Potential cost-effectiveness of nutrition interventions to prevent adverse pregnancy outcomes in the developing world

Insights into the neuroprotective mechanisms of 2-iminobiotin employing an in-vitro model of hypoxic-ischemic cell injury

Several animal models have been used to simulate cerebral hypoxia-ischemia and suggested neuroprotective effects of the biotin analogue 2-iminobiotin (2-IB). The aims of this study were to employ a human in-vitro hypoxia model to confirm protective effects of 2-IB on neuronal cells, determine the optimal neuroprotective concentrations of 2-IB and scrutinize underlying cellular effects of 2-IB. Neuronal IMR-32 cells were exposed to hypoxia employing an enzymatic hypoxia system and were thereafter incubated with various concentrations of 2-IB (10 to 300ng/ml). Cell damage, metabolic activity and generation of reactive oxygen species were quantified using colorimetric/fluorometric lactate dehydrogenase (LDH), tetrazolium-based (MTS) and reactive oxygen species assays. Proteome profiling arrays were performed to evaluate the regulation of cell stress protein expression by hypoxia and 2-IB. Seven hours of hypoxia led to morphological changes in IMR-32 cultures, increased neuronal cell damage (P<0.001), reduction of metabolic activity (P<0.01) and enhanced reactive oxygen species production (P<0.05). Post-hypoxic application of 2-IB (30ng/ml) attenuated hypoxia-induced LDH release (P<0.05) and increased metabolic activity of IMR-32 cells (P<0.05), while reactive oxygen species production was only by trend decreased. Array-based protein expression profiling revealed that 2-IB attenuated the expression of several hypoxia-induced cell stress-associated proteins by more than 25% (pp38α, HIF2α, ADAMTS1, pHSP27, PON2, PON3 and p27). Hypoxia-induced neuronal cell damage can be simulated using the described in-vitro model. 2-IB inhibits hypoxia-mediated neurotoxicity most efficiently at 30ng/ml and the underlying mechanisms involve a downregulation of stress-associated protein expression. Our results suggest 2-IB as a potential drug for the treatment of perinatal hypoxia-ischemia.

Determinants of gestational night blindness in pregnant women from Rio de Janeiro, Brazil

OBJECTIVE

To describe the prevalence and determinants of gestational night blindness in pregnant women receiving care in a hospital in Rio de Janeiro, Brazil.

DESIGN

Cross-sectional study of pregnant and postpartum women receiving care in a public hospital in Rio de Janeiro from 1999 to 2001 (group I; n 225) or from 2005 to 2008 (group II; n 381). Night blindness was identified through a standardized and validated interview (WHO, 1996). The determinants of gestational night blindness were identified through a hierarchical logistic regression model.

SETTING

Public maternity hospital in Rio de Janeiro, RJ, Brazil.

SUBJECTS

Adult pregnant and postpartum women (n 606), aged ≥20 years.

RESULTS

The prevalence of gestational night blindness was 9·9 %. The final model revealed that not living in the South Zone of Rio de Janeiro (distal level: adjusted OR=1·846; 95 % CI 1·002, 3·401), belonging to group I (intermediate level: adjusted OR=2·183; 95 % CI 1·066, 4·471) and for the proximal level, having a history of abortion (adjusted OR=2·840; 95 % CI 1·134, 7·115) and having anaemia during the first and second trimesters of pregnancy (adjusted OR=3·776; 95 % CI 1·579, 9·029) were determinants of gestational night blindness.

CONCLUSION

Gestational night blindness should be assessed for during the prenatal care of all pregnant women, especially those living in deprived areas of the city and/or who have a history of abortion or anaemia. Nutritional monitoring is recommended during pregnancy to control gestational night blindness.

Effects of multimicronutrient supplementation during pregnancy on postnatal growth of children under 5 years of age: a meta-analysis of randomized controlled trials

Background

The beneficial effect of antenatal multiple micronutrients supplementation on infant birth outcomes has been proposed by previous meta-analyses. However, their benefits on postnatal health of children have not been summarized. A meta-analysis of randomized controlled trials was conducted to evaluate the effect of maternal multimicronutrient supplementation on postnatal growth of children under 5 years of age.

Methods

We searched both published and ongoing trials through the PubMed, EMBASE, CENTRAL (OVID platform), Web of Science, BIOSIS Previews, Chinese Science Citation Database, Scopus, ProQuest, ClinicalTrials.gov, Chinese Biomedical Database, and WANFANG database for randomized controlled trials. Reference lists of included studies and relevant reviews were also reviewed for eligible studies. Standard mean difference (SMD) was employed as the index for continuous variables by using fixed effects models. Trend analysis by visual inspection was applied to evaluate the change of mean difference of weight and height between the groups over time.

Results

Nine trials (12 titles) from nine different countries were retrieved for analysis. Pooled results showed that antenatal multimicronutrient supplementation increased child head circumference (SMD = 0.08, 95% CI: 0.00–0.15) compared with supplementation with two micronutrient or less. No evidence was found for the benefits of antenatal multimicronutrient supplementation on weight (P = 0.11), height (P = 0.66), weight-for-age z scores (WAZ) (P = 0.34), height-for-age z scores (HAZ) (P = 0.81) and weight-for-height z scores (WHZ) (P = 0.22). A positive effect was found on chest circumference based on two included studies.

Conclusions

Antenatal multimicronutrient supplementation has a significant positive effect on head circumference of children under 5 years. No impact of the supplementation was found on weight, height, WAZ, HAZ and WHZ.

Atenção nutricional e ganho de peso gestacional em adolescentes: uma abordagem quantiqualitativa

Neste estudo procurou-se avaliar o impacto da assistência nutricional (intervenção) sobre o ganho de peso gestacional total de adolescentes e compreender a percepção destas sobre a intervenção. Trata-se de uma investigação quantiqualitativa com triangulação de métodos, realizada em uma maternidade pública do Rio de Janeiro com 204 adolescentes, subdivididas nos grupos pré-intervenção e intervenção. A hipótese de homogeneidade de proporções foi testada por análises bi e multivariada, por meio de regressão de Poisson com variância robusta. Na abordagem qualitativa realizou-se entrevista semiestruturada com 12 adolescentes, cujos dados foram submetidos à análise de conteúdo. Os resultados apontam que a intervenção não exerceu efeito positivo na adequação do ganho de peso gestacional total. As adolescentes perceberam o plano alimentar como um conjunto de regras incompatíveis com suas condições de grávidas. A categoria "quase toda consulta era a mesma coisa" surgiu como síntese da percepção sobre a intervenção. Concluiu-se que há necessidade de reavaliar o instrumental tecnocientífico balizador da assistência nutricional e transformá-la em cuidado centrado na tomada de decisões compartilhadas.

Prevalance of pregnancy associated asymptomatic bacteriuria: a study done in a tertiary care hospital

OBJECTIVES

A prospective study was conducted in the Department of microbiology (IGMC) and the Department of obstetrics & gynecology (KNH), Shimla, and Himachal Pradesh over a period of 1 year from May 2005 to April 2006 on 463 asymptomatic pregnant females with a period of gestation (POG) 28 weeks or less. The aim was to find out the prevalence of pregnancy associated bacteriuria and bacterial causes responsible for this entity.

METHODS

The pregnant women were taught to collect the urine sample by aseptic technique which was then subjected to semi quantitative culture method.

RESULTS

Significant bacteriuria was present in 7.34% cases. About 78% samples were found to be sterile. Insignificant count and growth of contaminants was positive in 1 and 13% samples, respectively. The most common etiological agent came out to be E. coli followed by other gram positive and gram negative organisms.

CONCLUSION

Asymptomatic bacteriuria is a common occurrence which should be diagnosed and treated in early pregnancy keeping in view its adverse effects on pregnancy.

Prevention and treatment of malaria in pregnancy

Malaria in pregnancy is a substantial public health issue in many tropical countries. However, its prevention and treatment have been hindered because of fears of adverse drug effects in pregnant women recruited to intervention studies. This article details the pharmacological agents and management strategies currently or potentially available for use in pregnant women with or at risk of malaria. There are deficiencies in pharmacokinetic, tolerability, safety and efficacy data for even well-established drugs and combinations. This can have serious implications for the design of rational dose regimens. Approaches such as intermittent preventive treatment are increasingly employed in endemic areas with proven benefits, but the emergence of parasite drug resistance means that new strategies and drug regimens should be continually evaluated.

Could a simple antenatal package combining micronutritional supplementation with presumptive treatment of infection prevent maternal deaths in sub-Saharan Africa?

BACKGROUND

Reducing maternal mortality is a key goal of international development. Our objective was to determine the potential impact on maternal mortality across sub-Saharan Africa of a combination of dietary supplementation and presumptive treatment of infection during pregnancy. Our aim was to demonstrate the importance of antenatal interventions in the fight against maternal mortality, and to stimulate debate about the design of an effective antenatal care package which could be delivered at the lowest level of the antenatal health system or at community level.

METHODS

We collated evidence for the effectiveness of antenatal interventions from systematic reviews and controlled trials, and we selected interventions which have demonstrated potential to prevent maternal deaths. We used a model-based analysis to estimate the total reduction in maternal mortality in sub-Saharan Africa which could be achieved by combining these interventions into a single package, based on a WHO systematic review of causes of maternal deaths.

RESULTS

Severe hypertensive disorders, puerperal sepsis and anemia are causes of maternal deaths which could be prevented to some extent by prophylactic measures during pregnancy. A package of pills comprising calcium and iron supplements and appropriate anti-microbial and anti-malarial drugs could reduce maternal mortality in sub-Saharan Africa by 8% (range <1% to 20%). This estimate is based on Cochrane Review estimates for the effectiveness of daily calcium supplements in reducing the risk of death/serious morbidity due to hypertensive disorders (RR = 0.80, 95% CI 0.65-0.97), anti-microbial prophylaxis in reducing the odds of puerperal sepsis/postpartum endometritis (OR = 0.49, 95% CI 0.23-1.06), anti-malarial prophylaxis in reducing the risk of severe antenatal anemia (RR = 0.62, 95% CI 0.50-0.78), and iron supplementation in reducing the risk of iron deficiency anemia at term (RR = 0.33, 95% CI 0.16-0.69).

CONCLUSION

Maternal mortality could be reduced by a combination of micronutrient supplementation and presumptive treatment of infection during pregnancy. Such an approach could be adopted in resource-poor settings where visits to antenatal clinics are infrequent and would complement existing Safe Motherhood activities.