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Lwin MW, Timby E, Ivarsson A, Eurenius E, Vaezghasemi M, Silfverdal SA, Lindkvist M. Abnormal birth weights for gestational age in relation to maternal characteristics in Sweden: a five year cross-sectional study. BMC Public Health 2023; 23:976. [PMID: 37237290 DOI: 10.1186/s12889-023-15829-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Abnormal birth weight - small for gestational age (SGA) and large for gestational age (LGA) - are important indicators for newborn health. Due to changes in lifestyle in recent decades, it is essential to keep up-to-date with the latest information on maternal factors linked to abnormal birth weight. The aim of this study is to investigate SGA and LGA in relation to maternal individual, lifestyle and socioeconomic characteristics. . METHODS This is a register-based cross-sectional study. Self-reported data from Sweden's Salut Programme maternal questionnaires (2010-2014) were linked with records in the Swedish Medical Birth Register (MBR). The analytical sample comprised 5089 singleton live births. A Swedish standard method using ultrasound-based sex-specific reference curves defines the abnormality of birth weight in MBR. Univariable and multivariable logistic regressions were used to examine crude and adjusted associations between abnormal birth weights and maternal individual, lifestyle and socioeconomic characteristics. A sensitivity analysis, using alternative definitions of SGA and LGA under the percentile method, was undertaken. RESULTS In multivariable logistic regression, maternal age and parity were associated with LGA (aOR = 1.05, CI = 1.00, 1.09) and (aOR = 1.31, CI = 1.09, 1.58). Maternal overweight and obesity were strongly associated with LGA (aOR = 2.28, CI = 1.47, 3.54) and (aOR = 4.55, CI = 2.85, 7.26), respectively. As parity increased, the odds of delivering SGA babies decreased (aOR = 0.59, CI = 0.42, 0.81) and preterm deliveries were associated with SGA (aOR = 9.46, CI = 5.67, 15.79). The well-known maternal determinants of abnormal birthweight, such as unhealthy lifestyles and poor socioeconomic factors, were not statistically significant in this Swedish setting. CONCLUSIONS The main findings suggest that multiparity, maternal pre-pregnancy overweight and obesity are strong determinants for LGA babies. Public health interventions should address modifiable risk factors, especially maternal overweight and obesity. These findings suggest that overweight and obesity is an emerging public health threat for newborn health. This might also result in the intergenerational transfer of overweight and obesity. These are important messages for public health policy and decision making.
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Affiliation(s)
- Min Wai Lwin
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Erika Timby
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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Rahman MO, Yoneoka D, Murano Y, Yorifuji T, Shoji H, Gilmour S, Yamamoto Y, Ota E. Detecting geographical clusters of low birth weight and/or preterm birth in Japan. Sci Rep 2023; 13:1788. [PMID: 36720964 PMCID: PMC9889813 DOI: 10.1038/s41598-023-28642-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
In Japan, mean birth weight has significantly decreased from 3152 g in 1979 to 3018 g in 2010 and the prevalence of preterm birth (PTB) has risen to 5.7% in the last thirty years. However, the presence and magnitude of geographical differences in low birthweight (LBW) and/or PTB in Japan is not well understood. We implemented spatial analysis to identify localized clusters and hot spots of LBW and/or PTB during 2012-2016. The Japan national birth database was used in this study. A total of 5,041,685 (male: 2,587,415, female: 2,454,270) births were used for spatial analysis using empirical Bayes estimates of the incidence rate of LBW and/or PTB and spatial scan tests to detect hot-spot areas with p values calculated from Monte Carlo iterations. The most and second likely clusters were located in two areas: (1) the small islands in south-west Japan (Amami and Okinawa, Relative risk = 1.09-1.67 with p < 0.001) and (2) the cities on the base of Mt. Fuji, stretching over three neighboring prefectures of Yamanashi, Shizuoka and Kanagawa (Relative risk = 1.10-1.55 with p < 0.001), respectively. We need to optimize the medical resource allocations based on the evidence in geographical clustering of LBW and/or PTB at specific locations in Japan.
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Affiliation(s)
- Md Obaidur Rahman
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Daisuke Yoneoka
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan. .,Tokyo Foundation for Policy Research, Tokyo, Japan.
| | - Yayoi Murano
- Department of Pediatrics and Adolescent Medicine, Faculty of medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takashi Yorifuji
- Department of Obstetrics and Gynecology, Faculty of medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiromichi Shoji
- Department of Pediatrics and Adolescent Medicine, Faculty of medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Stuart Gilmour
- Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, OMURA Susumu & Mieko Memorial, St. Luke's Center for Clinical Academia, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yoshiko Yamamoto
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Erika Ota
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan.,Tokyo Foundation for Policy Research, Tokyo, Japan
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Bombana M, Wensing M, Wittenborn L, Ullrich C. Health Education about Lifestyle-Related Risk Factors in Gynecological and Obstetric Care: A Qualitative Study of Healthcare Providers' Views in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11674. [PMID: 36141943 PMCID: PMC9517227 DOI: 10.3390/ijerph191811674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/05/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Lifestyle-related risk factors (LRRFs) during pregnancy and lactation are associated with a range of health problems. However, previous studies have shown a large knowledge gap among pregnant women regarding the effects of LRRFs. This study aimed to investigate the role of health education about LRRFs during pregnancy and lactation in gynecological and obstetric care from healthcare providers' (HCPs) point of view. METHODS To explore the views of healthcare providers, a qualitative study was performed. In 2019, 22 in-depth interviews were conducted with a purposive sample of 9 gynecologists and 13 midwives. Participants came from different inpatient and outpatient care settings and from rural, urban, and socially deprived areas in southern Germany. All the interviews were tape-recorded and transcribed verbatim. A combined inductive and deductive approach was applied for data analysis. RESULTS Interviews with HCPs showed that they were aware of the possible impacts of LRRFs during pregnancy and lactation. They noted the importance of action, specifically among women with low socioeconomic status (SES), migrants, and women with a concerning medical history or other specific needs. However, the interviews showed that, at present, there is no standardized practice of educating patients on LRRFs in routine care. This was attributed to a lack of guidelines and time, unfavorable regulations, and undefined responsibilities. The priority of health education is lower in inpatient healthcare settings as compared to outpatient healthcare settings. HCPs apply a demand-driven healthcare approach, focusing on a woman's medical history, needs, and personal circumstances. HCPs voiced the importance of implementing pre-conception education across different healthcare settings, garnering support from other health organizations, and setting out clearly defined responsibilities among HCPs. CONCLUSIONS This qualitative study explored HCPs' perspectives on health education about LRRFs during pregnancy and lactation. The results from this study emphasize the need for a central strategy for health education about LRRFs during pregnancy and lactation in gynecological and obstetric care.
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Affiliation(s)
- Manuela Bombana
- Department of General Medicine and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
- Department of Prevention, AOK Baden-Württemberg, Presselstrasse 19, 70191 Stuttgart, Germany
| | - Michel Wensing
- Department of General Medicine and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Lisa Wittenborn
- Department of General Medicine and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Medicine and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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The role of body dissatisfaction and self-compassion in pregnancy-related anxiety. J Affect Disord 2022; 313:84-91. [PMID: 35772628 DOI: 10.1016/j.jad.2022.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/28/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Women undergo significant physical, physiological, and psychological changes during pregnancy. They are also exposed to sociocultural pressure to meet appearance-related ideals. These pregnancy-related changes and sociocultural appearance-related pressures may place pregnant women at greater vulnerability to developing body dissatisfaction and psychological distress. To date, however, little is known about how sociocultural pressure may influence pregnancy-related anxiety, or factors that may protect against such distress during pregnancy. This study examined whether body dissatisfaction mediated the relationship between appearance-related sociocultural pressure and pregnancy-related anxiety, and whether this relationship was moderated by self-compassion and/or self-criticism. METHOD A cross-sectional sample of 253 pregnant women (Mage = 26.28, SDage = 4.43) completed an online questionnaire measuring sociocultural pressure, body dissatisfaction, pregnancy-related anxiety, and self-compassion. RESULTS Moderated mediation analyses revealed body dissatisfaction fully mediated the relationship between sociocultural pressure and pregnancy-related anxiety. Analyses confirmed the moderating role of self-compassion and self-criticism on the relationship between sociocultural pressure and body dissatisfaction, but not on the relationship between body dissatisfaction and pregnancy-related anxiety. LIMITATIONS The cross-sectional nature of this study limits confirmation of the direction of relationships between sociocultural pressure, body dissatisfaction and pregnancy-related anxiety. CONCLUSIONS While the findings of this study need to be replicated in prospective and longitudinal studies, they suggest that sociocultural pressure to meet appearance-related standards contribute to body dissatisfaction, which in turn may facilitate pregnancy-related anxiety. Self-compassion may protect the body image of pregnant women against negative effects of appearance-related sociocultural pressure.
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Wang T, Li Q, Chen L, Ni B, Sheng X, Huang P, Zhang S, Chen L, Qin J. Effect of maternal alcohol consumption during the pre-pregnancy/early-pregnancy period on congenital heart disease: A prospective cohort study in Central China. Prev Med 2022; 155:106963. [PMID: 35065976 DOI: 10.1016/j.ypmed.2022.106963] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/23/2021] [Accepted: 01/15/2022] [Indexed: 12/26/2022]
Abstract
Evidence of associations between maternal alcohol consumption and congenital heart disease (CHD) are mixed. Previous studies have been potentially biased due to recall bias or unmeasured confounding. This study aimed to examine the association of maternal alcohol consumption in 3 months before pregnancy and in early pregnancy with risks of offspring congenital heart disease (CHD) and its seven common subtypes. A prospective cohort study was conducted in Central China. From 03/13/2013 to 12/31/2019, a total of 44,048 pregnant women with singleton pregnancies at 8-14 gestational weeks were included and followed to 3 months postpartum. 564 births were diagnosed with CHD at the end of follow-up. Multivariable modified Poisson regression models were used to estimate the relative risks (RRs) of CHD in offspring exposed to maternal alcohol consumption during the pre-pregnancy and early-pregnancy period, adjusting for confounders identified by directed acyclic graphs. In the multivariable analyses, increased risks of CHDs were found in offspring exposed to maternal alcohol consumption both in 3 months before pregnancy (adjusted-RR:3.14; 95% confidence intervals[CIs]:2.30-4.28) and in early pregnancy (adjusted-RR:1.86; 95%CIs:1.13-3.05). More specifically, the offspring exposed to maternal alcohol consumption in 3 months before pregnancy had the highest increased risk of Tetralogy of Fallot (adjusted-RR:8.62; 95%CIs:3.61-20.61). These findings persisted in analyses that were further adjusted for the other behavior variables other than the characteristic being assessed, and were also confirmed by sensitivity analyses. Our study supports the need for continued efforts for public health messages surrounding the potential risks of alcohol consumption prior to or during pregnancy.
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Affiliation(s)
- Tingting Wang
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China; Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiongxuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Bin Ni
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Xiaoqi Sheng
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Peng Huang
- Department of Thoracic Cardiac Surgery, Hunan Children's Hospital, Changsha, Hunan, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
| | - Letao Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China.
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Hong L, Le T, Lu Y, Shi X, Xiang L, Liu M, Zhang W, Zhou M, Wang J, Xu D, Yu X, Zhao K. Distinct trajectories of perinatal depression in Chinese women: application of latent growth mixture modelling. BMC Pregnancy Childbirth 2022; 22:24. [PMID: 35012496 PMCID: PMC8751241 DOI: 10.1186/s12884-021-04316-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Current research on perinatal depression rarely pays attention to the continuity and volatility of depression symptoms over time, which is very important for the early prediction and prognostic evaluation of perinatal depression. This study investigated the trajectories of perinatal depression symptoms and aimed to explore the factors related to these trajectories. METHODS The study recruited 550 women during late pregnancy (32 ± 4 weeks of gestation) and followed them up 1 and 6 weeks postpartum. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Latent growth mixture modelling (LGMM) was used to identify trajectories of depressive symptoms during pregnancy. RESULTS Two trajectories of perinatal depressive symptoms were identified: "decreasing" (n = 524, 95.3%) and "increasing" (n = 26, 4.7%). History of smoking, alcohol use and gestational hypertension increased the chance of belonging to the increasing trajectories, and a high level of social support was a protective factor for maintaining a decreasing trajectory. CONCLUSIONS This study identified two trajectories of perinatal depression and the factors associated with each trajectory. Paying attention to these factors and providing necessary psychological support services during pregnancy would effectively reduce the incidence of perinatal depression and improve patient prognosis.
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Affiliation(s)
- Lan Hong
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Tao Le
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Yinping Lu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Xiang Shi
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Ludan Xiang
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Meng Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Wenmiao Zhang
- Department of Obstetrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meixi Zhou
- Department of Obstetrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiangling Wang
- Department of Obstetrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dongwu Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Ke Zhao
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China.
- The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, 325035, China.
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Nwankwo HC, Habtu M, Rutayisire E, Kalisa R. Prevalence and factors associated with preterm birth in a rural district hospital, Rwanda. Pan Afr Med J 2022; 43:173. [PMID: 36879632 PMCID: PMC9984828 DOI: 10.11604/pamj.2022.43.173.34113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/02/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction globally, the leading cause of neonatal mortality is preterm birth which may hinder the achievement of Sustainable Development Goal 3.2 target. We aimed to determine the prevalence and factors associated with preterm delivery at Kabutare hospital, Rwanda. Methods a cross-sectional study was conducted between August and September 2020. Mothers were interviewed using a standard pretested semi-structured questionnaire and additional data were extracted from medical records of obstetric files. Gestational age was assessed using the Ballard score. Adjusted Odds Ratios and their 95% confidence intervals were calculated for multivariable logistic regression analysis to take care of all potential confounders. Results the prevalence of preterm birth was 17.5% (95% CI: 12.9% - 22.9%). The independent factors associated with preterm birth after considering multiple logistic regression were husband being a smoker (adjusted Odds Ratio (aOR) = 5.9; 95% CI; 1.9-18; p= 0.002), antenatal care (ANC) attendance ≤ 3 visits (aOR=3.9; 95% CI; 1.1-13.8; p=0.04) and low mother's Mid Upper Arm Circumference (MUAC) < 23cm (aOR=5.6, 95% CI; 1.8-18.9; p=0.004). Conclusion: preterm delivery was high in Huye district. Thus, we recommend ANC sessions to emphasize on maternal nutritional education which is of good quality and quantity, discourage maternal alcohol consumption as well as passive smoking.
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Affiliation(s)
- Hellen Chinwe Nwankwo
- Mount Kenya University, School of Health Sciences, Department of Public Health, Kigali Campus, Rwanda
| | - Michael Habtu
- Mount Kenya University, School of Health Sciences, Department of Public Health, Kigali Campus, Rwanda
| | - Erigene Rutayisire
- Mount Kenya University, School of Health Sciences, Department of Public Health, Kigali Campus, Rwanda
| | - Richard Kalisa
- School of Public Health, University of Rwanda, Kigali, Rwanda
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Addila AE, Azale T, Gete YK, Yitayal M. The effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes among pregnant women attending antenatal care at public health facilities in Gondar town, Northwest Ethiopia: a prospective cohort study. Subst Abuse Treat Prev Policy 2021; 16:64. [PMID: 34446055 PMCID: PMC8390259 DOI: 10.1186/s13011-021-00401-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The teratogenic effect of fetal alcohol exposure may lead to actual and potential problems, instantly after birth, at infancy; or even later, and mental impairment in life. This study aimed to investigate the effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes at Gondar town public health facilities, Northwest Ethiopia. METHODS A facility-based prospective cohort study was performed among 1778 pregnant women who were booked for antenatal care in selected public health facilities from 29 October 2019 to 7 May 2020 in Gondar town. We used a two-stage random sampling technique to recruit and include participants in the cohort. Data were collected using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) standardized and pre-tested questionnaire. Multivariable analysis was performed to examine the association between reported prenatal alcohol exposure (non-hazardous and hazardous) and interested adverse birth outcomes using log-binomial regression modeling. The burden of outcomes was reported using the adjusted risk ratio and population-attributable risk (PAR). RESULTS A total of 1686 pregnant women were included in the analysis, which revealed that the incidences of low birth weight, preterm, and stillbirth were 12.63% (95% CI: 11.12, 14.31), 6.05% (95% CI: 5.00, 7.29) and 4.27% (95% CI: 3.4, 5.35), respectively. Non-hazardous and hazardous alcohol consumption during pregnancy was significantly associated with low birth weight (ARR = 1.50; 95% CI: 1.31, 1.98) and (ARR = 2.34; 95% CI: 1.66, 3.30), respectively. Hazardous alcohol consumption during pregnancy was also significantly associated with preterm birth (ARR = 2.06; 95% CI: 1.21, 3.52). The adjusted PAR of low birth weight related to non-hazardous and hazardous alcohol drinking during pregnancy was 11.72 and 8.44%, respectively. The adjusted PAR of hazardous alcohol consumption was 6.80% for preterm. CONCLUSIONS Our findings suggest that there is an increasing risk of adverse birth outcomes, particularly preterm delivery and low birth weight, with increasing levels of alcohol intake. This result showed that the prevention of maternal alcohol use during pregnancy has the potential to reduce low birth weight and preterm birth. Hence, screening women for alcohol use during antenatal care visits and providing advice with rigorous follow-up of women who used alcohol may save the fetus from the potential risks of adverse birth outcomes.
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Affiliation(s)
- Alemu Earsido Addila
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Brink LT, Nel DG, Hall DR, Odendaal HJ. The Intricate Interactions between Maternal Smoking and Drinking During Pregnancy and Birthweight Z-Scores of Preterm Births. JOURNAL OF WOMEN'S HEALTH CARE AND MANAGEMENT 2021; 2:10.47275/2692-0948-121. [PMID: 34723283 PMCID: PMC8553154 DOI: 10.47275/2692-0948-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The extent to which smoking and drinking in a local community is associated with nutrition and Z-scores of infants from spontaneous preterm deliveries, is uncertain. AIM To investigate associations of different levels of maternal smoking and drinking in spontaneous preterm birth with infant birthweight Z-scores. METHODS Information, including gestational age (determined by earliest ultrasound), maternal arm circumference (measured at enrolment), smoking-drinking data (obtained up to 4 occasions), birthweight data (obtained from medical records) and birthweight Z-scores (calculated from INTERGROWTH- 21st study), collected over a period of nine years was used to compare 407 spontaneous preterm births with 3 493 spontaneous term births Analyses of variance, correlations and multiple regression were performed in STATISTICA. RESULTS Women with spontaneous preterm birth, had significantly lower gravidity and smaller arm circumference when compared to women with spontaneous birth at term. Women with spontaneous preterm birth drank more and heavier during pregnancy, and more smoked. Gestational age at birth was significantly longer in heavy-smokers-heavy-drinkers compared to heavy-smokers-no-drinkers (7.1 days) and in no-smokers-heavy-drinkers when compared to no-smokers-no-drinkers (11.2 days). Birthweight was significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-no-drinkers (240g) and in heavy-smokers-low-drinkers when compared to no-smokers-low-drinkers (273g). Birthweight Z-scores were significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-low-drinkers and low-smokers-no-drinkers; and, also significantly lower in heavy-smokers-low-drinkers when compared to low-smokers-low-drinkers and no-smokers-low-drinkers. CONCLUSION Alcohol aggravates the detrimental effect of smoking on birthweight and birthweight Z-scores but seems to counteract the negative association of smoking with gestational age.
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Affiliation(s)
- Lucy T Brink
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Daan G Nel
- Department of Statistics and Actuarial Science, Stellenbosch University, South Africa
| | - David R Hall
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Hein J Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Kurita H, Motoki N, Inaba Y, Misawa Y, Ohira S, Kanai M, Tsukahara T, Nomiyama T. Maternal alcohol consumption and risk of offspring with congenital malformation: the Japan Environment and Children's Study. Pediatr Res 2021; 90:479-486. [PMID: 33230193 PMCID: PMC8460444 DOI: 10.1038/s41390-020-01274-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/20/2020] [Accepted: 09/25/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The association between fetal exposure to alcohol and congenital structural disorders remains inconclusive. The present study searched for relationships between maternal alcohol consumption during pregnancy and the risk of congenital malformations. METHODS We evaluated the fixed dataset of a large national birth cohort study including 73,595 mothers with a singleton live birth. Information regarding the alcohol consumption of mothers was obtained from self-reported questionnaires. Physicians assessed for 6 major congenital malformations (congenital heart defects [CHDs], male genital abnormalities, limb defects, cleft lip and/or cleft palate [orofacial clefts (OFC)], severe brain abnormalities, and gastrointestinal obstructions) up to 1 month after birth. Multiple logistic regression analysis was performed to identify associations between maternal alcohol consumption during pregnancy and each malformation. RESULTS The prevalence of maternal drinking in early pregnancy and until the second/third trimester was 46.6% and 2.8%, respectively. The onset of CHD was inversely associated with mothers who quit drinking during early pregnancy (OR 0.85, 95% CI 0.74-0.98). There was no remarkable impact of maternal drinking habit status on the other congenital malformations after adjustment for covariates. CONCLUSIONS Maternal alcohol consumption during pregnancy, even in early pregnancy, displayed no significant adverse impact on congenital malformations of interest. IMPACT This large-scale Japanese cohort study revealed that no teratogenic associations were found between maternal retrospective reports of periconceptional alcohol consumption and congenital malformations after adjustment for covariates. This is the first nationwide birth cohort study in Japan to assess the effect of maternal alcohol consumption during pregnancy on major congenital malformations. Our finding indicated that maternal low-to-moderate alcohol consumption during pregnancy, even in early pregnancy, displayed no significant adverse impact on congenital heart defects, male genital abnormalities, limb defects, orofacial clefts, severe brain abnormalities, or gastrointestinal obstructions.
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Affiliation(s)
- Hiroshi Kurita
- grid.263518.b0000 0001 1507 4692Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano Japan ,grid.263518.b0000 0001 1507 4692Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Nagano Japan
| | - Noriko Motoki
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Yuji Inaba
- grid.263518.b0000 0001 1507 4692Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano Japan ,grid.416376.10000 0004 0569 6596Department of Neurology, Nagano Children’s Hospital, Azumino, Nagano Japan
| | - Yuka Misawa
- grid.263518.b0000 0001 1507 4692Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano Japan ,grid.416376.10000 0004 0569 6596Department of Rehabilitation, Nagano Children’s Hospital, Azumino, Nagano Japan
| | - Satoshi Ohira
- grid.263518.b0000 0001 1507 4692Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano Japan ,grid.263518.b0000 0001 1507 4692Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Nagano Japan
| | - Makoto Kanai
- grid.263518.b0000 0001 1507 4692Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano Japan
| | - Teruomi Tsukahara
- grid.263518.b0000 0001 1507 4692Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano Japan ,grid.263518.b0000 0001 1507 4692Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano Japan
| | - Tetsuo Nomiyama
- grid.263518.b0000 0001 1507 4692Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano Japan ,grid.263518.b0000 0001 1507 4692Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano Japan
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11
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Römer P, Mathes B, Reinelt T, Stoyanova P, Petermann F, Zierul C. Systematic review showed that low and moderate prenatal alcohol and nicotine exposure affected early child development. Acta Paediatr 2020; 109:2491-2501. [PMID: 32603488 DOI: 10.1111/apa.15453] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
AIM We systematically reviewed the literature on the influence of low and moderate amounts of prenatal alcohol and nicotine exposure on early child development. This paper also suggests possible directions for future research in order to tackle the controversial findings identified. METHODS The PubMed and Web of Science electronic databases were searched together with the reference lists of the selected papers. Empirical studies were included if they focused on the effects of low or moderate exposure, reported outcomes on child development within the first 2 years of life and were published in English between January 2009 and December 2019. The eligibility of the included studies was based on three authors reading the full text. RESULTS The final sample comprised 17 papers. Of these, 13 focused on the effects of prenatal alcohol exposure and they reported decreased sensory sensibility, smaller body sizes and increased cognitive capacities. The other four looked at prenatal nicotine exposure, and they primarily found impairments in children's orienting, communication and motor skills. CONCLUSION Any amount of prenatal alcohol and nicotine exposure appeared to risk healthy child development. There were many reasons for consumption and numerous effects on the child, but representative data from interdisciplinary research were missing.
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Affiliation(s)
- Pia Römer
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Birgit Mathes
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Tilman Reinelt
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Polina Stoyanova
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Franz Petermann
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Claudia Zierul
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
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12
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Oechsle A, Wensing M, Ullrich C, Bombana M. Health Knowledge of Lifestyle-Related Risks during Pregnancy: A Cross-Sectional Study of Pregnant Women in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228626. [PMID: 33233790 PMCID: PMC7699927 DOI: 10.3390/ijerph17228626] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 12/19/2022]
Abstract
This study aimed to investigate (1) pregnant women’s level of knowledge of lifestyle-related risk factors during pregnancy and their potential health impact on their offspring, and (2) the factors affecting women’s knowledge of lifestyle-related risk factors during pregnancy. A cross-sectional observational study of pregnant women was carried out in obstetric and gynecologic care settings at three hospitals in Southern Germany. Data from 209 pregnant women revealed large knowledge gaps on lifestyle-related risk factors during pregnancy and their potential health impact. Factors affecting women’s knowledge of lifestyle-related risk factors during pregnancy were specifically associated with socioeconomic status, e.g., lower household net income, middle educational level, and statutory health insurance status. Women who had received information from their gynecologist had a higher level of knowledge of lifestyle-related risk factors during pregnancy. This study showed that health promotion regarding lifestyle-related risks during pregnancy specifically needs to address women from the low-to-middle socioeconomic status group. Gynecologists seem particularly effective in providing this information.
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Affiliation(s)
- Anja Oechsle
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (A.O.); (M.W.); (C.U.)
| | - Michel Wensing
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (A.O.); (M.W.); (C.U.)
| | - Charlotte Ullrich
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (A.O.); (M.W.); (C.U.)
| | - Manuela Bombana
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (A.O.); (M.W.); (C.U.)
- Department of Health Promotion, AOK Baden-Württemberg, Presselstrasse 19, 70191 Stuttgart, Germany
- Correspondence: ; Tel.: +49-711-2593-7945
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13
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Dryer R, Graefin von der Schulenburg I, Brunton R. Body dissatisfaction and Fat Talk during pregnancy: Predictors of distress. J Affect Disord 2020; 267:289-296. [PMID: 32217229 DOI: 10.1016/j.jad.2020.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND During pregnancy, women are vulnerable to mood and anxiety disorders due to the significant physical and emotional changes that occur during this period. For some women, pregnancy can also present as a period of immense body dissatisfaction due to the substantial changes in body shape and size. OBJECTIVES This study examined the mediating role of Fat Talk (i.e., engaging in disparaging comments about one's body shape and size with others) in the relationship between (a) body dissatisfaction and distress in pregnant women (i.e., pregnancy-related anxiety, depression and eating disorder symptomatology), and (b) sociocultural pressure to meet the thin ideal and distress. METHOD A nonclinical sample of 408 pregnant women (Mage = 28.24 years, SDage = 5.04, range 18-44 years) completed measures of body dissatisfaction, sociocultural pressure, pregnancy-related anxiety, depression and eating disorder symptomatology. FINDINGS Analyses confirmed the partial mediating role of Fat Talk between body dissatisfaction and all three measures of distress, when examined individually. Fat Talk also mediated the relationship between sociocultural pressure (i.e., peers/family and media) and the three measures of distress. Age also partially mediated the relationship between body dissatisfaction and a composite measure of pregnancy distress. CONCLUSIONS The results suggest that women face sociocultural pressures for thinness and body dissatisfaction even when pregnant, and that engaging in Fat Talk contribute to greater levels of pregnancy-related anxiety, depression and eating disorder symptomatology. The role of Fat Talk in regard to pregnancy distress may be more pertinent to younger women.
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Affiliation(s)
- Rachel Dryer
- School of Behavioural & Health Sciences, Australian Catholic University, Strathfield, New South Wales 2135, Australia.
| | | | - Robyn Brunton
- School of Psychology, Charles Sturt University, Bathurst, New South Wales 2795, Australia
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Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can result in detrimental developmental complications. The objective of this study was to estimate the most recent PAE prevalence data for the state of West Virginia (WV) and associated factors. METHOD In all, 1830 newborn residual dried blood spots (DBS) in the WV Newborn Screening Repository were analyzed for phosphatidylethanol (PETH). Data were matched with Project WATCH data (94% match, N = 1729). RESULTS The prevalence of late pregnancy PAE was 8.10% (95%CI: 6.81, 9.38) for all births, 7.61% (95%CI: 6.26, 8.97) for WV residents only, and ranged from 2.27 to 17.11% by region. The significant factors associated with PAE included smoking (OR: 2.03, 95% CI: 1.40, 2.94), preterm births (OR: 1.88; 95% CI: 1.23, 2.89), birth weight of ≤2000 g vs. >3000 g (OR: 2.62, 95%CI: 1.19, 5.79), no exclusive breastfeeding intention (OR: 1.45, 95% CI: 1.02, 2.04), and not exclusively breastfeeding before discharge (OR: 1.61; 95% CI: 1.09, 2.38). CONCLUSION The prevalence of PAE is higher than previously shown for the state. Accurate and timely estimates are vital to inform public health workers, policymakers, researchers, and clinicians to develop and promote effective prevention strategies to lower PAE prevalence and provide targeted interventions and treatment services for infants affected by PAE.
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15
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Weile LKK, Hegaard HK, Wu C, Tabor A, Wolf HT, Kesmodel US, Henriksen TB, Nohr EA. Alcohol Intake in Early Pregnancy and Spontaneous Preterm Birth: A Cohort Study. Alcohol Clin Exp Res 2019; 44:511-521. [PMID: 31803953 DOI: 10.1111/acer.14257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 11/19/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Limited research has addressed whether maternal alcohol intake in early pregnancy increases the risk of spontaneous preterm birth. In the current study, we examined how alcohol binge drinking and weekly alcohol intake in early pregnancy were associated with spontaneous preterm birth in a contemporary cohort of Danish women. METHODS We included 15,776 pregnancies of 14,894 women referred to antenatal care at Copenhagen University Hospital, Denmark, between 2012 and 2016. Self-reported alcohol intake in early pregnancy was obtained from a Web-based questionnaire completed prior to the women's first visit at the department. Information on spontaneous preterm birth was extracted from the Danish Medical Birth Register. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of spontaneous preterm birth according to self-reported alcohol binge drinking and weekly intake of alcohol in early pregnancy were derived from Cox regression. RESULTS Women reporting 1, 2, and ≥ 3 binge drinking episodes had an aHR for spontaneous preterm birth of 0.88 (95% CI 0.68 to 1.14), 1.34 (95% CI 0.98 to 1.82), and 0.93 (95% CI 0.62 to 1.41), respectively, compared to women with no binge drinking episodes. Women who reported an intake of ≥ 1 drink per week on average had an aHR for spontaneous preterm birth of 1.09 (95% CI 0.63 to 1.89) compared to abstainers. When restricting to nulliparous women or cohabiting women with ≥ 3 years of higher education, this estimate was 1.28 (95% CI 0.69 to 2.40) and 1.20 (95% CI 0.67 to 2.15), respectively. CONCLUSION We found no evidence that maternal alcohol intake in early pregnancy was associated with a higher risk of spontaneous preterm birth, neither for alcohol binge drinking nor for a low average weekly intake of alcohol.
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Affiliation(s)
- Louise Katrine Kjaer Weile
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Hanne Kirstine Hegaard
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark.,The Research Unit Women's and Children's Health, Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen N, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Chunsen Wu
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Ann Tabor
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark.,The Research Unit Women's and Children's Health, Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen N, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Hanne Trap Wolf
- Department of Obstetrics and Gynecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Tine Brink Henriksen
- Department of Pediatrics (Intensive Care Neonatology), Aarhus University Hospital, Aarhus N, Denmark.,Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Ellen Aagaard Nohr
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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16
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Arnold C, Ullrich C, Wensing M, Pfinder M. Prenatal Alcohol Exposure and the Associated Risk of Elevated Blood Pressure: A Cross-sectional Analysis of 3- to 17-Year-Olds in Germany. Am J Hypertens 2019; 32:1118-1125. [PMID: 31269195 DOI: 10.1093/ajh/hpz107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/16/2019] [Accepted: 07/02/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND As the prevalence of obesity and high blood pressure increases among the population, early action is needed to reduce blood pressure. Certain lifestyles during pregnancy have negative effects resulting in high blood pressure for children and adolescents. Using data from the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS), this study analyzed: (i) the association between low-to-moderate prenatal alcohol exposure (PAE) and the risk of increased systolic and diastolic blood pressure and (ii) whether associations were modified by socioeconomic status (SES), prenatal smoke exposure (PSE), and body mass index (BMI) of the children and adolescents. METHODS We applied multivariate logistic regression analyses and stratified analyses by SES, PSE, and BMI with cross-sectional data from the KiGGS study (N = 14,253) to examine the association between PAE and prehypertension or hypertension in 3- to 17-year-olds. RESULTS Of the surveyed children and adolescents, 13.7% had a systolic prehypertension and 11.5% had a diastolic prehypertension. A further 7.5% were identified as having systolic hypertension and 6.0% diastolic hypertension. In the regression analyses, PAE resulted in a decreased risk of systolic prehypertension (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.70, 0.99) and diastolic prehypertension (OR: 0.82, 95% CI: 0.68, 0.98). Risk reductions were not significant in surveyed children and adolescents with hypertension. Interactions between PAE and SES, PSE, and offspring BMI were not significant. CONCLUSIONS Contrary to our initial hypothesis, PAE reduces the risk of prehypertension. Animal studies suggest that vasodilation is induced by nitric oxide in small quantities of PAE.
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Affiliation(s)
- Christine Arnold
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Pfinder
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
- Department of Health Promotion, AOK Baden-Württemberg, Stuttgart, Germany
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Pfinder M, Lhachimi S. Lifestyle-related risk factors during pregnancy: even low-to-moderate drinking during pregnancy increases the risk for adolescent behavioral problems. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1664668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Manuela Pfinder
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
- Department of Health Promotion, AOK Baden-Württemberg, Stuttgart, Germany
| | - Stefan Lhachimi
- Research Group for Evidence-Based Public Health, Leibniz-Institute for Prevention Research and Epidemiology BIPS GmbH (BIPS), Bremen, Germany
- Health Sciences Bremen, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
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18
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Klaman SL, Andringa K, Horton E, Jones HE. Concurrent Opioid and Alcohol Use Among Women Who Become Pregnant: Historical, Current, and Future Perspectives. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2019; 13:1178221819852637. [PMID: 31210730 PMCID: PMC6545650 DOI: 10.1177/1178221819852637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 01/07/2023]
Abstract
The numbers of women using opioids who become pregnant have captured the
attention of media, research, policy, and community. At the same time, there is
an ever-growing use of alcohol among women who continue drinking during
pregnancy that has received less focus. Although both untreated opioid use
disorder and alcohol misuse pose risks for maternal, fetal, and child
morbidities, alcohol is the substance with the most significant documentation of
harms. As we focus on the opioid epidemic in the United States, it is critical
that we do not overlook alcohol use during pregnancy. Both opioid use and
alcohol use during pregnancy are important public health challenges and often
happen concurrently. Thus, this commentary aims to (1) highlight the historical
and current context of opioid and alcohol use during pregnancy; (2) summarize
the current knowledge of opioids and alcohol use during pregnancy; and (3)
detail future directions in how health care providers can help identify and
therapeutically respond to women with concurrent opioid and alcohol use
disorder.
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Affiliation(s)
- Stacey L Klaman
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Horizons, Carrboro, NC, USA
| | | | | | - Hendrée E Jones
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Departments of Psychiatry & Behavioral Sciences and Gynecology & Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Is the socioeconomic status of immigrant mothers in Brussels relevant to predict their risk of adverse pregnancy outcomes? BMC Pregnancy Childbirth 2018; 18:422. [PMID: 30367602 PMCID: PMC6204002 DOI: 10.1186/s12884-018-2043-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 10/05/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Understanding and tackling perinatal health inequities in industrialized countries requires analysing the socioeconomic determinants of adverse pregnancy outcomes among immigrant populations. Studies show that among certain migrant groups, education is not associated with adverse pregnancy outcomes. We aim to extend this analysis to further dimensions of socioeconomic status (SES) and to other settings. The objective of this study is to identify sociodemographic characteristics associated with adverse pregnancy outcomes, according to the origin of mothers residing in Brussels. METHODS We analysed all singleton live births in Brussels between 2005 and 2010 (n = 97,844). The data arise from the linkage between three administrative databases. Four groups of women were included according to their place of birth: Belgium, EU, North Africa, and Sub-Saharan Africa. For each group, logistic regression was carried out to estimate the odds ratios of low birthweight (LBW) and small for gestational age (SGA) according to SES indicators (household income, maternal employment status, maternal education) and single parenthood. RESULTS Three key findings emerge from this study: 1) 25% of children were born into a household under the poverty threshold. This proportion was much higher for mothers born outside of the EU. 2) For North African immigrants, SES indicators didn't influence the pregnancy outcomes, whereas their risk of LBW increased with single parenthood. 3) For Sub-Saharan Africans the risk of LBW increased with low household income. CONCLUSION In a region where immigrant mothers are at high poverty risk, we observe a classic social gradient in perinatal outcomes only for mothers born in Belgium or the EU. In the other groups, SES influences perinatal outcomes less systematically. To develop interventions to reduce inequities from birth, it's important to identify the determinants of perinatal health among immigrants and to understand the underlying mechanisms in different contexts.
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Domanski G, Lange AE, Ittermann T, Allenberg H, Spoo RA, Zygmunt M, Heckmann M. Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: a population-based study. BMC Pregnancy Childbirth 2018; 18:367. [PMID: 30200916 PMCID: PMC6131836 DOI: 10.1186/s12884-018-2005-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/31/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most frequent complication during pregnancy. Untreated GDM is a severe threat to maternal and neonatal health. Based on recent evidence, up to 15% of all pregnancies may be affected by GDM. We hypothesized that in a rural birth cohort, higher maternal BMI and adverse socioeconomic conditions would promote GDM, which in turn would lead to adverse effects on pregnancy outcomes. METHODS The current study is a part of a population-based cohort study examining the health and socioeconomic information from 5801 mothers and their children. The study, titled the Survey of Neonates in Pomerania (SNiP), was based in northeastern Pomerania, Germany (2002-2008). RESULTS The cumulative incidence of GDM was 5.1%. Multiple logistic regression revealed prepregnancy overweight (OR 1.84 (95% CI 1.27-2.68)), prepregnancy obesity (OR 3.67 (2.48-5.44)) and maternal age (OR 1.06 (1.03-1.08)) as risk factors for GDM (p = 0.001). Alcohol use during pregnancy (OR 0.61 (0.41-0.90), a higher monthly income (OR 0.62 (0.46-0.83)), and the highest level of education (OR 0.44 (0.46-0.83)) decreased the risk of GDM. Newborns of GDM mothers had an increased risk of hypoglycaemia (OR 11.71 (7.49-18.30)) or macrosomia (OR 2.43 (1.41-4.18)) and were more often delivered by primary (OR 1.76 (1.21-2.60)) or secondary C-section (OR 2.00 (1.35-2.97)). Moreover, they were born 0.78 weeks (95% CI -1.09 - -0.48 weeks) earlier than infants of mothers without diabetes, resulting in higher percentage of late preterm infants with a gestational age of 32-36 weeks (11.1% vs. 6.96%). CONCLUSIONS Age and BMI before pregnancy were the predominant mediators of the increased risk of GDM, whereas a higher income and educational level were protective. GDM affected relevant perinatal and neonatal outcomes based on its association with an increased risk of delivery by C-section, preterm birth, macrosomia at birth and neonatal hypoglycaemia.
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Affiliation(s)
- Grzegorz Domanski
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Anja Erika Lange
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, Div. SHIP – Clinical Epidemiological Research, University Medicine Greifswald, Walter Rathenau Str. 48, 17475 Greifswald, Germany
| | - Heike Allenberg
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Robert Andreas Spoo
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Marek Zygmunt
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17487 Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
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Deressa AT, Cherie A, Belihu TM, Tasisa GG. Factors associated with spontaneous preterm birth in Addis Ababa public hospitals, Ethiopia: cross sectional study. BMC Pregnancy Childbirth 2018; 18:332. [PMID: 30103704 PMCID: PMC6090733 DOI: 10.1186/s12884-018-1957-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 07/30/2018] [Indexed: 11/17/2022] Open
Abstract
Background Spontaneous preterm birth is commencement of labor with intact or pre labor rapture of membrane and birth before 37 weeks of gestation. The aim of this study was to identify common factors associated with spontaneous preterm birth in Addis Ababa public hospitals. Methods After random selection of three hospitals from the six Addis Ababa’s Public hospitals having Neonatal intensive care unit, systematic sampling was employed to select study units from admission log book of the neonates. Data were collected using structured checklist. Finally, data entered to EpiData 3.1 and transported to SPSS 22 for analysis. Bivariate and multivariate logistic regression analysis was done for the variables. Result The mean gestational age of preterm birth was 32.45 (±2.903 SD). Majority (66.1%) of preterm births were spontaneous and 33.9% were induced preterm births. Hypertension during pregnancy [P = 0.001, AOR = 0.182, 95% CI: (0.067, 0.493)] and maternal HIV infection [P = 0.041, AOR = 3.408 95% CI: (1.048, 11.079)] significantly associated with spontaneous preterm birth. Conclusion Those mothers who were diagnosed with hypertension during pregnancy less likely gave spontaneous preterm birth than who had no history of hypertension during pregnancy and HIV positive mothers gave spontaneous preterm more likely than HIV negative mothers. Thus, giving emphasis to these factors with appropriate care during pregnancy is important to reduce spontaneous preterm birth.
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Affiliation(s)
- Ababe Tamirat Deressa
- School of Nursing and Midwifery, College of medicine and health sciences, Hawassa University, Hawassa, Ethiopia.
| | - Amsale Cherie
- Department of Nursing and midwifery, School of Allied health sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Melese Belihu
- School of health Sciences, College of medicine and health sciences, Hawassa University, Hawassa, Ethiopia
| | - Gemechu Ganfure Tasisa
- Midwifery department, School of health sciences, MaddaWalabu University, Bale Robe, Ethiopia
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22
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Praestegaard C, Kesmodel PS, Kesmodel US. Is TWEAK a valid screening questionnaire to identify alcohol risk drinkers among pregnant women in Denmark? Acta Obstet Gynecol Scand 2018; 97:483-490. [PMID: 29383707 DOI: 10.1111/aogs.13314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 01/19/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Identification of pregnant alcohol risk drinkers is crucial to prevent adverse birth outcomes. The TWEAK screening instrument has shown promising results for identifying risk drinkers. However, as the effectiveness of the screening questionnaire has only been investigated among American women with mainly low socioeconomic status, we aimed to investigate the ability of TWEAK to identify alcohol risk drinkers among pregnant Danish women. MATERIAL AND METHODS During 2000, Danish-speaking women referred to the Midwife Center at Aarhus University Hospital (n = 1554) and Fredericia Hospital (n = 499) for routine antenatal care were invited to participate in the study at their first visit. The women were interviewed about their periconceptional and current drinking habits including average weekly alcohol consumption and binge drinking. Additionally, the women were also asked the questions related to the TWEAK questionnaire. RESULTS We found that the sensitivity of TWEAK to identify periconceptional risk drinking was quite low, but its ability to identify risk drinkers during pregnancy was marginally higher. Our results suggested that older age (odds ratio 1.46, 95% confidence interval 0.95-2.23), current smoking (odds ratio 2.33, 95% confidence interval 1.63-3.33), being single (odds ratio 2.38, 95% confidence interval 1.38-4.11) and a TWEAK score with a cut-off score of ≥1 (odds ratio 2.75, 95% confidence interval 2.02-3.76) increased the risk of high-risk drinking during pregnancy. CONCLUSIONS In a Danish setting, TWEAK does not seem as an optimal screening tool to identify periconceptional risk drinkers but it may be useful in identifying high-risk drinking during pregnancy.
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Affiliation(s)
- Camilla Praestegaard
- Department of Obstetrics & Gynecology, Herlev University Hospital, Herlev, Denmark
| | - Pia S Kesmodel
- Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrik S Kesmodel
- Department of Obstetrics & Gynecology, Herlev University Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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Different Risk Factors for Very Low Birth Weight, Term-Small-for-Gestational-Age, or Preterm Birth in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020369. [PMID: 29466290 PMCID: PMC5858438 DOI: 10.3390/ijerph15020369] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/11/2018] [Accepted: 02/14/2018] [Indexed: 12/29/2022]
Abstract
From 1985 to 2013, the mean birth weight of infants in Japan decreased from 3120 g to 3000 g, and the low-birth-weight rate among live births increased from 6.3% to 9.6%. No prospective study has elucidated the risk factors for poor fetal growth and preterm birth in recent Japanese parents, such as increased parental age, maternal body figure, assisted reproductive technology (ART), and socioeconomic status. Participants were mother–infant pairs (n = 18,059) enrolled in a prospective birth cohort in Hokkaido, Japan from 2002 to 2013. Parental characteristics were obtained via self-reported questionnaires during pregnancy. Medical records helped identify very-low-birth-weight (VLBW; <1500 g), term-small-for-gestational-age (term-SGA), and preterm-birth (PTB; <37 weeks) infants. We calculated relative risks (RRs) for PTB, VLBW, and term-SGA birth based on parental characteristics. The prevalence of PTB, VLBW, and term-SGA was 4.5%, 0.4%, and 6.5%, respectively. Aged parents and ART were risk factors for PTB and VLBW. Maternal alcohol drinking during pregnancy increased the risk; a parental educational level of ≥16 years reduced risk of term-SGA. Maternal pre-pregnancy BMI of <18.5 kg/m2 increased the risk of PTB and term-SGA. The RR for low BMI was highest among mothers who have low educational level. Among various factors, appropriate nutritional education to maintain normal BMI is important to prevent PTB and term-SGA in Japan.
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24
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Myers B, Koen N, Donald KA, Nhapi RT, Workman L, Barnett W, Hoffman N, Koopowitz S, Zar HJ, Stein DJ. Effect of Hazardous Alcohol Use During Pregnancy on Growth Outcomes at Birth: Findings from a South African Cohort Study. Alcohol Clin Exp Res 2017; 42:369-377. [PMID: 29197115 PMCID: PMC5887896 DOI: 10.1111/acer.13566] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
Background Cohort studies have noted associations between hazardous alcohol use during pregnancy and infant growth outcomes, but many have not controlled for potential psychosocial confounders. To assess the unique contribution of hazardous alcohol use, we examined its effect on infant growth outcomes while controlling for maternal psychosocial stressors and hazardous tobacco and drug use in a cohort of 986 pregnant South African women enrolled into the Drakenstein Child Health Study between 2012 and 2015. Methods Data on psychosocial stressors and maternal risk behaviors were collected between 28 and 32 weeks of gestation. Participants were categorized as hazardous alcohol users if they obtained moderate or high scores (>10) on the Alcohol, Smoking and Substance Involvement Screening Test at this assessment or retrospectively reported drinking at least 2 drinks weekly during any trimester of pregnancy. Infant growth outcomes were recorded at delivery. Multivariable regression models examined correlates of hazardous alcohol use and associations between hazardous alcohol use and birth outcomes. Results Overall, 13% of mothers reported hazardous alcohol use. Recent exposure to intimate partner violence (adjusted odds ratio (aOR) = 2.08; 95% confidence interval (CI): 1.37, 3.18) and hazardous tobacco use (aOR = 5.03; 95% CI: 2.97, 8.52) were significant correlates of hazardous alcohol use. After controlling for potential psychosocial confounders, hazardous alcohol use remained associated with lower infant weight‐for‐age (B = −0.35, 95% CI: −0.56, −0.14), height‐for‐age (B = −0.46, 95% CI: −0.76, −0.17), and head‐circumference‐for‐age z‐scores (B = −0.43, 95% CI: −0.69, −0.17). Conclusions Interventions to reduce hazardous alcohol use among pregnant women in South Africa are needed to prevent alcohol‐related infant growth restrictions. As these growth deficits may lead to neurodevelopmental consequences, it is critical to identify alcohol‐related growth restrictions at birth and link exposed infants to early interventions for neurodevelopment.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Raymond T Nhapi
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lesley Workman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Nadia Hoffman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Sheri Koopowitz
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Anxiety and Stress Disorders, Cape Town, South Africa
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25
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Strandberg-Larsen K, Poulsen G, Bech BH, Chatzi L, Cordier S, Dale MTG, Fernandez M, Henriksen TB, Jaddoe VW, Kogevinas M, Kruithof CJ, Lindhard MS, Magnus P, Nohr EA, Richiardi L, Rodriguez-Bernal CL, Rouget F, Rusconi F, Vrijheid M, Andersen AMN. Association of light-to-moderate alcohol drinking in pregnancy with preterm birth and birth weight: elucidating bias by pooling data from nine European cohorts. Eur J Epidemiol 2017; 32:751-764. [PMID: 29027084 DOI: 10.1007/s10654-017-0323-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/06/2017] [Indexed: 12/31/2022]
Abstract
Women who drink light-to-moderately during pregnancy have been observed to have lower risk of unfavourable pregnancy outcomes than abstainers. This has been suggested to be a result of bias. In a pooled sample, including 193 747 live-born singletons from nine European cohorts, we examined the associations between light-to-moderate drinking and preterm birth, birth weight, and small-for-gestational age in term born children (term SGA). To address potential sources of bias, we compared the associations from the total sample with a sub-sample restricted to first-time pregnant women who conceived within six months of trying, and examined whether the associations varied across calendar time. In the total sample, drinking up to around six drinks per week as compared to abstaining was associated with lower risk of preterm birth, whereas no significant associations were found for birth weight or term SGA. Drinking six or more drinks per week was associated with lower birth weight and higher risk of term SGA, but no increased risk of preterm birth. The analyses restricted to women without reproductive experience revealed similar results. Before 2000 approximately half of pregnant women drank alcohol. This decreased to 39% in 2000-2004, and 14% in 2005-2011. Before 2000, every additional drink was associated with reduced mean birth weight, whereas in 2005-2011, the mean birth weight increased with increasing intake. The period-specific associations between low-to-moderate drinking and birth weight, which also were observed for term SGA, are indicative of bias. It is impossible to distinguish if the bias is attributable to unmeasured confounding, which change over time or cohort heterogeneity.
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Affiliation(s)
- Katrine Strandberg-Larsen
- Section for Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1014, Copenhagen K, Denmark.
| | - Gry Poulsen
- Section for Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1014, Copenhagen K, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethimno, Greece
| | - Sylvaine Cordier
- National Institute of Health and Medical Research (INSERM), U1085-IRSET, University of Rennes, Rennes, France
| | - Maria Teresa Grønning Dale
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Tine Brink Henriksen
- Department of Pediatrics, Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Wv Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Manolis Kogevinas
- ISGlobal Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Claudia J Kruithof
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - Ellen Aagaard Nohr
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin, Italy
| | - Clara L Rodriguez-Bernal
- FISABIO-Universitat Jaume I-Universitat de València Joint Research Unit of Epidemiology and Environmental Health, València, Spain.,Health Services Research Area, FISABIO Salud Pública.Valencia, Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain
| | - Florence Rouget
- National Institute of Health and Medical Research (INSERM), U1085-IRSET, University of Rennes, Rennes, France
| | - Franca Rusconi
- Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy
| | - Martine Vrijheid
- ISGlobal Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,University Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Anne-Marie Nybo Andersen
- Section for Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1014, Copenhagen K, Denmark
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26
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Pregnancy-specific anxiety and its association with background characteristics and health-related behaviors in a low-risk population. Compr Psychiatry 2017; 75:6-13. [PMID: 28279817 DOI: 10.1016/j.comppsych.2017.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/29/2016] [Accepted: 02/02/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pregnancy-specific anxiety is an important risk factor for adverse pregnancy outcomes. It is therefore needed to gain insight in which women are at risk for elevated levels (> 85th percentile) of pregnancy-specific anxiety. Additionally, given that unhealthy behaviour has been suggested as a possible pathway linking pregnancy-specific anxiety to adverse pregnancy outcomes, it is important to examine whether higher levels of pregnancy-specific anxiety are associated with negative health-related behaviours (smoking, alcohol use and too much weight gain). METHODS Using a study sample of 4541 low-risk pregnant women who filled in the Pregnancy Related Anxiety Questionnaire-Revised (PRAQ-R), we first examined which socio-demographic, pregnancy-related and psychological background characteristics were significantly associated with a PRAQ-R score above the 85th percentile. Secondly, we examined the association between pregnancy-specific anxiety and self-reported health-related behaviours (smoking, alcohol use and too much weight gain) while controlling for significant background characteristics. For both research questions, backward regression analysis was applied. RESULTS Results showed that nulliparity (OR=2.33, 95% confidence interval (CI)=1.97-2.77), anxious or depressed mood (OR=3.29, 95% CI=2.74-3.94) and non-Dutch ethnicity, especially Turkish (OR=3.47, 95% CI=2.16-5.59) or Moroccan (OR=2.97, 95% CI=1.84-4.81), were most strongly associated with elevated pregnancy-specific anxiety levels. Women with higher pregnancy-specific anxiety levels were more likely to gain too much weight during pregnancy (odds ratio (OR) linear term=1.49, 95% CI=1.21-1.83), while both very low and high levels of pregnancy-specific anxiety were associated with smoking (OR linear term=0.13, 95% CI=0.04-0.45, OR quadratic term=1.81, 95% CI=1.32-2.47). No association with alcohol use was found. CONCLUSIONS In conclusion, our results show nulliparity, anxious or depressed mood and non-Dutch ethnicity as three major vulnerability factors for elevated levels of pregnancy-specific anxiety. Furthermore, our results show an association between pregnancy-specific anxiety and negative health-related behaviours, which is worth examining in future studies.
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27
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Sania A, Brittain K, Phillips TK, Zerbe A, Ronan A, Myer L, Abrams EJ. Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study. BMJ Open 2017; 7:e014293. [PMID: 28320796 PMCID: PMC5372146 DOI: 10.1136/bmjopen-2016-014293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Psychosocial stressors such as depression and stress, intimate partner violence (IPV) and alcohol use have been linked to preterm and small-for-gestational-age (SGA) births in general populations. The prevalence of psychosocial stressors and alcohol abuse is high in many HIV-infected (HIV+) populations. Our objective was to evaluate the effects of psychosocial stressors and alcohol abuse on birth outcomes in HIV-infected women. METHODS Antenatal depression and non-specific psychological distress, periconception IPV and alcohol consumption were measured during the second trimester among HIV+ women initiating antiretroviral treatment with efavirenz + emtricitibine + tenofovir in Cape Town, South Africa. Log binomial regression models were used to estimate the risk ratios (RR) and 95% CIs of the effects of psychosocial stressors and periconception alcohol consumption on birth outcomes: SGA (birth weight <10th centile for gestational age) and preterm (<37 weeks) births. RESULTS Of the 571 mother-infant pairs, 26% of women reported hazardous alcohol consumption (Alcohol Use Disorders Identification Test-C score ≥3) periconception periods, 11% reported depressive symptoms, 7% reported non-specific psychological distress and 15% reported experiencing physical or psychological IPV. 14% of infants were born preterm and 12% were SGA. Infants born to women reporting hazardous drinking were twice (adjusted RR 2.00 (95% CI 1.13 to 3.54)) as likely to be SGA compared with women reporting low alcohol intake. Alcohol consumption did not have a significant effect on the incidence of preterm birth. Depressive symptoms, non-specific psychological distress, physical and psychological IPV did not increase the risk of SGA or preterm birth significantly. CONCLUSIONS The observed elevated risk of SGA births associated with periconception alcohol consumption underscores the urgent need to reduce alcohol consumption among women of childbearing age. Interventions targeting modifiable risk factors of adverse birth outcomes need to be integrated into HIV prevention and maternal child health programmes to improve the long-term health of HIV-exposed children. TRIAL REGISTRATION NUMBER NCT01933477; Pre-results.
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Affiliation(s)
- Ayesha Sania
- ICAP, Columbia University, Mailman School of Public Health, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centrefor Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centrefor Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP, Columbia University, Mailman School of Public Health, New York, USA
| | - Agnes Ronan
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centrefor Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centrefor Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Elaine J Abrams
- ICAP, Columbia University, Mailman School of Public Health, New York, USA
- College of Physicians and Surgeons, Columbia University, New York, USA
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28
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Huang QT, Hang LL, Zhong M, Gao YF, Luo ML, Yu YH. Maternal HCV infection is associated with intrauterine fetal growth disturbance: A meta-analysis of observational studies. Medicine (Baltimore) 2016; 95:e4777. [PMID: 27583932 PMCID: PMC5008616 DOI: 10.1097/md.0000000000004777] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Since the evidence regarding the association between maternal hepatitis C virus (HCV) infection and impaired intrauterine fetal growth had not been conclusive, the aim of the present study was to evaluate the risk of maternal HCV infection in association with intrauterine fetal growth restriction (IUGR) and/or low birth weight infants (LBW). We performed an extensive literature search of PubMed, MEDLINE, and EMBASE through December 1, 2015. The odds ratios (ORs) of HCV infection and IUGR/LBW were calculated and reported with 95% confidence intervals (95% CIs). Statistical analysis was performed using RevMen 5.3 and Stata 10.0. Seven studies involving 4,185,414 participants and 5094 HCV infection cases were included. Significant associations between HCV infection and IUGR (OR = 1.53, 95% CI: 1.40-1.68, fixed effect model) as well as LBW were observed (OR = 1.97, 95% CI: 1.43-2.71, random effect model). The results still indicated consistencies after adjusting for multiple risk factors which could affect fetal growth, including maternal age, parity, maternal smoking, alcohol abuse, drugs abuse, coinfected with HBV/HIV and preeclampsia. Our findings suggested that maternal HCV infection was significantly associated with an increased risk of impaired intrauterine fetal growth. In clinical practice, a closer monitoring of intrauterine fetal growth by a series of ultrasound might be necessary for HCV-infected pregnant population.
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Affiliation(s)
- Qi-tao Huang
- Nanfang Hospital
- Division of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
- Correspondence: Qi-tao Huang, Division of Obstetrics and Gynecology, 1838 North Guangzhou Avenue, Guangzhou 510515, People's Republic of China (e-mail: ); Mei Zhong, Division of Obstetrics and Gynecology, 1838 North Guangzhou Avenue, Guangzhou 510515, People's Republic of China (e-mail: )
| | - Li-lin Hang
- Division of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Mei Zhong
- Nanfang Hospital
- Correspondence: Qi-tao Huang, Division of Obstetrics and Gynecology, 1838 North Guangzhou Avenue, Guangzhou 510515, People's Republic of China (e-mail: ); Mei Zhong, Division of Obstetrics and Gynecology, 1838 North Guangzhou Avenue, Guangzhou 510515, People's Republic of China (e-mail: )
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Sbrana M, Grandi C, Brazan M, Junquera N, Nascimento MS, Barbieri MA, Bettiol H, Cardoso VC. Alcohol consumption during pregnancy and perinatal results: a cohort study. SAO PAULO MED J 2016; 134:146-52. [PMID: 27007799 PMCID: PMC10496540 DOI: 10.1590/1516-3180.2015.02040211] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 10/07/2015] [Accepted: 11/02/2015] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Alcohol consumption during pregnancy is a significant social problem that may be associated with adverse perinatal outcomes. The aim of this study was to describe alcohol consumption during pregnancy and to study its association with low birth weight, newborns small for gestational age and preterm birth. DESIGN AND SETTING Nested cohort study, in the city of Ribeirão Preto, São Paulo, Brazil. METHODS 1,370 women and their newborns were evaluated. A standardized questionnaire on health and lifestyle habits was applied to the mothers. Anthropometry was performed on the newborns. Alcohol consumption was defined as low, moderate or high, as defined by the World Health Organization. Adjusted logistic regression analysis was used. RESULTS 23% of the women consumed alcohol during pregnancy. Consumption mainly occurred in the first trimester (14.8%) and decreased as the pregnancy progressed. The median alcohol intake was 3.89 g (interquartile range, IQR = 8 g) per day. In the unadjusted analysis, alcohol consumption increased the risk of low birth weight almost twofold (odds ratio, OR 1.91; 95% confidence interval, CI: 1.25-2.92). The risk was lower in the adjusted analysis (OR 1.62; 95% CI: 1.03-2.54). Alcohol consumption did not show associations with small for gestational age or preterm birth. There was greater risk of low birth weight and newborns small for gestational age and preterm birth among mothers who were both smokers and drinkers. CONCLUSIONS The alcohol consumption rate during pregnancy was 23% and was independently associated with low birth weight, but there was no risk of newborns small for gestational age or preterm birth.
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Affiliation(s)
- Mariana Sbrana
- MD. Medical Resident, Department of Pediatrics, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
| | - Carlos Grandi
- MD, PhD. Postdoctoral Student, Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
| | - Murilo Brazan
- MD. Medical Resident, Department of Pediatrics, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
| | - Natacha Junquera
- MD. Medical Resident, Department of Pediatrics, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
| | - Marina Stevaux Nascimento
- MD. Medical Resident, Department of Pediatrics, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
| | - Marco Antonio Barbieri
- MD, PhD. Senior Professor, Department of Pediatrics, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
| | - Heloisa Bettiol
- MD, PhD. Associate Professor, Department of Pediatrics, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
| | - Viviane Cunha Cardoso
- MD, PhD. Adjunct Professor, Department of Pediatrics, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
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30
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Spyridou A, Schauer M, Ruf-Leuschner M. Prenatal screening for psychosocial risks in a high risk-population in Peru using the KINDEX interview. BMC Pregnancy Childbirth 2016; 16:13. [PMID: 26801404 PMCID: PMC4722714 DOI: 10.1186/s12884-016-0799-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 01/06/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Prenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother's health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. Mothers of low socio-economic status and especially those living in crime-ridden areas are even more exposed to a host of risk factors. Societies of extreme violence, poverty and inequalities, often present difficulties to provide adequate mental health care to the most needed populations. The KINDEX, a brief standardized instrument that assesses 11 different risk factors was used by midwives to identify pregnant women at-risk, in a suburban area with one of the highest levels of domestic violence in Lima. The instrument was designed to be used by medical staff to identify high-risk child-bearing women and, based on the results, to refer them to the adequate psychological or social support providers. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences. METHODS The study was conducted in cooperation with the gynecological department of a general hospital in a suburban area of Lima. Nine midwives conducted interviews using the KINDEX of ninety-five pregnant women attending the gynecological unit of the hospital. From these, forty pregnant women were re-interviewed by a clinical psychologist using established instruments in order to assess the feasibility of the prenatal assessment in public health settings and the relationship of the KINDEX with maternal perceived stress, psychopathology symptoms and trauma load during pregnancy. RESULTS We found high rates of risk factors in the examined pregnant women comparable with those found in the general population. Significant correlations were found between the KINDEX sum score and the three risks areas, stress, psychopathology and trauma load as assessed in the Clinical Expert interviews. The different risks assessed by the KINDEX are related to higher levels of stress, psychopathology and trauma load, depending on the risk. CONCLUSIONS The relationship between past adverse experience and current stressors with perceived maternal stress, psychopathology symptoms and traumatic experiences confirm the importance of prenatal assessment for psychosocial risks. The use of KINDEX by midwives providing obstetrical care to pregnant women in urban Peru is feasible and can be used to identify high-risk women and refer them to the adequate mental health or social services for necessary attention and support. Early interventions are essential to mitigating the adverse effects of maternal stress, trauma and psychopathology on the fetus and child.
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Affiliation(s)
- Andria Spyridou
- />Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457 Konstanz, Germany
- />vivo international, http://www.vivo.org
| | - Maggie Schauer
- />Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457 Konstanz, Germany
- />vivo international, http://www.vivo.org
| | - Martina Ruf-Leuschner
- />Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457 Konstanz, Germany
- />vivo international, http://www.vivo.org
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31
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Huang QT, Huang Q, Zhong M, Wei SS, Luo W, Li F, Yu YH. Chronic hepatitis C virus infection is associated with increased risk of preterm birth: a meta-analysis of observational studies. J Viral Hepat 2015; 22:1033-42. [PMID: 26081198 DOI: 10.1111/jvh.12430] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/03/2015] [Indexed: 02/07/2023]
Abstract
Although several epidemiological studies reported that maternal chronic hepatitis C virus (HCV) infection had significantly increased risk of undergoing adverse obstetrical and perinatal outcomes, studies on the relationship between HCV infection and risk of preterm birth (PTB) have yielded inconclusive and inconsistent results. Therefore, we conducted a meta-analysis to investigate the association between HCV infection and PTB. The electronic database was searched until 1 September 2014. Relevant studies reporting the association between HCV infection and the risk of PTB were included for further evaluation. Statistical analysis was performed using revmen 5.3 and stata 10.0. Nine studies involving 4186698 participants and 5218 HCV infection cases were included. A significant association between HCV infection and PTB was observed (odds ratio = 1.62, 95% CI 1.48-1.76, P < 0.001, fixed-effects model). Stratification according to maternal smoking/alcohol abuse, maternal drug abuse or coinfected with HBV and/or HIV matched groups still demonstrated that women with HCV infection had a high risk for PTB. Findings from our meta-analysis suggested that maternal HCV infection was significantly associated with an increased risk of PTB. In the future, pathophysiological studies are warranted to ascertain the causality and explore the possible biological mechanisms involved.
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Affiliation(s)
- Q-t Huang
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Q Huang
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - M Zhong
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - S-s Wei
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - W Luo
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - F Li
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Y-h Yu
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Smith LK, Draper ES, Evans TA, Field DJ, Johnson SJ, Manktelow BN, Seaton SE, Marlow N, Petrou S, Boyle EM. Associations between late and moderately preterm birth and smoking, alcohol, drug use and diet: a population-based case-cohort study. Arch Dis Child Fetal Neonatal Ed 2015; 100:F486-91. [PMID: 25972442 PMCID: PMC4680173 DOI: 10.1136/archdischild-2014-307265] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/08/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study explores the associations between lifestyle factors and late and moderate preterm birth (LMPT: 32(+0)-36(+6) weeks' gestation), a relatively under-researched group. STUDY DESIGN A population-based case-cohort study was undertaken involving 922 LMPT and 965 term (37+ weeks' gestation) singleton live and stillbirths born between 1 September 2009 and 31 December 2010 to women residing in Leicestershire and Nottinghamshire, UK. Poisson multivariable regression models were fitted to estimate relative risks (RR) of LMPT birth associated with maternal smoking, alcohol and recreational drug use, and diet. RESULTS Women who smoked during pregnancy were at 38% increased risk of LMPT birth compared with non-smokers (RR 1.38, 95% CI (1.04 to 1.84)). Low consumption of fruit and vegetables was associated with a 31% increased risk compared with those who reported eating higher consumption levels (RR 1.31 (1.03 to 1.66)). Women who did not have any aspects of a Mediterranean diet were nearly twice as likely to deliver LMPT compared with those whose diet included more Mediterranean characteristics (RR 1.81 (1.04 to 3.14)). Women who smoked and consumed low levels of fruit and vegetables (5% of women) were at particularly high risk (RR=1.81 (1.29 to 2.55)). There was no significant effect of alcohol or recreational drug use on LMPT birth. CONCLUSIONS Smoking and poor diet during pregnancy, factors that strongly impact on very preterm birth, are also important at later gestations and experienced together are associated with an elevated rate of risk. Our findings suggest early cessation of smoking during pregnancy may be an effective strategy to reduce LMPT births.
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Affiliation(s)
- Lucy K Smith
- Department of Health Science, University of Leicester, Leicester, UK
| | | | - T Alun Evans
- Department of Health Science, University of Leicester, Leicester, UK
| | - David J Field
- Department of Health Science, University of Leicester, Leicester, UK
| | | | | | - Sarah E Seaton
- Department of Health Science, University of Leicester, Leicester, UK
| | - Neil Marlow
- Institute for Womens Health, University College London, London, UK
| | - Stavros Petrou
- Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Elaine M Boyle
- Department of Health Science, University of Leicester, Leicester, UK
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Yang JY, Kwak HS, Han JY, Choi JS, Ahn HK, Oh YJ, Velázquez-Armenta EY, Nava-Ocampo AA. Could a first-trimester blood phosphatidylethanol concentration ⩾4 nM be useful to identify women with moderate-to-heavy prenatal alcohol exposure who are at high risk of adverse pregnancy outcomes? Med Hypotheses 2015; 85:965-8. [PMID: 26365248 DOI: 10.1016/j.mehy.2015.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 08/30/2015] [Indexed: 10/23/2022]
Abstract
It is accepted that blood phosphatidylethanol (PEth) concentrations are reliable biomarkers of ethanol (alcohol) exposure. We therefore conducted a preliminary study to test the hypothesis that elevated blood PEth concentrations can help to identifying women with prenatal alcohol exposure who are at higher risk of adverse pregnancy outcomes. The study included 35 first-trimester pregnant women who self-reported alcohol ingestion and had PEth blood concentration ⩾4 nM at recruitment. As a control group, 233 first-trimester pregnant women who self-reported as being either abstainers or light alcohol drinkers and had blood PEth concentrations <4 nM, were also included. All participants were followed up until completion of their pregnancies. Women with prenatal alcohol exposure and PEth concentrations ⩾4 nM had a risk ratio of spontaneous abortions of 3.21 (95%CI 0.93-11.06; P=0.074). Because of the potential implications in the prenatal care of women reporting risky alcohol exposure, the preliminary results from the present study indicate the need for testing the hypothesis in a more definitive approach.
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Affiliation(s)
- Jun-Young Yang
- National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Seoul, Republic of Korea; Department of Systems Biology, Yonsei University, Seoul, Republic of Korea
| | - Ho-Seok Kwak
- Department of Laboratory Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Jung-Yeol Han
- The Korean Motherisk Program, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea.
| | - June-Seek Choi
- The Korean Motherisk Program, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Kyong Ahn
- The Korean Motherisk Program, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Young-Jun Oh
- Department of Systems Biology, Yonsei University, Seoul, Republic of Korea
| | | | - Alejandro A Nava-Ocampo
- PharmaReasons - Pharmacological Research & Applied Solutions, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
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Lanting CI, van Dommelen P, van der Pal-de Bruin KM, Bennebroek Gravenhorst J, van Wouwe JP. Prevalence and pattern of alcohol consumption during pregnancy in the Netherlands. BMC Public Health 2015. [PMID: 26219278 PMCID: PMC4517493 DOI: 10.1186/s12889-015-2070-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective To estimate the prevalence of alcohol consumption during pregnancy in the Netherlands in 2007 and 2010. Method During two identical, nation-wide surveys in 2007 and 2010, questionnaires were handed out to mothers of infants aged ≤6 months who visited a Well-Baby Clinic. By means of the questionnaire mothers were, in addition to questions on infant feeding practices and background variables, asked about their alcohol consumption before, during and after pregnancy. Logistic regression analyses were used to look into relationships of alcohol consumption with maternal and infant characteristics. Results We obtained 2,715 questionnaires in 2007, and 1,410 in 2010. Within 6 months before pregnancy, 69 % of women consumed alcohol (data from 2010). During pregnancy 22 % consumed alcohol in 2007, 19 % in 2010. During the first three months of pregnancy, 17 % (2007) and 14 % (2010) of mothers consumed alcohol. Alcohol consumption was mainly one glass (~10 g alcohol) on less than one occasion per month. Compared to 2007, in 2010 more women consumed 1–3 or >3 glasses alcohol per occasion (resp. 11 % to 7 % and 1.4 to 0.7 %). Older women and those with a higher education consumed more alcohol, as did smokers. Birth weight, gestational age and weight for gestational age were not associated with alcohol consumption. In 2007 and 2010, 2.5 % resp. 2.4 % of pregnant women both smoked and consumed alcohol; resp. 70 % and 75 % did neither. Conclusion In contrast to Dutch guidelines which advice to completely abstain from alcohol, one in five women in the Netherlands consume alcohol during pregnancy.
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Affiliation(s)
- Caren I Lanting
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
| | - Paula van Dommelen
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
| | - Karin M van der Pal-de Bruin
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
| | - Jack Bennebroek Gravenhorst
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
| | - Jacobus P van Wouwe
- Departments of Child Health and Life Style, Netherlands Organization for Applied Scientific Research TNO, PO Box 3005, 2301 DA, Leiden, The Netherlands.
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Alcohol consumption during pregnancy: Cross-sectional survey. Midwifery 2014; 30:1173-8. [DOI: 10.1016/j.midw.2014.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 04/01/2014] [Accepted: 04/10/2014] [Indexed: 11/18/2022]
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Caspers Conway KM, Romitti PA, Holmes L, Olney RS, Richardson SD. Maternal periconceptional alcohol consumption and congenital limb deficiencies. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2014; 100:863-76. [PMID: 25132072 PMCID: PMC4427046 DOI: 10.1002/bdra.23292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/07/2014] [Accepted: 07/10/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Women of childbearing age report high rates of alcohol consumption, which may result in alcohol exposure during early pregnancy. Epidemiological research on congenital limb deficiencies (LDs) and periconceptional exposure to alcohol is inconclusive. METHODS Data from the National Birth Defects Prevention Study (NBDPS) were examined for associations between LDs and patterns of maternal periconceptional (1 month before conception through the first trimester) alcohol consumption among LD case (n = 906) and unaffected control (n = 8352) pregnancies with expected delivery dates from 10/1997 through 12/2007. Adjusted odds ratios (aORs) and 95% confidence intervals were estimated from unconditional logistic regression analysis for all LDs combined, specific LD subtypes (preaxial/terminal transverse), and LD anatomic groups (upper/lower limbs); interactions with folic acid (FA) supplementation were tested. RESULTS When compared with nondrinkers, inverse associations were found between all LDs combined, preaxial, and upper LDs and any reported periconceptional alcohol consumption (aORs ranged from 0.56-0.83), drinking without binging (aORs: 0.53-0.75), and binge drinking (≥4 drinks/occasion) (aORs: 0.64-0.94); however, none of the binge drinking aORs were statistically significant. Stratification by alcohol type showed inverse associations between all LDs combined, preaxial, transverse, and upper and lower LDs for drinking without binging of wine only (aORs: 0.39-0.67) and between all LDs combined and upper LDs for drinking without binging of combinations of alcohol (aORs: 0.63-0.87). FA did not modify observed associations. CONCLUSION Maternal periconceptional alcohol consumption did not emerge as a teratogen for selected LDs in the NBDPS. Future studies should evaluate additional rare LDs among more highly exposed populations.
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Affiliation(s)
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Lewis Holmes
- Genetics and Teratology Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard S. Olney
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra D. Richardson
- Congenital Malformations Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York
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Pfinder M, Liebig S, Feldmann R. Impact of Moderate Prenatal Alcohol Exposure on Problem Behaviors in Preschool and School Children. ZEITSCHRIFT FUR ENTWICKLUNGSPSYCHOLOGIE UND PADAGOGISCHE PSYCHOLOGIE 2014. [DOI: 10.1026/0049-8637/a000106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Data on the relation between moderate prenatal alcohol exposure (PAE) and behavioral disorders are inconsistent, and this raises new questions. We examined (1) the association between moderate PAE and problem behaviors and (2) whether these associations differed by levels of socioeconomic status (SES), fetal smoke exposure, or exposure to environmental tobacco smoke (ETS). Data were taken from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study. Parents evaluated children’s behaviors using the Strengths and Difficulties Questionnaire (SDQ). Results showed a slight, but insignificant, increase of problem behaviors in children with moderate PAE. In 3- to 6-year-olds, PAE had a stronger effect on hyperactivity/inattention in combination with fetal smoke exposure (odds ratio = 2.82), than did PAE alone. Effects were not stronger in low-SES children, but they were stronger in children with ETS. We conclude that moderate PAE might have adverse effects on neurodevelopment, with stronger effects in disadvantaged populations. To confirm our preliminary findings, further research should be conducted.
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Affiliation(s)
- Manuela Pfinder
- Bielefeld Graduate School of History and Sociology, University of Bielefeld, Bielefeld, Germany
| | - Stefan Liebig
- Bielefeld Graduate School of History and Sociology, University of Bielefeld, Bielefeld, Germany
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A prospective cohort study of alcohol exposure in early and late pregnancy within an urban population in Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:2049-63. [PMID: 24549147 PMCID: PMC3945584 DOI: 10.3390/ijerph110202049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/29/2014] [Accepted: 02/09/2014] [Indexed: 11/29/2022]
Abstract
Most studies of alcohol consumption in pregnancy have looked at one time point only, often relying on recall. The aim of this longitudinal study was to determine whether alcohol consumption changes in early and late pregnancy and whether this affects perinatal outcomes. We performed a prospective cohort study, conducted from November 2010 to December 2011 at a teaching hospital in the Republic of Ireland. Of the 907 women with a singleton pregnancy who booked for antenatal care and delivered at the hospital, 185 (20%) abstained from alcohol in the first trimester but drank in the third trimester, 105 (12%) consumed alcohol in the first and third trimesters, and the remaining 617 (68%) consumed no alcohol in pregnancy. Factors associated with continuing to drink in pregnancy included older maternal age (30–39 years), Irish nationality, private healthcare, smoking, and a history of illicit drug use. Compared to pre-pregnancy, alcohol consumption in pregnancy was markedly reduced, with the majority of drinkers consuming ≤ 5 units per week (92% in first trimester, 72–75% in third trimester). Perhaps because of this, perinatal outcomes were similar for non-drinkers, women who abstained from alcohol in the first trimester, and women who drank in the first and third trimester of pregnancy. Most women moderate their alcohol consumption in pregnancy, especially in the first trimester, and have perinatal outcomes similar to those who abstain.
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