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Yuan J, Yu Y, Liu D, Sun Y. Associations between distinct dimensions of early life adversity and accelerated reproductive strategy among middle-aged women in China. Am J Obstet Gynecol 2022; 226:104.e1-104.e14. [PMID: 34384774 DOI: 10.1016/j.ajog.2021.07.033] [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: 05/14/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Life history theory argues that unpredictable and harsh conditions such as early life adversity tends to produce a fast life history strategy, characterized by early sexual maturation and less parenting of offspring. It remains unclear whether all forms of early life adversity are associated with accelerated reproductive strategy, and most previous studies predominantly focused on single form of reproductive strategy indicators. OBJECTIVE To examine the associations between 2 distinct dimensions of early life adversity (ie, threat and deprivation) and reproductive strategies across global metrics. STUDY DESIGN We used data from 9674 middle-aged women of the China Health and Retirement Longitudinal Study. The experiences of threat and deprivation were assessed using the Life History Survey Questionnaire in 2014. Reproductive strategy information was assessed via self-report from the follow-up of 2013, 2015 and 2018, including age at menarche, age at natural menopause, age at first birth, total number of children, and number of abortions. Multivariate linear regression analyses were performed to assess the associations between distinct dimensions of early life adversity and multiple reproductive strategy indicators, adjusting for age, Hukou location, family socioeconomic status in adulthood and body mass index. RESULTS Of the 9674 women (mean [standard deviation] age at baseline, 55.89 [10.23] years), 4084 (42.20%) reported exposure to threat-related early life adversity and 7332 (75.79%) reported exposure to deprivation-related early life adversity. Early life adversity characterized by threat was associated with accelerated reproductive strategy. Compared with women who have no experiences of threat-related early life adversity, ≥3 threat-related early life adversity was associated with 3.7-month earlier age at menarche (β=-0.31, 95% confidence interval, -0.53 to -0.08; P=.007), 8.6-month earlier age at natural menopause (β=-0.72, 95% confidence interval, -1.29 to -0.15; P=.013), >1-year earlier age at first birth (β=-1.14, 95% confidence interval, -1.58 to -0.71; P<.0001), and an increased total number of children (β=0.25, 95% confidence interval, 0.10-0.41; P=.002). In contrast, experiences of deprivation were associated with delayed age at natural menopause (β=.50, 95% confidence interval, 0.06-0.94; P=.025) and increased number of abortions (β=.17, 95% confidence interval, 0.01-0.34, P=.037), in models adjusting for co-occurring threat exposures. CONCLUSION This study suggests that early life adversity characterized by threat was associated with accelerated reproductive strategy, whereas deprivation was associated with slower reproduction strategy. Future research should clarify the biological pathways between different dimensions of early life adversity and reproductive strategies and further determine whether accelerated reproduction is an adaptive response to early life adversity in humans.
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Iqbal Z, Jilanee SDA, Uppada LP, Imtiaz S, Khan H, Shah SMH, Tousif S, Rahim A. Evaluating the Clinical Risk Factors Associated With Miscarriages in Women in Karachi, Pakistan. Cureus 2021; 13:e19057. [PMID: 34824942 PMCID: PMC8610211 DOI: 10.7759/cureus.19057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Spontaneous pregnancy loss is unquestionably common worldwide, with roughly 5% of pregnancies ending in this way. Miscarriage can lead to serious psychological issues for women as well as their mothers. Although, it is irreversible but can be prevented through proper risk assessment of women. The goal of this study is to find clinical predictors of miscarriages in Karachi, Pakistani women. Methodology The study is a retrospective chart review that used data of women having livebirth and miscarriages at the Liaquat National Hospital Karachi Pakistan. Data of a total of 517 women were included in the study, out of which 453 have had a live birth, and 64 had miscarriages. To determine the factors associated with miscarriages, multivariable logistic regression was used. Results The mean age of women was 31.08 (±5.10) years. Age of mother over 40 years (adjusted odds ratio [AOR]=10.28; p-value=0.001), overweight and obesity (AOR=3.01; p-value=0.001) and history of miscarriage (AOR=2.91; p-value=0.003) are variables significantly associated with miscarriages. Conclusion Findings of the current study shown that risk factors of miscarriages included age of mother, increased BMI and previous history of miscarriages. All these factors need to be considered while providing antenatal care to mothers to mitigate the risk of miscarriages.
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Affiliation(s)
- Zafar Iqbal
- Emergency Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Emergency Department, The Kidney Center, Karachi, PAK
| | | | | | - Samahir Imtiaz
- Medical College, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | | | - Sohaib Tousif
- Medical School, Ziauddin Medical University, Karachi, PAK
| | - Anum Rahim
- Indus Hospital Research Center, The Indus Hospital, Karachi, PAK
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Park J, Lee G. Association of Eating Alone with Depressive Symptoms and Suicidal Ideation among Korean Adults. Korean J Fam Med 2021; 42:219-224. [PMID: 34038990 PMCID: PMC8164923 DOI: 10.4082/kjfm.20.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In recent years, eating dinner alone has become a rising social issue in Korea. Depression is one of the primary health problems that can lead to numerous negative consequences. However, few studies have focused on people who eat alone and the effect of eating alone on depression. We investigated the association between eating dinner alone and depression. METHODS Our cross-sectional study included data from 14,093 Korean adults aged above 19 years old; data were sourced from the Korea National Health and Nutrition Examination Survey in 2014, 2016, and 2018, when the Patient Health Questionnaire (PHQ-9) was used. We classified participants based on their dinner habits: eating alone or social eating. Depression and suicidal ideation among participants were measured using the PHQ-9. Multivariate logistic regression analysis was used to investigate whether eating alone was related to depression or suicidal ideation after adjusting for age, sex, household income, education, alcohol, smoking, exercise, frequency of eating out, and living arrangement. RESULTS Individuals who ate dinner alone (22.9%) had higher depression and suicidal ideation rates than those who ate with others. Those who ate alone had greater odds ratios (ORs) of depressive symptoms (depression: OR, 1.42; 95% confidence interval [CI], 1.27-1.58; suicidal ideation: OR, 1.49; 95% CI, 1.25-1.78) after adjustment for covariates. The subgroup analysis shows that the odds of suicidal ideation among individuals who eat alone were nonexistent among those who performed regular aerobic exercise. CONCLUSION Eating dinner alone is closely associated with depressive symptoms, particularly suicidal ideation. Therefore, providing opportunities to eat with others may be effective for maintaining the mental health of adults.
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Affiliation(s)
- Joonyoung Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
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Magnus MC, Ferreira DDS, Borges MC, Tilling K, Lawlor DA, Fraser A. Cardiometabolic health during early adulthood and risk of miscarriage: a prospective study. Wellcome Open Res 2021; 5:205. [PMID: 33644403 PMCID: PMC7888356 DOI: 10.12688/wellcomeopenres.16245.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Several studies have found that women who are overweight or obese have an increased risk of miscarriage. There is also some evidence of associations of other aspects of cardiometabolic health, including blood pressure and lipids, with miscarriage risk, although these have not been examined to the same extent as body-mass index (BMI). Methods: Our objective was to investigate the risk of miscarriage according to pre-pregnancy cardiometabolic health. We examined pre-pregnancy levels of BMI, blood pressure, fasting insulin and metabolites profile at age 18 and risk of miscarriage by age 24. The study included adult female offspring in the Avon Longitudinal Study of Parents and Children with a pregnancy between 18 and 24 years of age (n=434 for BMI and blood pressure; n=265 for metabolites). We used log-binomial regression to calculate adjusted associations between cardiometabolic health measures and miscarriage. Results: The overall risk of miscarriage was 22%. The adjusted relative risks for miscarriage were 0.96 (95% CI: 0.92-1.00) for BMI (per unit increase), 0.98 (0.96-1.00) for systolic blood pressure, and 1.00 (0.97-1.04) for diastolic blood pressure (per 1 mmHg increase). Total cholesterol, total lipids and phospholipids in HDL-cholesterol were associated with increased likelihood of miscarriage, but none of the p-values for the metabolites were below the corrected threshold for multiple testing (p-value ≤0.003). Conclusions: Our findings indicate no strong evidence to support a relationship between pre-pregnancy cardiometabolic health and risk of miscarriage in young, healthy women who became pregnant before age 24. Future studies are necessary that are able to evaluate this question in samples with a wider age range.
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Affiliation(s)
- Maria C. Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, 0213, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Diana D. S. Ferreira
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Carolina Borges
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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Chukwuagwu IU, Ukibe NR, Ogbu II, Ikimi CG, Agu VO, Kalu OA, Ukibe SN, Awalu JC. Evaluation of Serum Interleukin 6, Tumor Necrosis Factor-Alpha, and Interferon-Gamma Levels in Relation to Body Mass Index and Blood Pressure in HIV Seropositive Pregnant Women Coinfected with Malaria. Interdiscip Perspect Infect Dis 2020; 2020:2424802. [PMID: 33193759 PMCID: PMC7641722 DOI: 10.1155/2020/2424802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/23/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022] Open
Abstract
Malaria and HIV are leading causes of morbidity and mortality, particularly in sub-Saharan Africa. Both diseases are highly endemic and have a wide geographic overlap with severe impact on pregnancy. This was a case-control study designed to evaluate the levels of interleukin -6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ) and their relationship with some anthropometric indices such as body mass index (BMI) and blood pressure in HIV-malaria coinfected women attending antenatal clinic at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. 122 pregnant women and 30 nonpregnant women (control) aged between 18 and 42 years were recruited for the study. Screening of HIV antibodies was done using a national algorithm. Peripheral malaria was determined using rapid detection and the Giemsa stain technique. Cytokines were assayed using the enzyme-linked immunosorbent assay technique. HIV-malaria coinfected pregnant women showed significantly higher levels of IL-6, IFN-γ, TNF-α, and blood pressure with reduced BMI value compared with HIV seronegative pregnant and nonpregnant control participants (p ≤ 0.001, respectively). The findings indicated significant cytokine imbalance which suggests an active inflammatory process and reduced cellular immunity. The increased BMI and blood pressure level observed indicate overweight and possible hypertension which could subsequently lead to preeclampsia and other adverse pregnancy outcomes.
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Affiliation(s)
- Ikechukwu Uzoma Chukwuagwu
- Department of Medical Laboratory, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, PMB 5025, Nnewi, Anambra State, Nigeria
| | - Nkiruka Rose Ukibe
- Department of Medical Laboratory, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, PMB 5025, Nnewi, Anambra State, Nigeria
| | - Innocent Ikechi Ogbu
- Department of Medical Laboratory, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, PMB 5025, Nnewi, Anambra State, Nigeria
| | - Charles German Ikimi
- Department of Biochemistry, Faculty of Science, Federal University of Otuoke, Yenagoa, Beyalsa State, Nigeria
| | - Victoria Ogechi Agu
- Department of Medical Laboratory, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, PMB 5025, Nnewi, Anambra State, Nigeria
| | - Ofia Anya Kalu
- Department of Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, PMB 5025, Nnewi, Anambra State, Nigeria
| | - Solomon Nwabueze Ukibe
- Department of Medical Microbiology, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, PMB 5025, Nnewi, Anambra State, Nigeria
| | - Joseph Chimezie Awalu
- Department of Medical Laboratory, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, PMB 5025, Nnewi, Anambra State, Nigeria
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Magnus MC, Ferreira DDS, Borges MC, Tilling K, Lawlor DA, Fraser A. Cardiometabolic health during early adulthood and risk of miscarriage: a prospective study. Wellcome Open Res 2020; 5:205. [PMID: 33644403 PMCID: PMC7888356 DOI: 10.12688/wellcomeopenres.16245.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 11/08/2023] Open
Abstract
Background: Several studies have found that women who are overweight or obese have an increased risk of miscarriage. There is also some evidence of associations of other aspects of cardiometabolic health, including blood pressure and lipids, with miscarriage risk, although these have not been examined to the same extent as body-mass index (BMI). Methods: Our objective was to investigate the risk of miscarriage according to pre-pregnancy cardiometabolic health. We examined pre-pregnancy levels of BMI, blood pressure, fasting insulin and metabolites profile at age 18 and risk of miscarriage by age 24. The study included adult female offspring in the Avon Longitudinal Study of Parents and Children with a pregnancy between 18 and 24 years of age (n=434 for BMI and blood pressure; n=265 for metabolites). We used log-binomial regression to calculate adjusted associations between cardiometabolic health measures and miscarriage. Results: The overall risk of miscarriage was 22%. The adjusted relative risks for miscarriage were 0.96 (95% CI: 0.92-1.00) for BMI (per unit increase), 0.98 (0.96-1.00) for systolic blood pressure, and 1.00 (0.97-1.04) for diastolic blood pressure (per 1 mmHg increase). Total cholesterol, total lipids and phospholipids in HDL-cholesterol were associated with increased likelihood of miscarriage, but none of the p-values for the metabolites were below the corrected threshold for multiple testing (p-value ≤0.003). Conclusions: Pre-pregnancy cardiometabolic health in late adolescence was not associated with miscarriage risk in young, healthy women who became pregnant before age 24.
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Affiliation(s)
- Maria C. Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, 0213, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Diana D. S. Ferreira
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Carolina Borges
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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Moshtaghi A, Vaziri H, Sariri R, Shaigan H. Polymorphism of MnSOD (Val16Ala) gene in pregnancies with blighted ovum: A case-control study. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.8.503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Santos AMD, Benute GRG, Santos NOD, Nomura RMY, de Lucia MCS, Francisco RPV. Presence of eating disorders and its relationship to anxiety and depression in pregnant women. Midwifery 2017; 51:12-15. [DOI: 10.1016/j.midw.2017.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 05/03/2017] [Accepted: 05/06/2017] [Indexed: 10/19/2022]
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Bye A, Shawe J, Stephenson J, Bick D, Brima N, Micali N. Differences in pre-conception and pregnancy healthy lifestyle advice by maternal BMI: Findings from a cross sectional survey. Midwifery 2016; 42:38-45. [DOI: 10.1016/j.midw.2016.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 08/30/2016] [Accepted: 09/21/2016] [Indexed: 10/21/2022]
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Balsells M, García-Patterson A, Corcoy R. Systematic review and meta-analysis on the association of prepregnancy underweight and miscarriage. Eur J Obstet Gynecol Reprod Biol 2016; 207:73-79. [PMID: 27825031 DOI: 10.1016/j.ejogrb.2016.10.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/19/2016] [Accepted: 10/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Maternal underweight, overweight and obesity have been associated with a higher risk of miscarriage. Most individual reports and all meta-analyses have addressed high body mass index. OBJECTIVES To review the literature and summarize the risk of miscarriage in underweight women vs those with normal weight. METHODS A Medline Search (1st January 1990-20th November 2015, human, in English, French, Italian, Spanish or Portuguese) was conducted. Both spontaneous pregnancies and pregnancies after assisted reproduction techniques were considered. Cohort and case control studies were included if they reported data on the outcome of interest (clinical miscarriage), in underweight and normal weight women. Information on clinical miscarriage in other body mass index categories was collected when available. Two investigators reviewed the abstracts, full text papers and extracted data. Review Manager 5.1 software was used to summarize the results. RESULTS 32 studies (30 cohort, 2 case control) and a total of 265,760 women were included. In cohort studies, the relative risk (RR) of clinical miscarriage in underweight women was 1.08, 95% CI 1.05-1.11; p<0.0001). The corresponding figures were RR 1.09, 95% CI 1.04-1.13; p<0.0001 for overweight women and RR 1.21, 95% CI 1.15-1.27; p<0.00001 for obese women. In case control studies, the odds ratio (OR) of clinical miscarriage in underweight women was 1.02, 95% CI 0.46-2.30; p=0.95). The corresponding figures were OR 1.01, 95% CI 0.88-1.16; p=0.89 for overweight women and OR 1.26, 95% CI 1.01-1.57; p=0.04 for obese women. The limitations of this study are that it is restricted to studies with information on underweight women and that I2 ranges from 0 to 91% in different subgroups. CONCLUSION We conclude that maternal underweight is associated with a slightly increased risk of clinical miscarriage, similar to that of overweight women and lower than the risk observed in obesity. The heterogeneity displayed in some subgroups limits the strength of the conclusion.
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Affiliation(s)
- Montserrat Balsells
- Department of Endocrinology and Nutrition, Hospital Mútua de Terrassa, Plaça Dr Robert 5, Terrassa 08221 Barcelona, Spain.
| | - Apolonia García-Patterson
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, S Antoni Mª Claret 167, Barcelona 08025, Spain.
| | - Rosa Corcoy
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, S Antoni Mª Claret 167, Barcelona 08025, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain.
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O’Connor DL, Blake J, Bell R, Bowen A, Callum J, Fenton S, Gray-Donald K, Rossiter M, Adamo K, Brett K, Khatri N, Robinson N, Tumback L, Cheung A. Consensus canadien sur la nutrition féminine : adolescence, reproduction, ménopause et au-delà. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:555-609.e19. [DOI: 10.1016/j.jogc.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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O'Connor DL, Blake J, Bell R, Bowen A, Callum J, Fenton S, Gray-Donald K, Rossiter M, Adamo K, Brett K, Khatri N, Robinson N, Tumback L, Cheung A. Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:508-554.e18. [PMID: 27368135 DOI: 10.1016/j.jogc.2016.01.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To provide health care professionals in Canada with the basic knowledge and tools to provide nutrition guidance to women through their lifecycle. OUTCOMES Optimal nutrition through the female lifecycle was evaluated, with specific focus on adolescence, pre-conception, pregnancy, postpartum, menopause, and beyond. The guideline begins with an overview of guidance for all women, followed by chapters that examine the evidence and provide recommendations for the promotion of healthy nutrition and body weight at each life stage. Nutrients of special concern and other considerations unique to each life stage are discussed in each chapter. EVIDENCE Published literature, governmental and health agency reports, clinical practice guidelines, grey literature, and textbook sources were used in supporting the recommendations made in this document. VALUES The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care. CHAPTER 2: GENERAL FEMALE NUTRITION: Summary Statements Recommendations CHAPTER 3: ADOLESCENCE NUTRITION: Summary Statements Recommendations CHAPTER 4: PRE-CONCEPTUAL NUTRITION: Summary Statement Recommendations CHAPTER 5: NUTRITION IN PREGNANCY: Summary Statements Recommendations CHAPTER 6: POSTPARTUM NUTRITION AND LACTATION: Summary Statements Recommendations CHAPTER 7: NUTRITION DURING MENOPAUSE AND BEYOND: Summary Statement Recommendations.
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Madero S, Rodriguez A, Vassena R, Vernaeve V. Endometrial preparation: effect of estrogen dose and administration route on reproductive outcomes in oocyte donation cycles with fresh embryo transfer. Hum Reprod 2016; 31:1755-64. [PMID: 27141040 DOI: 10.1093/humrep/dew099] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/08/2016] [Indexed: 12/23/2022] Open
Abstract
STUDY QUESTION Is there a difference in live birth rates following endometrial preparation with either a constant or increasing estrogen dose in fresh embryo transfer from oocyte donation cycles? SUMMARY ANSWER There is no difference in live birth rates between a constant dose versus an increasing dose of estrogen after fresh embryo transfer in oocyte donation cycles with oral or transdermal supplementation. WHAT IS KNOWN ALREADY Endometrial preparation (EP) with estrogen and progesterone, and embryo-endometrial synchronicity are determinant for adequate embryo implantation. Estrogen is crucial and different exogenous administration patterns could imply variations on EP. Moreover, estrogen undergoes metabolization by the intestines and liver when administered orally, an effect that is bypassed by transdermal administration. Information on the effect of replacement patterns and route of administration of E on reproductive outcomes of women undergoing fresh embryo transfer from oocyte donation cycles is scarce. STUDY DESIGN, SIZE, DURATION Retrospective cohort study including 8362 embryo transfers following ICSI, corresponding to 8254 patients, between October 2010 and March 2015. A total of 5593 (66.9%) patients received an increasing E dose (ID) (oral: 2 mg/day day(d)1-7, 4 mg days d8-12, 6 mg d13-embryo transfer; transdermal: 75 µg/3 days on d1-6, 150 µg/3 days d7-embryo transfer) while 2769 (33.1%) received a constant dose (CD) of estrogen (oral: 6 mg/day 1-embryo transfer; transdermal: 150 µg/3 days d1-embryo transfer). Embryos were generated by ICSI with fresh or vitrified donor oocytes fertilized with either fresh or frozen sperm from either the couple partner or donor. PARTICIPANTS/MATERIALS, SETTING, METHODS Cohort allocation was not related to patient characteristics; instead it reflected an internal policy change in E administration. Effect of estrogen dose (ID versus CD) on biochemical, clinical, ongoing and live birth rates, stratified by administration route, was analyzed by univariate and multivariate analysis adjusted by donor and recipient demographic and cycle characteristics. MAIN RESULTS AND THE ROLE OF CHANCE No difference in live birth rate was found between CD and ID for oral (33.0 versus 32.5%, P = 0.81) and transdermal (35.3 versus 33.5%, P = 0.33) supplementation. Biochemical pregnancy rate was higher in CD than ID (53.7 versus 47.5%, P < 0.001) when patients received oral supplementation. Adjusted analysis confirmed that oral administration had a greater impact on biochemical pregnancy rates than transdermal (odds ratio (OR) 1.28; 95% confidence interval (CI) 1.11-1.48, P = 0.001 versus OR 1.13; 95% CI 1.00-1.30, P = 0.055). Sub-analysis of transfers between day 12 and 15 of estrogen supplementation showed no difference between CD and ID in pregnancy outcomes. Demographic variables and cycle characteristics were comparable between both groups. Moreover, the use of the oocyte donation model reduces confounding factors related to oocyte age, embryo aneuploidy, and embryo quality. LIMITATIONS, REASONS FOR CAUTION The greatest limitation of this study is its retrospective nature. On the other hand, this study was performed using donated oocytes; although this is unlikely to affect the results, we cannot exclude the possibility that a high quality female gamete responds differently to endometrial state in comparison to a patient's own oocytes. WIDER IMPLICATIONS OF THE FINDINGS In fresh embryo transfer from oocyte donation cycles, changes in the protocol of E replacement do not seem to have an impact on clinical outcomes and performance; for this reason estrogen replacement protocols can be adjusted to the patient's characteristics and preferences as well as to the most cost effective strategy. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- S Madero
- Clínica EUGIN, 08029 Barcelona, Spain
| | | | - R Vassena
- Clínica EUGIN, 08029 Barcelona, Spain
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Jung SJ, Park SK, Shin A, Lee SA, Choi JY, Hong YC, Yoo KY, Lee JK, Kang D. Body mass index at age 18-20 and later risk of spontaneous abortion in the Health Examinees Study (HEXA). BMC Pregnancy Childbirth 2015; 15:228. [PMID: 26403183 PMCID: PMC4582827 DOI: 10.1186/s12884-015-0665-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Spontaneous abortion (SA) affects 11.2% of recognized pregnancies in Korea. Many studies have focused on the increased risk of SA in obese populations, but there are few studies that have focused on underweight (Body mass index (BMI) <18.5 kg/m2) women, especially in relation to pre-pregnancy BMI. The aim of this study was to examine the role of pre-pregnancy BMI at age 18–20 in later SA. Methods Among the women who were ever pregnant in the Health Examinees Study (HEXA), which was one of the cohorts studied in the KoGES (Korean Genome and Epidemiology Study) from 2004 to 2012 (N = 80,447), the likelihood of SA based on pre-pregnancy BMI, classified by the criteria for Asians (Underweight: <18.5 kg/m2; Normal range: 18.5-22.9 kg/m2; Overweight at risk: 23–24.9 kg/m2; Obese I: 25–29.9 kg/m2; Obese II: ≥30 kg/m2), was presented as odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression models. Results Being underweight or obese relative to the normal weight range was associated with a higher likelihood of SA (OR = 1.10 [95% CI = 1.05–1.15] in underweight women and OR = 1.06 [95% CI = 0.96–1.16] in obese women), and this effect was much greater in women who experienced recurrent SAs (for three or more SAs: OR = 1.29 [95% CI 1.14–1.46] in underweight women and OR = 1.39 [95% CI 1.09–1.78] in obese women). Obesity was associated with an increased likelihood of SA at a younger age (≤25 years), whereas underweight was associated with an increased OR of SA at an older age (≥26 years). Discussion As this study was conducted with baseline data of original cohort which focused on other chronic diseases, recall for previous pregnancy-related information might be less accurate. However, this study shows strength in its large size and prospective potential. Conclusions Pre-pregnancy BMI at ages 18–20 years revealed a U-shaped association with SA, and underweight and obese women showed increased likelihood for SA during different age periods. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0665-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sun Jae Jung
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sue Kyung Park
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea.
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sang-Ah Lee
- Department of Preventive Medicine, Kangwon National University, Seoul, South Korea.
| | - Ji-Yeob Choi
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea.
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Keun-Young Yoo
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Jong-Koo Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.
| | - Daehee Kang
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea.
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Shamim AA, Schulze K, Merrill RD, Kabir A, Christian P, Shaikh S, Wu L, Ali H, Labrique AB, Mehra S, Klemm RDW, Rashid M, Sungpuag P, Udomkesmalee E, West KP. First-trimester plasma tocopherols are associated with risk of miscarriage in rural Bangladesh. Am J Clin Nutr 2015; 101:294-301. [PMID: 25646326 DOI: 10.3945/ajcn.114.094920] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Tocopherols were discovered for their role in animal reproduction, but little is known about the contribution of deficiencies of vitamin E to human pregnancy loss. OBJECTIVE We sought to determine whether higher first-trimester concentrations of α-tocopherol and γ-tocopherol were associated with reduced odds of miscarriage (pregnancy losses <24 wk of gestation) in women in rural Bangladesh. DESIGN A case-cohort study in 1605 pregnant Bangladeshi women [median (IQR) gestational age: 10 wk (8-13 wk)] who participated in a placebo-controlled vitamin A- or β-carotene-supplementation trial was done to assess ORs of miscarriage in women with low α-tocopherol (<12.0 μmol/L) and γ-tocopherol (<0.81 μmol/L; upper tertile cutoff of the γ-tocopherol distribution in women who did not miscarry). RESULTS In all women, plasma α- and γ-tocopherol concentrations were low [median (IQR): 10.04 μmol/L (8.07-12.35 μmol/L) and 0.66 μmol/L (0.50-0.95 μmol/L), respectively]. In a logistic regression analysis that was adjusted for cholesterol and the other tocopherol, low α-tocopherol was associated with an OR of 1.83 (95% CI: 1.04, 3.20), whereas a low γ-tocopherol concentration was associated with an OR of 0.62 (95% CI: 0.41, 0.93) for miscarriage. Subgroup analyses revealed that opposing ORs were evident only in women with BMI (in kg/m(2)) ≥18.5 and serum ferritin concentration ≤150 μg/L, although low BMI and elevated ferritin conferred stronger risk of miscarriage. CONCLUSIONS In pregnant women in rural Bangladesh, low plasma α-tocopherol was associated with increased risk of miscarriage, and low γ-tocopherol was associated with decreased risk of miscarriage. Maternal vitamin E status in the first trimester may influence risk of early pregnancy loss. The JiVitA-1 study, from which data for this report were derived, was registered at clinicaltrials.gov as NCT00198822.
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Affiliation(s)
- Abu Ahmed Shamim
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Kerry Schulze
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Rebecca D Merrill
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Alamgir Kabir
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Parul Christian
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Saijuddin Shaikh
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Lee Wu
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Hasmot Ali
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Alain B Labrique
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Sucheta Mehra
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Rolf D W Klemm
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Mahbubur Rashid
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Pongtorn Sungpuag
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Emorn Udomkesmalee
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Keith P West
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
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Gallot V, Nedellec S, Capmas P, Legendre G, Lejeune-Saada V, Subtil D, Nizard J, Levêque J, Deffieux X, Hervé B, Vialard F. Fausses couches précoces « à répétition » : bilan et prise en charge. ACTA ACUST UNITED AC 2014; 43:812-41. [DOI: 10.1016/j.jgyn.2014.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
OBJECTIVES Study of epidemiology of pregnancy loss. MATERIALS AND METHOD A systematic review of the literature was performed using Pubmed and the Cochrane library databases and the guidelines from main international societies. RESULTS The occurrence of first trimester miscarriage is 12% of pregnancies and 25% of women. Miscarriage risk factors are ages of woman and man, body mass index greater than or equal to 25kg/m(2), excessive coffee drinking, smoking and alcohol consumption, exposure to magnetic fields and ionizing radiation, history of abortion, some fertility disorders and impaired ovarian reserve. Late miscarriage (LM) complicates less than 1% of pregnancies. Identified risk factors are maternal age, low level of education, living alone, history of previous miscarriage, of premature delivery and of previous termination of pregnancy, any uterine malformation, trachelectomy, existing bacterial vaginosis, amniocentesis, a shortened cervix and a dilated cervical os with prolapsed membranes. Fetal death in utero has a prevalence of 2% in the world and 5/1000 in France. Its main risk factors are detailed in the chapter.
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18
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Gaskins AJ, Rich-Edwards JW, Colaci DS, Afeiche MC, Toth TL, Gillman MW, Missmer SA, Chavarro JE. Prepregnancy and early adulthood body mass index and adult weight change in relation to fetal loss. Obstet Gynecol 2014; 124:662-669. [PMID: 25198273 PMCID: PMC4172495 DOI: 10.1097/aog.0000000000000478] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine prospectively the relationships of prepregnancy body mass index (BMI), BMI at age 18 years, and weight change since age 18 years with risk of fetal loss. METHODS Our prospective cohort study included 25,719 pregnancies reported by 17,027 women in the Nurses' Health Study II between 1990 and 2009. In 1989, height, current weight, and weight at age 18 years were self-reported. Current weight was updated every 2 years thereafter. Pregnancies were self-reported, with case pregnancies lost spontaneously and comparison pregnancies ending in ectopic pregnancy, induced abortion, or live birth. RESULTS Incident fetal loss was reported in 4,494 (17.5%) pregnancies. Compared with those of normal BMI, the multivariate relative risks of fetal loss were 1.07 (95% CI [confidence interval] 1.00-1.15) for overweight women, 1.10 (95% CI 0.98-1.23) for class I obese women, and 1.27 (95% CI 1.11-1.45) for class II and class III obese women (P trend ≤ .001). Body mass index at age 18 years was not associated with fetal loss (P trend=.59). Compared with women who maintained a stable weight (± 4 kg) between age 18 years and before pregnancy, women who lost weight had a 20% (95% CI 9-29%) lower risk of fetal loss. This association was stronger among women who were overweight at age 18 years. CONCLUSION Being overweight or obese before pregnancy was associated with higher risk of fetal loss. In women overweight or obese at age 18 years, losing 4 kg or more was associated with a lower risk of fetal loss. LEVEL OF EVIDENCE : II.
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Affiliation(s)
- Audrey J. Gaskins
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Janet W. Rich-Edwards
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Connors Center for Women’s Health and Gender Biology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniela S. Colaci
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Myriam C. Afeiche
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Thomas L. Toth
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew W. Gillman
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Stacey A. Missmer
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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19
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Hahn KA, Hatch EE, Rothman KJ, Mikkelsen EM, Brogly SB, Sørensen HT, Riis AH, Wise LA. Body size and risk of spontaneous abortion among danish pregnancy planners. Paediatr Perinat Epidemiol 2014; 28:412-23. [PMID: 25225009 PMCID: PMC4356022 DOI: 10.1111/ppe.12142] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies indicate that female obesity increases the risk of spontaneous abortion (SAB). Central adiposity, height, and location of typical weight gain have not been examined as risk factors for SAB. METHODS We examined the associations between selected anthropometric factors and risk of SAB among 5132 women enrolled in a Danish Internet-based prospective cohort study of pregnancy planners. We used Cox proportional hazards regression models, with gestational weeks as the time scale, to compute hazard ratios (HRs) of SAB and 95% confidence intervals (CIs). RESULTS After adjustment for potential confounders, the HRs for SAB among underweight (body mass index (BMI, kg/m(2) ) <20), overweight (BMI: 25-29) and obese (BMI ≥30) women were 1.00 [95% CI: 0.81, 1.24], 0.90 [95% CI: 0.73, 1.09] and 1.23 [95% CI: 0.98, 1.54], respectively, compared with normal weight women (BMI 20-24). The association between obesity and SAB was stronger for early SAB (<8 weeks gestation); HR: 1.34 95% CI: 1.01, 1.77. The HR for height ≥174 cm vs. <166 cm was 0.81 [95% CI: 0.66, 1.00]. Increased waist-to-hip ratio (WHR) was inversely associated with risk of SAB (HR: 0.81; 95% CI: 0.63, 1.05). Waist circumference and location of typical weight gain were not appreciably associated with SAB risk. CONCLUSIONS This study confirms previous studies that have shown a small positive association between obesity and SAB risk. Our results suggest that obesity is a stronger risk factor for early pregnancy losses, and that small stature and low WHR are associated with an increased risk of SAB.
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Affiliation(s)
- Kristen A. Hahn
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Kenneth J. Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA,RTI Health Solutions, Research Triangle Park, NC
| | - Ellen M. Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Susan B. Brogly
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Henrik T. Sørensen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders H. Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA,Slone Epidemiology Center, Boston University, Boston, MA
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Pawlowski B, Nowak J, Borkowska BARBARA, Drulis-Kawa Z. Human body morphology, prevalence of nasopharyngeal potential bacterial pathogens, and immunocompetence handicap principal. Am J Hum Biol 2014; 26:305-10. [DOI: 10.1002/ajhb.22510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/29/2013] [Accepted: 01/08/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Boguslaw Pawlowski
- Department of Human Biology; University of Wroclaw; Kuznicza 35 50-138 Wroclaw Poland
| | - Judyta Nowak
- Department of Human Biology; University of Wroclaw; Kuznicza 35 50-138 Wroclaw Poland
| | - BARBARA Borkowska
- Department of Human Biology; University of Wroclaw; Kuznicza 35 50-138 Wroclaw Poland
| | - Zuzanna Drulis-Kawa
- Department of Pathogen Biology and Immunology; University of Wroclaw; Przybyszewskiego 63/77 51-148 Wroclaw Poland
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Gupta S, Fedor J, Biedenharn K, Agarwal A. Lifestyle factors and oxidative stress in female infertility: is there an evidence base to support the linkage? ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2013.849418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Pregnancy loss after frozen-embryo transfer—a comparison of three protocols. Fertil Steril 2012; 98:1165-9. [DOI: 10.1016/j.fertnstert.2012.07.1058] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 06/06/2012] [Accepted: 07/03/2012] [Indexed: 11/18/2022]
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23
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Benammar A, Sermondade N, Faure C, Dupont C, Cedrin-Durnerin I, Sifer C, Hercberg S, Levy R. Nutrition et fausses couches spontanées : une revue de la littérature. ACTA ACUST UNITED AC 2012; 40:162-9. [DOI: 10.1016/j.gyobfe.2012.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 09/07/2011] [Indexed: 12/14/2022]
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Kumar S. Occupational, Environmental and Lifestyle Factors Associated With Spontaneous Abortion. Reprod Sci 2011; 18:915-30. [DOI: 10.1177/1933719111413298] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sunil Kumar
- Division of Reproductive and Cytotoxicology, National Institute of Occupational Health (ICMR), Ahmedabad, Gujarat, India
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Samaraweera Y, Abeysena C. Maternal sleep deprivation, sedentary lifestyle and cooking smoke: Risk factors for miscarriage: A case control study. Aust N Z J Obstet Gynaecol 2010; 50:352-7. [PMID: 20716263 DOI: 10.1111/j.1479-828x.2010.01190.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To determine risk factors for miscarriage. METHODS A case control study was carried out at the gynaecological wards and antenatal clinics of the De Soysa Maternity Hospital in Sri Lanka. A case was defined as that of mothers with a confirmed diagnosis of partial or full expulsion of the fetus during the first 28 weeks of gestation. Controls comprised ante-natal clinic attendees whose period of gestation was <28 weeks and carrying a viable fetus. Two hundred and thirty cases and 504 controls were selected. A pre-tested interviewer-administered questionnaire and modified life events inventory were used to gather data. Multivariate logistic regression was applied separately for first and second trimester miscarriages and the results were expressed as odds ratios (OR) and as 95% confidence intervals (95% CI). RESULTS Sleeping < or =8 h/day (OR:3.80, 95% CI:1.01-14.3) was found to be a risk factor for first trimester miscarriage controlling for the effect of period of gestation. Sleeping < or =8 h/day (OR:2.04, 95% CI:1.24-3.37), standing < or =3 h/day (OR:1.83, 95% CI:1.08-3.10), exposure to cooking smoke (OR:3.83, 95% CI:1.50-9.90) and physical trauma during the pregnancy (OR:43.2, 95% CI:4.55-411.4) were found to be risk factors for second trimester miscarriage controlling for the effect of period of gestation. CONCLUSIONS Sleep deprivation, a sedentary lifestyle, exposure to cooking smoke and physical trauma during pregnancy were risk factors for miscarriage. Most of the risk factors are therefore modifiable.
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Baba S, Noda H, Nakayama M, Waguri M, Mitsuda N, Iso H. Risk factors of early spontaneous abortions among Japanese: a matched case-control study. Hum Reprod 2010; 26:466-72. [PMID: 21156724 DOI: 10.1093/humrep/deq343] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND No epidemiological studies have examined risk factors for early spontaneous abortions among Japanese women. In this matched case-control study, we investigated the associations of reproductive, physical, and lifestyle characteristics of women and their husbands with early spontaneous abortion <12 weeks of gestation. METHODS Information was collected through medical records for 430 cases of early spontaneous abortion and 860 controls of term delivery. Two controls were individual-matched to one case according to maternal age (± 3 years) and calendar year of events (either early spontaneous abortion or delivery). Multivariable conditional odds ratios (ORs) and 95% confidence interval (CI) were calculated with conditional logistic-regression. RESULTS The risk of early spontaneous abortions was higher for women with a past history of early spontaneous abortions; OR was 1.98 (95% CI: 1.35, 2.89) for one previous spontaneous abortion, 2.36 (95% CI: 1.47, 3.79) for two, and 8.73 (95% CI: 5.22, 14.62) for three or more. Other factors also influence risk; an OR of 2.39 (95% CI: 1.26, 4.25) was found for women who smoked, and 1.65 (95%CI: 1.17, 2.35) for women working outside the home. CONCLUSIONS Our finding suggests that for Japanese women, smoking and working may be important public health issue targets for the prevention of early spontaneous abortions.
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Affiliation(s)
- Sachiko Baba
- Public Health, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Watanabe H, Inoue K, Doi M, Matsumoto M, Ogasawara K, Fukuoka H, Nagai Y. Risk factors for term small for gestational age infants in women with low prepregnancy body mass index. J Obstet Gynaecol Res 2010; 36:506-12. [PMID: 20598029 DOI: 10.1111/j.1447-0756.2010.01170.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM The purpose of our study was to investigate the association between low maternal prepregnancy body mass index (BMI) less than 18.5 kg/m(2) and the incidence of small for gestational age (SGA) infants. MATERIAL & METHODS This was a cross-sectional study. The women with BMI of less than 25.0 kg/m(2) who gave birth to single term infants (37-42 weeks) at clinics and hospitals in the Tokyo metropolitan area between 2003 and 2004 were analyzed for risk factors for SGA. RESULTS Five hundred and seventy-two women were underweight (BMI < 18.5 kg/m(2)) and 2708 (75.1%) were normal (18.5 <or= BMI < 25.0 kg/m(2)). Birthweight, analyzed by multiple regression analysis, was highly related (P < 0.05) to gestational age, maternal age, parity, prepregnancy BMI, maternal weight gain and maternal smoking status. Women with a less than 9 kg weight during pregnancy were 1.8 times (confidence interval [CI], 1.6-2.2) more likely to give birth to an SGA infant compared with women who gained 9-12 kg. Maternal smoking more than 10 cigarettes per day was associated with an increased risk of having an SGA infant (odds ratio [OR], 2.5; CI, 1.8-3.5). Women with prepregnancy BMI less than 21.0 kg/m(2) were associated with an increased risk of having an SGA infant (OR, 1.6; CI, 1.3-2.2 for BMI < 18.5 kg/m(2), and OR, 1.4; CI, 1.2-1.7 for 18.5 <or= BMI <or= 21.0 kg/m(2)). CONCLUSION We conclude that the detrimental effect of low prepregnancy BMI in Japanese women on birthweight and incidence of SGA infants. Our findings suggest that appropriate maternal BMI at conception followed by adequate weight gain during pregnancy may have a substantial influence on reducing the SGA infants and increasing the birthweight.
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Affiliation(s)
- Hiroko Watanabe
- Clinical Nursing, Maternity Nursing and Midwifery, Shiga University of Medical Science, Otsu, Shiga, Japan.
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Metwally M, Saravelos SH, Ledger WL, Li TC. Body mass index and risk of miscarriage in women with recurrent miscarriage. Fertil Steril 2010; 94:290-5. [DOI: 10.1016/j.fertnstert.2009.03.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 02/16/2009] [Accepted: 03/04/2009] [Indexed: 10/20/2022]
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Dunker KLL, Alvarenga MDS, Alves VPDO. Transtornos alimentares e gestação: uma revisão. JORNAL BRASILEIRO DE PSIQUIATRIA 2009. [DOI: 10.1590/s0047-20852009000100010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Estudar o impacto dos transtornos alimentares nas funções reprodutivas, problemas na gestação e puerpério, e dificuldades com a alimentação dos filhos. MÉTODOS: Realizou-se revisão da literatura nos últimos 28 anos nos bancos de dados MedLine e Lilacs. Combinaram-se os descritores anorexia nervosa, bulimia nervosa, transtornos alimentares e gestação. RESULTADOS: Os estudos de revisão, estudos de caso e pesquisas realizadas com gestantes apontam uma associação entre TA e uma variedade de complicações na gestação, no parto, para o feto, com aumentado risco de morbidade perinatal, além de complicações na alimentação futura da criança. CONCLUSÕES: Observa-se uma maior necessidade de acompanhamento especializado, principalmente no pré-natal, em relação aos hábitos alimentares e preocupação com peso e forma corporais - especialmente nas mulheres que apresentam ganho ponderal inadequado, hiperêmese gravídica, picacismo, entre outros.
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30
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Arck PC, Rücke M, Rose M, Szekeres-Bartho J, Douglas AJ, Pritsch M, Blois SM, Pincus MK, Bärenstrauch N, Dudenhausen JW, Nakamura K, Sheps S, Klapp BF. Early risk factors for miscarriage: a prospective cohort study in pregnant women. Reprod Biomed Online 2008; 17:101-13. [PMID: 18616898 DOI: 10.1016/s1472-6483(10)60300-8] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Many pregnancies are lost during early gestation, but clinicians still lack tools to recognize risk factors for miscarriage. Thus, the identification of risk factors for miscarriage during the first trimester in women with no obvious risk for a pregnancy loss was the aim of this prospective cohort trial. A total of 1098 women between gestation weeks 4 and 12 in whom no apparent signs of a threatened pregnancy could be diagnosed were recruited. Demographic, anamnestic, psychometric and biological data were documented at recruitment and pregnancy outcomes were registered subsequently. Among the cases with sufficiently available data, 809 successfully progressing pregnancies and 55 subsequent miscarriages were reported. In this cohort, risk of miscarriage was significantly increased in women at higher age (>33 years), lower body mass index (< or =20 kg/ m(2)) and lower serum progesterone concentrations (< or =12 ng/ml) prior to the onset of the miscarriage. Women with subsequent miscarriage also perceived higher levels of stress/demands (supported by higher concentrations of corticotrophin-releasing hormone) and revealed reduced concentrations of progesterone-induced blocking factor. These risk factors were even more pronounced in the subcohort of women (n = 335) recruited between gestation weeks 4 and 7. The identification of these risk factors and development of an interaction model of these factors, as introduced in this article, will help clinicians to recognize pregnant women who require extra monitoring and who might benefit from therapeutic interventions such as progestogen supplementation, especially during the first weeks of pregnancy, to prevent a miscarriage.
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Affiliation(s)
- Petra C Arck
- Centre of Internal Medicine and Dermatology, Division of Psycho-Neuro-Immunology, Charité, University Medicine Berlin, Germany.
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31
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[Very preterm birth: should we be interested in maternal pre-pregnancy body mass index?]. Arch Pediatr 2008; 15:1068-75. [PMID: 18434108 DOI: 10.1016/j.arcped.2008.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 12/14/2007] [Accepted: 02/19/2008] [Indexed: 11/20/2022]
Abstract
UNLABELLED Link between maternal body mass index (BMI) and pregnancy outcome is not clear. OBJECTIVE To appreciate the impact of prepregnancy maternal BMI on very preterm birth (22-32 gestation's weeks). SECONDARY OBJECTIVE To assess how maternal BMI does explain the mechanism of very preterm birth among live births. METHODS Population-based study, including each mother with a live or stillborn baby was included in a geographically defined (Poitou-Charentes and Franche-comté, France) case-control study in 2004 to 2006. Leanness (BMI<18.5kg/m(2)) and overweight and obesity (BMI> or =25kg/m(2)) were defined according to World Health Organization's standards. Statistical analysis consisted in a polynomial regression on 832 mothers of very preterm babies and 431 mothers of full-term babies, taking account for confounders as maternal age, birth country, educational level, maternal work and smoking during the pregnancy. RESULTS Leanness is a risk factor for very preterm live birth (aOR=1.73 [1.12-2.68]), overweight is a risk factor for stillbirth. (aOR=1.71 [1.03-2.84]). Among mothers of live born babies, leanness is a risk factor for spontaneous preterm birth (aOR=2.12 [1.20-3.74]), whereas overweight is a risk factor for very preterm birth on medical decision due to gestational hypertension (aOR=2.85 [1.80-4.52]). CONCLUSION Morbid maternal stoutness before pregnancy is a complex risk factor for very preterm delivery. Women and couples should be informed and practitioners should be aware in order to prevent and manage this pathological status.
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Veleva Z, Tiitinen A, Vilska S, Hydén-Granskog C, Tomás C, Martikainen H, Tapanainen JS. High and low BMI increase the risk of miscarriage after IVF/ICSI and FET. Hum Reprod 2008; 23:878-84. [PMID: 18281684 DOI: 10.1093/humrep/den017] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The extremes of BMI are associated with an increased risk of miscarriage both in spontaneously conceived pregnancies and after fertility treatment. The aim of the present study was to study the effect of BMI on miscarriage rate (MR) in fresh IVF/ICSI, and in spontaneous and hormonally substituted frozen-thawed embryo (FET) cycles. METHODS Analysis was carried out on 3330 first pregnancy cycles, performed during the years 1999-2004, of which 2198 were fresh, 666 were spontaneous and 466 were hormonally substituted FET cycles. A categorical, a linear and a quadratic models of the effect of BMI on miscarriage were studied by logistic regression. Factors related to patient characteristics, protocol and embryo parameters were also examined. RESULTS MR was higher in hormonally substituted FET (23.0%), compared with the fresh cycles (13.8%) and spontaneous FET (11.4%, P < 0.0001). Multivariate logistic regression revealed that the relationship between BMI and the risk of miscarriage is not linear but quadratic (U-shaped) (P = 0.01), indicating a higher risk of miscarriage in underweight and obese women. Hormonal substitution for FET was also associated with a 1.7-fold higher MR, compared with the fresh cycles (P = 0.002, 95% confidence interval 1.2-2.3). CONCLUSIONS Obese and underweight women have an increased risk of miscarriage, and hormonally substituted FET is associated with an even higher MR.
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Affiliation(s)
- Zdravka Veleva
- Department of Obstetrics and Gynecology, University of Oulu, PO Box 5000, Oulu FIN-90014, Finland
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Banda Y, Chapman V, Goldenberg RL, Chi BH, Vermund SH, Stringer JSA. Influence of body mass index on pregnancy outcomes among HIV-infected and HIV-uninfected Zambian women. Trop Med Int Health 2007; 12:856-61. [PMID: 17596253 PMCID: PMC2570322 DOI: 10.1111/j.1365-3156.2007.01857.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the influence of body mass index (BMI) on pregnancy outcomes of HIV-infected and HIV-uninfected Zambian women and to assess the possible role of BMI on mother-to-child transmission rate of HIV. METHODS We analysed data from a clinical trial on nevirapine administration for the prevention of mother-to-child transmission of HIV in Lusaka, Zambia. Demographic characteristics, medical information and pregnancy outcomes were used in this secondary analysis. RESULTS A total of 1211 women were included in this analysis and 36% were HIV-infected. Among HIV-infected women, maternal parity and prior stillbirths increased with increasing BMI in univariate analysis. Mean birth weight rose as well at 28.3 g [95% confidence interval (CI)=14.0-42.6] of infant weight per BMI unit. Transmission of HIV from mother to child appeared inversely related to BMI when compared according to BMI quartile (P for trend=0.07). In the HIV-uninfected group, infant birth weight increased with increasing BMI, at 32.7 g (95% CI=23.5-41.9) of infant weight per BMI unit. CONCLUSION Birth weight increased alongside BMI in both HIV-infected and HIV-uninfected women. There is a suggestion that women with lower BMI have a greater risk of perinatal HIV transmission, even after adjustments for HIV viral load and CD4 count.
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Affiliation(s)
- Yolan Banda
- School of Medicine, University of Zambia, Lusaka, Zambia
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Victoria Chapman
- Center for Research in Women's Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert L. Goldenberg
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Center for Research in Women's Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Benjamin H. Chi
- School of Medicine, University of Zambia, Lusaka, Zambia
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Schools of Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sten H. Vermund
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jeffrey S. A. Stringer
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Center for Research in Women's Health, University of Alabama at Birmingham, Birmingham, AL, USA
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