≥ 1000 ml within 24 hours postpartum. RESULTS Of 17 187 cesarean deliveries during the study period, 649 patients were included for analysis. The mean EBL was 1774.3 ± 1564.4 ml (range: 1000-26 000 ml). Among the patients, 166 (25.6%) experienced massive PPH (blood loss > 2000 ml). Intraoperative blood transfusions were necessary for 264 patients (40.7%), while 504 individuals (77.7%) needed intraoperative vasopressors. The analysis revealed uterine atony as the leading cause of PPH in 62.7% (n = 407) of the patients, with abnormal placentation following at 29.3% (n = 190). Abnormal placentation was associated with a significantly higher mean EBL of 2345.0 ± 2303.9 ml compared to uterine atony, which had a mean EBL of 1504.0 ± 820.7 ml (P < 0.001). Abnormal placentation also significantly increased the likelihood of blood transfusions and hysterectomies (P < 0.001 for both) and led to more intensive care unit admissions (P = 0.032). The risk of EBL exceeding 2000 ml was markedly higher in patients with abnormal placentation (odds ratio [OR] 5.12, 95% confidence interval [CI] 3.45-7.57, P < 0.001) and in cases involving trauma to the internal organs (OR 2.33, 95% CI 1.16-4.71, P = 0.018) than in patients with uterine atony. The study documented three instances of perioperative cardiac arrest, one of which was fatal. CONCLUSIONS These findings highlight the importance of comprehensive perioperative management strategies, including the ready availability of adequate blood and blood products, particularly in scenarios predisposed to significant hemorrhage. TRIAL REGISTRATION Clinical trial registration: Clinicaltrial.gov registration number NCT04833556 (April 6, 2021).
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Affiliation(s)
- Patchareya Nivatpumin
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Jitsupa Nithi-Uthai
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Tripop Lertbunnaphong
- Faculty of Medicine Siriraj Hospital, Department of Obstetrics and Gynecology, Mahidol University, Bangkok, Thailand
| | - Nattapon Sukcharoen
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Thanyarat Soponsiripakdee
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Pawana Yonphan
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
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Ghosh R, Konipo AN, Treleaven E, Rozenshteyn S, Beckerman J, Whidden C, Johnson A, Kayentao K, Liu J. Factors influencing pregnancy care and institutional delivery in rural Mali: a secondary baseline analysis of a cluster-randomised trial. BMJ Open 2024; 14:e084315. [PMID: 38594181 PMCID: PMC11015193 DOI: 10.1136/bmjopen-2024-084315] [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] [Received: 01/15/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE The vast majority of the 300 000 pregnancy-related deaths every year occur in South Asia and sub-Saharan Africa. Increased access to quality antepartum and intrapartum care can reduce pregnancy-related morbidity and mortality worldwide. We used a population-based cross-sectional cohort design to: (1) examine the sociodemographic risk factors and structural barriers associated with pregnancy care-seeking and institutional delivery, and (2) investigate the influence of residential distance to the nearest primary health facility in a rural population in Mali. METHODS A baseline household survey of Malian women aged 15-49 years was conducted between December 2016 and January 2017, and those who delivereda baby in the 5 years preceding the survey were included. This study leverages the baseline survey data from a cluster-randomised controlled trial to conduct a secondary analysis. The outcomes were percentage of women who received any antenatal care (ANC) and institutional delivery; total number of ANC visits; four or more ANC visits; first ANC visit in the first trimester. RESULTS Of the 8575 women in the study, two-thirds received any ANC in their last pregnancy, one in 10 had four or more ANC visits and among those that received any ANC, about one-quarter received it in the first trimester. For every kilometre increase in distance to the nearest facility, the likelihood of the outcomes reduced by 5 percentage points (0.95; 95% CI 0.91 to 0.98) for any ANC; 4 percentage points (0.96; 95% CI 0.94 to 0.98) for an additional ANC visit; 10 percentage points (0.90; 95% CI 0.86 to 0.95) for four or more ANC visits; 6 percentage points (0.94; 95% CI 0.94 to 0.98) for first ANC in the first trimester. In addition, there was a 35 percentage points (0.65; 95% CI 0.56 to 0.76) decrease in likelihood of institutional delivery if the residence was within 6.5 km to the nearest facility, beyond which there was no association with the place of delivery. We also found evidence of increase in likelihood of receiving any ANC care and its intensity increased with having some education or owning a business. CONCLUSION The findings suggest that education, occupation and distance are important determinants of pregnancy and delivery care in a rural Malian context. TRIAL REGISTRATION NUMBER NCT02694055.
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Affiliation(s)
- Rakesh Ghosh
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | | | - Emily Treleaven
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Sasha Rozenshteyn
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Caroline Whidden
- MUSO, Route de 501 Lodgements SEMA, Bamako, Mali
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Ari Johnson
- MUSO, Route de 501 Lodgements SEMA, Bamako, Mali
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Kassoum Kayentao
- MUSO, Route de 501 Lodgements SEMA, Bamako, Mali
- Malaria Research & Training Centre, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Jenny Liu
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
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Yang Y, Shao Y, Chen H, Guo X, Liang Y, Wang Y, Zhao Y. Characteristics and treatment for severe postpartum haemorrhage in different midwifery hospitals in one district of Beijing in China: an institution-based, retrospective cohort study. BMJ Open 2024; 14:e077709. [PMID: 38569676 PMCID: PMC11146356 DOI: 10.1136/bmjopen-2023-077709] [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] [Received: 07/13/2023] [Accepted: 12/08/2023] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To identify the characteristics and treatment approaches for patients with severe postpartum haemorrhage (SPPH) in various midwifery institutions in one district in Beijing, especially those without identifiable antenatal PPH high-risk factors, to improve regional SPPH rescue capacity. DESIGN Retrospective cohort study. SETTING This study was conducted at 9 tertiary-level hospitals and 10 secondary-level hospitals in Haidian district of Beijing from January 2019 to December 2022. PARTICIPANTS The major inclusion criterion was SPPH with blood loss ≥1500 mL or needing a packed blood product transfusion ≥1000 mL within 24 hours after birth. A total of 324 mothers with SPPH were reported to the Regional Obstetric Quality Control Office from 19 midwifery hospitals. OUTCOME MEASURES The pregnancy characteristics collected included age at delivery, gestational weeks at delivery, height, parity, delivery mode, antenatal PPH high-risk factors, aetiology of PPH, bleeding amount, PPH complications, transfusion volume and PPH management. SPPH characteristics were compared between two levels of midwifery hospitals and their association with antenatal PPH high-risk factors was determined. RESULTS SPPH was observed in 324 mothers out of 106 697 mothers in the 4 years. There were 74.4% and 23.9% cases of SPPH without detectable antenatal PPH high-risk factors in secondary and tertiary midwifery hospitals, respectively. Primary uterine atony was the leading cause of SPPH in secondary midwifery hospitals, whereas placental-associated disorders were the leading causes in tertiary institutions. Rates of red blood cell transfusion over 10 units, unscheduled returns to the operating room and adverse PPH complications were higher in patients without antenatal PPH high-risk factors. Secondary hospitals had significantly higher rates of trauma compared with tertiary institutions. CONCLUSION Examining SPPH cases at various institutional levels offers a more comprehensive view of regional SPPH management and enhances targeted training in this area.
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Affiliation(s)
- Yike Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
| | - Yu Shao
- Haidian Maternal and Child Health Hospital, Beijing, Beijing, China
| | - Huan Chen
- Peking University Health Science Center, Beijing, Beijing, China
| | - Xiaoyue Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yingzhi Liang
- Haidian Maternal and Child Health Hospital, Beijing, Beijing, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
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Nigenda G, Serván-Mori E. Human resources for health and maternal mortality in Latin America and the Caribbean over the last three decades: a systemic-perspective reflections. Int J Equity Health 2024; 23:67. [PMID: 38561759 PMCID: PMC10983735 DOI: 10.1186/s12939-024-02154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The role of human resources for health in the operation of health systems is crucial. However, training and incorporating them into institutions is a complex process due to the continuous misalignment between the supply and demand of health personnel. Taking the case of the Latin American and Caribbean region countries, this comment discusses the relationship between the availability of human resources for health and the maternal mortality ratio for the period 1990-2021. It proposes the need to resume planning exercises from a systemic perspective that involves all areas of government and the private sector linked to the training and employment of health workers. MAIN TEXT We used secondary data from a global source to show patterns in the relationship between these two aspects and identify gaps in the Latin American and Caribbean regions. The results show enormous heterogeneity in the response of regional health systems to the challenge of maternal mortality in the region. Although most countries articulated specific programs to achieve the reduction committed by all countries through the Millennium Development Goals, not all had the same capacity to reduce it, and practically none met the target. In addition, in the English Caribbean countries, we found significant increases in the number of health personnel that do not explain the increases in the maternal mortality rate during the period. CONCLUSIONS The great lesson from the data shown is that some countries could articulate responses to the problem using available resources through effective strategies, considering the specific needs of their populations. Although variations in maternal mortality rate cannot be explained solely through the provision of health personnel, it is important to consider that it is critical to find new modalities on how human resources for health could integrate and create synergies with other resources to increase systems capacity to deliver care according to conditions in each country.
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Affiliation(s)
- Gustavo Nigenda
- Faculty of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health of Mexico, Universidad Av. 655, Cuernavaca, Morelos, Mexico.
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McDougall A, Nguyen R, Nguyen PY, Allen C, Cheang S, Makama M, Mills K, Hastie R, Ammerdorffer A, Gulmezoglu AM, Vogel JP. The effects of probiotics administration during pregnancy on preeclampsia and associated maternal, fetal, and newborn outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2024; 6:101322. [PMID: 38447676 DOI: 10.1016/j.ajogmf.2024.101322] [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: 12/19/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE This study aimed to synthesize the available evidence on probiotic administration during pregnancy for the prevention of preeclampsia and its effects on related maternal, fetal, and newborn outcomes. DATA SOURCES Six databases were systematically searched for eligible studies, namely Ovid MEDLINE, Embase, CINAHL, Cochrane, Global Index Medicus, and the Maternity and Infant Care Database, from inception to August 2, 2023. STUDY ELIGIBILITY CRITERIA Randomized controlled trials that evaluated the effects of probiotic administration on women during any stage of pregnancy were eligible for inclusion. METHODS The protocol was registered with the International Prospective Register of Systematic Reviews under identifier CRD42023421613. Evaluating study eligibility, extracting data, assessing risk of bias (ROB-2 tool), and rating certainty (Grading of Recommendations, Assessment, Development and Evaluations) were conducted independently by 2 authors. The primary outcomes were incidence of preeclampsia, eclampsia, and maternal mortality. A meta-analysis was performed, and the results were reported as risk ratios with 95% confidence intervals. RESULTS A total of 29 trials (7735 pregnant women) met the eligibility criteria. There was heterogeneity across the trials in the population of enrolled women and the type of probiotic tested (20 different strains), although most used oral administration. Probiotics may make no difference to the risk of preeclampsia (risk ratio, 1.14; 95% confidence interval, 0.84-1.53; 11 trials; 2401 women; low certainty evidence), preterm birth at <37 weeks' gestation (risk ratio, 0.93; 95% confidence interval, 0.66-1.30; 18 trials, 4016 women; low certainty evidence), or gestational age at delivery (mean difference, -0.03 weeks [≈0.2 days]; 95% confidence interval, -0.16 to 0.10 weeks [≈ -1.1 to 0.7 days]; 13 trials, 2194 women; low certainty evidence). It is difficult to assess the effects of probiotics on other secondary outcomes because the evidence was of very low certainty, however, no benefits or harms were observed. CONCLUSION Limited evidence suggests that probiotic supplementation does not affect the risk for preeclampsia. Further high-quality trials are needed to definitively assess the benefits and possible harms of probiotic supplementation during pregnancy. There is also a lack of data from trials that included women who were undernourished or who experienced microbial dysbiosis and for whom probiotic supplementation might be useful.
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Affiliation(s)
- Annie McDougall
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel); Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia (Dr McDougall).
| | - Renae Nguyen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Phi-Yen Nguyen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Connor Allen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Sarah Cheang
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Maureen Makama
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel); School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia (Dr Makama and Prof Vogel)
| | - Kate Mills
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Australia (Dr Hastie)
| | - Anne Ammerdorffer
- Concept Foundation, Geneva, Switzerland (Dr Ammerdorffer and Dr Gulmezoglu)
| | - A Metin Gulmezoglu
- Concept Foundation, Geneva, Switzerland (Dr Ammerdorffer and Dr Gulmezoglu)
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel); School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia (Dr Makama and Prof Vogel)
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Lu XR, Tao Q, Qin Z, Liu XW, Li SH, Bai LX, Ge WB, Liu YX, Li JY, Yang YJ. A combined transcriptomics and proteomics approach to reveal the mechanism of AEE relieving hyperlipidemia in ApoE -/- mice. Biomed Pharmacother 2024; 173:116400. [PMID: 38484560 DOI: 10.1016/j.biopha.2024.116400] [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: 01/08/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
Hyperlipidemia caused by abnormal lipid metabolism has reached epidemic proportions. This phenomenon is also common in companion animals. Previous studies showed that AEE significantly improves abnormal blood lipids in hyperlipidemia rats and mice, but its mechanism is still not clear enough. In this study, the mechanism and potential key pathways of AEE on improving hyperlipidemia in mice were investigated through the transcriptome and proteome study of ApoE-/- mice liver and the verification study on high-fat HepG2 cells. The results showed that AEE significantly decreased the serum TC and LDL-C levels of hyperlipidemia ApoE-/- mice, and significantly increased the enzyme activity of CYP7A1. After AEE intervention, the results of mice liver transcriptome and proteome showed that differential genes and proteins were enriched in lipid metabolism-related pathways. The results of RT-qPCR showed that AEE significantly regulated the expression of genes related to lipid metabolism in mice liver tissue. AEE significantly upregulated the protein expression of CYP7A1 in hyperlipidemia ApoE-/- mice liver tissue. The results in vitro showed that AEE significantly decreased the levels of TC and TG, and improved lipid deposition in high-fat HepG2 cells. AEE significantly increased the expression of CYP7A1 protein in high-fat HepG2 cells. AEE regulates the expression of genes related to lipid metabolism in high-fat HepG2 cells, mainly by FXR-SHP-CYP7A1 and FGF19-TFEB-CYP7A1 pathways. To sum up, AEE can significantly improve the hyperlipidemia status of ApoE-/- mice and the lipid deposition of high-fat HepG2 cells, and its main pathway is probably the bile acid metabolism-related pathway centered on CYP7A1.
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Affiliation(s)
- Xiao-Rong Lu
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China
| | - Qi Tao
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China
| | - Zhe Qin
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China
| | - Xi-Wang Liu
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China
| | - Shi-Hong Li
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China
| | - Li-Xia Bai
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China
| | - Wen-Bo Ge
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China
| | - Ya-Xian Liu
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China
| | - Jian-Yong Li
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China.
| | - Ya-Jun Yang
- Key Lab of New Animal Drug of Gansu Province,Key Lab of Veterinary Pharmaceutical Development of Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Science of Chinese Academy of Agricultural Sciences, Lanzhou 730050, PR China.
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Montgomery-Csobán T, Kavanagh K, Murray P, Robertson C, Barry SJE, Vivian Ukah U, Payne BA, Nicolaides KH, Syngelaki A, Ionescu O, Akolekar R, Hutcheon JA, Magee LA, von Dadelszen P. Machine learning-enabled maternal risk assessment for women with pre-eclampsia (the PIERS-ML model): a modelling study. Lancet Digit Health 2024; 6:e238-e250. [PMID: 38519152 PMCID: PMC10983826 DOI: 10.1016/s2589-7500(23)00267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/27/2023] [Accepted: 12/14/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Affecting 2-4% of pregnancies, pre-eclampsia is a leading cause of maternal death and morbidity worldwide. Using routinely available data, we aimed to develop and validate a novel machine learning-based and clinical setting-responsive time-of-disease model to rule out and rule in adverse maternal outcomes in women presenting with pre-eclampsia. METHODS We used health system, demographic, and clinical data from the day of first assessment with pre-eclampsia to predict a Delphi-derived composite outcome of maternal mortality or severe morbidity within 2 days. Machine learning methods, multiple imputation, and ten-fold cross-validation were used to fit models on a development dataset (75% of combined published data of 8843 patients from 11 low-income, middle-income, and high-income countries). Validation was undertaken on the unseen 25%, and an additional external validation was performed in 2901 inpatient women admitted with pre-eclampsia to two hospitals in south-east England. Predictive risk accuracy was determined by area-under-the-receiver-operator characteristic (AUROC), and risk categories were data-driven and defined by negative (-LR) and positive (+LR) likelihood ratios. FINDINGS Of 8843 participants, 590 (6·7%) developed the composite adverse maternal outcome within 2 days, 813 (9·2%) within 7 days, and 1083 (12·2%) at any time. An 18-variable random forest-based prediction model, PIERS-ML, was accurate (AUROC 0·80 [95% CI 0·76-0·84] vs the currently used logistic regression model, fullPIERS: AUROC 0·68 [0·63-0·74]) and categorised women into very low risk (-LR <0·1; eight [0·7%] of 1103 women), low risk (-LR 0·1 to 0·2; 321 [29·1%] women), moderate risk (-LR >0·2 and +LR <5·0; 676 [61·3%] women), high risk (+LR 5·0 to 10·0, 87 [7·9%] women), and very high risk (+LR >10·0; 11 [1·0%] women). Adverse maternal event rates were 0% for very low risk, 2% for low risk, 5% for moderate risk, 26% for high risk, and 91% for very high risk within 48 h. The 2901 women in the external validation dataset were accurately classified as being at very low risk (0% with outcomes), low risk (1%), moderate risk (4%), high risk (33%), or very high risk (67%). INTERPRETATION The PIERS-ML model improves identification of women with pre-eclampsia who are at lowest and greatest risk of severe adverse maternal outcomes within 2 days of assessment, and can support provision of accurate guidance to women, their families, and their maternity care providers. FUNDING University of Strathclyde Diversity in Data Linkage Centre for Doctoral Training, the Fetal Medicine Foundation, The Canadian Institutes of Health Research, and the Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Paul Murray
- Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Sarah J E Barry
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - U Vivian Ukah
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| | - Beth A Payne
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Argyro Syngelaki
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Olivia Ionescu
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK; Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - Ranjit Akolekar
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK; Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Institute of Women and Children's Health, University of British Columbia, Vancouver, BC, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London UK.
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30
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Carducci ME, Izbizky G. [Advanced maternal age as a risk factor for adverse maternal and perinatal outcomes]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2024; 81:24-39. [PMID: 38537099 PMCID: PMC11110671 DOI: 10.31053/1853.0605.v81.n1.41447] [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: 06/19/2023] [Accepted: 10/23/2023] [Indexed: 04/05/2024] Open
Abstract
Introduction A progressive increase in the age of women at first pregnancy is observed, a situation that has been associated with a greater risk of adverse maternal and perinatal effects. Objective The aim of this study was to describe the characteristics and the maternal and perinatal outcomes of nulliparas of 40 years and older and compare them with those of nulliparas under 40. Study design This was a retrospective cohort analysis of a database of pregnancy population who had attended their deliveries in a private university hospital. Results An association was observed between maternal age ≥ 40 with the maternal compound adverse outcome (OR 1,3; 95% CI: 1,1-1,6), gestational diabetes (OR 3,6; 95% CI: 1,80-3,7), hypertensive disorders/preeclampsia (OR 2,2; 95% CI: 1,6-3,1) and postpartum hemorrhage (4,7; 95% CI: 1,2-16,3), with advanced maternal age persisting as an independent risk factor for the maternal compound adverse outcome (OR 1,3; 95% CI: 1,1 -1,6) and the perinatal compound adverse outcome (OR 1,40; 95% CI: 1,2-1,7) in the multivariate analysis. A higher rate of preterm birth was observed in the group of older nulliparas (OR 1,6; 95% CI: 1,3-2,0) with a higher requirement for admission to NICU for their newborns (OR 1,3; 95% CI: 1,0-1,8). Conclusions Women with advanced maternal age constitute a high-risk population, whose attention and follow-up would require a differential approach aiming to improve maternal and perinatal outcomes.
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Affiliation(s)
- Maria Eugenia Carducci
- Servicio de Obstetricia, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano de Buenos Aires..
| | - Gustavo Izbizky
- Servicio de Obstetricia, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano de Buenos Aires. .
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Brownfoot F, Rolnik DL. Prevention of preeclampsia. Best Pract Res Clin Obstet Gynaecol 2024; 93:102481. [PMID: 38373378 DOI: 10.1016/j.bpobgyn.2024.102481] [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: 06/05/2023] [Revised: 08/19/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
Preeclampsia is a relatively common pregnancy complication and constitutes a major cause of morbidity and mortality for mothers and children worldwide. It disproportionally affects low-resource countries. Appropriate identification of individuals at increased risk and prevention of the disease and its complications remain healthcare and research priorities, and the investigation of potential interventions to prevent preeclampsia has driven much of the obstetric research in recent decades. In this article, we review the scientific literature on the topic, highlighting established benefits and remaining questions regarding different non-pharmacological and pharmacological strategies, including exercise, the timing of birth, aspirin and calcium use, among others, as well as potential novel therapies under investigation.
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Affiliation(s)
- Fiona Brownfoot
- Mercy Hospital for Women, Heidelberg, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel Lorber Rolnik
- Women's and Newborn, Monash Health, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
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Anguzu R, Livergood CM, Hoppe KK, Kulinski J, Fitzgerald GD, Palatnik A. Association between body mass index and chronic hypertension in patients with hypertension disorders of pregnancy one-year postpartum. Pregnancy Hypertens 2024; 35:32-36. [PMID: 38134483 PMCID: PMC10939881 DOI: 10.1016/j.preghy.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To determine the association between body mass index (BMI) and chronic hypertension (CHTN) one-year postpartum following pregnancies complicated by hypertensive disorders of pregnancy (HDP). STUDY DESIGN A retrospective cohort study of patients with HDP (gestational hypertension or preeclampsia) in a single Midwestern academic center from 2014 to 2018. The primary outcome was CHTN at one-year postpartum, defined as systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg or taking antihypertensive medication at one-year postpartum. The primary exposure variable was BMI at one-year postpartum, categorized as underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-<30 kg/m2), and obese (≥30 kg/m2) and as continuous BMI variable. Descriptive statistics and adjusted logistic regression analysis were performed. RESULTS Out of 596 patients with HDP included in this analysis, 275 (46.1 %) had CHTN one-year postpartum. Mean one-year postpartum BMI was 27.9 ± 5.2 kg/m2. Prevalence of CHTN at one-year postpartum was higher in obese (38.1 %) and overweight (30.0 %) groups compared to the normal weight group (29.9 %), p < 0.001. In multivariate logistic regression, obesity at one-year postpartum, compared to normal, was associated with 73 % higher likelihood of CHTN following HDP (adjusted OR 1.73, 95 % CI 1.06-2.84). With BMI as a continuous variable, each unit increase in BMI one-year postpartum was associated with 6 % higher likelihood of CHTN (adjusted OR 1.06, 95 % CI 1.02-1.15). CONCLUSIONS Obesity at one-year postpartum following HDP was associated with a higher risk of CHTN compared with normal BMI. Weight is a modifiable risk factor that should be targeted in postpartum interventions to reduce cardiovascular disease following HDP.
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Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Christine M Livergood
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kara K Hoppe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, WI, USA
| | - Jacquelyn Kulinski
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Garrett D Fitzgerald
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Sliwa K, van der Meer P, Viljoen C, Jackson AM, Petrie MC, Mebazaa A, Hilfiker-Kleiner D, Maggioni AP, Laroche C, Regitz-Zagrosek V, Tavazzi L, Roos-Hesselink JW, Hamdan R, Frogoudaki A, Ibrahim B, Farhan HAF, Mbakwem A, Seferovic P, Böhm M, Pieske B, Johnson MR, Bauersachs J. Socio-economic factors determine maternal and neonatal outcomes in women with peripartum cardiomyopathy: A study of the ESC EORP PPCM registry. Int J Cardiol 2024; 398:131596. [PMID: 37979788 DOI: 10.1016/j.ijcard.2023.131596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/20/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a global disease with substantial morbidity and mortality. The aim of this study was to analyze to what extent socioeconomic factors were associated with maternal and neonatal outcomes. METHODS In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global PPCM registry, under the auspices of the ESC EORP Programme. We investigated the characteristics and outcomes of women with PPCM and their babies according to individual and country-level sociodemographic factors (Gini index coefficient [GINI index], health expenditure [HE] and human developmental index [HDI]). RESULTS 739 women from 49 countries (Europe [33%], Africa [29%], Asia-Pacific [15%], Middle East [22%]) were enrolled. Low HDI was associated with greater left ventricular (LV) dilatation at time of diagnosis. However, baseline LV ejection fraction did not differ according to sociodemographic factors. Countries with low HE prescribed guideline-directed heart failure therapy less frequently. Six-month mortality was higher in countries with low HE; and LV non-recovery in those with low HDI, low HE and lower levels of education. Maternal outcome (death, re-hospitalization, or persistent LV dysfunction) was independently associated with income. Neonatal death was significantly more common in countries with low HE and low HDI, but was not influenced by maternal income or education attainment. CONCLUSIONS Maternal and neonatal outcomes depend on country-specific socioeconomic characteristics. Attempts should therefore be made to allocate adequate resources to health and education, to improve maternal and fetal outcomes in PPCM.
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Affiliation(s)
- Karen Sliwa
- Cape Heart Institute, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Charle Viljoen
- Cape Heart Institute, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alice M Jackson
- Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, United Kingdom
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, United Kingdom
| | - Alexandre Mebazaa
- Department of Anaesthesia and Critical Care, University Hospitals Saint Louis-Lariboisière Paris, University Paris Diderot, Paris, France
| | | | - Aldo P Maggioni
- ANMCO Research Centre, Firenze, Italy; EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France
| | - Vera Regitz-Zagrosek
- Berlin Institute of Gender in Medicine (GiM), Charité - Universitätsmedizin, Berlin, Germany
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Righab Hamdan
- Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | | | | | - Hasan Ali Farhan Farhan
- Iraqi Board for Medical Specializations, Scientific Council of Cardiology, College of Medicine, University of Baghdad, Baghdad Heart Center, Baghdad, Iraq
| | - Amam Mbakwem
- Department of Medicine, College of Medicine and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Petar Seferovic
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Mark R Johnson
- Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, United Kingdom
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
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Muriithi FG, Banke-Thomas A, Forbes G, Gakuo RW, Thomas E, Gallos ID, Devall A, Coomarasamy A, Lorencatto F. A systematic review of behaviour change interventions to improve maternal health outcomes in sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002950. [PMID: 38377077 PMCID: PMC10878526 DOI: 10.1371/journal.pgph.0002950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
The rate of decline in the global burden of avoidable maternal deaths has stagnated and remains an issue of concern in many sub-Saharan Africa countries. As per the most recent evidence, an average maternal mortality ratio (MMR) of 223 deaths per 100,000 live births has been estimated globally, with sub-Saharan Africa's average MMR at 536 per 100,000 live births-more than twice the global average. Despite the high MMR, there is variation in MMR between and within sub-Saharan Africa countries. Differences in the behaviour of those accessing and/or delivering maternal healthcare may explain variations in outcomes and provide a basis for quality improvement in health systems. There is a gap in describing the landscape of interventions aimed at modifying the behaviours of those accessing and delivering maternal healthcare for improving maternal health outcomes in sub-Saharan Africa. Our objective was to extract and synthesise the target behaviours, component behaviour change strategies and outcomes of behaviour change interventions for improving maternal health outcomes in sub-Saharan Africa. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Our protocol was published a priori on PROSPERO (registration number CRD42022315130). We searched ten electronic databases (PsycINFO, Cochrane Database of Systematic Reviews, International Bibliography of Social Sciences, EMBASE, MEDLINE, Scopus, CINAHL PLUS, African Index Medicus, African Journals Online, and Web of Science) and included randomised trials and quasi-experimental studies. We extracted target behaviours and specified the behavioural interventions using the Action, Actor, Context, Time, and Target (AACTT) framework. We categorised the behaviour change strategies using the intervention functions described in the Behaviour Change Wheel (BCW). We reviewed 52 articles (26 randomized trials and 26 quasi-experimental studies). They had a mixed risk of bias. Out of these, 41 studies (78.8%) targeted behaviour change of those accessing maternal healthcare services, while seven studies (13.5%) focused on those delivering maternal healthcare. Four studies (7.7%) targeted mixed stakeholder groups. The studies employed a range of behaviour change strategies, including education 37 (33.3%), persuasion 20 (18%), training 19 (17.1%), enablement 16 (14.4%), environmental restructuring 8 (7.2%), modelling 6 (5.4%) and incentivisation 5 (4.5%). No studies used restriction or coercion strategies. Education was the most common strategy for changing the behaviour of those accessing maternal healthcare, while training was the most common strategy in studies targeting the behaviour of those delivering maternal healthcare. Of the 52 studies, 40 reported effective interventions, 7 were ineffective, and 5 were equivocal. A meta-analysis was not feasible due to methodological and clinical heterogeneity across the studies. In conclusion, there is evidence of effective behaviour change interventions targeted at those accessing and/or delivering maternal healthcare in sub-Saharan Africa. However, more focus should be placed on behaviour change by those delivering maternal healthcare within the health facilities to fast-track the reduction of the huge burden of avoidable maternal deaths in sub-Saharan Africa.
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Affiliation(s)
- Francis G. Muriithi
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Aduragbemi Banke-Thomas
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, Greenwich, London, United Kingdom
| | - Gillian Forbes
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Ruth W. Gakuo
- Department of Nursing, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Lenton, Nottingham, United Kingdom
| | - Eleanor Thomas
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Ioannis D. Gallos
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Adam Devall
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Arri Coomarasamy
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, United Kingdom
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Diamond-Smith N, Gopalakrishnan L, Patil S, Fernald L, Menon P, Walker D, El Ayadi AM. Temporary childbirth migration and maternal health care in India. PLoS One 2024; 19:e0292802. [PMID: 38329972 PMCID: PMC10852266 DOI: 10.1371/journal.pone.0292802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/28/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Women in South Asia often return to their natal home during pregnancy, for childbirth, and stay through the postpartum period-potentially impacting access to health care and health outcomes in this important period. However, this phenomenon is understudied (and not even named) in the demographic or health literature, nor do we know how it impacts health. OBJECTIVE The aim of this study is to measure the magnitude, timing, duration, risk factors and impact on care of this phenomenon, which we name Temporary Childbirth Migration. METHODS Using data from 9,033 pregnant and postpartum women collected in 2019 in two large states of India (Madhya Pradesh and Bihar) we achieve these aims using descriptive statistics and logistic regression models, combined with qualitative data from community health workers about this practice. RESULTS We find that about one third of women return to their natal home at some point in pregnancy or postpartum, mostly clustered close to the time of delivery. Younger, primiparous, and non-Hindu women were more likely to return to their natal home. Women reported that they went to their natal home because they believed that they would receive better care; this was born out by our analysis in Bihar, but not Madhya Pradesh, for prenatal care. CONCLUSIONS Temporary childbirth migration is common, and, contrary to expectations, did not lead to disruptions in care, but rather led to more access to care. CONTRIBUTION We describe a hitherto un-named, underexplored yet common phenomenon that has implications for health care use and potentially health outcomes.
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Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Lakshmi Gopalakrishnan
- School of Public Health, University of California, Berkeley, California, United States of America
| | | | - Lia Fernald
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Purnima Menon
- International Food Policy Research Center, New Delhi, India
| | - Dilys Walker
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Alison M. El Ayadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, United States of America
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Al-Khatib A, Sagot P, Cottenet J, Aroun M, Quantin C, Desplanches T. Major postpartum haemorrhage after frozen embryo transfer: A population-based study. BJOG 2024; 131:300-308. [PMID: 37550089 DOI: 10.1111/1471-0528.17625] [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: 01/27/2023] [Revised: 06/12/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To investigate the effect on major postpartum haemorrhage (PPH) of mode of conception, differentiating between naturally conceived pregnancies, fresh embryo in vitro fertilisation (fresh-IVF) and frozen embryo transfer (frozen-IVF). DESIGN Retrospective cohort study. SETTING The French Burgundy Perinatal Network database, including all deliveries from 2006 to 2020, was linked to the regional blood centre database. POPULATION OR SAMPLE In all, 244 336 women were included, of whom 240 259 (98.3%) were singleton pregnancies. METHODS The main analyses were conducted in singleton pregnancies, including 237 608 naturally conceived, 1773 fresh-IVF and 878 frozen-IVF pregnancies. Multivariate logistic regression models adjusted on maternal age, body mass index, smoking, parity, induction of labour, hypertensive disorders, diabetes, placenta praevia and/or accreta, history of caesarean section, mode of delivery, birthweight, birth place and year of delivery, were used. MAIN OUTCOME MEASURES Major PPH was defined as PPH requiring blood transfusion and/or emergency surgery and/or interventional radiology. RESULTS The prevalence of major PPH was 0.74% (n = 1749) in naturally conceived pregnancies, 1.92% (n = 34) in fresh-IVF pregnancies, and 3.30% (n = 29) in frozen-IVF pregnancies. The risk of major PPH was higher in frozen-IVF pregnancies than in both naturally conceived pregnancies (adjusted odds ratio [aOR] 2.63, 95% CI 1.68-4.10) and fresh-IVF pregnancies (aOR 2.78, 95% CI 1.44-5.35). CONCLUSIONS We found that frozen-IVF pregnancies have a higher risk of major PPH and they should be subject to increased vigilance in the delivery room.
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Affiliation(s)
- Amélie Al-Khatib
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
| | - Paul Sagot
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Service de Biostatistique et d'Informatique Médicale (DIM), Dijon University Hospital, Dijon, France
| | - Massinissa Aroun
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Service de Biostatistique et d'Informatique Médicale (DIM), Dijon University Hospital, Dijon, France
- Clinical Epidemiology Unit, Inserm, CIC 1432, Dijon, France
- Clinical Investigation Centre, Dijon University Hospital, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Thomas Desplanches
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
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Dwarkanath P, Muhihi A, Sudfeld CR, Wylie BJ, Wang M, Perumal N, Thomas T, Kinyogoli SM, Bakari M, Fernandez R, Raj JM, Swai NO, Buggi N, Shobha R, Sando MM, Duggan CP, Masanja HM, Kurpad AV, Pembe AB, Fawzi WW. Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy. N Engl J Med 2024; 390:143-153. [PMID: 38197817 PMCID: PMC10921922 DOI: 10.1056/nejmoa2307212] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The World Health Organization recommends 1500 to 2000 mg of calcium daily as supplementation, divided into three doses, for pregnant persons in populations with low dietary calcium intake in order to reduce the risk of preeclampsia. The complexity of the dosing scheme, however, has led to implementation barriers. METHODS We conducted two independent randomized trials of calcium supplementation, in India and Tanzania, to assess the noninferiority of a 500-mg daily dose to a 1500-mg daily dose of calcium supplementation. In each trial, the two primary outcomes were preeclampsia and preterm birth, and the noninferiority margins for the relative risks were 1.54 and 1.16, respectively. RESULTS A total of 11,000 nulliparous pregnant women were included in each trial. The cumulative incidence of preeclampsia was 3.0% in the 500-mg group and 3.6% in the 1500-mg group in the India trial (relative risk, 0.84; 95% confidence interval [CI], 0.68 to 1.03) and 3.0% and 2.7%, respectively, in the Tanzania trial (relative risk, 1.10; 95% CI, 0.88 to 1.36) - findings consistent with the noninferiority of the lower dose in both trials. The percentage of live births that were preterm was 11.4% in the 500-mg group and 12.8% in the 1500-mg group in the India trial (relative risk, 0.89; 95% CI, 0.80 to 0.98), which was within the noninferiority margin of 1.16; in the Tanzania trial, the respective percentages were 10.4% and 9.7% (relative risk, 1.07; 95% CI, 0.95 to 1.21), which exceeded the noninferiority margin. CONCLUSIONS In these two trials, low-dose calcium supplementation was noninferior to high-dose calcium supplementation with respect to the risk of preeclampsia. It was noninferior with respect to the risk of preterm live birth in the trial in India but not in the trial in Tanzania. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT03350516; Clinical Trials Registry-India number, CTRI/2018/02/012119; and Tanzania Medicines and Medical Devices Authority Trials Registry number, TFDA0018/CTR/0010/5).
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Affiliation(s)
- Pratibha Dwarkanath
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Alfa Muhihi
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Christopher R Sudfeld
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Blair J Wylie
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Molin Wang
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Nandita Perumal
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Tinku Thomas
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Shabani M Kinyogoli
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Mohamed Bakari
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Ryan Fernandez
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - John-Michael Raj
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Ndeniria O Swai
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Nirmala Buggi
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Rani Shobha
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Mary M Sando
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Christopher P Duggan
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Honorati M Masanja
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Anura V Kurpad
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Andrea B Pembe
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Wafaie W Fawzi
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
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Cantor AG, Jungbauer RM, Skelly AC, Hart EL, Jorda K, Davis-O'Reilly C, Caughey AB, Tilden EL. Respectful Maternity Care : A Systematic Review. Ann Intern Med 2024; 177:50-64. [PMID: 38163377 DOI: 10.7326/m23-2676] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Severe maternal morbidity and mortality are worse in the United States than in all similar countries, with the greatest effect on Black women. Emerging research suggests that disrespectful care during childbirth contributes to this problem. PURPOSE To conduct a systematic review on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving maternal and infant health outcomes for those who are pregnant and postpartum, and strategies for implementation. DATA SOURCES Systematic searches of Ovid Medline, CINAHL, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and SocINDEX for English-language studies (inception to July 2023). STUDY SELECTION Randomized controlled trials and nonrandomized studies of interventions of RMC versus usual care for effectiveness studies; additional qualitative and noncomparative validation studies for definitions and measurement studies. DATA EXTRACTION Dual data abstraction and quality assessment using established methods, with resolution of disagreements through consensus. DATA SYNTHESIS Thirty-seven studies were included across all questions, of which 1 provided insufficient evidence on the effectiveness of RMC to improve maternal outcomes and none studied RMC to improve infant outcomes. To define RMC, authors identified 12 RMC frameworks, from which 2 main concepts were identified: disrespect and abuse and rights-based frameworks. Disrespect and abuse components focused on recognizing birth mistreatment; rights-based frameworks incorporated aspects of reproductive justice, human rights, and antiracism. Five overlapping framework themes include freedom from abuse, consent, privacy, dignity, communication, safety, and justice. Twelve tools to measure RMC were validated in 24 studies on content validity, construct validity, and internal consistency, but lack of a gold standard limited evaluation of criterion validity. Three tools specific for RMC had at least 1 study demonstrating consistency internally and with an intended construct relevant to U.S. settings, but no single tool stands out as the best measure of RMC. LIMITATIONS No studies evaluated other health outcomes or RMC implementation strategies. The lack of definition and gold standard limit evaluation of RMC tools. CONCLUSION Frameworks for RMC are well described but vary in their definitions. Tools to measure RMC demonstrate consistency but lack a gold standard, requiring further evaluation before implementation in U.S. settings. Evidence is lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. (PROSPERO: CRD42023394769).
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology; Department of Family Medicine; and Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.)
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., E.L.H., C.D.)
| | - Andrea C Skelly
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, and Aggregate Analytics, Fircrest, Washington (A.C.S.)
| | - Erica L Hart
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., E.L.H., C.D.)
| | - Katherine Jorda
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (K.J., A.B.C.)
| | - Cynthia Davis-O'Reilly
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., E.L.H., C.D.)
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (K.J., A.B.C.)
| | - Ellen L Tilden
- Department of Obstetrics and Gynecology and School of Nursing, Oregon Health & Science University, Portland, Oregon (E.L.T.)
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Planey AM, Bozkurt B, Aijaz M, Weinstein J, Khairat S, Shea CM. Telehealth Use by Pregnancy Stage Among Commercially Insured Patients in the United States, 2016-2019. Telemed J E Health 2024; 30:93-102. [PMID: 37327021 DOI: 10.1089/tmj.2022.0516] [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: 06/17/2023] Open
Abstract
Introduction: Relatively little is known about the proportion of maternal health services utilized through telehealth and whether rural-urban disparities in telehealth use exist throughout antenatal, delivery, and postpartum phases of maternal services. In this study, we describe patterns of care, including telehealth utilization, by rurality and racial/ethnic composition of the health service area during the antenatal, labor/delivery, and postpartum stages of pregnancy among commercially insured patients between 2016 and 2019. Methods: We present univariate and comparative descriptive statistics of patient and facility characteristics and site of care by the degree of rurality and racial/ethnic composition of the health service area (defined as geozips). The individual-level utilization data for 238,695 patients were aggregated to the geo-zip level (n = 404). Results: Between 2016 and 2019, 3.5% of pregnancy, delivery, and postpartum-related visits among commercially insured patients were delivered through telehealth. Telehealth use was higher in the antenatal (3.5% of claim lines) and postpartum (4.1% of claim lines) periods, compared with labor and delivery (0.7% of claim lines). We also found that the proportion of telehealth services (of total services billed) increased with the share of Black and Latinx residents at the geozip level. Discussion: Our findings highlight disparities in telehealth use, consistent with findings from studies using different data sources and time periods. Future research is needed to examine whether the relative differences in proportion of telehealth services, even if small, are associated with telehealth capacity in the hospital or community and why the proportion of telehealth services differs across community-level characteristics, specifically rurality and proportion of Black and Latinx residents.
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Affiliation(s)
- Arrianna Marie Planey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Burcu Bozkurt
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Monisa Aijaz
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Josh Weinstein
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Saif Khairat
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher M Shea
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Keepanasseril A, Maurya DK, Velmurugan B, Karuppusamy D, Pillai AA, Parameswaran S, Kar SS. Impact of near-miss event during pregnancy and childbirth on maternal health at 12 months. Int J Gynaecol Obstet 2024; 164:227-235. [PMID: 37489017 DOI: 10.1002/ijgo.15010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/17/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To assess the impact of maternal near-miss on late maternal death and the prevalence of hypertension or chronic kidney disease (CKD) and mental health problems at 12 months of follow up. METHODS This prospective cohort study was conducted in a tertiary hospital in the southeastern region of India from May 2018 to August 2019, enrolling those with maternal near-miss and with follow up for 12 months. The primary outcomes were incidence of late maternal deaths and prevalence of hypertension and CKD during follow up. RESULTS Incidence of maternal near miss was 6.7 per 1000 live births. Among those who had a near miss, late maternal deaths occurred in 7.2% (95% confidence interval [CI] 3.1%-11.3%); prevalence of CKD was 23.0% (95% CI 16.2%-29.8%), and of hypertension was 56.2% (95% CI 50.5%-66.5%) and only two women had depression on follow up. After adjusting for age, parity, socioeconomic status, gestational age at delivery, hemoglobin levels, and perinatal loss, only serum creatinine was independently associated with late maternal death and CKD on follow up. CONCLUSIONS Women who survive a life-threatening complication during pregnancy and childbirth are at increased risk of mortality and one or more long-term sequelae contributing to the non-communicable disease burden. A policy shift to increase postpartum follow-up duration, following a high-risk targeted approach after a near-miss event, is needed.
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Affiliation(s)
- Anish Keepanasseril
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Dilip Kumar Maurya
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Bharathi Velmurugan
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Dhamotharan Karuppusamy
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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Toffolutti V, Paglino E, Kentikelenis A, Mencarini L, Aassve A. Does bribery increase maternal mortality? Evidence from 135 Sub-Saharan African regions. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000847. [PMID: 38048332 PMCID: PMC10695367 DOI: 10.1371/journal.pgph.0000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/16/2023] [Indexed: 12/06/2023]
Abstract
About 295,000 women died globally during and following pregnancy and childbirth in 2017. Two-thirds of these deaths occurred in Sub-Saharan Africa. By linking individual and regional data from 135 regions in 17 Sub-Saharan African countries over the period 2002-2018 this study explores how bribery affects maternal mortality in Sub-Saharan Africa. Our results show that the percentage of people who had first-hand experience in bribery is significantly and positively associated with pregnancy related deaths. We find that a 10 p.p. increase in the prevalence of bribery is associated with up to 41 [95% CI: 10-73] additional deaths for every 1,000 pregnancy-related deaths. However, the healthcare system quality appears to be an important moderator. To reduce maternal mortality, policy makers should not only increase investments in healthcare, they need also to implement measures to combat corruption.
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Affiliation(s)
- Veronica Toffolutti
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
| | - Eugenio Paglino
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania (PA), United States of America
| | - Alexandros Kentikelenis
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Letizia Mencarini
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Arnstein Aassve
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
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Hackelöer M, Schmidt L, Verlohren S. New advances in prediction and surveillance of preeclampsia: role of machine learning approaches and remote monitoring. Arch Gynecol Obstet 2023; 308:1663-1677. [PMID: 36566477 PMCID: PMC9790089 DOI: 10.1007/s00404-022-06864-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/18/2022] [Indexed: 12/26/2022]
Abstract
Preeclampsia, a multisystem disorder in pregnancy, is still one of the main causes of maternal morbidity and mortality. Due to a lack of a causative therapy, an accurate prediction of women at risk for the disease and its associated adverse outcomes is of utmost importance to tailor care. In the past two decades, there have been successful improvements in screening as well as in the prediction of the disease in high-risk women. This is due to, among other things, the introduction of biomarkers such as the sFlt-1/PlGF ratio. Recently, the traditional definition of preeclampsia has been expanded based on new insights into the pathophysiology and conclusive evidence on the ability of angiogenic biomarkers to improve detection of preeclampsia-associated maternal and fetal adverse events.However, with the widespread availability of digital solutions, such as decision support algorithms and remote monitoring devices, a chance for a further improvement of care arises. Two lines of research and application are promising: First, on the patient side, home monitoring has the potential to transform the traditional care pathway. The importance of the ability to input and access data remotely is a key learning from the COVID-19 pandemic. Second, on the physician side, machine-learning-based decision support algorithms have been shown to improve precision in clinical decision-making. The integration of signals from patient-side remote monitoring devices into predictive algorithms that power physician-side decision support tools offers a chance to further improve care.The purpose of this review is to summarize the recent advances in prediction, diagnosis and monitoring of preeclampsia and its associated adverse outcomes. We will review the potential impact of the ability to access to clinical data via remote monitoring. In the combination of advanced, machine learning-based risk calculation and remote monitoring lies an unused potential that allows for a truly patient-centered care.
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Affiliation(s)
- Max Hackelöer
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Leon Schmidt
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Stefan Verlohren
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Bauer ME, Admon LK. Embracing Labor Neuraxial Analgesia as a Tool to Reduce Health Inequities and Hemorrhage-related Maternal Morbidity. Anesthesiology 2023; 139:717-718. [PMID: 37934107 DOI: 10.1097/aln.0000000000004783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Melissa E Bauer
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Lindsay K Admon
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
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Mahajan NN, Kesarwani S, Kumbhar P, Kuppusamy P, Pophalkar M, Thamke P, Asawa R, Sharan S, Mahale SD, Gajbhiye RK. Increased risk of early-onset preeclampsia in pregnant women with COVID-19. Hypertens Pregnancy 2023; 42:2187630. [PMID: 36891839 DOI: 10.1080/10641955.2023.2187630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To estimate incidence, risk of early and late-onset preeclampsia (PE) and understand their relationship with severity of COVID-19. METHODS Pregnant women with COVID-19 (n = 1929) were enrolled from 1 April 2020 to 24 February 2022. Primary outcome measure was incidence and risk of early onset PE in women with COVID-19. RESULTS The incidence of early and late-onset PE was 11.4% and 5.6%. Moderate to severe COVID-19 was associated with eight times higher risk of early onset PE [aOR = 8.13 (1.56-42.46), p = 0.0129] compared to asymptomatic group. CONCLUSIONS Risk of early onset PE was higher in pregnant women with symptomatic COVID-19 as compared to asymptomatic women.
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Affiliation(s)
- Niraj N Mahajan
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Shweta Kesarwani
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Padmaja Kumbhar
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Periyasamy Kuppusamy
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Madhura Pophalkar
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Pratiksha Thamke
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Ruchi Asawa
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Saumya Sharan
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Smita D Mahale
- Emeritus Scientist, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Rahul K Gajbhiye
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
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Oliveira D, de Oliveira JM, Martins MDR, Barroso MR, Castro R, Cordeiro L, Pereira F. Maternal Profiles and Pregnancy Outcomes: A Descriptive Cross-Sectional Study from Angola. Matern Child Health J 2023; 27:2091-2098. [PMID: 37815656 DOI: 10.1007/s10995-023-03782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To characterize pregnant women admitted to Irene Neto Maternity Hospital, Lubango city, Huíla province, and their pregnancy outcomes. METHODS We conducted a descriptive cross-sectional facility-based survey between October 2016 and September 2017, involving 500 pregnant women, followed from admission in labor until the end of delivery. Mean (SD) was computed for quantitative variables, while relative and absolute frequencies were determined for categorical variables. Additionally, confidence intervals were estimated. RESULTS Among pregnant women 18.3% were adolescents (≤ 19 years) and 14.5% had advanced maternal age (≥ 35 years). Illiteracy was reported by 8.2%. One in three (33.6%) had a short stature (< 1.55 m). Malaria was the most frequent infection during pregnancy (16.3%). Upon admission, 18.1% were anemic (Hb < 11 g/dl) and 36.0% had hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), contrasting with the few cases reported of chronic hypertension and pregnancy-induced hypertension. There were 15 twin pregnancies. Cesarean section was performed in 25.2% of the women, although there was no medical indication for 23.0% of women having cesareans. Two maternal deaths occurred in our sample. Among live births from singleton pregnancies (97.1%), birth asphyxia (Apgar < 7 at 5 min) was observed in 22.7% and 10.3% had low birth weight (< 2.5 kg). CONCLUSIONS There are very few studies reporting pregnancy outcomes in Angola. This analysis presents data from Huíla province, the second most populous province. We identified characteristics for higher risk of adverse pregnancy outcomes: adolescence, illiteracy, and short stature. Among newborn outcomes, birth asphyxia and low birth weight demand special attention. Further research is needed to explore the non-medical indications for cesarean section and to better understand the twinning rate in Lubango.
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Affiliation(s)
- Dinamene Oliveira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal.
| | | | - Maria do Rosário Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria Rosalina Barroso
- Unidade de Cuidados Intensivos Neonatais, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Rita Castro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
| | - Lemuel Cordeiro
- Gabinete de Ensino, Pesquisa e Pós-graduação, Clínica Girassol, Luanda, Angola
| | - Filomena Pereira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
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Williams CR, Valeria Bahamondes M, Gómez Ponce de León R, da Costa Machado H, Bahamondes L, Caffe S, Serruya SJ. Analysing the context and characteristics of legal abortion and comprehensive post-abortion care among adolescents aged 10-14 in a network of sentinel centres in Latin America: a retrospective cross-sectional study, 2016-2020. Sex Reprod Health Matters 2023; 31:2175442. [PMID: 36919908 PMCID: PMC10026806 DOI: 10.1080/26410397.2023.2175442] [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: 03/16/2023] Open
Abstract
Pregnancy-related complications are a substantial source of morbidity and mortality among adolescents in low- and middle-income countries. While the youngest adolescents (those aged 10-14) are considered to be at particularly high risk of adverse outcomes, there is little empirical data available on their sexual and reproductive health. Using a unique dataset of clinical records drawn from a regional network of sentinel centres providing legal abortion and comprehensive post-abortion care in 12 Latin American and Caribbean countries, we described the population of adolescents aged 10-14 seeking legal abortion and post-abortion care and calculated institutional rates of complications, using older adolescents (aged 15-19) and young adults (aged 20-24) as comparator groups. We also assessed the quality of care provided as compared to WHO recommendations. Nearly 17% (89 out of 533) of young adolescents sought care when they were already at 15 or more weeks' gestation. Young adolescents were at higher risk of pre-procedure and intra-operative complications than older adolescents and young adults, though the trend is less clear for the most severe complications. In general, the quality of care provided by centres in the network was aligned with WHO recommendations for safe abortion and comprehensive post-abortion care. Taken together, these findings provide insight into the challenges facing the global health community in assuring the sexual and reproductive health and rights of the youngest adolescents, and outline avenues for future research, advocacy, and evidence-based policymaking.
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Affiliation(s)
- Caitlin R Williams
- PhD Candidate, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Valeria Bahamondes
- International Consultant, Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Rodolfo Gómez Ponce de León
- Regional Reproductive Health Advisor, Latin American Center for Perinatology/Women's Health and Reproductive Health Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Helymar da Costa Machado
- Statistician, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Cidade Universitária, Rua Alexander Fleming 101, Campinas, SP 13083-881, Brazil
| | - Luis Bahamondes
- Professor of Gynaecology, Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Sonja Caffe
- Regional Adolescent Health Advisor, Pan American Health Organization/World Health Organization, Washington, DC, USA
| | - Suzanne Jacob Serruya
- Director, Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
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Fu R, Li Y, Li X, Jiang W. Hypertensive Disorders in Pregnancy: Global Burden From 1990 to 2019, Current Research Hotspots and Emerging Trends. Curr Probl Cardiol 2023; 48:101982. [PMID: 37479005 DOI: 10.1016/j.cpcardiol.2023.101982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
Hypertensive disorders in pregnancy (HDP) constitute a worldwide health problem for pregnant women and their infants. This study provided HDP burden over 1990 to 2019 by region and age distribution, and predicted changes in related values for the next 25 years. We then conducted an econometric analysis of the author distribution, collaborative networks, keyword burst clustering, and spatio-temporal analysis of HDP-related publications from 2012 to 2022 to access current scientific developments and hotspots. The number of pregnant women with HDP has been increasing over the past 30 years, with regional and age-stratified differences in the burden of disease. Additionally, projections suggest an increase of deaths due to maternal HDP among adolescents younger than 20 years. Current research is mostly centered on pre-eclampsia, with hot keywords including trophoblast, immune tolerance, frozen-thawed embryo transfer, aspirin, gestational diabetes association, and biomarkers. Researches on the pathological mechanism, classification, and subtypes of HDP need to be further advanced.
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Affiliation(s)
- Ru Fu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yihui Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaogang Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Jiang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China.
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Glenzer MM, Correia M, Nhantumbo V, Barnes RF, Luis E, Boaventura I, Manguele N, Silva P, von Drygalski A. Postpartum hemorrhage in Sub-Saharan Africa-a prospective study in metropolitan Mozambique. J Thromb Haemost 2023; 21:3463-3476. [PMID: 37709148 DOI: 10.1016/j.jtha.2023.09.002] [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: 03/22/2023] [Revised: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Estimates indicate approximately ≈500 to 1000 maternal deaths per 100,000 live births in Sub-Saharan Africa (SSA) (vs ≈5-20 in developed countries). Postpartum hemorrhage (PPH) seems a major contributor to maternal mortality (MM), but there are no comprehensive data for the region. OBJECTIVES Analyze MM, PPH, and associated risk factors. METHODS We collected prospective data on MM, PPH, and associated risk factors in metropolitan Mozambique. We recorded consecutive deliveries at the Maputo Central Hospital between February 2019 and January 2021. Data included age, HIV status, parity, delivery mode, notes, vital signs, laboratory values, and fetal parameters. PPH was determined by charted diagnosis, blood loss of >500 mL, transfusion, and/or notes indicating significant bleeding. RESULTS Of 8799 deliveries, ≈40% occurred in women residing outside Maputo City ("nonlocal"), with similar demographic characteristics between local and nonlocal women. However, compared with local women, nonlocal women had worse outcomes, including higher rates of MM (1.52% vs 0.78%; P =.0012) and PPH (16.51% vs 12.39%; P <.0001), whereby PPH was strongly associated with MM (adjusted odds ratio = 5.56; P <.0001). Almost all women with uterine atony (≈1%) experienced PPH. For women receiving laboratory tests on admission (drawn only if in distress; local, n = 561; nonlocal, n = 514), both cohorts revealed similar distributions of hemoglobin levels and platelet counts. Prepartum anemia (≈57%) and thrombocytopenia (≈21%) were prominent risk factors for PPH; risk increased with increasing severity and was additive in the presence of both. CONCLUSIONS PPH is a serious problem in Maputo province, a metropolitan area of SSA, portending high MM. Identification of correctable risk factors, including anemia, should catalyze the development of region-specific prevention protocols.
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Affiliation(s)
- Michael M Glenzer
- Department of Medicine, University of California San Diego, San Diego, California, USA.
| | - Momade Correia
- Department of Gynecology/Obstetrics, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Virgilio Nhantumbo
- Department of Hematology, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Richard Fw Barnes
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Elvira Luis
- Department of Gynecology/Obstetrics, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Ines Boaventura
- Department of Gynecology/Obstetrics, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Nelia Manguele
- Department of Hematology, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Patricia Silva
- Department of Hematology, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique
| | - Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, California, USA
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Hemat S, Alemi S, Ahmady S, Nakamura K. Increase in institutional delivery and child immunisation coverage through an appreciative inquiry-based community dialogue intervention in Afghanistan. PUBLIC HEALTH IN PRACTICE 2023; 6:100436. [PMID: 37859869 PMCID: PMC10582473 DOI: 10.1016/j.puhip.2023.100436] [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: 05/18/2023] [Revised: 09/03/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Objective A community dialogue intervention with an appreciative inquiry approach was undertaken to improve institutional delivery and child immunisation coverage in a hard-to-reach province, namely, Kandahar, in Afghanistan. This study aimed to evaluate the intervention's effectiveness in promoting institutional delivery and child immunisation. Study design A pre-post intervention evaluation study. Methods An intervention and a non-intervention district were selected in Kandahar. Children aged under 5 years participated in surveys at baseline (October 2018) and follow-up (Post-intervention: November 2019). We analysed age, sex, place of birth, and confirmed immunisation coverage data concerning 1046 and 927 children pre- and post-interventions, respectively. Changes in institutional delivery and confirmed immunisation status were evaluated using net intervention effect and difference-in-difference (DID) analysis. Results Institutional delivery rates increased from 66.3% to 83.6% (p = 0.016) in the intervention district and decreased from 71.3% to 46.7% (p < 0.001) in the non-intervention district, with a net intervention effect of 41.9%. Full immunisation coverage among children aged 12-23 months and 24-35 months significantly increased from 26.4% to 76.9% (p < 0.001) and from 40.0% to 78.6% (p < 0.001), respectively, in the intervention district, whereas coverage significantly decreased in the non-intervention district. The net intervention effects were 59.1% and 44.8% for children aged 12-23 months and 24-35 months, respectively. The DID analysis also revealed significant differences in outcomes after intervention at follow-up. The results concerning antigen-specific immunisation coverage indicated a significant increase in immunisation coverage in the intervention district. Conclusions The appreciative inquiry-based community dialogue intervention considerably increased institutional delivery and child immunisation coverage, even in a hard-to-reach province in Afghanistan.
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Affiliation(s)
- Shafiqullah Hemat
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
- Ministry of Public Health, Kabul, Afghanistan
| | - Sharifullah Alemi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | | | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
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Rice B, Mbatidde L, Oluleye O, Onwuanyi A, Adedinsewo D. Managing hypertension in African Americans with heart failure: A guide for the primary care clinician. J Natl Med Assoc 2023:S0027-9684(23)00144-X. [PMID: 38135590 DOI: 10.1016/j.jnma.2023.11.004] [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: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Hypertension is the predominant risk factor for cardiovascular disease related morbidity and mortality among Black adults in the United States. It contributes significantly to the development of heart failure and increases the risk of death following heart failure diagnosis. It is also a leading predisposing factor for hypertensive disorders of pregnancy and peripartum cardiomyopathy in Black women. As such, all stakeholders including health care providers, particularly primary care clinicians (including physicians and advanced practice providers), patients, and communities must be aware of the consequences of uncontrolled hypertension among Black adults. Appropriate treatment strategies should be identified and implemented to ensure timely and effective blood pressure management among Black individuals, particularly those with, and at risk for heart failure.
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Affiliation(s)
- Bria Rice
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Lydia Mbatidde
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, United States
| | | | - Anekwe Onwuanyi
- Department of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Demilade Adedinsewo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States.
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