1
|
Falcão IR, Ribeiro-Silva RDC, Alves FJO, Ortelan N, Silva NJ, Fiaccone RL, de Almeida MF, Pescarini JM, Lisboa CS, Júnior EPP, Paixao ES, Ferreira AJF, Teixeira CSS, Rocha ADS, Katikireddi SV, Ali MS, Dundas R, Leyland A, Rodrigues LC, Ichihara MY, Barreto ML. Evaluating the effect of Bolsa Familia, Brazil's conditional cash transfer programme, on maternal and child health: A study protocol. PLoS One 2022; 17:e0268500. [PMID: 35604890 PMCID: PMC9126365 DOI: 10.1371/journal.pone.0268500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conditional Cash Transfer Programs have been developed in Latin America in response to poverty and marked social inequalities on the continent. In Brazil, the Bolsa Familia Program (BFP) was implemented to alleviate poverty and improve living conditions, health, and education for socioeconomically vulnerable populations. However, the effect of this intervention on maternal and child health is not well understood. METHODS We will evaluate the effect of BFP on maternal and child outcomes: 1. Birth weight; 2. Preterm birth; 3. Maternal mortality; and 4. Child growth. Dynamic retrospective cohort data from the 100 Million Brazilian Cohort (2001 to 2015) will be linked to three different databases: Live Birth Information System (2004 to 2015); Mortality Information System (2011 to 2015); and Food and Nutritional Surveillance System (2008 to 2017). The definition of exposure to the BFP varies according to the outcome studied. Those who never received the benefit until the outcome or until the end of the follow-up will be defined as not exposed. The effects of BFP on maternal and child outcomes will be estimated by a combination of propensity score-based methods and weighted logistic regressions. The analyses will be further stratified to reflect changes in the benefit entitlement before and after 2012. DISCUSSION Harnessing a large linked administrative cohort allows us to assess the effect of the BFP on maternal and child health, while considering a wide range of explanatory and confounding variables.
Collapse
Affiliation(s)
- Ila Rocha Falcão
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Flávia Jôse Oliveira Alves
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Naiá Ortelan
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Natanael J. Silva
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rosemeire L. Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | | | - Júlia M. Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cinthia Soares Lisboa
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Feira de Santana State University, Feira de Santana, Brazil
| | - Elzo Pereira Pinto Júnior
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Enny S. Paixao
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrea J. F. Ferreira
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Camila Silveira Silva Teixeira
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Aline dos Santos Rocha
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - M. Sanni Ali
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Laura C. Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Mauricio L. Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
2
|
Martín-Palumbo G, Duque Alcorta M, Atanasova VB, Rego Tejeda MT, Antolín Alvarado E, Bartha JL. Prenatal prediction of very late onset small-for-gestational age newborns in low-risk pregnancies. J Matern Fetal Neonatal Med 2022; 35:9816-9820. [PMID: 35341457 DOI: 10.1080/14767058.2022.2054322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To find a multivariate model for predicting small-for-gestational age newborns at 36 weeks' gestation by using clinical, biochemical and ultrasound measurements. MATERIALS AND METHODS We evaluated 564 low-risk pregnant women and recorded maternal age, maternal body mass index, maternal mean blood pressure, soluble fms-like tyrosine kinase-1 (multiples of the median), placental growth factor (multiples of the median), soluble fms-like tyrosine kinase-1/placental growth factor ratio, estimated fetal weight centile and mean uterine artery pulsatility index at 36 weeks. Binary logistic regression was used. Statistical significance was set at 95% level (p < 0.05). RESULTS We found three multivariate models showing relatively small differences in predictive capability. Model 1 only included estimated fetal weight centiles (area under the curve [AUC] 0.86; R2 = 0.42; p < 0.0001), Model 2 estimated fetal weight centiles and placental growth factor (multiples of the median) (AUC 0.87; R2 = 0.44; p < 0.0001) and Model 3 estimated fetal weight centiles, placental growth factor (multiples of the median) and mean uterine artery pulsatility index (AUC 0.88; R2 = 0.45; p < 0.0001). CONCLUSION Small-for-gestational age at delivery may be predicted by using a multivariate formula. The inclusion of parameters other than estimated fetal weight centile at 36 weeks' gestation modestly improves the predictive capability of the model. Clinical decisions should consider whether or not these slight differences deserve a change in current strategies.
Collapse
Affiliation(s)
- Giovanna Martín-Palumbo
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | | | - Vangeliya Blagoeva Atanasova
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - María Teresa Rego Tejeda
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Eugenia Antolín Alvarado
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| |
Collapse
|
3
|
Yovo E, Accrombessi M, Agbota G, Hocquette A, Atade W, Ladikpo OT, Mehoba M, Degbe A, Mombo-Ngoma G, Massougbodji A, Jackson N, Fievet N, Heude B, Zeitlin J, Briand V. Assessing fetal growth in Africa: Application of the international WHO and INTERGROWTH-21st standards in a Beninese pregnancy cohort. PLoS One 2022; 17:e0262760. [PMID: 35061819 PMCID: PMC8782373 DOI: 10.1371/journal.pone.0262760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 01/04/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Fetal growth restriction is a major complication of pregnancy and is associated with stillbirth, infant death and child morbidity. Ultrasound monitoring of pregnancy is becoming more common in Africa for fetal growth monitoring in clinical care and research, but many countries have no national growth charts. We evaluated the new international fetal growth standards from INTERGROWTH-21st and WHO in a cohort from southern Benin. METHODS Repeated ultrasound and clinical data were collected in women from the preconceptional RECIPAL cohort (241 women with singleton pregnancies, 964 ultrasounds). We modelled fetal biometric parameters including abdominal circumference (AC) and estimated fetal weight (EFW) and compared centiles to INTERGROWTH-21st and WHO standards, using the Bland and Altman method to assess agreement. For EFW, we used INTERGROWTH-21st standards based on their EFW formula (IG21st) as well as a recent update using Hadlock's EFW formula (IG21hl). Proportions of fetuses with measurements under the 10th percentile were compared. RESULTS Maternal malaria and anaemia prevalence was 43% and 69% respectively and 11% of women were primigravid. Overall, the centiles in the RECIPAL cohort were higher than that of INTERGROWTH-21st and closer to that of WHO. Consequently, the proportion of fetuses under 10th percentile thresholds was systematically lower when applying IG21st compared to WHO standards. At 27-31 weeks and 33-38 weeks, respectively, 7.4% and 5.6% of fetuses had EFW <10th percentile using IG21hl standards versus 10.7% and 11.6% using WHO standards. CONCLUSION Despite high anemia and malaria prevalence in the cohort, IG21st and WHO standards did not identify higher than expected proportions of fetuses under the 10th percentiles of ultrasound parameters or EFW. The proportions of fetuses under the 10th percentile threshold for IG21st charts were particularly low, raising questions about its use to identify growth-restricted fetuses in Africa.
Collapse
Affiliation(s)
- Emmanuel Yovo
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Manfred Accrombessi
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
- Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gino Agbota
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
- IRD UMI 233 TransVIHMI- UM-INSERM U1175, Montpellier, France
| | - Alice Hocquette
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - William Atade
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | | | - Murielle Mehoba
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Auguste Degbe
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nikki Jackson
- Department of Obstetrics and Gynaecology, Oxford University, Oxford, United Kingdom
| | | | - Barbara Heude
- INSERM, UMR 1153, Centre for Research in Epidemiology and StatisticS (CRESS), “EArly life Research on later Health” (EARoH) team, Paris, France
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Valérie Briand
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- IRD, Inserm, Université de Bordeaux, IDLIC team, UMR 1219, Bordeaux, France
| |
Collapse
|
4
|
Kajdy A, Modzelewski J, Jakubiak M, Pokropek A, Rabijewski M. Effect of antenatal detection of small-for-gestational-age newborns in a risk stratified retrospective cohort. PLoS One 2019; 14:e0224553. [PMID: 31671164 PMCID: PMC6822749 DOI: 10.1371/journal.pone.0224553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Small-for-gestational-age (SGA) are neonates born with birth weight below the 10th centile for a given week of pregnancy. It is a risk factor of perinatal and neonatal morbidity and mortality. There is an ongoing debate whether prenatal detection of SGA neonates is good predictor of perinatal outcome especially in low risk populations. Our primary aim was to compare the odds ratios for unfavorable outcome in a risk stratified cohort of SGA neonates in regard to prenatal detection status. METHODS This is a retrospective cohort study analysing the effect of prenatal detection on perinatal outcome. This cohort has been divided into a predefined low-risk and high-risk population. Electronic records of 39,032 singleton deliveries from 2010 through 2016 were analysed. SGA was defined as newborn weight below the 10th percentile on the Fenton growth chart. Detected SGA (dSGA) neonates were those that were admitted for delivery with a prenatal ultrasound diagnosis of abnormal growth. Undetected SGA (uSGA) were neonates that were found to be below the 10th percentile after birth. Perinatal and neonatal outcome was compared. RESULTS The detection rate in high-risk pregnancies was almost 45.7% versus low risk where it amounted to 18.9%. In both the high-risk and low-risk populations there was a significantly higher risk of composite mortality for undetected SGA compared to approporiate-for-gestational-age (AGA) (OR 7.95 CI 4.76-13.29; OR 14.4 CI 4.99-41.45 respectively). The odds for the composite neonatal outcome were significantly higher for dSGA and uSGA than for AGA in all the studied populations except for the uSGA in high risk population (OR 1.57 CI 0.97-3.53). Importantly, there was not a single case of intrauterine fetal death among detected SGA, in the low risk group. CONCLUSIONS Prenatal detection of SGA status is related to perinatal outcomes, especially mortality. Therefore, assessment of SGA status even in low-risk pregnancies could help predict potential perinatal and neonatal complications.
Collapse
Affiliation(s)
- Anna Kajdy
- Centre of Postgraduate Medical Education, Department of Reproductive Health, Warsaw, Poland
- * E-mail:
| | - Jan Modzelewski
- Centre of Postgraduate Medical Education, Department of Reproductive Health, Warsaw, Poland
| | - Monika Jakubiak
- Centre of Postgraduate Medical Education, Department of Reproductive Health, Warsaw, Poland
| | - Artur Pokropek
- Institute of Philosophy and Sociology Polish Academy of Sciences, Warsaw, Poland
| | - Michał Rabijewski
- Centre of Postgraduate Medical Education, Department of Reproductive Health, Warsaw, Poland
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW Two-thirds of the pregnancies complicated by stillbirth demonstrate growth restriction. Identification of the foetus at risk of growth restriction is essential to reduce the risk of stillbirth. The aim of this review is to critically appraise the current evidence regarding clinical utility of cerebroplacental ratio (CPR) in antenatal surveillance. RECENT FINDINGS The CPR has emerged as an assessment tool for foetuses at increased risk of growth disorders. CPR is a better predictor of adverse events compared with middle-cerebral artery or umbilical artery Doppler alone. The predictive value of CPR for adverse perinatal outcomes is better for suspected small-for-gestational age foetuses compared with appropriate-for-gestational age (AGA) foetuses. CPR could be useful for the risk stratification of small-for-gestational age foetuses to determine the timing of delivery and also to calculate the risk of intrapartum compromise or prolonged admission to the neonatal care unit. Although there are many proposed cut-offs for an abnormal CPR value, evidence is currently lacking to suggest the use of one cut-off over another. CPR appears to be associated with increased risk of intrapartum foetal compromise, abnormal growth velocity, and lower birthweight in AGA foetuses as well. Moreover, birthweight differences are better explained with CPR compared to other factors such as ethnicity. However, the role of CPR in predicting adverse perinatal outcomes such as acidosis or low Apgar scores in AGA foetuses is yet to be determined. SUMMARY CPR appears to be a useful surrogate of suboptimal foetal growth and intrauterine hypoxia and it is associated with a variety of perinatal adverse events.
Collapse
|
6
|
Policiano C, Reis-de-Carvalho C, Clode N, Mendes Graça L. National-survey for evaluation of the best screening method of late fetal growth restriction in low risk pregnancy: A prospective study. Eur J Obstet Gynecol Reprod Biol 2019; 240:187-191. [PMID: 31310919 DOI: 10.1016/j.ejogrb.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare knowledge and practices surrounding third trimester screening of fetal growth restriction (FGR) in low risk pregnancies among Portuguese Gynecologists/Obstetricians (GOs) and General Practitioners (GPs). Primary outcome was to compare the proportion of GOs that consider the need of a third trimester ultrasound (estimation of fetal weight) for screening of FGR in low risk pregnancies and the best time to perform it with the corresponding proportion of GPs. STUDY DESIGN We have conducted a prospective, observational cohort study based on application of surveys to GOs and GPs. Questionnaires were sent by e-mail to physicians and they filled them online. A second reminder e-mail was sent 7 days later. Recruitment was also done personally at scientific meetings. A total of 573 surveys were available for analysis, 298 corresponded to GOs and 275 to GPs. We used χ2 test to compare dichotomous variables and Kruskal-Wallis test for the comparison of ordinal variables. P values <0.05 were considered statistically significant. RESULTS The vast majority of GOs and GPs (93%) considered that third trimester ultrasound is useful and needed for surveillance of low risk pregnancy. A higher proportion of GOs (38%) selected 35th-37th weeks as the best time to perform the ultrasound compared to GPs (10%) (p < 0.001). GOs (51%) consider that symphysis-fundus distance is a measurement with moderate accuracy for screening of FGR while GPs (61%) attribute a low accuracy (p < 0.001). Fifty percent (50%) of GOs consider that performing a third trimester ultrasound will have no impact on cesarean delivery rate for fetal distress, while 41% of GPs consider that routine ultrasound will contribute to increase this rate (p < 0.001). The majority of GPs (52%) consider that routine ultrasound will contribute to diminish the admission rate to neonatal intensive care unit while GOs revealed a dichotomy with 43% of respondents reporting that it will diminish the rate and 40% that it will have no impact. CONCLUSION Varied opinions among the clinicians included in our sample reflect the controversy that remains on the best screening of FGR in low risk pregnancies.
Collapse
Affiliation(s)
- Catarina Policiano
- Department of Obstetrics and Gynecology, CHLN-Hospital Universitário de Santa Maria, Lisbon, Portugal.
| | - Catarina Reis-de-Carvalho
- Department of Obstetrics and Gynecology, CHLN-Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Nuno Clode
- Department of Obstetrics and Gynecology, CHLN-Hospital Universitário de Santa Maria, Lisbon, Portugal
| | | |
Collapse
|
7
|
Kalafat E, Morales-Rosello J, Thilaganathan B, Dhother J, Khalil A. Risk of neonatal care unit admission in small for gestational age fetuses at term: a prediction model and internal validation. J Matern Fetal Neonatal Med 2018; 32:2361-2368. [DOI: 10.1080/14767058.2018.1437412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Erkan Kalafat
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
- Department of Statistics, Middle East Technical University, Ankara, Turkey
| | - Jose Morales-Rosello
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
| | - Basky Thilaganathan
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
| | - Jasreen Dhother
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St. George’s Hospital, St. George’s University of London, London, UK
| |
Collapse
|