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Xie L, Liang Z, Wang X, Luo X. The prevalence of preterm and low birth weight infants among migrant women in the Pearl River Delta region, China: a population-based birth cohort study. BMC Public Health 2024; 24:1179. [PMID: 38671398 PMCID: PMC11055229 DOI: 10.1186/s12889-024-18667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The existing literature evaluating the association between neonatal morbidity and migrant status presents contradictory results. The purpose of this study was to compare the risk of preterm birth (PTB) and low birth weight (LBW) among newborns from local and migrant women in China's Pearl River Delta (PRD) region. METHODS In this observational population-based study, we included all live singleton deliveries from PRD region local women and migrant women. Data were sourced from the Guangdong Medical Birth Registry Information System between Jan 1, 2014, and Dec 31, 2020. Women were categorized into three groups by maternal migrant status: local women from PRD region, migrant women from Guangdong province or from other provinces. The outcome variables that were examined included two adverse birth outcomes: PTB and LBW. The association between the risk of PTB and LBW and maternal migrant status was assessed using logistic regression. RESULTS During 2014-2020, 5,219,133 single live deliveries were recorded, corresponding 13.22% to local women and the rest to migrant women coming from Guangdong (53.51%) and other provinces (33.26%). PTB prevalence was highest among local women (5.79%), followed by migrant women from Guangdong (5.29%), and the lowest among migrants from other provinces (4.95%). This association did not change after including maternal age, infant sex, delivery mode, and birth season in the models. Compared to local women, migrant women from other provinces had a lower risk of LBW (4.00% vs. 4.98%, P < 0.001). The prevalence of PTB and LBW was higher among local women than migrants. The odds of delivery PTB and LBW were higher for women who were age ≥ 35. Among the three maternal migration groups, the age-LBW association displayed a typical U-shaped pattern, with those in the youngest (16-24 years) and oldest (≥ 35) age categories exhibiting the higher odds of delivering a LBW neonate. With respect to infant sex, the prevalence of PTB was significantly higher in males than females among the three maternal migration groups. An opposite trend was found for LBW, and the prevalence of LBW was higher in females among the three maternal migration groups. CONCLUSION The findings of this study contribute to the understanding of the epidemiology of PTB and LBW among migrant women. Our study suggests that it is the health and robust nature of migrant mothers that predisposes them to better birth outcomes. It is important to recognize that the results of this study, while supportive of the healthy migrant effect, cannot be considered definitive without some exploration of motivation for moving and changes in lifestyle postmigration.
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Affiliation(s)
- Lulu Xie
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Zhijiang Liang
- Department of Public Health, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Xionghu Wang
- Department of Health Care, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Xianqiong Luo
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, 511442, China.
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Gebremichael MA, Lema TB. Effect of behavior change communication through the health development army on birth weight of newborns in Ambo district, Ethiopia: a cluster randomized controlled community trial. BMC Womens Health 2024; 24:200. [PMID: 38532388 PMCID: PMC10964566 DOI: 10.1186/s12905-024-03009-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: 06/01/2022] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Poor behavior change communication on maternal nutrition and health throughout pregnancy is thought to be to blame for Ethiopia's high rate of low birthweight babies, and this has implications for neonatal morbidity and mortality. The effect of behavior change communication on birth weight in the study district was not examined. This study was to determine whether improving neonatal birthweight using nutrition and health behavior change communication (NHBCC) interventions was successful. METHODS A cluster randomized controlled trial was conducted in the Ambo district of Ethiopia from May 5, 2018-January 30, 2019. At the beginning of the study, 385 women in the 24 intervention groups and 385 women in the 24 control groups were recruited. In the intervention group, health development armies delivered the NHBCC core message every two weeks for four months by grouping pregnant women in specific clusters. Pregnant women in the control group received the routine treatment offered by the healthcare system during their ANC visits. Within 24 h of birth, the birthweights of 302 and 292 neonates in the intervention and control groups, respectively, were measured at the end point of the study. A binary generalized linear model analysis was employed. RESULT The control group had a larger absolute risk of neonates with low birthweight (0.188 vs. 0.079, p < 0.001) than the intervention group. Pregnant women in the intervention group had an absolute risk difference of 10.9% for low birthweight. Pregnant women who received the intervention were 62% less likely to have low-risk birthweight compared to pregnant women who were in the control group (ARR = 0.381, 95% CI: 0.271-0.737). CONCLUSION Nutrition and health behavior change Communication by health development armies improves birthweight. The findings demonstrated that to improve birthweight, NHBCC must be administered to pregnant women in groups via health development armies in their communities. TRIAL REGISTRATION NUMBER PACTR201805003366358.
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Affiliation(s)
- Mitsiwat Abebe Gebremichael
- Department of Public Health, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia.
- Ambo University, P. O. Box 19, Ambo, Ethiopia.
| | - Tefera Belachew Lema
- Department of Nutrition and Dietetics, Faculty of Public health, Jimma University, Jimma, Ethiopia
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Vanzele PAR, Sparvoli LG, de Camargo PP, Tragante CR, Beozzo GPNS, Krebs VLJ, Cortez RV, Taddei CR. Establishment of oral microbiome in very low birth weight infants during the first weeks of life and the impact of oral diet implementation. PLoS One 2023; 18:e0295962. [PMID: 38100452 PMCID: PMC10723731 DOI: 10.1371/journal.pone.0295962] [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: 08/30/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
Very low birth weight (VLBW) infants, mostly preterm, have many barriers to feeding directly from the mother's breast, and need to be fed alternatively. Feeding is a major influencer in oral microbial colonization, and this colonization in early life is crucial for the promotion of human health. Therefore, this research aimed to observe the establishment of oral microbiome in VLBW infants during their first month of life through hospitalization, and to verify the impact caused by the implementation of oral diet on the colonization of these newborns. We included 23 newborns followed during hospitalization and analyzed saliva samples collected weekly, using 16S rRNA gene sequencing. We observed a significant decrease in richness and diversity and an increase in dominance over time (q-value < 0.05). The oral microbiome is highly dynamic during the first weeks of life, and beta diversity suggests a microbial succession in early life. The introduction of oral diet does not change the community structure, but affects the abundance, especially of Streptococcus. Our results indicate that although time is related to significant changes in the oral microbial profile, oral feeding benefits genera that will remain colonizers throughout the host's life.
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Affiliation(s)
- Pedro A. R. Vanzele
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Luiz Gustavo Sparvoli
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Patricia P. de Camargo
- Neonatal Intensive Care Center, Children’s Institute, Hospital das Clínicas, São Paulo Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Carla R. Tragante
- Neonatal Intensive Care Center, Children’s Institute, Hospital das Clínicas, São Paulo Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Glenda P. N. S. Beozzo
- Neonatal Intensive Care Center, Children’s Institute, Hospital das Clínicas, São Paulo Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Vera L. J. Krebs
- Neonatal Intensive Care Center, Children’s Institute, Hospital das Clínicas, São Paulo Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Ramon V. Cortez
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Carla R. Taddei
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
- School of Arts, Sciences and Humanity, University of São Paulo, São Paulo, SP, Brazil
- Division of Clinical Laboratory, University Hospital ‐ University of São Paulo, São Paulo, SP, Brazil
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He S, Zhang H, Liu X, Li Y, Wang B, Zhang X, Chen H. Under-5, infant, and neonatal mortality trends and causes of death, 1991-2022: Findings from death surveillance in Xicheng district of Beijing, China. Prev Med Rep 2023; 36:102461. [PMID: 38116270 PMCID: PMC10728313 DOI: 10.1016/j.pmedr.2023.102461] [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: 05/29/2023] [Revised: 08/08/2023] [Accepted: 10/05/2023] [Indexed: 12/21/2023] Open
Abstract
Overall, China has made substantial progress in improving child survival over the past few decades, but a detailed understanding of child mortality trend at local level is limited. This study aimed to present a comprehensive analysis of under-5, infant, and neonatal mortality rates and its trend in Xicheng district of Beijing, China. We used the surveillance data of under-5 children reported by Preventive Health Department of Xicheng District Community Health Service Center from 1991 to 2022. The data was collected based on the Child Death Reporting Card of the Beijing Under-5 Mortality Rate Surveillance Network. Data check was performed by each community health service center and related medical institutions. We extracted data included maternal age, date of death, date of birth, gender, census register, classification of any causes of death, and utilization of healthcare services before death and doubly input it in the Excel 2016 program. Categorization of the causes of death was adapted by the International Categorization of Diseases (ICD-10). Mortality rates and distribution of the leading causes of death were analyzed with descriptive statistics and the Pearson's Chi-square test using SAS 14.0 software. The Chi-square trend test was used to explore the trends in mortality. Interrupted time series analysis (ITSA) was conducted to assess the impact of the two-child policy on mortality using STATA statistical packages. From 1991 to 2022, totally, there were 166,061 live births and 793 (4.78 ‰) under-5 deaths. The mortality rates of under-5 children, infants and neonates in Xicheng district decreased from 14.75 ‰, 11.25 ‰ and 8.00 ‰ to 1.03 ‰, 0.83 ‰ and 0.41 ‰ respectively. All mortality rates showed an overall significant decline trend (χ2 trend for neonatal = -15.8136, P trend for neonatal < 0.001; χ2 trend for infant = -17.6652, P trend for infant < 0.001; χ2 trend for under-5 = -18.9103, P trend for under-5 < 0.001). The leading causes of death among under-5 children were congenital heart disease (1.65 ‰), birth asphyxia (1.44 ‰), and other congenital abnormalities (except congenital heart disease and down's syndrome) (1.36 ‰). ITSA results showed that the two-child policy did not change the overall decreased trend of child mortality rates. Future preventive measures for child healthcare should give a priority for congenital heart disease, birth asphyxia, and other congenital abnormalities.
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Affiliation(s)
- Shuqing He
- Xicheng District Maternal and Child Health Hospital, Beijing 100054, PR China
| | - Haoran Zhang
- College of Preschool Education, Beijing Youth Politics College, Beijing 100102, PR China
| | - Xiaorong Liu
- Xicheng District Maternal and Child Health Hospital, Beijing 100054, PR China
| | - Yugang Li
- College of Preschool Education, Beijing Youth Politics College, Beijing 100102, PR China
| | - Bing Wang
- Xicheng District Maternal and Child Health Hospital, Beijing 100054, PR China
| | - Xiaowen Zhang
- Xicheng District Maternal and Child Health Hospital, Beijing 100054, PR China
| | - Huiyan Chen
- Xicheng District Maternal and Child Health Hospital, Beijing 100054, PR China
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Zhou R, Yu H, Qian N, Jin S, Cai R, Chen L, Wang C, Wu F. Secular trends of low birth weight, preterm birth, and small for gestational age in Shanghai from 2004 to 2020: an age-period-cohort analysis. BMC Pregnancy Childbirth 2023; 23:540. [PMID: 37495942 PMCID: PMC10373378 DOI: 10.1186/s12884-023-05799-9] [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: 12/08/2022] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Although highly heterogeneous among countries, the incidence rates of low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA) have been increasing globally over the past two decades. To better understand the cause of these secular trends, this study aimed to investigate the effects of age, period, and birth cohort on LBW, PTB, and SGA rates in Shanghai. METHODS Data from 2,958,695 singleton live births at 24-41 gestational weeks between 2004 and 2020 were obtained for this study. Age-period-cohort models based on Poisson regression were used to evaluate the independent effects of maternal age, delivery period, and maternal birth cohort on the trends in LBW, PTB, and SGA. RESULTS The overall prevalence rates of LBW, PTB, and SGA were 2.9%, 4.7%, and 9.3%, respectively, and significant changes were observed (average annual change: + 10.7‰, + 9.1‰, -11.9‰) from 2004 to 2020. Cohort effect increased steadily, from 1960 (risk ratio [RR] = 0.71, 95% confidence interval [CI]: 0.65-0.78) to 1993 (RR = 0.97, 95% CI: 0.94-1.01) for LBW and from 1960 (RR = 0.69, 95% CI: 0.64-0.75) to 2004 (RR = 1.02, 95% CI: 0.94-1.12) for PTB. A strong cohort effect was found with the highest risk of SGA (RR = 1.82, 95% CI: 1.72-1.93) in 1960 and the lowest risk (RR = 0.57, 95% CI: 0.54-0.61) in 2004, compared with the reference cohort of 1985. There was a "U-shaped" maternal age effect on LBW and PTB and a weak period effect on the three birth outcomes. CONCLUSIONS Our findings suggested a significant independent effect of age, period, and birth cohort on the three birth outcomes. The increasing rates of LBW and PTB motivated us to focus on young and advanced pregnant women. Meanwhile, the prevalence of SGA decreased steadily, illustrating the need for further research on the mechanisms underlying these trends.
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Affiliation(s)
- Rongfei Zhou
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Huiting Yu
- School of Public Health, Fudan University, Shanghai, 200032, China
- Vital Statistical Department, Shanghai Municipal Center for Disease Control and Prevention, Institute of Health Information, Shanghai, 200336, China
| | - Naisi Qian
- Vital Statistical Department, Shanghai Municipal Center for Disease Control and Prevention, Institute of Health Information, Shanghai, 200336, China
| | - Shan Jin
- Vital Statistical Department, Shanghai Municipal Center for Disease Control and Prevention, Institute of Health Information, Shanghai, 200336, China
| | - Renzhi Cai
- Vital Statistical Department, Shanghai Municipal Center for Disease Control and Prevention, Institute of Health Information, Shanghai, 200336, China
| | - Lei Chen
- Vital Statistical Department, Shanghai Municipal Center for Disease Control and Prevention, Institute of Health Information, Shanghai, 200336, China
| | - Chunfang Wang
- Vital Statistical Department, Shanghai Municipal Center for Disease Control and Prevention, Institute of Health Information, Shanghai, 200336, China
| | - Fan Wu
- School of Public Health, Fudan University, Shanghai, 200032, China.
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Papadopoulou SK, Mentzelou M, Pavlidou E, Vasios GK, Spanoudaki M, Antasouras G, Sampani A, Psara E, Voulgaridou G, Tsourouflis G, Mantzorou M, Giaginis C. Caesarean Section Delivery Is Associated with Childhood Overweight and Obesity, Low Childbirth Weight and Postnatal Complications: A Cross-Sectional Study. Medicina (B Aires) 2023; 59:medicina59040664. [PMID: 37109623 PMCID: PMC10146198 DOI: 10.3390/medicina59040664] [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: 02/26/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Background and Objectives: In the last decades, simultaneously increasing trends have been recorded for both caesarean section delivery and childhood overweight/obesity around the world, which are considered serious public health concerns, negatively affecting child health. Aim: The present study aims to investigate whether caesarean section is associated with the increased rates of childhood overweight/obesity, low childbirth anthropometric indices and postnatal complications in pre-school age. Materials and Methods: This is a cross-sectional study in which 5215 pre-school children aged 2–5 years old were enrolled from nine different Greek regions after applying specific inclusion and exclusion criteria. Non-adjusted and adjusted statistical analysis was performed to assess the impact of caesarean section in comparison to vaginal delivery. Results: Children delivered by caesarean section were significantly more frequently overweight or obese at the age of 2–5 years, also presenting a higher prevalence of low birth weight, length and head circumference. Caesarean section was also associated with higher incidence of asthma and diabetes type I at the age of 2–5 years. In a multivariate analysis, caesarean section increased the risk of childhood overweight/obesity and low childbirth anthropometric indices even if adjusting for several childhood and maternal confounding factors. Conclusions: Increasing trends were recorded for both caesarean section delivery and childhood overweight/obesity, which are considered serious public health concerns. Caesarean section independently increased childhood overweight/obesity in pre-school age, highlighting the emergent need to promote health policies and strategies to inform future mothers about its short and long-term risks and that this mode of delivery should preferably be performed only when there are strong medical recommendations in emergency obstetric conditions.
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Affiliation(s)
- Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
- Correspondence: (S.K.P.); (C.G.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Georgios K Vasios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Anastasia Sampani
- First Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
- Correspondence: (S.K.P.); (C.G.)
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Sindiani A, Awadallah E, Alshdaifat E, Melhem S, Kheirallah K. The relationship between maternal health and neonatal low birth weight in Amman, Jordan: a case-control study. J Med Life 2023; 16:290-298. [PMID: 36937486 PMCID: PMC10015569 DOI: 10.25122/jml-2022-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/30/2023] [Indexed: 03/21/2023] Open
Abstract
This study aimed to examine the relationship between maternal health during pregnancy and low birth weight (LBW), as well as the impact of COVID-19 on the socio-economic status of pregnant women and its effect on LBW. The study was conducted in Amman, Jordan, and included 2260 mothers who visited Abu-Nusair comprehensive health center between January and December 2020. A matched case-control design was used with 72 cases and 148 controls selected for data collection through medical records and face-to-face interviews. Results showed that factors such as a monthly income of 400 JD or less, living with an extended family, exposure to passive smoking, maternal weight gain of 6-10 kg, maternal anemia, maternal hypertension, delivery by cesarean section, and previous history of LBW newborns were positively associated with an increased risk of LBW. Conversely, factors such as a monthly income above 700 JD, living with a core family, daily intake of iron, calcium, and vitamin D, prenatal visits, healthy food intake, and planning for pregnancy were associated with a lower risk of LBW. COVID-19 infection and its effects on work, family finances, antenatal care visits, and food supply were also positively linked with LBW. In conclusion, socioeconomic status, maternal health, COVID-19, and its impacts were significant risk factors for LBW.
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Affiliation(s)
- Amer Sindiani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- Corresponding Author: Amer Sindiani, Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. E-mail:
| | - Ekram Awadallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Eman Alshdaifat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Shatha Melhem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Xu Z, Liu H, Zhou S, Chen T, Meng C, Li S, Yan X, Liu X. Trend analysis of mortality rates and causes of death in children under 5 years of age in Xuzhou, China from 2016 to 2020. Front Pediatr 2023; 11:1067293. [PMID: 36896397 PMCID: PMC9990838 DOI: 10.3389/fped.2023.1067293] [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] [Received: 10/11/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
Objectives To analyze the trends in mortality and causes of death among children under 5 years of age in Xuzhou, China between 2016 and 2020, in order to protect children's health and provide a basis for formulating child survival, development, and protection strategies. Methods A population-based epidemiological study was conducted. Data were obtained from the Xuzhou Center for Disease Control Prevention. We input the data into the excel database and analyzed with SPSS20.0. Results There were 1,949 children under 5 years of age died in Xuzhou, The number of deaths from 2016 to 2020 were 573 (29.40%), 577 (29.60%), 371 (19.04%), 334 (17.14%), and 94 (4.82%) respectively, mortality in children showed a downward trend. The number of deaths was relatively high in January (195 cases, 10.01%), February (190 cases, 9.75%), and May (180 cases, 9.24%), while was relatively small in July (147 cases, 7.54%), August (139 cases, 7.13%), and September (118 cases, 6.05%). The leading causes of death (COD) in children under 5 years of age were neonatal suffocation and hypoxia (323 cases, 16.57%). Pizhou (528 cases, 27.09%) showed the highest number of deaths in children under 5 years of age in China, and the Kaifa (25 cases, 1.28%) zone showed the lowest death toll. Conclusions Our research suggested that the current strategies for reducing child mortality should prioritize the actions on neonatal deaths and conduct targeted interventions for the main cause.
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Affiliation(s)
- Zhiyuan Xu
- Department of Emergency, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Haonan Liu
- Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shuaishuai Zhou
- Department of Cardiovascular, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Tiancheng Chen
- Department of Emergency, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chao Meng
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shengli Li
- Department of Medical Record Statistics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xianliang Yan
- Department of Emergency, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Emergency, Suining County People's Hospital, Xuzhou, China
| | - Xiao Liu
- Department of Emergency, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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9
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Lu L, Zhao S, Chen Y. Air pollution and timing of childbirth: a retrospective survey analysis based on birth registration data of Chinese newborns. Front Public Health 2023; 11:1032852. [PMID: 37206867 PMCID: PMC10189152 DOI: 10.3389/fpubh.2023.1032852] [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: 08/31/2022] [Accepted: 04/07/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives Currently, there is a lack of research on whether people will take action to avoid the harm of air pollution and the heterogeneous behavior of different groups. The goal of this paper is to examine the effects of air pollution on the resulting differential effects on newborns and the timing of pregnancy. Methods Based on a survey of newborns in a total of 32 hospitals in 12 cities across China in 2011, and after matching with city-level air pollution data, a multiple regression statistical method is then used to examine how the pollution level in a certain period is related to the number of conceptions in that certain period, after controlling for region and season fixed effects. Results We first demonstrate that exposure to air pollution during pregnancy is associated with a significant increase in adverse birth outcomes. Most importantly, the empirical results show that the number of conceptions decreased significantly during periods of severe air pollution. Conclusion Evidence suggests that air pollution may be causing some families to delay conception to reduce the possible adverse impact on neonatal outcomes. This helps us to understand the social cost of air pollution more, and then make more accurate environmental policies.
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Affiliation(s)
- Liqi Lu
- School of Economics, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuxiao Chen
- School of Politics and Public Administration, Zhengzhou University, Zhengzhou, Henan Province, China
- *Correspondence: Yuxiao Chen,
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Jiang Q, Liu R, Liu T, Liang J, Wu Y, Feng B, Liu S, Li H, Pan D, Qiu X, Huang D. Relationship between exposure of alkylphenols in serum of pregnant women during early pregnancy and adverse birth outcomes. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:52954-52963. [PMID: 35274207 DOI: 10.1007/s11356-022-19445-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Alkylphenols are a type of endocrine disruptors, which are commonly found in personal care products, food, and water and are more harmful to the human body. To investigate the relationship between exposure of alkylphenols in serum of pregnant women during early pregnancy and adverse birth outcomes, a total of 2035 healthy pregnant women and their neonates were recruited in the birth cohort of Zhuang nationality in Guangxi from 2015 to 2018. The peripheral venous blood samples were collected from pregnant women in early pregnancy; the concentrations of nonylphenol (NP), 4-nonylphenol (4-N-NP), 4-tert-octylphenol (4-T-OP), and 4-n-octylphenol (4-N-OP) in serum were detected by ultra-performance liquid performance chromatography-tandem mass spectrometry (UPLC-MS). Binary logistic regression showed that NP [OR = 1.40 (95% CI: 1.00, 1.94)] was positively associated with preterm birth. Restricted cubic spline analyses showed that logNP and log4-T-OP had non-linearity associations with preterm birth (logNP: Poverall = 0.006, Pnon-linear = 0.003; log4-T-OP: Poverall = 0.004, Pnon-linear = 0.002). Multiple linear regression analysis showed that maternal serum concentration of NP was negatively associated with birth weight of perinatal infants (β = -14.68, 95% CI: -29.18, -0.19), which may be sensitive in male neonates (β = -26.18, 95% CI: -47.33, -5.02). The findings demonstrate that nonylphenol is a risk factor of preterm birth, and nonylphenol is negatively associated with the birth weight in male infants.
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Affiliation(s)
- Qunjiao Jiang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Runfeng Liu
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Tao Liu
- Huaihua Center for Disease Control and Prevention, Huaihua, 418000, Hunan, China
| | - Jun Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yanan Wu
- Medical Administration Division, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebe, 075000, China
| | - Baoying Feng
- Department of Nutrition, RuiKang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine, Nanning, 530011, Guangxi, China
| | - Shun Liu
- Department of Child and Adolescent Health & Maternal and Child Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Han Li
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Dongxiang Pan
- Department of Child and Adolescent Health & Maternal and Child Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Dongping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China.
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Ahenkorah B, Sakyi SA, Helegbe G, Owiredu EW, Fondjo LA, Ofosu W, Der EM, Amoani B, Larbi AA, Cheetham S, Arthur-Johnson P, Kwablah GJ, Gyan B. Foeto-maternal complications associated with low birth weight: A prospective multicenter study in northern Ghana. PLoS One 2022; 17:e0266796. [PMID: 35395061 PMCID: PMC8992983 DOI: 10.1371/journal.pone.0266796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/11/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
The study evaluated the socio-demographic characteristics, obstetric variables and foeto-maternal complications associated with low birth weight (LBW) in order to provide better treatment and management options.
Methods
The prospective study conducted from February, 2019 to June, 2020 recruited 312 primigravid pregnant women who reported for antenatal care in three tertiary referral hospitals in northern Ghana. Their socio-demographic, obstetric and adverse foeto-maternal outcome information were obtained with a well-structured questionnaire according to the World Health Organisation (WHO) guidelines. Participants’ blood samples were collected for haematological tests. Odds ratio [OR, 95% confidence interval (CI)] for the association between socio-demographic, obstetric characteristics, foeto-maternal complications and haematological tests in relation to LBW were assessed using logistic regression model.
Results
This study reported a LBW prevalence of 13.5%. Increasing maternal systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 1st visit, before and after delivery significantly increased the odds of LBW. Preterm delivery (PTD<37 weeks) (COR = 9.92, 95% CI (4.87–2020), p<0.001), preeclampsia (PE) (COR = 5.94, 95% CI (2.96–11.94), p<0.001), blood transfusion (COR = 14.11, 95% CI (2.50–79.65), p = 0.003), caesarian delivery (COR = 3.86, 95% CI (1.96–7.58), p<0.001) and male sex neonates (COR = 2.25, 95%CI (1.14–4.47), P = 0.020) presented with increased odds of LBW. Increasing gestational age at delivery presented with 28% reduced odds of LBW (COR = 0.72, 95% CI (1.12–4.40), P = 0.023). Upon controlling for potential confounders in multivariate logistic regression, only gestational age at delivery (AOR = 0.67, 95% CI (0.47–0.96), P = 0.030) remained significantly associated with reduced odds of LBW.
Conclusion
This study found that high blood pressure at 1st visit, before and after delivery results in increased chances of delivering a baby with LBW. Furthermore, PTD<37 weeks, having PE in current pregnancy, and male sex potentiate the risk of LBW. On the other hand, increasing gestational age reduces the risk of LBW. Thus, we recommend that midwives should intensify education to pregnant women on the benefits of regular ANC visits to aid in the early detection of adverse foeto-maternal complications. We also recommend proper clinical management of pregnancies associated with an elevated blood pressure at registration. Also, maternal intrapartum blood pressure measurement could be used to predict LBW in low resourced settings.
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Affiliation(s)
- Benjamin Ahenkorah
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Medical Laboratory Science, Bolgatanga Technical University, Bolgatanga-Upper East Region, Ghana
- * E-mail:
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gideon Helegbe
- School of Medicine and Health Science, University for Development Studies, Tamale, Ghana
| | - Eddie-Williams Owiredu
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Linda Ahenkorah Fondjo
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Edmund Muonir Der
- School of Medicine and Health Science, University for Development Studies, Tamale, Ghana
| | - Benjamin Amoani
- Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Amma Aboagyewa Larbi
- Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Susanna Cheetham
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Ben Gyan
- Department of Immunology, Noguchi Memorial Institute for Medical Research, Accra, Ghana
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12
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Prevalence and Factors Associated with Low Birth Weight and Preterm Delivery in the Ho Municipality of Ghana. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3955869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background. Low birth weight and preterm delivery are birth outcomes that can predict newborns’ survival, development, and long-term health outcomes. This study assessed the prevalence and factors associated with low birth weight and preterm delivery in the Ho Municipality of Ghana. Methods. This retrospective, cross-sectional study analysed data from 680 birth records between October and December 2018. Univariate and multivariate logistic regression models predicted low birth weight and preterm delivery factors. Results. The prevalence of low birth weight and preterm delivery was 12.9% and 14.1%, respectively. Increasing maternal age (AOR: 0.52; 95% CI: 0.28–0.98), multiparity (AOR: 0.54; 95% CI: 0.30–0.94) and increasing doses of sulphadoxine-pyrimethamine (AOR: 0.43; 95% CI: 0.22–0.84) significantly reduced the odds of low birth weight. However, caesarean section (AOR: 1.94; 95% CI: 0.1.16–3.27) and hypertension (AOR: 2.06; 95% CI: 1.27–03.33) significantly increased the likelihood of low birth weight. An increasing number of antenatal care visits (AOR: 0.38; 95% CI: 0.18–0.80) and doses of sulphadoxine-pyrimethamine (AOR: 0.43; 95% CI: 0.19–0.97) were significantly associated with decreased odds of preterm delivery, while caesarean section increased the odds of preterm delivery by two folds (AOR: 2.14; 95% CI: 1.15–3.99). Conclusion. This study shows that maternal age, parity, number of antenatal care visits, hypertension, SP/IPTp, and caesarean section were independently associated with low birth weight and preterm delivery. Education and interventions should be prioritised as vitally important on these factors to reduce the risk and complications associated with these birth outcomes.
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13
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Wu SW, Zhang WY. Effects of Modes and Timings of Delivery on Feto-Maternal Outcomes in Women with Severe Preeclampsia: A Multi-Center Survey in Mainland China. Int J Gen Med 2021; 14:9681-9687. [PMID: 34934345 PMCID: PMC8684395 DOI: 10.2147/ijgm.s335893] [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: 08/24/2021] [Accepted: 11/04/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Pregnancy termination is the only effective treatment for preeclampsia. However, there are controversies on the selection of modes of delivery. The objective was to evaluate whether mode of delivery in labor differentially affected the rate of adverse maternal outcomes related to severe preeclampsia. OBJECTIVE This study aimed to evaluate whether the modes and timings of delivery affects adverse maternal outcomes in pre-eclampsia. METHODS Clinical data from 2516 singleton pregnant women with severe preeclampsia were collected in a multicenter, large-sample, cross-sectional study in mainland China. The patients were divided into cesarean-delivery (CD) and vaginal-delivery (VD) categories and then into Group 1 (≤27+ 6 weeks), Group 2 (28-33+ 6 weeks), Group 3 (34-36+ 6 weeks), and Group 4 (≥37 weeks) according to the mode of delivery and gestational weeks. All data were exported into the SPSS software and analyzed by the Student's t-tests or Mann-Whitney U-tests and the chi-squared test. RESULTS A total of 2516 singleton pregnant women with severe preeclampsia were collected and the overall cesarean section rate was 84.9%. The vaginal delivery rates among the four groups were significantly different with 70%, 19.7%, 6.6%, 15.1% in groups 1, 2, 3, 4, respectively (P<0.05), while perinatal mortality was lower in the CD groups than VD groups (3.3% vs 50.4%, P<0.05). The neonatal asphyxia rate was significantly higher with CD than with VD in Group 2 (36.4% vs 12.9%, P<0.05). The perinatal mortality with CD, 3, and 4 was significantly lower than with VD (10.0% vs 68.5% in Groups 2, 2.3% vs 28.3% in Groups 3, 0.8% vs 5.6% in Groups 4, all P<0.05). CONCLUSION Most pregnant women with severe preeclampsia opted for a cesarean section in China. The lower perinatal mortality was associated with cesarean section, but the rate of maternal PPH or mortality was not related with the mode of delivery. So cesarean section is the safer delivery mode for the pregnant women complicated with severe preeclampsia.
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Affiliation(s)
- Shao-Wen Wu
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wei-Yuan Zhang
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
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14
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Jing S, Chen C, Gan Y, Vogel J, Zhang J. Incidence and trend of preterm birth in China, 1990-2016: a systematic review and meta-analysis. BMJ Open 2020; 10:e039303. [PMID: 33310797 PMCID: PMC7735132 DOI: 10.1136/bmjopen-2020-039303] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/19/2020] [Accepted: 11/24/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To update the WHO estimate of preterm birth rate in China in 1990-2016 and to further explore variations by geographic regions and years of occurrence. DESIGN Systematic review and meta-analysis. DATA SOURCES Pubmed, Embase, Cochrane Library and Sinomed databases were searched from 1990 to 2018. ELIGIBILITY CRITERIA Studies were included if they provided preterm birth data with at least 500 total births. Reviews, case-control studies, intervention studies and studies with insufficient information or published before 1990 were excluded. We estimated pooled incidence of preterm birth by a random effects model, and preterm birth rate in different year, region and by livebirths or all births in subgroup analyses. RESULTS Our search identified 3945 records. After the removal of duplicates and screening of titles and abstracts, we reviewed 254 studies in full text and excluded 182, leaving 72 new studies. They were combined with the 82 studies included in the WHO report (154 studies, 187 data sets in total for the meta-analysis), including 24 039 084 births from 1990 to 2016. The pooled incidence of preterm birth in China was 6.09% (95% CI 5.86% to 6.31%) but has been steadily increasing from 5.36% (95% CI 4.89% to 5.84%) in 1990-1994 to 7.04% (95% CI 6.09% to 7.99%) in 2015-2016. The annual rate of increase was about 1.05% (95% CI 0.85% to 1.21%). Northwest China appeared to have the highest preterm birth rate (7.3%, 95% CI 4.92% to 9.68% from 1990 to 2016). CONCLUSIONS The incidence of preterm birth in China has been rising gradually in the past three decades. It was 7% in 2016. Preterm birth rate varied by region with the West having the highest occurrence.
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Affiliation(s)
- Shiwen Jing
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuexin Gan
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Joshua Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Jun Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Cui H, Wang Z, Yu J, Liu C. Birthweight is an independent predictor of birth asphyxia in twins: A retrospective cross-sectional cohort study of 5337 Chinese twins. Eur J Obstet Gynecol Reprod Biol 2020; 257:106-113. [PMID: 33387841 DOI: 10.1016/j.ejogrb.2020.12.014] [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: 04/23/2020] [Revised: 11/19/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Few studies are available on birth asphyxia risks in twin neonates. This retrospective multi-center cross-sectional study determined the birthweight percentiles of 5337twins and birth asphyxia incidence of the twin population. METHODS We retrieved sociodemographic and obstetric data from the electronic records systems of participating centers. Neonate birthweight was measured within 24 h of birth. Perinatal asphyxia was diagnosed if 5-minute Apgar score was ≤5, or resuscitation was required 10 min after birth. The primary outcome was the incidence of birth asphyxia. RESULTS Totally 5337 neonates were eligible. The mean neonatal birthweight was 2227.1 ± 608.99 g and the 5th, 50th, and 95th percentiles of birthweight were 970, 2400, and 3080 g, respectively. The mean Apgar score was 9.06 ± 1.73 at 1 min and 8.99 ± 1.74 at 5 min. Totally 13.5 % (705/5222) twins had asphyxia and 9.35 % and 4.16 % twins had moderate and severe asphyxia, respectively. Twins with a birthweight< 1500 g had the highest asphyxia rate (64.8 %) and twins with a birthweight between 2500 and 3000 g had the lowest asphyxia rate (3.6 %). Stepwise logistic regression analysis revealed that higher birthweight was associated with a significantly reduced risk of asphyxia [OR 0.772 (95 %CI 0.755, 0.789), P < 0.001]. The AUROC for mean twin birthweight was 0.86±0.01 (95 %CI 0.84, 0.88) using a cutoff of 1950 g, with a sensitivity of 0.84 and a specificity of 0.78. CONCLUSION Twins have lower birthweight versus singletons and a significant proportion of twins, especially twins with lower birthweight, are at risk of birth asphyxia. Birthweight is an independent predictor of asphyxia and should be further explored as a predictive marker for stratifying asphyxia risks in twin neonates.
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Affiliation(s)
- Hong Cui
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ziwei Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jinzhe Yu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Caixia Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
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- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Jeena PM, Asharam K, Mitku AA, Naidoo P, Naidoo RN. Maternal demographic and antenatal factors, low birth weight and preterm birth: findings from the mother and child in the environment (MACE) birth cohort, Durban, South Africa. BMC Pregnancy Childbirth 2020; 20:628. [PMID: 33076865 PMCID: PMC7574237 DOI: 10.1186/s12884-020-03328-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birthweight (LBW) and preterm birth (PB) remain the leading cause of morbidity and mortality in neonates worldwide. The aim of this study was to identify maternal demographic and antenatal factors associated with PB and LBW among low socio-economic communities. METHODS Pregnant women (n = 1099) were recruited in the first trimester into the Mother and Child in the Environment (MACE) birth cohort in Durban, South Africa. Maternal factors such as demographic information, health status, residential area, occupational, personal and environmental smoking and biomass fuel use were obtained through standardised interviews, while clinical status was obtained in each trimester and antenatal information on HIV status and treatment, syphilis and conditions such as pregnancy induced hypertension, diabetes etc. was extracted from the antenatal assessments. Key outcomes of interest were preterm birth and low birthweight. The latter data was obtained from the clinical assessments performed by midwives at delivery. Logistic regression models identified factors associated with PB and LBW. RESULTS Of the 760 live births, 16.4 and 13.5% were preterm and LBW, respectively. Mothers who delivered by caesarean section had an increased odds of having LBW babies (Adjusted odds ratio (AOR): 1.7; 95% CI: 1.1-2.7) and PB (AOR: 1.7, 95% CI: 1.1-2.7) versus normal vaginal deliveries. Mothers > 30 years (AOR: 1.8, 95% CI: 1.1-2.9) and current smokers (AOR: 2.7, 95% CI: 1.3-5.8) had an increased odds of having PB babies. Compared to younger mothers and non-smokers respectively. An effect of PB and LBW was seen among mothers with high BMI (25.0-29.9 kg/m2) (PB: AOR: 0.5, 95% CI: 0.3-0.9 and LBW: AOR: 0.5, 0.5, CI: 0.3-0.8), and obese BMI (> 30 kg/m2) (PB: AOR: 0.5, 95% CI: 0.3-0.9 and LBW: AOR: 0.4, CI: 0.2-0.7). Maternal HIV (PB AOR: 1.4 and LBW AOR: 1.2) and history of sexually transmitted infections (PB AOR: 2.7 and LBW AOR: 4.2) were not statistically significant. CONCLUSION Maternal age, cigarette smoking and caesarean delivery were associated with LBW and PB. Findings highlight the need of maternal health interventions to improve new-born health outcomes.
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Affiliation(s)
- Prakash M. Jeena
- Discipline of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kareshma Asharam
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Room 321, George Campbell Building, Durban, 4041 South Africa
| | - Aweke A. Mitku
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Room 321, George Campbell Building, Durban, 4041 South Africa
| | - Pragalathan Naidoo
- Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N. Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Room 321, George Campbell Building, Durban, 4041 South Africa
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Cheng FK. Using Acupuncture in Labor Pain and Childbirth-Related Issues: A Narrative Review. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-19-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDLatent threats, such as prolonged labor duration and postpartum hemorrhage, endanger women and newborns during and post childbirth, which produce burdens on natal care and public health expenditures. Acupuncture, a traditional Chinese medical practice, has increasingly been used for labor delivery in various countries to cope with these problems.METHODThis narrative review searched 29 English and Chinese electronic databases. Thirty-one empirical studies, carried out in Asia, America, Africa, the Middle East, Europe, and Australia were reviewed according to inclusion and exclusion criteria.RESULTSAcupuncture is adopted with positive signs toward labor pain relief, delivery mode, labor duration, postpartum hemorrhage, APGAR score (an evaluation for a neonatal evaluation), and birth weight.DISCUSSIONWith support of earlier studies, the satisfactory effects of acupuncture on labor delivery reviewed in this research have been noted by obstetric researchers and scholars, physicians, nurses, and midwives.CONCLUSIONThis review recommends the use of acupuncture in obstetric profession with respect to maternal-related healthcare.
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18
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Silva AAMD, Carvalho CAD, Bettiol H, Goldani MZ, Lamy Filho F, Lamy ZC, Domingues MR, Cardoso VC, Cavalli RDC, Horta BL, Barros AJD, Barbieri MA. Mean birth weight among term newborns: direction, magnitude and associated factors. CAD SAUDE PUBLICA 2020; 36:e00099419. [PMID: 32267386 DOI: 10.1590/0102-311x00099419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/06/2019] [Indexed: 11/22/2022] Open
Abstract
A trend towards increasing birth weight has been shown, but factors that explain these trends have not been elucidated. The objectives of this study were to evaluate changes in mean birth weight of term newborns and to identify factors associated with them. All cohorts are population-based studies in which random samples of births (Ribeirão Preto, São Paulo State in 1978/1979, 1994 and 2010; Pelotas, Rio Grande do Sul State in 1982, 1993 and 2004; and São Luís, Maranhão State in 1997/1998 and 2010, Brazil). A total of 32,147 full-term, singleton live births were included. Mean birth weight reduced in the first study period (-89.1g in Ribeirão Preto from 1978/1979 to 1994, and -27.7g in Pelotas from 1982 to 1993) and increased +30.2g in Ribeirão Preto from 1994 to 2010 and +24.7g in São Luís from 1997 to 2010. In the first period, in Ribeirão Preto, mean birth weight reduction was steeper among mothers with high school education and among those born 39-41 weeks. In the second period, the increase in mean birth weight was steeper among mothers with low schooling in Ribeirão Preto and São Luís, females and those born 37-38 weeks in Ribeirão Preto and cesarean section in São Luís. Birth weight decreased in the first study period then increased thereafter. The variables that seem to have been able to explain these changes varied over time.
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Factors Associated with Preterm Birth and Low Birth Weight in Abu Dhabi, the United Arab Emirates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041382. [PMID: 32098043 PMCID: PMC7068537 DOI: 10.3390/ijerph17041382] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/21/2022]
Abstract
Both preterm birth and low birth weight (LBW) represent major public health problems worldwide due to their association with the catastrophic effects of morbidity and mortality. Few data exist about such adverse pregnancy outcomes. The current study aimed to investigate the prevalence of and factors associated with preterm birth and LBW among mothers of children under two years in Abu Dhabi, United Arab Emirates. Data were collected in clinical and non-clinical settings across various geographical areas in Abu Dhabi. The data were analyzed using both descriptive and inferential statistics. A total of 1610 mother–child pairs were included in the current study. Preterm birth rate was 102 (6.3%) with a 95% confidence interval [CI] (6.1%, 6.5%) and the LBW rate was 151 (9.4%) with a 95% CI (9.3%, 9.5%). The mean (SD) of gestational age (GA) and birth weight at delivery was 39.1 (1.9) weeks and 3080.3 (518.6) grams, respectively. Factors that were positively associated with preterm birth were Arab mothers, maternal education level below secondary, caesarean section, and LBW. LBW was associated with female children, caesarean section (CS), first child order, and preterm birth. The current study highlighted the need for further interventional research to tackle these public health issues such as reducing the high CS rate and improving maternal education.
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Vilanova CS, Hirakata VN, de Souza Buriol VC, Nunes M, Goldani MZ, da Silva CH. The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil. Popul Health Metr 2019; 17:15. [PMID: 31775758 PMCID: PMC6882357 DOI: 10.1186/s12963-019-0195-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) newborns present different health outcomes when classified in different birth weight strata. This study evaluated the relationship of birth weight with Infant mortality (IM) through the influence of biological, social, and health care factors in a time series. METHODS Retrospective cohort study with data collected from Information Systems (Live Births and Mortality). The mortality trends were performed for each birth weight stratum: extremely low, < 1000 g; very low, 1000-1499 g; low, 1500-2499 g; insufficient, 2500-2999 g; adequate, 3000-3900 g; and macrosomia, > 4000 g. Chi-square tests analyzed IM rates. Sequential Poisson regression analyzed the impact of the determinant factors. RESULTS A total of 277,982 newborns were included in the study and 2088 died before their first year. There was a tendency for a decrease in mortality in all strata of weight. With the exception of macrosomics, all other strata had a higher risk for IM when compared with adequate birth weight. Extremely LBW newborns presented higher risk for mortality when born in a public hospital. A higher percentage of infant deaths were associated with lower maternal age and lower schooling for all strata. Prenatal care with less than three visits demonstrated a risk for IM in low, insufficient, and adequate birth weight strata. The cesarean section was a protective factor for IM in Extremely and Very LBW strata and it was a risk factor in adequate birth weight stratum. CONCLUSIONS LBW had a greater association with IM, especially those children of younger mothers and those born in public hospitals.
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Affiliation(s)
- Cássia Simeão Vilanova
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vânia Naomi Hirakata
- Research Group and Graduate Studies, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Viviane Costa de Souza Buriol
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marina Nunes
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marcelo Zubaran Goldani
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2400/Sala 414, Porto Alegre, RS 90035-003 Brazil
- Pediatrics Service, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Clécio Homrich da Silva
- Postgraduate Program in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2400/Sala 414, Porto Alegre, RS 90035-003 Brazil
- Pediatrics Service, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Hasan F, Alam MM, Hossain MG. Associated factors and their individual contributions to caesarean delivery among married women in Bangladesh: analysis of Bangladesh demographic and health survey data. BMC Pregnancy Childbirth 2019; 19:433. [PMID: 31752772 PMCID: PMC6873680 DOI: 10.1186/s12884-019-2588-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 11/08/2019] [Indexed: 12/04/2022] Open
Abstract
Background Caesarean section (CS) delivery has a significant effect on maternal and neonatal health especially in a developing country like Bangladesh. The aim of the study was to determine the risk factors and their individual contribution to CS delivery among Bangladeshi married women in reproductive age. Methods The cross sectional secondary data was used in this study. Data was extracted from Bangladesh Demographic and Health Survey (BDHS), 2014 dataset. BDHS-2014 collected data from all over Bangladesh. Stepwise logistic regression analysis and population attributable fractions (PAF) were utilized in this study. Results A total number of 4422 married Bangladeshi women having at least one child (age ≤ 5 years) were considered in this study. The prevalence of CS delivery among Bangladeshi women was 23.94%. The stepwise logistic regression model showed that location (division), type of residence, education of respondent and her husband, working status, age at first birth, number of children, wealth index and baby’s birth weight were most important predictors of CS delivery among Bangladeshi mothers. PAF demonstrated that overweight or obese women had highest contribution (23.36%) among the risk factors of CS delivery, followed by age at first birth (age > 20 years) (18.97%), highest wealth quintile (17.39%), higher education (15.93%), living in urban environment (14.39%), having lower number of ever born children (1–2 children) (13.58%), living in Dhaka division (12.11%), delivering large size of child at birth (11.13%) and housewife (6.55%). Conclusions In the present study, we have identified the important risk factors and their individual contribution to CS delivery in Bangladesh. Consequently, these factors can be considered for reducing the rate of CS delivery in Bangladesh.
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Affiliation(s)
- Farhana Hasan
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Md Mesbahul Alam
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Md Golam Hossain
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
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Miao H, Li B, Li W, Yao F, Chen Y, Chen R, Lin J, Wu Y, Guo P, Zhao Q. Adverse birth outcomes in Guangdong province, China, 2014-2017: a spatiotemporal analysis of 2.9 million births. BMJ Open 2019; 9:e030629. [PMID: 31727652 PMCID: PMC6886959 DOI: 10.1136/bmjopen-2019-030629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Adverse birth outcomes pose a great threat to the public health and bring a heavy burden of disease in China. A comprehensive examination of the temporal and spatial trends of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) epidemics can provide some elementary information for subsequent aetiological and epidemiological studies. This study aimed to characterise the spatiotemporal features of PTB, LBW and SGA based on a large cohort of live births in China. DESIGN Spatiotemporal descriptive analysis was performed in Guangdong province, China, from 2014 to 2017. SETTING Data involving 2 917 098 live births in Guangdong province, China from 2014 to 2017 was collected from Guangdong Birth Certificate System. Information was collected, including the date of birth, gestational age in week, birth weight, sex of the infant, age of the mother and registered residence of the mother. RESULTS The estimated rate of PTB, LBW and SGA was 4.16%, 4.14% and 12.86%, respectively. For temporal trends, the rates of PTB, LBW and SGA showed seasonal fluctuations, especially for LBW and SGA. In addition, there were regional differences in the rates of PTB, LBW and SGA between the Pearl River Delta and Non-Pearl River Delta regions. From 2014 to 2017, the high rates of PTB and LBW expanded from the Pearl River Delta region to the Non-Pearl River Delta regions. However, compared with the Pearl River Delta region, the rate of SGA was higher in the Non-Pearl River Delta regions on the whole. CONCLUSION The findings of this study contribute to the understanding of the aetiology and epidemiology of PTB, LBW and SGA in south China.
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Affiliation(s)
- Huazhang Miao
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Bing Li
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Wu Li
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Fei Yao
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Yuliang Chen
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Ruyin Chen
- Department of Clinical Medicine, Shantou University Medical College, Shantou, China
| | - Jiumin Lin
- Department of Hepatology and Infectious Diseases, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yuntao Wu
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Qingguo Zhao
- Epidemiological Research Office of Key Laboratory of Male Reproduction and Genetics (National Health Commission of PRC), Family Planning Special Hospital of Guangdong Province, Guangzhou, China
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Olukade T, Yaya S, Bishwajit G, Uthman OA. Socio-demographic determinants of post-caesarean neonatal mortality in Nigeria. J OBSTET GYNAECOL 2019; 40:342-348. [PMID: 31353990 DOI: 10.1080/01443615.2019.1627300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neonatal mortality remains a major health concern in sub-Saharan Africa. We conducted a cross-sectional, population-based, retrospective analysis of 31,828 births between 2009 and 2013 to explore the relationship between socio-demographic variables and post-caesarean neonatal mortality in Nigeria. We calculated the caesarean section (CS) rates, the odds of having a CS and post-CS neonatal mortality within variable subgroups. The national average CS rate was 2.1%. The CS rate increased with the increasing wealth index, educational attainment, maternal age, higher among urban residents and among those from the Southern part of Nigeria. The odds of experiencing post-CS neonatal mortality was significantly higher in the Northern regions (OR 2.51-3.17) among rural residents (OR 2.63), economically poorer groups (OR 3.68), with no formal education (OR 3.01) and older maternal age groups (OR 1.76-2.0). Efforts to increase the rate and quality of peripartum services delivered to pregnant women are needed among both advantaged and disadvantaged groups.Impact statementWhat is already known on this subject? In sub-Saharan Africa, a caesarean section is a lifesaving procedure for both the women and their unborn babies. The neonatal mortalities that occur following the procedure need to be explored and quantified.What do the results of this study add? Socioeconomic differentials exist in the access to a caesarean section. However, these differentials have a limited influence on neonatal mortality post-caesarean section in Nigeria.What are the implications of these findings for clinical practice and/or further research? While socio-demographic variables influence access to health care services, timeliness and quality of care are factors to be considered in ensuring societies get the benefits of caesarean section as a lifesaving procedure.
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Affiliation(s)
- Tawa Olukade
- Center for Evidence-Based Global Health, Minna, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK
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Huang L, Tian FY, Fan L, He YH, Peng D, Xie C, Tao L, Yuan SX, Jia DQ, Chen WQ. Appetite during the second and third trimesters mediates the impact of prenatal environmental tobacco smoke exposure on symmetric full-term low birth weight. J Matern Fetal Neonatal Med 2018; 33:1544-1553. [PMID: 30198354 DOI: 10.1080/14767058.2018.1522299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To examine the relationship of prenatal environmental tobacco smoke (ETS) exposure and full-term low birth weight (FT-LBW) when taking anthropometric proportionality into consideration, and explore whether appetite mediates their association.Study design: We conducted a case-control study among pregnant women at two Women and Children's Hospitals in Guangdong, China. Information was collected through interview and medical records review. A series of logistic and linear regressions were used to examine the relationships of prenatal ETS exposure, appetite, and FT-LBW.Results: After adjusting for the potential confounders, prenatal ETS exposure was significantly negatively associated with FT-LBW (OR: 1.83, 95%CI: 1.35-2.48) and negatively correlated with maternal appetite in second and third trimester during pregnancy (β: -0.11, standard error: 0.03). Moreover, mediation analysis illustrated that maternal appetite partially mediated 12.00% of their relationship. However, subgroup analysis showed that prenatal ETS exposure was linked to higher risk of symmetric FT-LBW (OR: 2.26, 95%CI: 1.56-3.26) but not asymmetric FT-LBW. And maternal appetite explained only 6.45% of their relationship.Conclusions: Maternal prenatal ETS exposure increased risk of having symmetric FT-LBW infant, and appetite might mediate their relationship partially. This study emphasizes the importance of sample homogeneity and stresses the needs to improve the public awareness of the harmful effects of ETS.
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Affiliation(s)
- Lihua Huang
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Fu-Ying Tian
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lijun Fan
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-Hui He
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ding Peng
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chuanbo Xie
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Liu Tao
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shi-Xin Yuan
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - De-Qin Jia
- Foshan Women and Children's Hospital, Foshan, China
| | - Wei-Qing Chen
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Department of Information Management, Xinhua College, Sun Yat-sen University, Guangzhou, China
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Tian FY, Wang XM, Xie C, Zhao B, Niu Z, Fan L, Hivert MF, Chen WQ. Placental surface area mediates the association between FGFR2 methylation in placenta and full-term low birth weight in girls. Clin Epigenetics 2018; 10:39. [PMID: 29588807 PMCID: PMC5863829 DOI: 10.1186/s13148-018-0472-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/14/2018] [Indexed: 12/14/2022] Open
Abstract
Background Fibroblast growth factor receptor 2 (FGFR2) gene encodes a protein of the fibroblast growth factor receptor family. FGFR2 gene expression is associated with the regulation of implantation process of placenta which plays a vital role in fetal growth. DNA methylation is widely known as a mechanism of fetal growth. However, it is unclear whether and how DNA methylation of FGFR2 gene in the placenta is associated with full-term low birth weight. This case-control study aims to explore the links between FGFR2 methylation in placenta and full-term low birth weight and to further examine the mediation effect of placental surface area on this association. Results We conducted analyses for each of the five valid CpG sites at FGFR2 in 165 mother-baby pairs (86 FT-LBW vs. 79 FT-NBW) and found that per one standard deviation increase in the DNA methylation of CpG 11 at FGFR2 was associated with 1.64-fold higher risk of full-term low birth weight (OR = 1.64, 95% CI = [1.07, 2.52]) and 0.18 standard deviation decrease in placental surface area (β = - 0.18; standard error = 0.08, p = 0.02). The mediation effect of placental surface area on the association between DNA methylation and full-term low birth weight was significant in girls (OR = 1.38, 95% CI = [1.05, 1.80]) but not in boys. The estimated mediation proportion was 48.38%. Conclusion Our findings suggested that placental surface area mediated the association between DNA methylation of FGFR2 in placenta and full-term low birth weight in a sex-specific manner. Our study supported the importance of placental epigenetic changes in placental development and fetal growth.
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Affiliation(s)
- Fu-Ying Tian
- 1Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Room 715, 74 Zhongshan Road 2, Guangzhou, 510080 Guangdong China
| | - Xi-Meng Wang
- 1Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Room 715, 74 Zhongshan Road 2, Guangzhou, 510080 Guangdong China
| | - Chuanbo Xie
- Department of Cancer Prevention Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bo Zhao
- 3Children's Hospital Boston and Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115 USA
| | - Zhongzheng Niu
- 4Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, 265 Farber Hall, Buffalo, NY 14214 USA
| | - Lijun Fan
- 1Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Room 715, 74 Zhongshan Road 2, Guangzhou, 510080 Guangdong China
| | - Marie-France Hivert
- 5Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA USA.,6Diabetes Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA USA.,7Department of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec Canada.,8Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12th Avenue North, wing 9, door 6, Sherbrooke, Québec Canada
| | - Wei-Qing Chen
- 1Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Room 715, 74 Zhongshan Road 2, Guangzhou, 510080 Guangdong China.,9Department of Information Management, Xinhua College, Sun Yat-sen University, Guangzhou, Guangdong China
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Huang L, Luo Y, Wen X, He YH, Ding P, Xie C, Liu T, Yuan SX, Jia DQ, Chen WQ. Gene-gene-environment interactions of prenatal exposed to environmental tobacco smoke, CYP1A1 and GSTs polymorphisms on full-term low birth weight: relationship of maternal passive smoking, gene polymorphisms, and FT-LBW. J Matern Fetal Neonatal Med 2018; 32:2200-2208. [PMID: 29338478 DOI: 10.1080/14767058.2018.1429394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the interaction effects of prenatal exposed to environmental tobacco smoke (ETS) and genotypes of cytochrome P4501A1 (CYP1A1), glutathione S-transferases (GSTs) on the risk of full-term low birth weight (FT-LBW). STUDY DESIGN We conducted a case-control study among pregnant women at two Women and Children's Hospitals in Guangdong, China (n = 910). Information was collected through interview, medical records review, and blood lab tests. Maternal selfreport and serum cotinine concentration were combined to define prenatal exposed to ETS. Logistic regression approach was applied for statistical analysis. RESULTS Our results showed that regardless of genotypes, prenatal exposed to ETS significantly increased the risk of FT-LBW. Then, two-way interactions showed increased prevalence of FT-LBW in prenatal exposed to ETS mothers with the CYP1A1 variant genotype (MspI "CC"), or with GSTT1-null genotype. Furthermore, three-way interactions showed that women with CYP1A1 variant (MspI "TC" or BsrDI "AG") genotypes and GSTT1 "null" genotype had higher risk to give birth of FT-LBW. Additionally, among nonexposed ETS mothers, genotype did not independently confer adverse effects on FT-LBW. CONCLUSIONS Our results revealed that prenatal exposed to ETS is independently associated with FT-LBW while gene polymorphisms of CYP1A1 and GSTs merely play modified roles in this process. This study extends understanding of three-way interaction, and stresses the need to tobacco control toward pregnant women for better pregnant outcomes.
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Affiliation(s)
- Lihua Huang
- a Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health , School of Public Health, Sun Yat-Sen University , Guangzhou , China
| | - Yijuan Luo
- a Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health , School of Public Health, Sun Yat-Sen University , Guangzhou , China.,b Shenzhen Center for Disease Control and Prevention , Shenzhen , China
| | - Xiaozhong Wen
- c Department of Pediatrics, Division of Behavioral Medicine , School of Medicine and Biomedical Sciences, State University of New York at Buffalo , Buffalo , NY , USA.,d Department of Social and Preventive Medicine , School of Public Health and Health Professions, State University of New York at Buffalo , Buffalo , NY , USA
| | - Yan-Hui He
- a Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health , School of Public Health, Sun Yat-Sen University , Guangzhou , China
| | - Peng Ding
- a Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health , School of Public Health, Sun Yat-Sen University , Guangzhou , China
| | - Chuanbo Xie
- a Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health , School of Public Health, Sun Yat-Sen University , Guangzhou , China
| | - Tao Liu
- a Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health , School of Public Health, Sun Yat-Sen University , Guangzhou , China
| | - Shi-Xin Yuan
- e Shenzhen Women and Children's Hospital , Shenzhen , China
| | - De-Qin Jia
- f Foshan Women and Children's Hospital , Foshan , China
| | - Wei-Qing Chen
- a Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health , School of Public Health, Sun Yat-Sen University , Guangzhou , China.,g Department of Information Management , Xinhua College, Sun Yat-Sen University , Guangzhou , China
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Cao H, Wang J, Li Y, Li D, Guo J, Hu Y, Meng K, He D, Liu B, Liu Z, Qi H, Zhang L. Trend analysis of mortality rates and causes of death in children under 5 years old in Beijing, China from 1992 to 2015 and forecast of mortality into the future: an entire population-based epidemiological study. BMJ Open 2017; 7:e015941. [PMID: 28928178 PMCID: PMC5623503 DOI: 10.1136/bmjopen-2017-015941] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To analyse trends in mortality and causes of death among children aged under 5 years in Beijing, China between 1992 and 2015 and to forecast under-5 mortality rates (U5MRs) for the period 2016-2020. METHODS An entire population-based epidemiological study was conducted. Data collection was based on the Child Death Reporting Card of the Beijing Under-5 Mortality Rate Surveillance Network. Trends in mortality and leading causes of death were analysed using the χ2 test and SPSS 19.0 software. An autoregressive integrated moving average (ARIMA) model was fitted to forecast U5MRs between 2016 and 2020 using the EViews 8.0 software. RESULTS Mortality in neonates, infants and children aged under 5 years decreased by 84.06%, 80.04% and 80.17% from 1992 to 2015, respectively. However, the U5MR increased by 7.20% from 2013 to 2015. Birth asphyxia, congenital heart disease, preterm/low birth weight and other congenital abnormalities comprised the top five causes of death. The greatest, most rapid reduction was that of pneumonia by 92.26%, with an annual average rate of reduction of 10.53%. The distribution of causes of death differed among children of different ages. Accidental asphyxia and sepsis were among the top five causes of death in children aged 28 days to 1 year and accident was among the top five causes in children aged 1-4 years. The U5MRs in Beijing are projected to be 2.88‰, 2.87‰, 2.90‰, 2.97‰ and 3.09‰ for the period 2016-2020, based on the predictive model. CONCLUSION Beijing has made considerable progress in reducing U5MRs from 1992 to 2015. However, U5MRs could show a slight upward trend from 2016 to 2020. Future considerations for child healthcare include the management of birth asphyxia, congenital heart disease, preterm/low birth weight and other congenital abnormalities. Specific preventative measures should be implemented for children of various age groups.
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Affiliation(s)
- Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Department of Children’s Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yichen Li
- Department of Children’s Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Dongyang Li
- Department of Children’s Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jin Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yifei Hu
- Department of Child, Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing, China
| | - Kai Meng
- Department of Hospital Management, School of Health Administration and Education, Capital Medical University, Beijing, China
| | - Dian He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Bin Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Zheng Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Han Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinical Epidemiology, Beijing, China
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Tsai HT, Wu CH. Vaginal birth after cesarean section-The world trend and local experience in Taiwan. Taiwan J Obstet Gynecol 2017; 56:41-45. [PMID: 28254224 DOI: 10.1016/j.tjog.2016.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The trend of increasing cesarean section rates had evoked worldwide attention. Many approaches were introduced to diminish cesarean section rates. Vaginal birth after cesarean section (VBAC) is a route of delivery with diverse agreements. In this study, we try to reveal the world trend in VBAC and our experience of a 10-year period in a medical center in northern Taiwan. MATERIALS AND METHODS This is a retrospective study of all women who underwent elective repeat cesarean delivery or trial of labor after cesarean (TOLAC) following primary cesarean delivery by a general obstetrician-gynecologist in the Tamshui Branch of MacKay Memorial Hospital (Taipei, Taiwan) between 2006 and 2015. We excluded cases of preterm labor, two or more cesarean deliveries, and major maternal diseases. We compared the characteristics and outcomes between these groups. RESULTS We included 400 women with subsequent pregnancies who underwent elective repeat cesarean delivery or TOLAC during the study period. Among the study population, 112 women were excluded and 11 underwent repeat VBAC. A total of 204 (73.65%) cases underwent elective repeat cesarean delivery and 73 (26.35%) chose TOLAC. The rate of successful VBAC among the women who chose TOLAC was 84.93%. CONCLUSION With respect to maternal and fetal safety, and success rates and adverse effects of VBAC, the results of this study are promising and compatible with the global data. It shows that a trial of VBAC can be offered to pregnant women without contraindications with high success rates.
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Affiliation(s)
- Hsiu-Ting Tsai
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Hsun Wu
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.
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Tian FY, Hivert MF, Wen X, Xie C, Niu Z, Fan L, Gillman MW, Chen WQ. Tissue differences in DNA methylation changes at AHRR in full term low birth weight in maternal blood, placenta and cord blood in Chinese. Placenta 2017; 52:49-57. [PMID: 28454697 DOI: 10.1016/j.placenta.2017.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Very few study addressed the relationship between Aryl-hydrocarbon receptor repressor (AHRR) DNA methylation and low birth weight, especially in multiple tissues of mother-infant pairs. In this study, we aimed to investigate AHRR DNA methylation modification in cord blood, placenta and maternal blood between full term low birth weight (FT-LBW) and full term normal birth weight (FT-NBW) newborns. METHODS We enrolled 90 FT-LBW and 90 FT-NBW mother-infant pairs, of which all placenta and cord blood samples were collected while 45 maternal blood samples of each group were collected. We measured AHRR DNA methylation (Chr5: 373013-373606) using Sequenom MassARRAY, and assessed associations between AHRR DNA methylation and FT-LBW using logistic regression adjusting for maternal age, education, family income, delivery mode, and passive smoking. RESULTS FT-LBW babies had 3% lower methylation at Chr5: 373378 (CpG 13) in cord blood, and 4-9% higher methylation levels at Chr5: 373315, 373378, 373423, 373476 and 373490/373494 (CpG 10; 13; 15; 16; 17/18 respectively) in maternal blood, comparing with FT-NBW. The methylation of Chr5: 373378 (CpG 13) remained significant association with FT-LBW both in cord blood (OR = 0.90; 95% CI: 0.82, 0.98) and maternal blood (OR = 1.14; 95% CI: 1.04, 1.25) further adjusting for each other in the same model. We observed no significant difference at any CpG sites in placenta. DISCUSSION AHRR DNA methylation of cord and maternal blood might be independently associated with FT-LBW in different ways.
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Affiliation(s)
- Fu-Ying Tian
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA, USA; Diabetes Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA, USA; Department of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada; Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12th Avenue North, Wing 9, Door 6, Sherbrooke, Québec, Canada.
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
| | - Chuanbo Xie
- Department of Cancer Prevention Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Zhongzheng Niu
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Lijun Fan
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Matthew W Gillman
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA, USA.
| | - Wei-Qing Chen
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
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de Souza Buriol VC, Hirakata V, Goldani MZ, da Silva CH. Temporal evolution of the risk factors associated with low birth weight rates in Brazilian capitals (1996-2011). Popul Health Metr 2016; 14:15. [PMID: 27147908 PMCID: PMC4855447 DOI: 10.1186/s12963-016-0086-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/25/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To analyze the trend of low birth weight (LBW) and its determinants in Brazilian state capitals between 1996 and 2011. We intended to determine which variables are associated with LBW during the period studied. Methods This is a cross-sectional study that used data from the National Information System of Live Births from 26 state capitals and Brasilia (the federal capital), divided into five geographical regions. The Average Annual Percentage of Change (AAPC) was used to assess the possible time trend in the low birth weight rates for considering all regions together and each region separately, according to each variable, and the Poisson regression was calculated in order to demonstrate time trends in low birth weight and the impact of variables (age and educational maternal level, antenatal visits, type of delivery, and gestational age) during the period. All variables were analyzed together using the Poisson regression as well. Results From the total of 11,200,255 live births used in this study, there was a significant reduction in the number of live births, especially in the more developed regions. The low birth weight rate was 8 %, and it was stable during the period. Considering regional trends, the rate was higher in the Southeast and South regions, and significantly higher in the North, Northeast, and Central West regions. Improvements in maternal education and antenatal care coverage reduced the risk for low birth weight in all regions. Also, there was an increase in caesarean sections in all regions, with a small impact on low birth weight rates. Conclusions Improvements in education and health care reduced the risk for low birth weight in all Brazilian regions during the period of study. Trends in low birth weight rates and the associated factors differ from region to region, showing different stages of demographic, epidemiological and developmental transition in Brazil. The present study was approved by the Research Ethics Committee at the Hospital de Clínicas de Porto Alegre (Protocol 120323).
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Affiliation(s)
- Viviane Costa de Souza Buriol
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400/2° andar. Barrio Santa Cecilia, Porto Alegre, RS 90035-003 Brazil ; Child and Adolescent Health Study Centre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vânia Hirakata
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcelo Zubaran Goldani
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400/2° andar. Barrio Santa Cecilia, Porto Alegre, RS 90035-003 Brazil ; Child and Adolescent Health Study Centre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ; Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Clécio Homrich da Silva
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400/2° andar. Barrio Santa Cecilia, Porto Alegre, RS 90035-003 Brazil ; Child and Adolescent Health Study Centre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ; Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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